A study of the effect of cyproheptadine on gait in hemiplegic children.

The properties of cyproheptadine as an anti-spastic agent have been reported since 1980. In this study we sought to investigate whether gait function, as specified by stride length, cadence, heart rate, and also by questionnaire, correlated with cyproheptadine medication during a double-blind matched-placebo cross-over trial, undertaken on a group of 16 hemiplegic spastic patients aged 4-18 years. We found that neither qualitative nor quantitative analyses suggested any systematic change in gait parameters dependent on cyproheptadine medication. We conclude that our study on 16 patients showed no statistical evidence of improvement in spasticity due to the action of cyproheptadine. An effect was, however, found in the case of mean patient heart rate, which was 10% higher (P<0.003) at the end of the cyproheptadine medication period. Copyright 1998 Elsevier Science B.V.

Calculation of gait parameters direct from force plate readings.

Several parameters used in the assessment of pathological gait are normally determined by measurements obtained by means other than from force plate recordings. Methods are presented whereby parameters such as stride length, step length, cadence, single support time, average forward velocity and angle of foot in contact with the force plate are determined directly from force plate recordings of the gait.

Gait analysis of patients with low back pain before and after surgery.

Gait analysis could be a good objective and quantifiable assessment of function in patients with chronic low back pain. A study of the gait parameters of 20 normal subjects and 30 patients with low back pain, before and 2 years after surgery (mainly spinal arthrodesis) was undertaken. For the majority (67%) of patients, postoperative gait analysis confirmed their perception of pain and function. In a minority (33%) of patients, there was an improvement in gait parameters, despite the perception of continuing severe pain and poor physical functioning. It may be possible to reduce the number of patients experiencing symptomatic failure with surgery if this discrepancy between gait and disability due to pain can be discovered preoperatively. Then the advice against surgery could be given when indicated.

Variations of gait parameters in Duchenne muscular dystrophy.

The gait parameters (speed, stride length and cadence) of nine boys with Duchenne muscular dystrophy were compared with those of 21 normal boys in the same age range. Differences found were due to the altered ability to control their dynamic state and, to a lesser extent, physical limitations of joint range. This simple method of quantifying gait is proposed as a way in which progression or response to treatment in muscular dystrophy might be monitored. The information obtained may alert the clinician to the fact that the progressive muscle weakness and joint contractures have begun to cause compensatory mechanisms during walking to fail. It is also useful to obtain information on gait in clinical treatment trials as there are very few reliable methods for testing function in muscular dystrophy.

Vector (butterfly) diagrams for osteoarthritic gait: a preliminary report.

This paper describes briefly a simple three-dimensional vector diagram display combining all the force components of gait in one diagram. The locus of the centre of pressure of the feet on the ground is fully illustrated. This provides a useful reference for the consideration of the position of the centre of body mass over one foot or the other. In the case of some pathological gaits, the lateral displacement can be substantial. The traditional two-dimensional diagram fails to show some of these effects.

Legendre polynomial coefficients in the analysis of the horizontal and lateral component of the force plate measurements for an osteoarthritic gait.

The assessment of force plate measurement obtained from subjects with a pathological gait, normally carried out by visual examination of the force-time data, can be augmented by consideration of Legendre polynomial coefficients. The first seven coefficients are evaluated and presented for the horizontal (forwards) and lateral (sideways) components of the force-time curves. It is shown that for an accurate assessment of specific osteoarthritic abnormalities it is necessary to consider the horizontal and lateral component data in addition to that previously presented for the vertical component. Relevance The Legendre analysis identifies the major gait factors from the shape of the curves and gives a reliable method of reducing the dynamic data to a simple set of numerical values by formalizing the classic approach of visual examination of the force-time curves. The method is particularly suitable for assessing the clinical gait condition in respect of heel-strike, toe-off, and stability.

The use of double support time for monitoring the gait of muscular dystrophy patients.

Children with muscular dystrophy eventually lose the ability to walk and with it, their independence. Timely operative or orthotic intervention may delay this critical point. Quantifiable parameters, which aid in making this prediction should, therefore, be actively sought. In this study, using a simple gait analysis system, the gait. parameters of 10 boys with muscular dystrophy (MD) were compared with those of 22 normal boys in the same age range, and with their own parameters at subsequent follow-up. The results suggest that observation of the gait of MD boys and measurement of their double support time may be useful in monitoring the progress of their disease.

Knee moments in Duchenne muscular dystrophy.

The gait of 7 boys with Duchenne muscular dystrophy (DMD) who could walk unaided and 21 normal boys was analysed by means of a video recording technique linked to a Kistler force plate. An electronic device was used to superimpose the patient's ground reaction vector on the video recording of their walking. This recording was analysed to obtain sequential values for the moments developed around the knee during the walking cycle. The equinus gait of boys with DMD is shown to be a necessary adaptation to keep the forces about proximal joints, particularly the knee, within limits controllable by weakened muscles. These findings explain the observation that elongation of the Achilles tendon to correct contracture at the ankle can have irrevocably damaging effects on gait.

Height of centre of body mass during osteoarthritic gait.

Early attempts to locate the position of the centre of mass of the body during walking involved the use of cinematography, followed by kinetic analysis of the forces and couples acting about three axes at the ground and centre of mass. These methods, requiring data on the individual body segments, are too lengthy and complex for routine clinical use. A method is described which estimates both the trajectory and the mean height of the centre of mass, using only dynamic data from a single walk across one pair of force plates. Relating a possible trajectory height to the measured force vectors gives a profile for the horizontal velocity. The correct height is determined by seeking the smooth profile corresponding to the known horizontal velocity obtained by integration. Results are presented for 42 osteoarthritic patients undergoing total hip replacement operations.

Legendre polynomial coefficients in the analysis of the force plate measurements from an osteoarthritic gait.

The assessment of force plate measurements obtained from subjects with a pathological gait is normally carried out by a visual inspection of the force-time curves produced by the plate. It is shown that a valuable addition to that inspection is the derivation from the curves of Legendre polynomial coefficients, the first five coefficients being sufficient to indicate clearly, specific osteoarthritic abnormalities.

Osteoarthritic gait dynamics from force-plate measurements.

A method is presented for calculating the displacement of the centre of body mass in lateral, horizontal and vertical directions during pathological gait; evaluations are made from measurements obtained by a single pair of small force plates. Results are presented for pre- and postoperative gait for 42 patients who, initially suffering from osteoarthritis of the hip, have had total hip placements. The method is shown to be more convenient, more direct and less expensive than techniques in present use.

Regional hip blockade in osteoarthrosis. Effects on pain perception.

Eighteen patients with unilateral osteoarthrosis of the hip were investigated in a trial which involved the injection of nine with bupivacaine and nine with normal saline. All the patients completed daily pain analogue charts. Their pain, mobility and functional activity were assessed and gait characteristics analysed, once before the injection and then at three monthly intervals. All the patients recorded a decrease in pain level within two weeks of injection, but it subsequently rose to pre-injection levels. There were no other significant general improvements after the injection. A significant increase in the maximum force at toe-off for the good leg was recorded one month after the injection. However, no further significant differences were found in the gait performance of either group of patients throughout the study. It is concluded that the hip nerve regional blockade offers no useful relief to the pain of osteoarthrosis of the hip joint.