Carolyn Moore

Characteristic pelvic, hip, and knee kinematic patterns in children with lumbosacral myelomeningocele

Abstract The purpose of this study was to distinguish characteristic gait patterns in children with lumbosacral level myelomeningocele. Twenty-one patients were evaluated using gait analysis; kinematic patterns were analysed for the pelvis, hip, and knee. The patients were divided into two groups based upon presence (group I) or absence (group II) of muscle strength for the ankle plantarflexors. Distinguishable kinematic patterns were identified. The results showed that deviations in the patterns were most apparent at the pelvis and knee and were related to muscle weakness. The identification of these kinematic patterns is the first step towards establishing a framework from which improved evaluation and treatment of this patient population can be realized.

Valgus knee stress in lumbosacral myelomeningocele: a gait-analysis evaluation.

Twenty-five independent community-ambulating patients with lumbosacral-level myelomeningocele (N = 50 limbs) underwent gait analysis. The limbs of these patients were divided into two groups based on thigh-foot angle (TFA): Group I (n = 20) had marked external tibial torsion, TFA > or = 20 degrees, and group II had TFA between 10 and 20 degrees. Ten limbs were excluded because of neutral or internal alignment. Twenty normal limbs with TFA = 10 degrees served as controls. An abnormal internal varus knee stress during stance was identified in all group I limbs and 12 (70%) of 20 limbs group II limbs compared with controls, which demonstrated an internal valgus stress. This internal varus moment was greater in group I limbs than in the abnormal limbs in group II (p < 0.05). Knee flexion was the only other parameter found to correlate with this stress and only in group I limbs. We conclude that (a) in this patient group, increased external tibial torsion is likely to result in an abnormal internal varus knee stress; (b) TFA > 20 degrees appears significantly to increase this stress; and (c) knee flexion is an important related parameter, but only in limbs with TFA between 10 and 20 degrees. We believe that this abnormal stress may predispose the knee to late arthrosis and that derotational osteotomies to normalize the TFA may prove to have a favorable long-term effect.

Evaluation of residual clubfoot deformities using gait analysis.

Gait analysis was used to evaluate 15 patients who had previously undergone clubfoot surgery. Because six patients had had bilateral surgery, 21 feet had undergone previous clubfoot surgery. Three of the operated feet had no residual deformity. In the remaining 18 feet, the reason for referral was intoeing in 13, calcaneovalgus in three, hindfoot varus in one, and supination/adduction in one. Clinical assessment and information from the gait analysis were used to establish a treatment plan. Satisfactory treatment outcome was achieved in 13 patients, one result was unsatisfactory, and one result was undetermined.

Simulated gait patterns: the resulting effects on gait parameters, dynamic electromyography, joint moments, and physiological cost index

Abstract Equinus, crouch and crouch/equinus are common gait patterns seen in children with cerebral palsy. Six normal subjects simulated each of the above gait abnormalities to determine the effect on gait parameters, electromyography, joint moments and physiological cost index. Assessment of normal and the pathological gait patterns was performed using gait analysis. The results indicate that as the complexity of the gait pattern increases, the gait parameters decrease and the physiological cost index increases. Although abnormalities were found in electromyographic activity and joint moments, the patterns were similar to those found in children with cerebral palsy when walking in equinus, crouch and crouch/equinus. Abnormal joint positions produce significant effects on the parameters of gait used to assess the child with cerebral palsy. During interpretation of the gait analysis data significant emphasis must be placed on clinical evaluation and the determination of primary and secondary responses.

Energy cost of walking in low lumbar myelomeningocele.

The aim of this study was to determine whether it is more efficient for adolescents with low lumbar myelomeningocele (MM) to walk with a reciprocal or a swing-through gait pattern. Energy measurements for subjects with MM were compared for reciprocal and swing-through gait and also with an able-bodied control group. The rate of oxygen consumption (in milliliters per kilogram per minute) was higher for both the reciprocal and swing-through conditions compared with the control group, but there was no difference in the rate of consumption between the two modes of walking. Walking velocities (in meters per minute) were slower for both the reciprocal and swing-through conditions compared with the control group, with reciprocal walking significantly slower than swing-through gait. Oxygen cost (in milliliters per kilogram per meter) was higher for both the reciprocal and the swing-through conditions compared with the control group. Oxygen cost was higher for reciprocal walking than for swing-through gait. Swing-through gait proved to be the more efficient walking pattern in this group of subjects with MM.