Kinematic and electromyographic characteristics of children with cerebral palsy who exhibit genu recurvatum.

The objective of this article was to determine, using selected computerized gait analysis procedures, whether variation exists in the gait patterns of children with cerebral palsy who exhibit genu recurvatum. This descriptive study compared differences in kinematic, temporal-distance, and electromyographic (EMG) variables between two groups of children with cerebral palsy who exhibited genu recurvatum and age-matched controls. The setting was a motion analysis laboratory. Six children with cerebral palsy who showed genu recurvatum and a control group of four normal children participated in this study. Main outcome measures were hip-knee angle-angle diagrams, knee phase plane plots, knee angle versus time diagrams, stride length, cadence, single-limb support, and EMG data. Through use of hip-knee angle-angle diagrams, knee phase plane plots, and knee angle versus time diagrams, distinctive kinematic patterns emerged, allowing for grouping of subjects. Kinematic measures of knee angle at foot-floor contact and knee angle at greatest extension provided further support for the groups created, as did temporal-distance measures of stride length, cadence, and single-limb support. Analysis of variance procedures for the EMG data showed selected time points in the gait cycle during which differences between the groups were observed. Because differences in kinematic, temporal-distance, and EMG variables existed in this study to warrant grouping into two categories, physical therapists and orthopedic surgeons may need to vary the treatments they introduce dependent on the nature of the child's gait pattern.

Assessment of lower-extremity alignment in the transverse plane: implications for management of children with neuromotor dysfunction.

The authors present nine clinical assessment procedures designed to detect factors contributing to transverse-plane structural and joint alignment abnormality in children with neuromotor dysfunction. Where applicable, each assessment is accompanied by a discussion of the normal features of pediatric lower-extremity torsional and rotational alignment; limitations of the assessment procedures as regards reliability, specificity, and age-related normative findings; and clinical management suggestions. The authors urge clinical evaluators to expand the existing knowledge base.

Considerations related to weight-bearing programs in children with developmental disabilities.

Standing is a common modality used in the management of children with developmental disabilities. The purpose of this article is to examine the scientific basis for standing programs, with specific emphasis on the known effects of weight bearing on bone development. Guidelines for the use of standing programs are presented, and the supporting rationale is discussed.

Item reliability of the Milani-Comparetti Motor Development Screening Test.

The purpose of this study was to determine the level of interobserver and test-retest reliability of the Milani-Comparetti Motor Development Screening Test. Sixty healthy children, aged 1 through 16 months, were videotaped during administration of the Milani-Comparetti test. Four pediatric physical therapists independently viewed each videotape and scored the responses. Interobserver reliability was determined by calculation of percentage of agreement and the G statistic between a primary observer and each therapist. Forty-three children were retested within one week by the initial tester to examine test-retest reliability. Test-retest reliability was determined by percentage of agreement of items between the two test sessions and using the Kappa statistic. Interobserver percentage of agreement for the individual items on the Milani-Comparetti test ranged from 79% to 98%. The G statistic was significant for all items indicating the high percentage-of-agreement values were not due merely to chance agreement. Test-retest agreement ranged from 80% to 100%. Using Kappa statistic guidelines, excellent test-retest reliability (K greater than .75) was found for 82% of the test items, with good reliability of the remaining items. Acceptable interobserver and test-retest reliability was found for all items on the Milani-Comparetti test. Use of the Milani-Comparetti test as a clinical screening tool for prediction or follow-up of motor development in children at risk for developmental delays requires further evaluation.

Reliability of goniometric measurements of children with cerebral palsy.

The reliability of five lower-extremity goniometric measurements of 20 patients with moderate to severe hypertonicity was assessed by three pediatric physical therapists. The measurements were repeated on five of the children within one week. Intra-rater variation was less than inter-rater variation for all measurements, but variations of 10 to 15 degrees were found in inter-rater measurements. Intra-rater reliability was acceptable for measurements of hip extension, hip abduction and knee extension, but not for straight-leg raising or dorsiflexion.

Comparison of a clinical gait analysis method using videography and temporal-distance measures with 16-mm cinematography.

The purpose of this study was to compare a clinical gait analysis method using videography and temporal-distance measures with 16-mm cinematography in a gait analysis laboratory. Ten children with a diagnosis of cerebral palsy (means age = 8.8 +/- 2.7 years) and 9 healthy children (means age = 8.9 +/- 2.4 years) participated in the study. Stride length, walking velocity, and goniometric measurements of the hip, knee, and ankle were recorded using the two gait analysis methods. A multivariate analysis of variance was used to determine significant differences between the data collected using the two methods. Pearson product-moment correlation coefficients were determined to examine the relationship between the measurements recorded by the two methods. The consistency of performance of the subjects during walking was examined by intraclass correlation coefficients. No significant differences were found between the methods for the variables studied. Pearson product-moment correlation coefficients ranged from .79 to .95, and intraclass coefficients ranged from .89 to .97. The clinical gait analysis method was found to be a valid tool in comparison with 16-mm cinematography for the variables that were studied.

Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer.

The purpose of this study was to examine intratester and test-retest reliability using a hand-held dynamometer for the measurement of isometric muscle strength in 28 healthy children and children with Duchenne muscular dystrophy. The Dystrophic Group consisted of 14 children diagnosed with Duchenne muscular dystrophy, and the Healthy Group consisted of 14 age-matched children with no history of orthopedic or neuromuscular disorders. One physical therapist tested hip and knee extension, elbow flexion, and shoulder abduction in each child bilaterally. A two-way analysis of variance for repeated measures was used to analyze differences between measurements taken within and across the testing sessions. Pearson product-moment correlation coefficients were determined on mean values across the testing sessions for each variable. No significant differences (p greater than .05) between measurements taken within or across testing sessions were found in either the Dystrophic Group or the Healthy Group. Correlation coefficients for the Dystrophic Group ranged from .83 to .99 for the variables tested. Correlation coefficients for the Healthy Group ranged from .74 to .99. The results suggest that the hand-held dynamometer can be used as a reliable instrument in measuring the isometric strength of selected muscles in children.