Gait profile score and gait variable scores in spina bifida.

Quantitative data assessment on the basis of three-dimensional gait analysis has been routinely used in the evaluation of pathological gait of children with cerebral palsy. However, a similar quantitative methodology has not been applied for spina bifida patients in whom atypical gait patterns are thought to correlate with various levels of neurological paralysis. The purpose of this study is to investigate the differences among gait patterns in spina bifida between different levels of neurological lesions using quantitative methods: Gait profile score (GPS) and gait variable scores (GVS), scoring subject's gait deviation from a reference. In this cross-sectional study, 22 children with spina bifida (11 women, 11 men; mean age 9.4 years, SD 3.8 years, range 3-17 years), were examined using three-dimensional gait analysis from 2008 to 2018. Physical examination allowed for classification of each of the 44 limbs as either L4, L5 or S1 and comparison with the GPS and GVS using a linear mixed model. GPS and the GVS of the pelvis and hip range of motion in the coronal plane were significantly higher in the L4 group than in the L5 and S1 groups (GPS, P = 0.041, P = 0.003, respectively; GVS of pelvis, P = 0.001, P = 0.001; GVS of hip, P < 0.001, P < 0.001) GVS (foot progression angle) was significantly lower in the S1 group than in L4 and L5 groups (P < 0.001, P = 0.037). We found that GPS and GVS enable us to quantitatively assess the differences among gait patterns between different neurological levels. The scoring tool showed the potential for detecting individual neurological changes.

Motion analysis and surgical results of anterior transfer of flexor hallucis longus for equinovarus gait in children with hemiplegia.

BACKGROUND: Rigid equinovarus foot deformities are seen in patients with cerebral palsy (CP). This retrospective study was undertaken to evaluate flexor hallucis longus tendon (FHL) transfer with gastrocsoleus recession (GSR) using motion analyses and quantitative measurement, and to investigate postoperative complications. METHODS: This study included 10 hemiplegic CP patients who underwent FHL transfer with GSR, and were evaluated by motion analyses consisting of weight distribution in static standing position and three-dimensional gait analysis, both pre and post-operatively. They were assessed in terms of kinematic data, Gait Variable Scores (GVS), and Gait Profile Score (GPS). RESULTS: The mean age at operation was 7.3 years (range, 4-13 years), and mean follow-up duration was 35 months (range, 25-64 months) post-operatively. Weight distribution at surgical site significantly rose from 34.3% pre-operatively to 47.3% post-operatively, and abnormal asymmetry of weight distribution between surgical site and contralateral site disappeared post-operatively. Maximum ankle dorsiflexion (ADF) at initial contact rose from -20.9° to -6.28°. Similarly, Maximum ADF at both stance and swing phase rose from -13.8° to 17.7° (P = 0.0003), and from -19.5° to 1.35° (P = 0.001), respectively. Although mean GPS decreased from 15.6° pre-operatively to 11.8°, which corresponded to 2.38 times the minimal clinically important difference (MCID = 1.6°), three cases manifested talipes calcaneus at final follow-up. CONCLUSION: Although quantitative assessment showed that the potential value of FHL transfer with GSR was to obtain initial heel contact and maintain sufficient clearance from the ground in swing, it also revealed a risk of leading to talipes calcaneus. In the near future, we should establish accurate criteria for determination of transfer site, and consider the possibility of modification of this procedure in order to balance between recurrent equinus and significant talipes calcaneus. STUDY DESIGN: Clinical comparison between preoperative and postoperative.

Correlation of scoliotic curvature with Z-score bone mineral density and body mass index in patients with osteogenesis imperfecta.

STUDY DESIGN: A cross-sectional radiographic and clinical study of patients with osteogenesis imperfecta (OI). OBJECTIVE: To determine demographic, anthropometric, and radiographic parameters that correlate with development of scoliosis in patients with OI. SUMMARY OF BACKGROUND DATA: Despite the relatively high prevalence of scoliosis in patients with OI and its clinical significance, little is known about demographic and anthropometric parameters that correlate with the development of scoliosis. METHODS: Clinical records and spinal radiographs of 19 OI patients were reviewed. There were 5 male and 14 female patients with an average age of 14.2 years (range, 4-20 years). Seven patients were Sillence Type I and 12 patients were Type III. The Cobb angle of scoliosis was analyzed for correlations with age, body mass index (BMI), physical capability, leg-length discrepancy, Z-score bone mineral density (BMD) in the lumbar spine, thoracic kyphosis angle, and lumbar lordosis angle by using Pearson's correlation method. A probability of less than 0.05 was considered statistically significant. RESULTS: The average Cobb angle of scoliosis was 25.2 degrees (range, 5 degrees-108 degrees) including 6 patients with an angle of > or = 30 degrees. Five of these 6 patients were Sillence Type III. Statistical analysis showed a significant positive correlation between the extent of scoliosis and BMI, as well as leg-length discrepancy. There was an inverse correlation between the extent of scoliotic curvature and the Z-score BMD as well as the thoracic kyphosis angle. CONCLUSION: The correlation of scoliosis with the Z-score BMD and BMI supports the pathology of scoliosis based on vertebral fragility. Proper management of BMD and BMI may have therapeutic value in delaying the progression of scoliosis in patients with osteogenesis imperfecta.

Heel cord advancement combined with Vulpius' lengthening of the gastrocnemius.

The results of Achilles tendon lengthening to treat spastic pes equinus deformity are less than satisfactory, with high recurrence rates. To improve the outcome, heel cord advancement can be done. In the current study, the patients with severe contracture of the Achilles tendon were treated by heel cord advancement. Additional lengthening of the gastrocnemius muscle using the Vulpius technique was done to reattach the Achilles tendon to the calcaneus. Seventeen patients (20 feet) with spastic pes equinus deformities were treated with this technique, and satisfactory midterm postoperative results were obtained. The mean age of the patients at surgery was 10 years, and the mean duration of followup after surgery was 8 years. The mean tibioplantar angle decreased postoperatively, and there were no recurrences of pes equinus deformity and no appearance of pes calcaneus deformity. Walking ability improved in two patients and did not deteriorate in any of the patients. Seven of the patients were able to stand on only the affected foot after the operation. Our technique provides good correction of an equinus deformity with no recurrence, and with improvement of the physical activity level.