Shriners Hospitals for Children Salt Lake City

Salt Lake City, UT, United States

Shriners Hospitals for Children Salt Lake City

Salt Lake City, UT, United States
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MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Rozumalski A.,Gillette Childrens Specialty Healthcare | Swanson A.N.,University of Utah | And 6 more authors.
Spine | Year: 2014

Objective. Quantify 3-dimensional motions of the lumbar vertebrae during running via direct in vivo measurement and compare these motions to walking data from the same technique and running data from a skin-mounted technique.Summary of Background Data. Lumbar spine motions in running are only reported in 1 series of articles using a skin-mounted technique subject to overestimation and only instrumented a single vertebra.Methods. Refl ective marker triads were attached to Kirschner wires inserted into the spinous processes of L1-S1. Anatomic registration between each vertebra and attached triad was achieved using spinal computed tomographic scans. Skin-mounted trunk markers were used to assess thoracic motions. Subjects ran several times in a calibrated volume at self-selected speed while 3-dimensional motion data were collected.Results. Lumbar spine fl exion and pelvic rotation patterns in running were reversed compared with walking. Increased lumbar spine motions during running occurred at the most inferior segments. Thoracic spine, lumbar spine and pelvis exhibited signifi cantly greater range of sagittal plane motion with running. The pelvis had signifi cantly greater range of frontal plane motion, and the thoracic spine had signifi cantly greater range of transverse plane motion with running. Skin-mounted studies reported as much as 4 times the motion range determined by the indwelling bone pin techniques, indicating that the skin motion relative to the underlying bone during running was greater than the motion of the underlying vertebrae.Conclusion. The lumbar spine acts as a distinct functional segment in the spine during running, chiefl y contributing lateral fl exion to balance the relative motions between the trunk and pelvis. The lumbar spine is also shown to oppose thoracic spine sagittal fl exion. While the lumbar spine chiefl y contributes to frontal plane motion, the thoracic spine contributes the majority of the transverse plane motion. © 2014 Lippincott Williams & Wilkins.


MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | McMulkin M.L.,Shriners Hospitals for Children Spokane | Baird G.O.,Shriners Hospitals for Children Spokane | Stevens P.M.,Primary Childrens Medical Center
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: Torsional deformities of the lower extremity are common in children and are often corrected with rotational osteotomy. The effects of torsional abnormalities, and the effects of corrective osteotomy, are not well understood. A study of children with isolated idiopathic tibial torsional pathology undergoing a single corrective procedure may assist in understanding the biomechanics of torsional deformities and the effect of surgical correction. Methods: Preoperative and postoperative gait analyses were performed for eight subjects (eleven sides) with idiopathic excessive inward tibial torsion and ten subjects (fourteen sides) with excessive outward tibial torsion. Sagittal ankle and frontal knee moments were assessed and compared with those for age-matched controls. Results: Preoperatively, subjects exhibited abnormal frontal knee moments at push-off. Subjects with inward tibial torsion demonstrated excessive internal valgus moments, and subjects with outward tibial torsion demonstrated reduced internal valgus or relative internal varus moments compared with the control subjects. Ankle power was significantly reduced in the inward torsion group but not in the outward torsion group. Surgical correction of the torsional deformities normalized frontal plane knee moments in both inward and outward torsion groups and restored ankle power in the inward torsion group. Conclusions: In the present study, excessive tibial torsion adversely affected frontal knee moments and was associated with other kinematic and kinetic abnormalities. Corrective osteotomies improved all variables studied here and restored many to the values found in the control group. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.


MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Harjinder B.,Shriners Hospitals for Children Salt Lake City | Stevens P.M.,University of Utah | Stevens P.M.,Primary Childrens Medical Center
Strategies in Trauma and Limb Reconstruction | Year: 2011

Fixed knee flexion deformity can present as an insidious and significant problem in diverse etiologies, most commonly in cerebral palsy. Traditional surgical intervention has included posterior capsulotomy and supracondylar femoral osteotomy, both of which carry significant associated morbidity and risks. In the skeletally immature patient, guided growth may be used to correct or substantially diminish the deformity. We are presenting our early experience encompassing four subjects who completed instrumented gait analysis both prior to and after distal femoral anterior guided growth (hemiepiphysiodesis). Changes in gait and function resulting from surgery in each individual are reported. Outcomes indicate improved knee range of motion and alleviation of crouch at the knee with secondary improvements in the ankle, hip and pelvis. Three subjects with initially slow gait velocity improved to within normal limits by demonstrating increased stride length. A measure of overall gait kinematics showed improvements in all limbs. Anterior guided growth (hemiepiphysiodesis) of the distal femur resulted in positive quantitative changes in all four patients, though degree and types of changes were variable in this small series. Encouraged by these findings, we now prefer guided growth to extension supracondylar osteotomy for the skeletally immature patient with fixed knee flexion deformity. © 2011 The Author(s).


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | Salzberg C.,Utah State University | Macwilliams B.A.,Shriners Hospitals for Children Salt Lake City | Macwilliams B.A.,University of Utah | And 3 more authors.
Pediatric Physical Therapy | Year: 2014

PURPOSE: To evaluate the optimal duration and effects of plyometric training on the gross motor abilities of 3 boys with unilateral spastic cerebral palsy (9 years 11 months, 10 years, and 8 years 9 months). METHODS: This was a multiple-baseline, multiple-probe, single-subject experiment. The intervention followed the National Strength and Conditioning Association's guidelines for youth. The Gross Motor Function Measure 66, 10×5-m sprint, 20-m run, throw ball, broad jump, and vertical jump tests were used to evaluate gross motor abilities, agility, running speed, and power. RESULTS: Improvements were found in upper extremity power, Gross Motor Function Measure 66 scores, and agility. Findings for lower extremity power and running speed were inconsistent. Training duration ranged from 8 to 14 weeks. CONCLUSIONS: This study suggests that plyometric training improves gross motor ability, agility, and upper extremity power in boys with unilateral cerebral palsy. Treatment duration should be determined by an individual's capacity, the task, and the outcome measure. Copyright © 2014 Wolters Kluwer Health /Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy.


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.,University of Utah | Carey J.C.,Shriners Hospitals for Children Salt Lake City | And 7 more authors.
Human Movement Science | Year: 2012

The purpose of this study was to (1) extend the research findings of decreased muscular force production in grip strength to the lower extremity strength of children with NF1 and (2) to determine if there was a relationship between isometric strength and functional activities in children with NF1. Force production was assessed using a hand held dynamometer (HHD) and a functional task (hopping and jumping) on a force plate. Data from twenty-six children with NF1 were compared to data from 48 typically developing children of similar sex, weight and height. Children with NF1 demonstrated statistically significant lower force production with HHD (p< 0.01) during hip extension, but similar force production for knee extension and ankle plantar flexion compared to the control group. A relationship existed between the ground reaction forces at take-off from both hopping and jumping and the force generated from knee extensor strength in the NF1 group. The addition of a functional task to hand held dynamometry is useful for determining a relationship between common clinical measures and functional activities. © 2011 Elsevier B.V.


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Carey J.C.,University of Utah | And 4 more authors.
Pediatric Physical Therapy | Year: 2010

PURPOSE: Neurofibromatosis type 1 (NF1) is a genetic disorder with associated musculoskeletal abnormalities, tumors, and developmental delays. The purpose of this study was to investigate and characterize the motor proficiency of children with NF1. METHODS: Children with NF1 were assessed using the Bruininks-Oseretsky Test (BOT 2) instrument. The NF1 group scores were compared with age and sex-matched test norms. RESULTS: Twenty-six children participated in the study. The NF1 group had statistically significant lower scores (P < .05) for the total motor composite (Z = -1.62) and 7 of the 8 subtests. Nineteen percent (n = 5) scored in the average category, 54% (n = 14) scored in the below-average category, and 27% (n = 7) scored in the well-below-average category. CONCLUSIONS: Children with NF1 have significantly lower motor proficiency than the BOT 2 normative scores. The results indicate the BOT 2 is useful in identifying and characterizing delays in motor proficiency for children with NF1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy Association.


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Stevenson D.A.,Shriners Hospitals for Children Salt Lake City | Stevenson D.A.,University of Utah
Human Movement Science | Year: 2014

Previous research has evaluated the motor proficiency of children with neurofibromatosis type 1 (NF1) and found delays on the balance subtest. However the balance subtest was found to have low sensitivity for identifying balance impairments. This study examines the differences in postural control between children with NF1 and peers with typical development using a force plate. A single limb stance test on a force plate was completed for all participants. The force plate variables, center of pressure maximum distance in the anterior/posterior direction (COPmax A/P) and center of pressure velocity (COPvel A/P) were compared between groups. The NF1 group's performance was significantly poorer than the control group in both COPmax A/P (p=.01) and COPvel A/P (p=.01). When separated into specific age ranges, only the children in the NF1 group between 5 and 12. years of age demonstrated statistically significant differences in the COP variables. The COP variables for the 13- to 18-year-old group were not significantly different. These results indicate that young children with NF1 have poor postural control. However, postural control appears to improve with maturation. © 2014 Elsevier B.V.


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | Salzberg C.L.,Utah State University | Stevenson D.A.,Shriners Hospitals for Children Salt Lake City | Stevenson D.A.,University of Utah
Journal of Strength and Conditioning Research | Year: 2011

Johnson, BA, Salzberg, CL, and Stevenson, DA. A systematic review: plyometric training programs for young children. J Strength Cond Res 25(9): 2623-2633, 2011-The purpose of this systematic review was to evaluate the efficacy and safety of plyometric training for improving motor performance in young children; to determine if this type of training could be used to improve the strength, running speed, agility, and jumping ability of chil ren with low motor competence; and to examine the extent and quality of the current research literature. Primary research articles were selected if they (a) described the outcomes of a plyometric exercise intervention; (b) included measures of strength, balance, running speed, jumping ability, or agility; (c) included prepubertal children 5-14 years of age; and (d) used a randomized control trial or quasiexperimental design. Seven articles met the inclusion criteria for the final review. The 7 studies were judged to be of low quality (values of 4-6). Plyometric training had a large effect on improving the ability to run and jump. Preliminary evidence suggests plyometric training also had a large effect on increasing kicking distance, balance, and agility. The current evidence suggests that a twice a week program for 8-10 weeks beginning at 50- 60 jumps a session and increasing exercise load weekly results in the largest changes in running and jumping performance. An alternative program for children who do not have the capability or tolerance for a twice a week program would be a lowintensity program for a longer duration. The research suggests that plyometric training is safe for children when parents provide consent, children agree to participate, and safety guidelines are built into the intervention. © 2011 National Strength and Conditioning Association.


PubMed | University of Utah and Shriners Hospitals for Children Salt Lake City
Type: | Journal: Research in developmental disabilities | Year: 2014

We describe activity and participation in children and youth with neurofibromatosis type 1 (NF1), and compared an intervention and control group after a strengthening program using the Pediatric Outcomes Data Collection Instrument (PODCI) and the Childrens Assessment of Participation and Enjoyment (CAPE). Questionnaires were filled out by parents at baseline, 12-weeks, and 1-year. The intervention group performed a strengthening program twice a week for ten weeks, followed by a 9-month independent program. Thirty-six participants (18 control, 18 intervention) between the ages of 5- and 18-years (mean 10.6 years, SD 4.6 years) were enrolled, and 34 completed the 1-year assessment. There were significant differences between formal and informal participation (p<0.0001) in baseline CAPE scores for the entire cohort. At 12 weeks, PODCI upper extremity function improved in intervention and decreased in controls (p=0.040), while happiness declined in intervention and increased in control (p=0.003). There were no significant differences between control and intervention groups in any of the CAPE or PODCI change scores from baseline to 1-year. Upper extremity function, sport and physical function, comfort/pain and happiness PODCI scores were lower than normative values. The NF1 cohort had low participation in formal active physical and skill-based activities. The companionship and location dimensions suggest participation occurs with family and other relatives in the home or a relatives home and reflects a pattern of social isolation from peers.


PubMed | Shriners Hospitals for Children Salt Lake City
Type: Journal Article | Journal: The Journal of bone and joint surgery. American volume | Year: 2013

This study quantifies the three-dimensional motion of lumbar vertebrae during gait via direct in vivo measurement with the use of indwelling bone pins with retroreflective markers and motion capture. Two previous studies in which bone pins were used were limited to instrumentation of two vertebrae, and neither evaluated motions during gait. While several imaging-based studies of spinal motion have been reported, the restrictions in measurement volume that are inherent to imaging modalities are not conducive to gait applications.Eight healthy volunteers with a mean age of 25.1 years were screened to rule out pathology. Then, after local anesthesia was administered, two 1.6-mm Kirschner wires were inserted into the L1, L2, L3, L4, L5, and S1 spinous processes. The wires were clamped together, and reflective marker triads were attached to the end of each wire couple. Subjects underwent spinal computed tomography to anatomically register each vertebra to the attached triad. Subjects then walked several times in a calibrated measurement field at a self-selected speed while motion data were collected.Less than 4 of lumbar intersegmental motion was found in all planes. Motions were highly consistent between subjects, resulting in small group standard deviations. The largest motions were in the coronal plane, and the middle lumbar segments exhibited greater motions than the segments cephalad and caudad to them. Intersegmental lumbar flexion and axial rotation motions were both extremely small at all levels.The lumbar spine chiefly acts to contribute abduction during stance and adduction during swing to balance the relative motions between the trunk and pelvis. The lumbar spine acts in concert with the thoracic spine. While the lumbar spine chiefly contributes coronal plane motion, the thoracic spine contributes the majority of the transverse plane motion. Both contribute flexion motion in an offset phase pattern.This is a valid model for measuring the three-dimensional motion of the spine. Normative data were obtained to better understand the effects of spine disorders on vertebral motion over the gait cycle.

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