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Ladd A.L.,Stanford University | Crisco J.J.,University of Rhode Island | Hagert E.,Karolinska Institutet | Rose J.,Motion and Gait Analysis Laboratory | Weiss A.-P.C.,University of Rhode Island
Clinical Orthopaedics and Related Research®

Background The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and occupation may predispose individuals to OA. Questions/purposes What evidence links ligament structure, forces, and motion to progressive CMC disease? Specifically: (1) Do unique attributes of the bony and ligamentous anatomy contribute to OA? (2) Can discrete joint load patterns be established that contribute to OA? And (3) can thumb motion that characterizes OA be measured at the fine and gross level? Methods We addressed the morphology, load, and movement of the human thumb, emphasizing the CMC joint in normal and arthritic states. We present comparative anatomy, gross dissections, microscopic analysis, multimodal imaging, and live-subject kinematic studies to support or challenge the current understanding of the thumb CMC joint and its predisposition to disease. Results The current evidence suggests structural differences and loading characteristics predispose the thumb CMC to joint degeneration, especially related to volar or central wear. The patterns of degeneration, however, are not consistently identified, suggesting influences beyond inherent anatomy, repetitive load, and abnormal motion. Conclusions Additional studies to define patterns of normal use and wear will provide data to better characterize CMC OA and opportunities for tailored treatment, including prevention, delay of progression, and joint arthroplasty. © 2014 The Association of Bone and Joint Surgeons®. Source

Butler E.E.,Dartmouth College | Steele K.M.,University of Washington | Torburn L.,Motion and Gait Analysis Laboratory | Gamble J.G.,Stanford University | Rose J.,Stanford University
Journal of Medical Case Reports

Background: This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions. Case presentation: A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient's crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient's crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient's maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient's minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index. Conclusions: The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient's clinical motion analyses. Overall, our patient's crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child's walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy. © 2016 Butler et al. Source

Cahill-Rowley K.,Stanford University | Cahill-Rowley K.,Motion and Gait Analysis Laboratory | Rose J.,Stanford University | Rose J.,Motion and Gait Analysis Laboratory
Developmental Medicine and Child Neurology

Selective motor control (SMC) impairment involves movement patterns dominated by flexor or extensor synergies that interfere with functional movements in children with cerebral palsy (CP). Emerging evidence on neural correlates of impaired SMC has important implications for etiology and for the treatment for children with CP. Early evidence on the microstructure of brain white matter assessed with diffusion tensor imaging in adult patients after stroke suggests that the rubrospinal tract may compensate for injury to the corticospinal tract. Furthermore, the observed changes on diffusion tensor imaging corresponded to the degree of SMC impairment. The rubrospinal tract may provide imperfect compensation in response to corticospinal tract injury, resulting in diminished SMC. Cortical mapping evidence in stroke patients indicates that loss of SMC is also associated with increased overlap of joint representation in the sensorimotor cortices. The severity of SMC impairment can be assessed with the recently developed Selective Control Assessment of the Lower Extremity, a validated observation-based measure designed for children with spastic CP. Recent advances in neuroimaging and assessment of SMC provide an opportunity to better understand the etiology and impact of impaired SMC, which may ultimately guide strategic treatment for children with CP. © 2013 Mac Keith Press. Source

Cahill-Rowley K.,Stanford University | Cahill-Rowley K.,Motion and Gait Analysis Laboratory | Rose J.,Motion and Gait Analysis Laboratory | Rose J.,Stanford University
Gait and Posture

Children born preterm with very-low birth-weight (VLBW) have increased risk of motor impairment. Early identification of impairment guides treatment to improve long-term function. Temporal-spatial gait parameters are an easily-recorded assessment of gross motor function. The objective of this study was to characterize preterm toddlers' gait and its relationship with neurodevelopment. Velocity, cycle time, step width, step length and time asymmetry, %stance, %single-limb support, and %double-limb support were calculated for 81 VLBW preterm and 43 typically-developing (TD) toddlers. Neurodevelopment was assessed with Bayley Scales of Infant Development-3rd Edition (BSID-III) motor composite and gross motor scores. Mean step width (p = .009) was wider in preterm compared to TD toddlers. Preterm toddlers with <85 BSID-III motor composite scores, indicating mild-to-moderate delay, had significantly increased step width, step length asymmetry, and step time compared to TD toddlers. Step time was also significantly longer for lower-scoring compared to higher-scoring (≥85 BSID-III motor composite scores) preterm toddlers, suggesting that step time may be particularly sensitive to gradations of motor performance. Velocity, cycle time, step length asymmetry, %stance, step length, and step time significantly correlated with BSID-III gross motor scores, suggesting that these parameters may be revealing of gross motor function. The differences in gait between lower-scoring preterm toddlers and TD toddlers, together with the correlations between gait and BSID-III motor scores, suggest that temporal-spatial gait parameters may be useful in building a clinically-relevant, easily-conducted assessment of toddler gross motor development. © 2016 Elsevier B.V.. Source

Iuliano B.,Motion and Gait Analysis Laboratory | Grahn D.,Stanford University | Cao V.,Stanford University | Zhao B.,Motion and Gait Analysis Laboratory | And 2 more authors.
Journal of Alternative and Complementary Medicine

Background: T'ai chi chuan, the ancient Chinese martial art, is practiced by millions of people worldwide and is an activity of moderate intensity that involves slow, circular movements. Evidence of substantial health benefits of t'ai chi chuan is emerging, however, the physiologic mechanisms are not well-understood. T'ai chi chuan masters routinely report sensing qi or internal energy flow, particularly in the hands. The purpose of this case study was to determine whether physiologic responses normally associated with thermoregulation are activated during a basic t'ai chi chuan exercise. Methods: Trials consisted of three focus periods and one withdraw period (during which the subject withdrew internal energy in the hands), each followed by a rest period. Measurements included infrared-thermography (IR), thermocoupled temperature measures, and laser Doppler flowmetry. Results: Substantial increases in local palmar and face surface temperatures were observed with IR thermography during focus periods and substantial decreases were observed during the withdraw period. Fingertip surface baseline temperatures were 31.1°C for one trial, increased by 1.8°C during the focus period, and then decreased by 4.9°C during the withdraw period. A twofold increase in blood flow through fingertip regions paralleled changes in fingertip surface temperatures during focus periods. Conclusions: Changes in regional blood flow and surface temperatures closely paralleled onsets of focus, rest, and withdraw periods and appear to be volitional activations of known vasomotor mechanisms underlying non-hairy skin regions such as the hands and face. Changes in blood flow through these vascular structures are generally autonomic thermoregulatory responses, not normally under voluntary control, but may also represent a relaxation response. © Copyright 2011, Mary Ann Liebert, Inc. Source

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