Electro-suit treatment of children with unilateral cerebral palsy alters nonlinear dynamics of walking.

BACKGROUND: Cerebral palsy (CP) is characterized by spasticity and muscle contracture development and associated with mild to severe motor impairments including reduced gait function. Treatment with the Exopulse® suit has been shown to reduce spasticity of the affected muscles and constitutes a non-invasive alternative to pharmaceutical agents and surgical denervation. The present study investigated the effect of systematic treatment with the Exopulse® suit on the nonlinear dynamics and variability of trunk accelerations during walking in children with unilateral CP. METHODS: Twelve patients (mean age: 12 years, range 7-17 years) with unilateral CP (GMFCS level 1 and 2) received 24 weeks Exopulse® suit treatment with patient-specific muscle stimulation. Before and after the treatment, the patients completed 4 min treadmill walking while trunk accelerometry was obtained. The nonlinear dynamics was quantified by the largest Lyapunov exponent and the complexity index from the multiscale entropy and movement variability was quantified by the root mean square ratio. Pre- vs post-treatment differences were evaluated by a paired Student's t-test. FINDINGS: The largest Lyapunov exponent (p-value = 0.041) and the complexity index (p-value = 0.030) of the acceleration in the anterior-posterior direction was significantly lower post-treatment. No other between-trial differences were observed. INTERPRETATION: The present study suggests that 24 weeks of Exopulse® suit treatment alters the nonlinear dynamics but not the variability of the trunk accelerations during walking in children with unilateral CP. The temporal structure of the trunk acceleration in the anterior-posterior direction was altered towards that of healthy individuals.

The Danish version of the modified Constant-Murley shoulder score: reliability, agreement, and construct validity.

STUDY DESIGN: Test-retest study. Objectives To assess the reliability, agreement, and validity of the Danish version of the modified Constant-Murley score (CMS). BACKGROUND: Modified CMS guidelines were published in 2008. These modifications have recently been translated and cross-culturally adapted into a Danish version. However, the reliability and the validity of this version have yet to be established. METHODS: A total of 45 patients with shoulder impingement syndrome were examined by 2 raters using the modified version of the CMS and a questionnaire that included the Oxford shoulder score. Both raters had a minimum of experience using the CMS. Intrarater and interrater agreement and reliability were examined and compared. Construct validity was assessed by the correlation between the scores of the CMS and the Oxford shoulder score. RESULTS: The minimal detectable change was estimated to be 13 and 11 points for raters A and B, respectively. The intraclass correlation coefficient was 0.93 for rater A and 0.95 for rater B. Interrater comparison demonstrated a minimal detectable change of 12 points and an intraclass correlation coefficient of 0.94. The correlation coefficient between the CMS and the Oxford shoulder score was 0.76. CONCLUSION: The intrarater and interrater reliability and agreement of the Danish version of the modified CMS were found to be acceptable, and construct validity was confirmed.