Sam Augsburger

Comparison of gait with and without shoes in children

Full body gait analysis was used to determine if differences exist in kinematic, kinetic, and temporal-spatial data with and without shoes in able-bodied children. The greatest difference noted between conditions was an increase in stride length with shoes. Minimal changes were seen in kinematics and kinetics with the addition of shoes. Due to the very tight standard deviations of the data, these minimal changes in the magnitude of the curves resulted in statistically significant differences, yet these changes do not appear to be clinically significant. It is believed that this study establishes that barefoot gait analysis is sufficient for most clinical studies, and an additional assessment undertaken while wearing shoes is not necessary.

Age-related Kinetic changes in normal pediatrics

Kinetic data have become an important adjunct to kinematic and electromyography data in the interpretation of gait data and in the clinical decision making for children with pathologic gait patterns. A normative database is essential for comparison with the patterns of walking in children with gait abnormalities. Gait analyses of 23 able-bodied children (ages 4-10 years) were compared with those of five able-bodied adults. The patterns and amplitudes of the normal able-bodied childrens kinetics showed five significant differences from those of the adults: (a) diminished hip-abduction moment, (b) diminished plantar-flexion moment, (c) diminished A2 power generation, (d) diminished knee-extensor moment, and (e) pattern of knee-power data. The data indicated a progression toward the adult normals because differences were more significant in the youngest group (4- to 5-year-olds) than in the older groups (6- to 7- and 8- to 10-year-olds).

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

Generation, absorption, and transfer of mechanical energy during walking in children

The purpose of this study was to characterize the manner in which net joint moments and non-muscular forces generate, absorb, and transfer mechanical energy during walking in able-bodied children. Standard gait data from seven healthy subjects between 6 and 17 years of age were combined with a dynamic model of the whole body to perform a power analysis based on induced acceleration techniques. These data were used to determine how each moment and force generates energy to, absorbs energy from, and transfers energy among the major body segments. The joint moments were found to induce transfers of mechanical energy between body segments that generally exceeded the magnitudes of energy generation and absorption. The amount of energy transferred by gravitational and velocity-dependent forces was considerably less than for the joint moments. The hip and ankle joint moments had relatively simple power patterns that tended to oppose each other, particularly over the stance phase. The knee joint moment had a more complex power pattern that appeared distinct from the hip and ankle moments. The general patterns of mechanical energy flow were similar to previous reports in adults. The approach described in this paper should provide a useful complement to standard clinical gait analysis procedures.

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.