ABSTRACT
OBJECTIVES: The degree of abnormality of the gait pattern of children with bilateral spastic cerebral palsy (BSCP) can be reduced by lower limb orthopaedic surgery. However, little attention is paid to the effects of surgery on standing posture. Here, we investigated the abnormality of standing posture in young people with BSCP as well as the effects of surgery on standing posture. METHODS: We have developed an index of standing posture, the Standing Posture Score (SPS), which is similar in composition to the gait profile score (GPS). We applied SPS retrospectively to 32 typically developing children and 85 children with BSCP before and after surgery to the lower limbs aimed at improving gait. We investigated the relationship between SPS and GPS before surgery and also the relationship between changes in these variables before and after surgery. RESULTS: SPS is significantly higher in young people with BSCP. SPS reduces after surgery and this reduction is correlated with the reduction in GPS. INTERPRETATION: Successful surgery improves the alignment of the lower limbs in BSCP in standing and may have a positive impact on the activities of daily living which depend on a stable and efficient standing posture.
Subject(s)
Cerebral Palsy/physiopathology , Lower Extremity/surgery , Posture/physiology , Activities of Daily Living , Adolescent , Cerebral Palsy/complications , Cerebral Palsy/surgery , Child , Female , Gait/physiology , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/physiopathology , Gait Disorders, Neurologic/surgery , Humans , Male , Retrospective StudiesABSTRACT
Two-dimensional B-mode ultrasound imaging and motion tracking were combined to generate three-dimensional reconstructions of the medial gastrocnemius. Architectural and morphological features of this muscle could be visualised. The length of the gastrocnemius belly was measured in normally (ND) developing children and in children with spastic diplegic cerebral palsy (SDCP) who had plantarflexion contractures. Using a random effects linear model we demonstrated that the gastrocnemius muscle bellies of children with SDCP were shorter than those of ND children (P = 0.001) even when corrected for ankle position. The technique described could be used to evaluate muscular deformity before and after an intervention.
Subject(s)
Muscle, Skeletal/anatomy & histology , Muscle, Skeletal/diagnostic imaging , Adolescent , Cerebral Palsy/pathology , Child , Child, Preschool , Female , Humans , Male , Muscle, Skeletal/pathology , UltrasonographyABSTRACT
Two-dimensional ultrasound imaging was combined with motion analysis technology to measure distances between remote anatomical landmarks. The length of the belly of the medial gastrocnemius muscle in five normal adults (nine limbs) was estimated using this technique. Our results in vivo were similar to the reported data for the lengths of muscles in cadavers, and were consistent with the expected relationship between muscle belly length and ankle joint angle. Experiments in vitro demonstrated that the accuracy of the device was better than 2 mm over 20 cm. Measurements on the same subject on different occasions showed that the results were repeatable in vivo. Rendering of the reconstructed volume of a foam phantom gave results comparable to photographic images. This validated technique could be used to measure muscle lengths in children with spastic cerebral palsy and indicate which muscles had fixed shortening, and to what extent.
