Stewart C.,ORLAU |
Shortland A.P.,One Small Step Gaint Laboratory
Acta of Bioengineering and Biomechanics | Year: 2010
Clinicians face the daily challenge of assessing and treating patients with gait problems. Musculoskeletal models appear to show potential for assisting with the understanding of complex pathological movements, however they are also complex and reliant on multiple assumptions in order to maintain stability. This paper breaks down the process by which muscles produce movement into a series of steps. The contributions and limitations of modelling each separate step are then considered. The calf muscles serve as an illustration throughout the paper, as these muscles are frequently implicated in the development of pathological gait patterns. An argument is put forward for the development of a range of tools for use in clinical practice, leading to an enhanced appreciation of the importance of joint moments. Improved clinical understanding of the link between muscles and movement will allow clinicians to develop better treatment plans for their patients.
McFall J.,ORLAU |
McFall J.,University of Cardiff |
Stewart C.,ORLAU |
Stewart C.,Keele University |
And 5 more authors.
Gait and Posture | Year: 2015
This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys. All children maintained or improved their GMFCS level. Positive changes in ranges of motion and gait were observed at POST1 and these were generally maintained over adolescence to POST2. The mean Gait Profile Score (GPS) had improved by 3.2 points (14.7-11.5) at POST1, with a non-significant deterioration of 0.3 over the adolescent growth spurt. These positive results reflect the total package of care for the children, involving careful pre-operative selection by a multidisciplinary team and post-operative management including intensive physiotherapy and maintenance in tuned ankle foot orthoses. Fifty-nine per cent of children had some additional orthopaedic surgery, mostly bony procedures. The overall benefits arising from their management need to be considered in the light of the likely deterioration experienced by this patient group. The results of this study support the use of SDR as part of a management strategy for carefully selected children with cerebral palsy with the aim of optimizing gait at skeletal maturity. © 2015 Elsevier B.V.
Laracca E.,University of Bologna |
Stewart C.,ORLAU |
Postans N.,ORLAU |
Gait and Posture | Year: 2014
Children with cerebral palsy often undergo multiple orthopaedic surgical procedures in a single episode. Evidence of the effectiveness of individual components within the overall package is sparse. The introduction of musculoskeletal modelling in Oswestry has led to a more conservative management approach being taken with hamstring muscles for children walking in a degree of crouch. Muscles which were shown to be of at least normal length at initial contact were not surgically lengthened, as would have been the case previously. A retrospective review of 30 such patients was therefore possible, comparing 15 patients treated before the policy change who had their hamstrings lengthened with 15 treated after who did not. All patients had pre and post operative gait assessments and significant changes were observed for each group separately and for the two groups when compared. The comparison revealed that preserving the hamstrings does tend to reduce, and therefore normalize, the dynamic muscle length. Examination of the two patient groups separately, however, reveals a more complex picture with more global gait improvements seen when the hamstrings were lengthened. No absolute recommendation can be made to inform the clinical management of all children with normal to long hamstring muscles during gait. The final decision of whether to include a hamstring lengthening will need to take into account the characteristics of the individual child. © 2013 Elsevier B.V.