ABSTRACT
Initial heel contact is an important attribute of gait, and failure to complete the heel rocker reduces gait stability. One common goal in treating toe-walking is to restore heel strike and prevent or reduce early heel rise. Foot floor angle (FFA) is a measure of toe-walking that is valuable for quantifying foot orientation at initial contact when using ankle dorsiflexion angle alone is misleading. However, no age-standardized FFA norms exist for clinical evaluation. Our objectives were to: (1) obtain normative FFA in typically developing children; and (2) examine its utility in the example of toe-walking secondary to unilateral cerebral palsy. Gait kinematics were acquired and FFA trajectories computed for 80 typically developing children (4-18 years). They were also obtained retrospectively from 11 children with toe-walking secondary to unilateral cerebral palsy (4-10 years), before and after operative intervention, and compared to 40 age-matched, typically developing children. FFA at initial contact was significantly different (P<.001) between pre-surgery toe-walking (-14.7±9.7°; mean±standard deviation) and typical gait (18.7±2.8°). Following operative lengthening of the gastrocnemius-soleus complex on the affected side, FFA at initial contact (-0.9±5.3°) was significantly improved (P<.001). Furthermore, several cases were identified for which the sole use of ankle dorsiflexion angle to capture toe-walking is misleading. The assessment of FFA is a simple method for providing valuable quantitative information to clinicians regarding foot orientation during gait. The demonstrated limitations of using ankle dorsiflexion angle alone to estimate foot orientation further emphasize the utility of FFA in assessing toe-walking.
Subject(s)
Cerebral Palsy/physiopathology , Cerebral Palsy/rehabilitation , Foot Joints/physiology , Gait/physiology , Heel/physiology , Toes/physiology , Adolescent , Cerebral Palsy/complications , Child , Child, Preschool , Cohort Studies , Female , Humans , MaleABSTRACT
OBJECTIVES: To determine the number of children with severe brain injury due to closed head injury or hypoxic-ischemic encephalopathy as a proportion of all admissions of children <3 yrs of age in the regional pediatric intensive care unit; to determine the outcome of these children at >6 mos postinjury; and to explore the relationship of outcome measures to predictors of outcome obtained within the first 24 hrs after brain injury. DESIGN: Prospective, descriptive outcome study of an inception cohort. RESULTS: Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. PATIENTS: Of a cohort of 53 children of <3 yrs of age (4% of pediatric intensive care unit admissions, 1995-1998) admitted for severe acquired brain injury (Glasgow Coma Score,
ABSTRACT
OBJECTIVES: Study 1: To determine the interrater agreement on the Multiattribute Health Status Classification (MAHSC) for brain-injured children. Study 2: To determine the outcome of severe childhood traumatic brain injury (TBI) by comparing three measures: MAHSC, Functional Independence Measures (FIM/WeeFIM), and the Glasgow Outcome Scale. Designs: Study 1: Clinic recruitment of parents of patients. Study 2: Surveillance follow-up of an inception cohort. Settings: Study 1: The Brain Injury Clinic, Glenrose Rehabilitation Hospital, Edmonton, Canada. Study 2: Pediatric Intensive Care Unit, University of Alberta Hospital. PATIENTS: Study 1: Two physiatrists and parents of 50 children (5-18 yrs, 54% boys) independently completed the survey. Study 2: From a cohort of 51 patients (3-17 yrs, 69% boys, 6 deaths) consecutively admitted to the pediatric intensive care unit in 1995 and 1996 with severe TBI (Glasgow Coma Score = 8 within the first 24 hrs postinjury), parents of all survivors (71% boys) completed outcome measures at 6-12 months postinjury. MEASUREMENTS AND MAIN RESULTS: Study 1: The interrater agreement exceeded 70% for attributes of sensation, mobility, cognition, self-care, and general health. Study 2: Of 45 survivors, 34 (76%) had a "good recovery" on the Glasgow Outcome Scale, 16 (36%) had normal scores on the FIM/WeeFIM, and only 8 (18%) had normal attributes on the MAHSC. Correlations of measures were Glasgow Outcome Scale and MAHSC, -.73; Glasgow Outcome Scale and FIM/WeeFIM,.64; and MAHSC and FIM/WeeFIM, -.63. Sensitivity and specificity from acute injury predictors for the Glasgow Outcome Scale were 88% and 91%, respectively; for MAHSC 75% and 70%; and for FIM/WeeFIM 63% and 75%. CONCLUSIONS: The MAHSC has a high interrater reliability after brain injury and is a useful parent-report surveillance tool to audit outcome after severe TBI. It identified problems not addressed by the Glasgow Outcome Scale or FIM/WeeFIM. Most children with severe TBI have adverse outcomes.