Multiple gait patterns within the same Winters class in children with hemiplegic cerebral palsy.

BACKGROUND: Previous literature hypothesized that Winters type I are mainly characterized by a hypo-activation of dorsiflexors and type II by hyperactivation of plantarflexors around initial contact. However, it is currently not known if hemiplegic children belonging to the same Winters class really share the same muscle activation patterns, although this information might have relevant clinical implications in the patient management. METHODS: Gait data of 38 hemiplegic cerebral palsy children (16 Winters type I, 22 Winters type II) were analyzed, focusing on the foot and shank. A 2.5-minute walk test was considered, corresponding to more than 100 gait cycles for each child, analyzing the muscle activation patterns of tibialis anterior and gastrocnemius lateralis. The large stride-to-stride variability of gait data was handled in an innovative way, processing separately: 1) distinct foot-floor contact patterns, and for each specific foot-floor contact pattern 2) distinct muscle "activation modalities", averaging only across gait cycles with the same number of activations, and obtaining, in both cases, the pattern frequency-of-occurrence. FINDINGS: At least 2 representative foot-floor contact patterns within each Winters group, and up to 4-5 distinct muscle activation patterns were documented. INTERPRETATION: It cannot be defined a predominant muscle activation pattern specific for a Winters group. For a correct clinical assessment of a hemiplegic child, it is advisable to record and properly analyze gait signals during a longer period of time (2-3 min), rather than (subjectively) selecting a few "clean" gait cycles, since these cycles may not be representative of the patient's gait.

Dual task interference during gait in patients with unilateral vestibular disorders.

BACKGROUND: Vestibular patients show slower and unsteady gait; they have also been shown to need greater cognitive resources when carrying out balance and cognitive dual tasks (DT). This study investigated DT interference during gait in a middle-aged group of subjects with dizziness and unsteadiness after unilateral vestibular neuronitis and in a healthy control group. METHODS: Fourteen individuals with subacute unilateral vestibular impairment after neuronitis and seventeen healthy subjects performed gait and cognitive tasks in single and DT conditions. A statistical gait analysis system was used and spatio-temporal parameters were considered. The cognitive task, consisting of backward counting by three, was tape recorded and the number of right figures was then calculated. RESULTS: Both patients and controls showed a more conservative gait during DT and between groups significant differences were not found. A significant decrease in cognitive performance during DT was found only in the vestibular group. CONCLUSIONS: Results suggest that less attentional resources are available during gait in vestibular patients compared to controls, and that a priority is given in keeping up the motor task to the detriment of a decrease of the cognitive performance during DT.

Motor evoked potentials: prognostic value in motor recovery after stroke.

Accurate motor and functional prognosis after stroke is important for the optimal planning of a personalised rehabilitation programme, and clinical, demographic and radiological data are commonly employed for this purpose. It is becoming increasingly apparent that motor evoked potentials (MEPs), obtained through transcranial magnetic stimulation, can furnish complementary prognostic information on motor outcome after stroke, particularly when initial hand palsy is present. To evaluate the prognostic value of early MEPs together with other clinical variables, 19 subjects with first- ever stroke in the middle cerebral artery territory and hand palsy at onset, were evaluated in the acute phase. These cases were retrospectively selected out of a sample of 33 subjects. Multivariate analysis was carried out using amplitude of MEPs, National Institutes of Health Stroke Scale score (NIH) and Motricity Index as independent variables, and Medical Research Council scale score (MRC) as the dependent outcome variable at 4 months after stroke. The best model, which combined NIH and MEP data, accounted for 75.44% of the variability of the MRC. Our results suggest that the NIH and MEPs may yield information useful for predicting hand motor outcome after stroke in the presence of initial hand palsy, a condition in which a prognosis made on the basis solely of clinical data is deemed more difficult.