Gait & posture
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A better understanding of gait dysfunction for children and youth with Charcot-Marie-Tooth (CMT) will assist in developing appropriate treatments and understanding prognosis for ambulation. The purpose of this retrospective study was to document the typical gait patterns in children and youth (12±4 years) with CMT using motion analysis and relate these findings back to the clinical assessment at the ankle. All patients underwent a motion analysis as a component of treatment decision-making. ⋯ Delayed peak dorsiflexion in stance was the most common kinematic finding and consistent with ankle plantar flexor weakness. All patients showed significantly less (p<0.001) peak ankle moments and power generation in terminal stance than the typically developing controls. We concluded that children and youth with CMT present differently in terms of impairment and associated gait issues which therefore require patient specific treatment strategies.
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The gastrocnemius and soleus both contribute to the ankle plantarflexor moment during the mid- and terminal stance phases of gait. The gastrocnemius also generates a knee flexion moment that may lead to dynamic function that is unique from the soleus. This study used a muscle stimulation protocol to experimentally compare the contributions of individual plantarflexors to vertical support, forward propulsion and center of pressure (CoP) movement during normal gait. ⋯ However, late stance gastrocnemius activity induced forward acceleration, while both mid- and terminal stance soleus activity induced braking of forward velocity. The results suggested that the individual plantarflexors exhibit unique functions during normal gait, with the two muscles having opposite effects on forward propulsion. These empirical results are important both for enhancing the veracity of models used to predict muscle function in gait and also clinically as physicians seek to normalize gait in patients with plantarflexor dysfunction.
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Severe post-traumatic ankle arthritis poses a reconstructive challenge in active patients. Whereas traditional surgical treatments, i.e. arthrodesis and arthroplasty, provide good pain relief, arthrodesis is associated to functional and psychological limitations, and arthroplasty is prone to failure in the active patient. More recently the use of bipolar fresh osteochondral allografts transplantation has been proposed as a promising alternative to the traditional treatments. ⋯ EMG signals revealed a good recovery in activation of the biceps femoris. This study showed that osteochondral allograft transplantation improves gait patterns. Although re-evaluation at longer follow-ups is required, this technique may represent the right choice for patients who want to delay the need for more invasive joint reconstruction procedures.
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Trunk motor behavior has been reported to be altered in low-back pain. This may be associated with impaired lumbar proprioception, which could be compensated by trunk stiffening. We assessed trunk control by measuring center-of-pressure, lumbar kinematics and trunk muscle electromyography in 20 low-back pain patients and 11 healthy individuals during a seated balancing task, in conditions with and without disturbance of lumbar proprioception and occlusion of vision. ⋯ Furthermore, low-back pain patients had an about 20 degrees less flexed lumbar posture than healthy individuals, and, in contrast to our hypothesis, made larger thoraco-lumbar movements in the sagittal plane, as indicated by higher SDs of thoraco-lumbar flexion and lower (more negative) correlations between pelvis and thorax movements. Activation of the intersegmental longissimus relative to the iliocostalis muscle, which spans all lumbar segments, was lower in low-back pain patients compared to healthy individuals. This difference in muscle activation may be causal for larger thoraco-lumbar movements, and may be causative of reduced control over segmental lumbar movement, but may also reflect the need for larger corrective movements to compensate balance impairments.