Biomechanical responses of young adults with unilateral transfemoral amputation using two types of mechanical stance control prosthetic knee joints.

BACKGROUND: Prosthetic knee joint function is important in the rehabilitation of individuals with transfemoral amputation. OBJECTIVES: The objective of this study was to assess the gait patterns associated with two types of mechanical stance control prosthetic knee joints-weight-activated braking knee and automatic stance-phase lock knee. It was hypothesized that biomechanical differences exist between the two knee types, including a prolonged swing-phase duration and exaggerated pelvic movements for the weight-activated braking knee during gait. STUDY DESIGN: Prospective crossover study. METHODS: Spatiotemporal, kinematic, and kinetic parameters were obtained via instrumented gait analysis for 10 young adults with a unilateral transfemoral amputation. Discrete gait parameters were extracted based on their magnitudes and timing. RESULTS: A 1.01% ± 1.14% longer swing-phase was found for the weight-activated braking knee (p < 0.05). The prosthetic ankle push-off also occurred earlier in the gait cycle for the weight-activated braking knee. Anterior pelvic tilt was 3.3 ± 3.0 degrees greater for the weight-activated braking knee. This range of motion was also higher (p < 0.05) and associated with greater hip flexion angles. CONCLUSIONS: Stance control affects biomechanics primarily in the early and late stance associated with prosthetic limb loading and unloading. The prolonged swing-phase time for the weight-activated braking knee may be associated with the need for knee unloading to initiate knee flexion during gait. The differences in pelvic tilt may be related to knee stability and possibly the different knee joint stance control mechanisms. CLINICAL RELEVANCE: Understanding the influence of knee function on gait biomechanics is important in selecting and improving treatments and outcomes for individuals with lower-limb amputations. Weight-activated knee joints may result in undesired gait deviations associated with stability in early stance-phase, and swing-phase initiation in the late stance-phase of gait.

Long-term clinical evaluation of the automatic stance-phase lock-controlled prosthetic knee joint in young adults with unilateral above-knee amputation.

PURPOSE: The purpose of this study was to clinically evaluate the automatic stance-phase lock (ASPL) knee mechanism against participants' existing weight-activated braking (WAB) prosthetic knee joint. METHOD: This prospective crossover study involved 10 young adults with an above-knee amputation. Primary measurements consisted of tests of walking speeds and capacity. Heart rate was measured during the six-minute walk test and the Physiological Cost Index (PCI) which was calculated from heart rate estimated energy expenditure. Activity was measured with a pedometer. User function and quality of life were assessed using the Lower Limb Function Questionnaire (LLFQ) and Prosthetic Evaluation Questionnaire (PEQ). Long-term follow-up over 12 months were completed. RESULTS: Walking speeds were the same for WAB and APSL knees. Energy expenditure (PCI) was lower for the ASPL knees (p = 0.007). Step counts were the same for both knees, and questionnaires indicated ASPL knee preference attributed primarily to knee stability and improved walking, while limitations included terminal impact noise. Nine of 10 participants chose to keep using the ASPL knee as part of the long-term follow-up. CONCLUSIONS: Potential benefits of the ASPL knee were identified in this study by functional measures, questionnaires and user feedback, but not changes in activity or the PEQ.

Quantification of long-term effects of botulinum injection in a case of cerebral palsy affecting the upper limb movement.

OBJECTIVE: The aim of this work was to put into evidence the long-lasting modification induced by botulinum toxin injection and rehabilitative treatment on motor control. METHODS: In this contribution, we report the case of a female child showing hemiplegia, due to cerebral palsy. She underwent botulinum injection, followed by physical and occupational therapy. We quantified the biomechanical, cerebral and occupational aspects of her impaired upper limb, also dynamically, with respect to her pre- and post-treatment condition. RESULTS: Small long-lasting improvements--induced on biomechanics by botulinum injection--triggered wide cerebral modification, well reflected in improved contextual movements and motor strategy. CONCLUSION: These results provide evidences that small modifications in the end-effector performance often imply cerebral modifications and improvement in finalized motor strategy.

Movement analysis and EEG recordings in children with hemiplegic cerebral palsy.

Impaired hand function is often the most disabling symptom in children with hemiplegic cerebral palsy (CP). Literature provides a wide number of studies dealing either with the kinematics or the cerebral correlates of the impairment. Nevertheless, few studies exist merging both aspects together. The aim of this study is the integrated analyses of time and spatial parameters of both the affected and less-affected sides and of the EEG signal, recorded during the movement execution, for the quantitative description of the pointing gesture in children with CP. The participants (pathological and control subjects) were asked to execute a pointing task simultaneously with the recording by an optoelectronic system and an electroencephalographer. Kinematic data were processed for the extraction of several synthetic indexes, to be correlated with parameters derived from frequency analysis of the electroencephalographic signal. Kinematic results showed statistical differences (1) between the affected and the less-affected arms in patients and (2) between the less-affected arm in patients and the normal arm in controls. Further differences were found in kinematics with respect to bilateral or ipsilateral motor control, extracted from EEG. Given the different behavior evidenced by either ipsilateral or contralateral reorganization, and considering the role of feedback and feed-forward contributions to motor programming, some hypotheses emerged about the motor control during pointing task in CP.

Neurotomía periférica selectiva en el tratamiento de la espasticidad discapacitante del niño y adolescente / Peripheral selective neurotomy in the treatment of the disabling spasticity in child and adolescent

Abbreviations PSN Peripheral Selective Neurotomy;SEF Spastic Equinus Foot;SHA Spastic Hip Adduction;SHW Spastic Hand-Wrist Introduction.PSN is a microsurgical partial section of motor branches whose aim is supress the monosinaptic tonic stretching reflex leading to reduction of harmful spasticity without excessive paresis, restoring the tonic agonist-antagonist balance in a limb segment.Aims. Assess the benefits of PSN for treatment of disabling spasticity in children and teenager population. Method.19 consecutive patients (68 por ciento males,age 5-23 ), were treated through PSN.10 patients had SEF or SHA, and 9 had SHW.The inclusion criteria were age of 4 years or more; focused disabling spasticity at least grade 2 in Ashworth Mod. Scale; failure of previous non-surgical therapies; duration of spasticity more than 2 years, positive response to the motor anaesthetic block test; no evidence of irreductible muscle contracture. The goals of surgery were to improve function, cosmetics and confort of the affected limb segment. Clinical evaluation of spasticity (Ashworth Modified Scale), articular mobility (Goniometry), Gait (Video and gait analysis), and Prehension (Functional 440 pts. Scale), were performed. Results.The postoperative follow-up period range from 1 to 18 months. Spasticity was reduced in all the muscles denervated. The triceps surae spasticity reduction in SEF patients remain stable over a follow-up period of 6-18 months. 7/9 SEF patients improved ankle active dorsiflexion, ½ SHA improved hip abduction, while a mean improvement of 31.3° in wrist supination and 28.7° in wrist extension was achieved in the SHW group. 8/9 SEF patients showed improvement in 1 or more of the following gait features: ankle dorsiflexion, length of step, gait speed, proximal kinematic segment performance. The prehension improved in 7 patients (78 por ciento).All SHW patients improved their confort and limb cosmetics. 3 patients 15 por ciento) had transient dysesthesia...