Behandlungszentrum Aschau GmbH

Aschau im Chiemgau, Germany

Behandlungszentrum Aschau GmbH

Aschau im Chiemgau, Germany
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Bohm H.,Behandlungszentrum Aschau GmbH | Hosl M.,Behandlungszentrum Aschau GmbH | Doderlein L.,Behandlungszentrum Aschau GmbH
Gait and Posture | Year: 2017

Introduction Patellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis. Research question Which CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening? Methods 32 patients with CP between 8 and 18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD = 1.9) months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups. Results 34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt. Discussion Every third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy. © 2017 Elsevier B.V.


Bohm H.,Behandlungszentrum Aschau GmbH | Rammelmayr M.K.,TU Munich | Doderlein L.,Behandlungszentrum Aschau GmbH
European Journal of Physiotherapy | Year: 2015

Climbing therapy combines the challenge of height with strength, flexibility and coordination training. The typical climbing posture with abducted and external rotated hips, extended knees and ankle dorsiflexion might be ideally suited to improve typical intoeing, crouch and equinus gait pathologies in cerebral palsy. Therefore, the objective was to evaluate the effect of climbing therapy on gait function in children and adolescents with cerebral palsy. The study design was a single-blind randomized, controlled crossover trial that was carried out in a school for children with disabilities. Eight pupils with bilateral spastic cerebral palsy, Gross Motor Function Classification System level I-III, aged 7-18 years, participated. Six weeks of climbing therapy were compared with physical therapy of two sessions of 1.5 h per week each. Outcome measures were walking speed, step length, step time, Gait Profile Score, internal hip rotation, knee flexion at initial contact and peak ankle dorsiflexion. The results showed an improvement in walking speed, step length, step time in both therapies. Gait Profile Score, ankle dorsiflexion and knee flexion was improved in physical therapy, whereas it did not improve in climbing therapy. However, the difference between therapies was only significant in knee flexion. In conclusion, the use of climbing therapy instead of physical therapy must be critically discussed, as it may deteriorate crouch gait. Future climbing therapy protocols might be improved including more exercises aiming to strengthen the knee extensors in an upright body posture with extended hips and knees. © 2014 Informa Healthcare.


Niklasch M.,University of Heidelberg | Dreher T.,University of Heidelberg | Doderlein L.,Behandlungszentrum Aschau GmbH | Wolf S.I.,University of Heidelberg | And 3 more authors.
Gait and Posture | Year: 2015

The femoral derotation osteotomy (FDO) is seen as the golden standard treatment in children with cerebral palsy and internal rotation gait. Variable outcomes with cases of over- and undercorrection mainly in the less involved patients have been reported. The determination of the amount of derotation is still inconsistent. 138 patients (age: 11 (±3.3) years) with cerebral palsy and internal rotation gait were examined pre- and 1 year postoperatively after distal or proximal FDO, using standardized clinical examination and 3D gait analysis. Three groups were defined retrospectively depending on the amount of derotation in relation to the mean hip rotation in stance (MHR) during gait analysis: Group A (derotation angle > MHR. +. 10°), Group B (derotation angle. =. MHR. ±. 10°), Group C (derotation angle <. MHR. -. 10°), and compared according to their postoperative mean hip rotation. ANOVA with Bonferroni post hoc test was used for statistics (p<. 0.05). Group B had the greatest benefit with the highest rate (86%) of good results (postoperative MHR. =. ±15°). In contrast there were 14% cases of overcorrection and 5% cases of deterioration in Group A with only 81% good results and only 79% good results in Group C. It can be concluded, that it is less likely to have unsatisfactory outcomes if the amount of FDO is defined according to the findings of gait analysis compared with clinical examination. © 2014 Elsevier B.V.


Niklasch M.,University of Heidelberg | Doderlein L.,Behandlungszentrum Aschau GmbH | Klotz M.C.,University of Heidelberg | Braatz F.,Universitatsmedizin Gottingen | And 2 more authors.
Gait and Posture | Year: 2015

Internal rotation gait is common among children with bilateral cerebral palsy. However, despite bilaterally increased femoral anteversion asymmetric internal rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly performed bilaterally. Variable functional outcomes are reported especially in cases with mild internal hip rotation during gait and abnormal preoperative pelvic rotation. A major question is if a unilateral treatment of the more involved side in asymmetric cases leads to a comparable or even superior outcome.One hundred and nine children with spastic bilateral CP treated with FDO with pre- and 1-year postoperative 3D gait analysis were retrospectively collected. The asymmetry was calculated from the preoperative difference between both limbs in hip rotation obtained by 3D gait analysis. Twenty-eight children with asymmetry larger than 20° were selected and classified into two groups, according to whether they obtained a unilateral or bilateral FDO.Preoperative clinical examination and pre- and postoperative hip and pelvic rotation in gait analysis on the more and the less involved side did not differ significantly between both groups. Interestingly, in both groups, hip rotation did not change significantly in less-involved limbs, although intraoperative derotation averaged 25°. After unilateral FDO a significant change in pelvic rotation resulted, whereas this was not found after bilateral FDO.The results of this study suggest that unilateral FDO in children with asymmetric internal rotation gait leads to a comparable functional outcome compared to bilateral treatment. Furthermore, it was shown for the first time that considering the asymmetry has a positive effect on pelvic rotation. © 2015 Elsevier B.V.


PubMed | Private University of Applied Sciences, Göttingen, Behandlungszentrum Aschau GmbH and University of Heidelberg
Type: Journal Article | Journal: The bone & joint journal | Year: 2016

Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate.This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution.Two objective gait variables were calculated pre- and post-operatively; the Gillette Gait Index (GGI) and the Gait Profile Score (GPS). The results were analysed in three groups according to their childhood surgical history (group 1 = no surgery, group 2 = surgery other than SEMLS, group 3 = SEMLS). Improvements in gait were shown by a significant decrease of GPS (p = 0.001). Similar results were obtained for both legs (GGI right side and left side p = 0.01). Furthermore, significant improvements were found in all subgroups although this was less marked in group 3, where patients had undergone previous SEMLS.SEMLS is an effective and safe procedure to improve gait in adults with cerebral palsy. However, a longer rehabilitation period is to be expected than found in children. SEMLS is still effective in adult patients who have undergone previous SEMLS in childhood.Single-event multilevel surgery is a safe and effective procedure to improve gait disorders in adults with bilateral spastic cerebral palsy.


Bohm H.,Behandlungszentrum Aschau GmbH | Hosl M.,Behandlungszentrum Aschau GmbH | Schwameder H.,University of Salzburg | Doderlein L.,Behandlungszentrum Aschau GmbH
Gait and Posture | Year: 2014

Patients with cerebral palsy frequently experience foot dragging and tripping during walking due to reduced toe clearance mostly caused by a lack of adequate knee flexion in swing (stiff-knee gait). The aim of this study was to investigate adaptive mechanism to an uneven surface in stiff-knee walkers with cerebral palsy. Sixteen patients with bilateral cerebral palsy, GMFCS I-II and stiff-knee gait, mean age 14.1 (SD. = 6.2) years, were compared to 13 healthy controls with mean age 13.5 (SD. = 4.8) years. Gait analysis including EMG was performed under even and uneven surface conditions. Similar strategies to improve leg clearance were found in patients as well as in controls. Both adapted with significantly reduced speed and cadence, increased outward foot rotation, knee and hip flexion as well as anterior pelvic tilt. Therefore cerebral palsy and stiff-knee gait did not affect the adaptation capacity on the uneven surface.On the uneven surface an average increase in knee flexion of 7° (SD. = 3°) and 12° (SD. = 5°) was observed in controls and patients with cerebral palsy, respectively. Although rectus femoris activity was increased in patients with cerebral palsy, they were able to increase their knee flexion during swing. The results of this study suggest that walking on uneven surface has the potential to improve knee flexion in stiff-knee walkers. Therefore training on uneven surface could be used as a conservative treatment regime alone, in combination with Botulinum neurotoxin or in the rehabilitation of surgery. © 2014 Elsevier B.V.


Bohm H.,Behandlungszentrum Aschau GmbH | Stief F.,Behandlungszentrum Aschau GmbH | Dussa C.U.,Behandlungszentrum Aschau GmbH | Doderlein L.,Behandlungszentrum Aschau GmbH
Gait and Posture | Year: 2012

Excessive pelvic rotation in the transverse plane is common in patients with cerebral palsy. Knowing the underlying reasons is important for clinical decision making, since changes in pelvic retraction might have an effect on internally rotated gait. We hypothesized that the contralateral leg contributes considerably to pelvic rotation on the retracted side. Therefore the aim of this study is to calculate predictors for pelvic retraction using both, parameters from the retracted and from the contralateral protracted side. Thirty-two children with diplegia and 18 children with hemiplegia were examined by three-dimensional gait analysis followed by a clinical examination protocol. Stepwise multilinear regression of the response value mean pelvic retraction during stance phase was performed on 10 potential predictors of dynamic gait data and 10 corresponding predictors of clinical data of the retracted and the contralateral protracted side. Gait analysis revealed ankle push-off energy on the protracted side as the best predictors in hemiplegic patients explaining 59% of the variance in pelvic retraction. In diplegic patients external hip rotation of the protracted side was most accurate in predicting pelvic retraction (27%). Best clinical predictors for hemiplegic patients were ankle dorsiflexion on the retracted side (46%) and for diplegic patients it was the knee extension strength on the protracted side together with hip rotation on the retracted side (36%). In hemiplegic patients ankle push-off energy of the contralateral side is a significant compensation mechanism that might cause increased pelvic retraction to compensate for the weakness of the involved side. In diplegic patients prediction of pelvic retraction was only moderate and requires further investigation. © 2011 Elsevier B.V.


Hosl M.,Behandlungszentrum Aschau GmbH | Bohm H.,Behandlungszentrum Aschau GmbH | Multerer C.,Behandlungszentrum Aschau GmbH | Doderlein L.,Behandlungszentrum Aschau GmbH
Gait and Posture | Year: 2014

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds. © 2013.


Hochtl F.,TU Munich | Bohm H.,Behandlungszentrum Aschau GmbH | Senner V.,TU Munich
Procedia Engineering | Year: 2010

A biomechanical simulation model was developed to analyze energy efficient pedal forces in cycling. With a genetic optimisation algorithm muscle activation has been optimized in order to minimize metabolic energy consumption. Results show that the established mechanical definition of the Index of Efficiency is not appropriate to quantify pedaling technique, because it is not in agreement with metabolic efficiency of the biomechanical system.


Bohm H.,Behandlungszentrum Aschau GmbH | Doderlein L.,Behandlungszentrum Aschau GmbH
Gait and Posture | Year: 2012

In children with cerebral palsy (CP) analysis of gait asymmetry can provide insight into the control of walking and may help in guiding the clinician's treatment decisions. Running is more difficult that walking for the musculoskeletal system, however, in the literature it has been shown that gait deviations associated with CP maybe better tolerated during running. This leads us to the hypothesis that running might increase gait symmetry in patients with CP. Therefore the purpose of this study was to investigate the effect of running on asymmetries in spatio-temporal, kinematic and kinetic gait parameters for children with CP. Twenty-four children with diplegia and 25 with hemiplegia were examined using 3D gait analysis during running and walking. MANOVA on two factors: diagnosis (hemiplegic, diplegic) and movement (walking, running) was conducted on a total of 22 gait parameters. The MANOVA revealed a significant difference in symmetry between walking and running (p<0.001) and between patients groups (p=0.004). The detailed analysis of gait parameters demonstrated a significant decrease of symmetry in 13 of the 22 gait parameters investigated, only symmetry of step time was significantly increased. Therefore the hypothesis that gait symmetry improved with running in children with CP can be rejected. Based on the results of this study, asymmetries masked during walking might appear during running. Therefore, analysis of asymmetry of walking and running gives a more comprehensive assessment of the gait pathology for clinical decision making. © 2011 Elsevier B.V.

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