Hank White

Femoral Lengthening After Transfemoral Amputation

This retrospective study included four patients with transfemoral amputations who had undergone six lengthenings of their residual femurs. Initial femoral bone lengths averaged 15.5 cm with a mean final length of 21 cm. The average gain of limb length (ischium to end of soft tissue), however, was 2 cm (15%). Second lengthenings resulted in only 17% additional bone length, compared to 50% for first lengthenings. Treatment time was protracted and complications resulted from infection, bone healing, and pin migration. However, all patients reported substantial improvement in walking function and prosthetic use.

A Cross-sectional Study of Chest Kinematics and VO2 in Children With Adolescent Idiopathic Scoliosis During Steady-state Walking.

Study Design. A cross-sectional study. Objective. The aim of this study was to identify the differences in oxygen consumption in children with adolescent idiopathic scoliosis (AIS) and age-matched control subjects using traditional methods and chest kinematics. Summary of Background Data. AIS is a disorder affecting 2 to 3% of children between the ages of 10 and 16 and accounts for up to 85% of all scoliosis cases. The spinal deformities and subsequent rib conformational changes associated with AIS can have a significant deleterious effect on the oxygen consumption for children with mild to severe scoliosis. Previous studies found that the oxygen consumption in children with AIS was significantly more than that of peers and during walking require more energy than typically developing children. Methods. Thirty children (four male, 26 female), 11.7 to 18.7 years of age, were enrolled: 15 adolescent children diagnosed with mild to moderate AIS (mean cobb angle 36.2 degrees) and 15 matched adolescents. Oxygen consumption during steady-state treadmill walking was measured using a traditional methods and simultaneous kinematic analysis of the chest wall. Results. There were no significant differences in the volume of oxygen consumed in any of the phases of treadmill walking (resting, exercise, and recovery) or in breath per minute ventilation and tidal volume between control subjects and children with scoliosis (P > 0.05). Significant differences were found between assessment methods, with the kinematic analysis overestimating the average tidal volume while walking (P < 0.05). Conclusion. Children with mild to moderate AIS and typically developing children do not demonstrate oxygen consumption differences when walking at a steady state on a treadmill. However, kinematic analysis of the chest wall tends to overestimate the tidal volume when walking. An offset equation is required for some variables when using kinematic data to assess oxygen consumption in children who would otherwise not comply with traditional oxygen consumption testing. Level of Evidence: 3

Pedobarographic changes in Ponseti-treated clubfeet with and without anterior tibialis tendon transfer: changes due to growth and surgical intervention.

The aim of this study was to identify significant changes in pedobarographic parameters attributed to growth versus growth and surgical intervention for uninvolved feet, clubfeet (CF) subjected to anterior tibialis tendon transfer surgery, and unilateral nonsurgical CF. Participants underwent foot-pressure analysis preoperatively and 3 years postoperatively. Six parameters related to the lateral midfoot showed increases for uninvolved and nonsurgical CF, whereas CF subjected to surgery decreased. Transferring the anterior tibialis tendon resulted in improvements beyond typical growth and in a more balanced foot postoperatively. These changes are not simply changes in the peak pressure, but changes in force/pressure over time in the lateral foot.

Do Three Different Passive Assessments of Quadriceps Spasticity Relate to the Functional Activity of Walking for Children Diagnosed with Cerebral Palsy

A stiff-knee gait pattern is frequently associated with several impairments including quadriceps spasticity in children diagnosed with cerebral palsy (CP). The relationship of clinical measures of quadriceps spasticity and the stiff-knee gait pattern in children diagnosed with CP has not been well established. Therefore, the purpose of this study was to determine the ability of clinical measures of quadriceps spasticity (modified Ashworth scale [MAS], Ely tests, and pendulum test) to categorize a stiff-knee gait pattern in children with CP. Children were categorized as having a stiff-knee gait pattern based on kinematic and EMG gait data. Results of a logistic regression model revealed that the only significant measure was A1 of the pendulum test. Discriminant analysis functions were used to predict group membership (stiff-knee, not stiff-knee gait pattern) for each measure. The A1 of the pendulum test demonstrated the highest classification accuracy and the highest sensitivity compared to the other measures. Therefore, a negative pendulum test (indicated by an A1 value of 45 degrees or more) is more useful for ruling out a stiff-knee gait pattern compared to the other clinical measures.

Foot pressure analysis using the emed ® in typically developing children and adolescents: A summary of current techniques and typically developing cohort data for comparison with pathology

Foot pressure analysis is a valuable tool that can be used to quantify foot function in children. For researchers and clinicians who use foot pressure analysis, data from a typically developing population is used for comparison with subjects that have musculoskeletal conditions. However, differences between foot pressure data collection technology, data collection procedures and post-processing techniques make comparisons between devices, as well as direct comparisons of pediatric foot pressure data, difficult. When comparing data from multiple studies it is imperative that the studies utilize the same data collection and processing techniques, otherwise the data should not be directly compared. The purpose of this paper is to provide a summary of typically developing foot pressure data, explore factors that affect foot pressure data collection and provide suggestions for the standardization of foot pressure data collection and post processing. The results of this review demonstrate that the minimum data collection and processing recommendations for foot pressure data collection and post-processing are: using a midgait or two-step approach, allowing subjects to walk at their self-selected speed, collecting a minimum of three trials per foot, identifying at minimum medial and lateral hindfoot, forefoot, midfoot, the hallux and toes, and that parameters be reported in standard units.

Poster 435 Improvements in Functional Mobility After Hamstring Lengthening in Ambulatory Children with Cerebral Palsy

weeks later, each participant completed 12 weekly testing sessions. In 6 sessions, they used TDS to perform increasingly difficult computer tasks, including cursor navigation through a maze. These sessions were alternated with 6 weekly sessions using TDS to operate a power wheelchair through an obstacle course in unlatched, latched and semi-proportional control modes. Course completion time and number of errors traveling outside the designated path were recorded. Ability to tilt the wheelchair using TDS was measured. They also operated a smart-phone using tongue movements. Measures were: “throughput” (average rate of successful message delivery over a communication channel), “error rate” (in percentage), and “task completion time” (in minutes). Performance data were compared across testing sessions. Setting: Rehabilitation research laboratory. Results: There were no serious complications of tongue piercing or TDS testing procedures. All participants were able to use TDS to perform all tasks, with improvement in performance across testing sessions. Throughput (bits per second) increased in vertical tapping, horizontal tapping, center-out tapping, multi-directional tapping, and information transfer rate. Error rate and completion time decreased across sessions in all of the same measures, and in maze navigation and obstacle course performance. Conclusions: Preliminary evidence suggests that TDS is a safe and effective way to control wheelchairs, computers, and smartphones using tongue motion.

Poster 382 Gait Changes in Patients Diagnosed With Cerebral Palsy (GMFCS level 3) After Selective Dorsal Rhizotomy: A Retrospective Study

IV), and 142.5 cm (GMFCS V). The results demonstrated an inverse trend between functional severity based on GMFCS and both skinfold measurements and estimated body mass index. The average time required to obtain these measures was 4 minutes and 18 seconds. Conclusions: These preliminary data are consistent with published studies, lending external validity to this process. The results suggest that reliable anthropometric measures can be obtained and integrated into routine subspecialty care of children with cerebral palsy. Further investigation is needed to determine internal validity and to assess the effect of the availability of this clinical information on nutritional management and outcomes in children with cerebral palsy.

Poster 306: Swing Phase Adduction in Cerebral Palsy Diplegia: Correlation With Physical Examination

Disclosures: T. F. Chang, None. Objective: To investigate the relationship between the level of injury at initial admission to rehabilitation and the occurrence of depression at the 1-year follow-up evaluation in pediatric patients with spinal cord injury (SCI). Design: Prospective longitudinal study. Setting: SCI model systems comprehensive rehabilitation centers. Participants: 54 individuals with an average age of 16.83 years (SD 0.376) with a spinal cord injury. Patients were mostly men (74.1%) and white (70.4%). Other participants were African American (27.8%) or Asian/Pacific Islander (1.9%). The majority of patients incurred their SCI as a result of an automobile accident (51.9%), followed by gun shot wounds (20.4%), falls (11.1%), and other traumatic etiologies. Interventions: Not applicable. Main Outcome Measures: The Patient Health Questionnaire (Brief Version). Results: The majority of patients were not experiencing any depression at the annual follow-up examination (79.6%). Of those experiencing depressive symptoms, 11.1% (N 6) were classified with major depressive syndrome, while the other 9.3% (N 5) were classified as having other depressive syndrome. Conclusions: There was no clear relationship between the level of injury at admission to inpatient rehabilitation and the occurrence of depression at 1-year follow-up. Limitations and future research will be discussed.