ABSTRACT
The repeatability of both 3D kinematic measurements of arm movement during simple upper limb tasks and lower limb movement during gait analysis was evaluated in 10 children with hemiplegic cerebral palsy. All tasks were completed on two separate occasions, 1 week apart. The 3D lower limb gait analysis showed high levels of repeatability in the sagittal plane measures, with mean coefficient of multiple correlations (CMCs) greater than 0.92 between sessions. Transverse and frontal plane measures had mean CMCs greater than 0.7 between sessions. A 3D analysis of shoulder and elbow flexion/extension during the two functional tasks (hand to head and hand to mouth) was highly repeatable between sessions (mean CMCs, 0.87 to 0.95). Rotational measures at the shoulder and the elbow during the same tasks demonstrated moderate levels of inter-sessional repeatability (mean CMCs shoulder 0.49 to 0.63; elbow 0.63 to 0.74). Overall, the lower limb 3D kinematic analysis had similar levels of repeatability in both the hemiplegic limb and the limb with normal tone. The 3D kinematic analysis of movement of the hemiplegic upper limb during simple upper limb tasks also had moderate to good repeatability, suggesting it may be able to be used as an outcome measure in the hemiplegic upper limb.
Subject(s)
Cerebral Palsy/physiopathology , Hemiplegia/physiopathology , Lower Extremity/physiopathology , Upper Extremity/physiopathology , Adolescent , Ankle Joint/physiopathology , Biomechanical Phenomena , Child , Child, Preschool , Elbow Joint/physiopathology , Female , Gait/physiology , Hip Joint/physiopathology , Humans , Imaging, Three-Dimensional , Knee Joint/physiopathology , Male , Movement/physiology , Reproducibility of Results , Rotation , Shoulder Joint/physiopathologyABSTRACT
Thirteen skeletally mature subjects who had been treated as children for idiopathic toe-walking underwent gait analysis and calf muscle strength testing at an average of 10.8 years from the last intervention. Six had had serial casting only; seven had had either a percutaneous tendo Achilles lengthening or a Baker's gastroc-soleus lengthening. Sagittal plane kinematics at the ankle was altered in 12 of the 13 subjects, but the changes were detectable visually in only 3 subjects. One subject had increased ankle plantarflexion at initial contact, but the other 12 subjects had a normal first rocker. Peak ankle dorsiflexion in stance averaged only 9 degrees, and 11 of the subjects had a peak ankle dorsiflexion in stance greater than 2 standard deviations below normative values. Ankle dorsiflexion was also restricted on passive measures, but there was no correlation between ankle dorsiflexion non-weight-bearing and in gait. Inversion of second rocker was seen in two subjects with peak ankle dorsiflexion in stance occurring before 25% of the gait cycle. Power generation by the calf during a single heel-rise test was variable between subjects but within normative values compared with controls. The authors conclude that most subjects showed persistent changes in ankle kinematics and kinetics despite treatment but that this was not detectable visually in most subjects.
