Eye Gaze Gaming Intervention in Children with Dyskinetic Cerebral Palsy: A Pilot Study of Task Performance and Its Relation with Dystonia and Choreoathetosis.

OBJECTIVES: To investigate the operational competences screen navigation and dwell function underlying eye gaze performance, and the relation of dystonia and choreoathetosis with eye gaze performance in children with dyskinetic cerebral palsy (DCP). METHODS: During a 5-week intervention, ten participants with DCP played eye gaze video games daily for 30 minutes. Six games were used to assess task performance, fixation count, and eye movement accuracy during four measurements. Dystonia and choreoathetosis were evaluated using the Dyskinesia Impairment Scale. RESULTS: Eye gaze performance improved over time (p = .013). Moderate to strong within-subject correlations were found between eye movement accuracy and task performance, and between eye movement accuracy and fixation count. No significant correlations were found with the movement disorders. CONCLUSIONS: Eye gaze technology shows great potential to be a successful computer interface for children with severe DCP, thereby potentially improving their communication skills, participation levels, and quality of life.

Presence and severity of dystonia and choreoathetosis overflow movements in participants with dyskinetic cerebral palsy and their relation with functional classification scales.

Background: This cross-sectional study aims to investigate the presence and severity of overflow movements of dystonia and choreoathetosis in dyskinetic cerebral palsy (CP) and to assess the relationship of overflow movements with functional classification scales.Methods: Fifty-two subjects with dyskinetic CP were included. Presence and severity of dystonia and choreoathetosis overflow movements were assessed with the Dyskinesia Impairment Scale. Functional abilities were classified with the Gross Motor Function Classification System, Manual Ability Classification System, Viking Speech Scale, Communication Function Classification System, and Eating and Drinking Ability Classification System.Results: Dystonia and choreoathetosis overflow movements were simultaneously present. Median scores of dystonia overflow movements were significantly higher than choreoathetosis overflow movements. Dystonia and choreoathetosis overflow movements were significantly higher in extremities than in the central body. Correlations between dystonia and choreoathetosis overflow movements were fair. Moderate to good correlations were found between dystonia overflow score and Gross Motor Function Classification System, Manual Ability Classification System, and Eating and Drinking Ability Classification System.Conclusions: This is the first study to assess overflow movements in dyskinetic CP. All participants presented with dystonia and choreoathetosis overflow movements, with higher values for dystonia overflow movements. Dystonia overflow movements seem to have a larger impact on functional abilities.Implications for rehabilitationDystonia and choreoathetosis overflow movements are both present in children with dyskinetic cerebral palsy, with dystonia overflow movements being more severe than choreoathetosis overflow movements.Overflow movements impact heavily on daily functional ability and the execution of voluntary activities.Dystonia overflow movements show good correlations with functional classification scales.The measurable characteristics of overflow movements can be used as a guideline for targeted treatment with, e.g., botulinum-toxin-A injections.

Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study.

BACKGROUND: The aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since unicondylar knee replacement is a less invasive procedure, which more closely preserves knee joint anatomy, we hypothesized that one year post unicondylar knee arthroplasty patients would demonstrate more normal gait patterns than patients with total knee arthroplasty. RESEARCH QUESTION: Do unicondylar and total knee arthroplasty patients display similar gait kinematics one year after surgery? METHODS: Fourteen subjects (8 posterior stabilized and 6 medial unicondylar knee replacements) that were one year post surgery, and 6 healthy control subjects underwent a 3D gait analysis and a physical examination (range of motion, muscle strength). Statistical parametric mapping was used to compare gait kinematics of the lower limbs between groups. Additionally, differences in peak angles and clinical outcomes were assessed using a one-way ANOVA between subjects analysis. RESULTS: Both knee replacement groups showed reduced knee flexion range of motion and reduced muscle strength at the operated leg compared to the control group. Subjects with TKA demonstrated reduced knee flexion at loading response and midstance of the gait cycle. Both UKA and TKA demonstrated significantly less knee flexion during swing. SIGNIFICANCE: The results of this study demonstrate arthroplasty-specific differences in muscle strength, range of motion and gait kinematics of the lower limb one year after knee surgery. Future planning of post-surgery follow-up should addresses these arthroplasty-specific weaknesses and gait deviations.

The implementation of inertial sensors for the assessment of temporal parameters of gait in the knee arthroplasty population.

BACKGROUND: The use of inertial measurement units for the evaluation of temporal parameters of gait has been studied in many populations. However, currently no studies support the use of inertial measurement units for this purpose in the knee arthroplasty population. The objective of the present study was to investigate the agreement between an inertial measurement and camera based system for the assessment of temporal gait parameters in a knee arthroplasty population. METHODS: Sixteen knee arthroplasty patients performed 3 gait trials at a self-selected speed along a 6 m walk-way. During the gait trials, gyroscope data from shank-worn inertial measurement units and motion data from optoelectronic cameras were collected simultaneously. A custom-made peak detection algorithm was used to identify gait events from gyroscope data, in order to compute cycle time, stance time and swing time. A marker and coordinate based algorithm was used to calculate temporal gait parameters from kinematical data derived from the camera system. Temporal variables were compared between both methods by calculating intra-class correlation coefficients, mean errors and root mean squared errors. Furthermore, Bland-Altman plots were constructed to assess the agreement between both methods. FINDINGS: Overall good to excellent intra-class correlation values (0.826-0.972) were found. Root mean square errors between both methods ranged from 0.036 to 0.055 s. High levels of agreement were observed for all variables. INTERPRETATION: These findings suggest that inertial measurement units can be used for outside laboratory assessment (e.g. in a hospital environment) of temporal gait parameters in the knee arthroplasty population.

Functional outcomes in children and young people with dyskinetic cerebral palsy.

AIM: This cross-sectional study aimed to map the functional profile of individuals with dyskinetic cerebral palsy (CP), to determine interrelationships between the functional classification systems, and to investigate the relationship of functional abilities with dystonia and choreoathetosis severity. METHODS: Fifty-five children (<15y) and young people (15-22y) (30 males, 25 females; mean age 14y 6mo, standard deviation 4y 1mo) with dyskinetic CP were assessed using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Viking Speech Scale (VSS), as well as the Dyskinesia Impairment Scale. RESULTS: Over 50 per cent of the participants exhibited the highest limitation levels in GMFCS, MACS, and VSS. Better functional abilities were seen in EDACS and CFCS. Moderate to excellent interrelationship was found among the classification scales. All scales had significant correlation (rs =0.65 - 0.81) with dystonia severity except for CFCS in the young people group. Finally, only MACS (rs =0.40) and EDACS (rs =0.55) in the young people group demonstrated significant correlation with choreoathetosis severity. INTERPRETATION: The need for inclusion of speech, eating, and drinking in the functional assessment of dyskinetic CP is highlighted. The study further supports the strategy of managing dystonia in particular at a younger age followed by choreoathetosis in a later stage.

Sagittal evaluation of usual standing and sitting spinal posture.

Postural rehabilitation often plays an important role in the management of non-specific low back pain. While cervical and lumbar correlations have been demonstrated previously, the different role of the pelvis and the thoracic spine for postural control in sitting and standing remains unclear. The aim of this study was to investigate postural correlations between all spinal regions in standing and sitting. Based on digital photographs eight postural angles were analyzed in 99 young healthy persons. Pearson correlations between different postural angles were calculated. In sitting pelvic tilt demonstrated mostly medium correlations with five out of seven other postural angles, compared to three in standing. In standing trunk angle showed five out of seven mostly medium correlations with other regions compared to four out of seven in usual sitting. The low and different correlations suggest a large between-subject variability in sagittal spinal posture, without the existence of any optimal sagittal posture.