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Behrendt F.,University Childrens Hospital Basle | De Lussanet M.H.E.,University of Munster | Zentgraf K.,University of Munster | Zschorlich V.R.,University of Rostock
PLoS ONE | Year: 2016

Facilitation of the primary motor cortex (M1) during the mere observation of an action is highly congruent with the observed action itself. This congruency comprises several features of the executed action such as somatotopy and temporal coding. Studies using reachgrasp- lift paradigms showed that the muscle-specific facilitation of the observer's motor system reflects the degree of grip force exerted in an observed hand action. The weight judgment of a lifted object during action observation is an easy task which is the case for hand actions as well as for lifting boxes from the ground. Here we investigated whether the cortical representation in M1 for lumbar back muscles is modulated due to the observation of a whole-body lifting movement as it was shown for hand action. We used transcranial magnetic stimulation (TMS) to measure the corticospinal excitability of the m. erector spinae (ES) while subjects visually observed the recorded sequences of a person lifting boxes of different weights from the floor. Consistent with the results regarding hand action the present study reveals a differential modulation of corticospinal excitability despite the relatively small M1 representation of the back also for lifting actions that mainly involve the lower back musculature. © 2016 Behrendt et al. This is an open ccess article distributed under the terms of the reative Commons Attribution License, which permits nrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source


McGinley J.L.,Murdoch Childrens Research Institute | McGinley J.L.,University of Melbourne | Dobson F.,University of Melbourne | Ganeshalingam R.,The Royal Childrens Hospital | And 5 more authors.
Developmental Medicine and Child Neurology | Year: 2012

Aim To conduct a systematic review of single-event multilevel surgery (SEMLS) for children with cerebral palsy, with the aim of evaluating the quality of the evidence and developing recommendations for future research. Method The systematic review was conducted using standard search and extraction methods in Medline, EMBASE, CINAHL, and Cochrane electronic databases. For the purposes of this review, SEMLS was defined as two or more soft-tissue or bony surgical procedures at two or more anatomical levels during one operative procedure, requiring only one hospital admission and one period of rehabilitation. Studies were included if: (1) the primary focus was to examine the effect of SEMLS in children with cerebral palsy; (2) the results focused on multiple anatomic levels and reported findings of one or more World Health Organization International Classification of Functioning, Disability and Health (ICF) domains. Studies that focused on a single intervention or level, or on the utility of a specific outcome measure were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. The review also examined the reporting of surgery, adverse events, and rehabilitation. Results Thirty-one studies fulfilled the criteria for inclusion, over the period 1985 to October 2010. The MINORS score for these studies varied from 4 to 19, with marked variation in the quality of reporting. Study quality has improved over recent years. Valid measures of gait and function have been introduced and several of the most recent studies have addressed multiple dimensions of the ICF. A statistical synthesis of the outcome data was not conducted, although a trend towards favourable outcomes in gait was evident. Caution is advised with interpretation owing to the variable study quality. Uncontrolled studies may have resulted in an overestimation of treatment efficacy. Interpretation The design and reporting of studies of SEMLS are improving with the development of multidisciplinary teamwork and frameworks such as the ICF. However, the evidence base is limited by the lack of randomized clinical trials, especially when compared with other surgical interventions such as selective dorsal rhizotomy. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press. Source


Dreher T.,University of Heidelberg | Brunner R.,University Childrens Hospital Basle | Vegvari D.,Semmelweis University | Heitzmann D.,University of Heidelberg | And 4 more authors.
Gait and Posture | Year: 2013

During multilevel surgery, muscle-tendon lengthening (MTL) is commonly carried out in children with cerebral palsy. However, it is unclear if MTL also modifies increased muscle tone and if pathologic activation patterns are changed as an indirect effect of the biomechanical changes. Since investigations addressing this issue are limited, this study aimed at evaluating the effects of MTL on muscle tone and activation pattern. Forty-two children with spastic diplegia who were treated by MTL underwent standardized muscle tone testing (modified Ashworth and Tardieu test), dynamic EMG and three-dimensional gait analysis before, one and three years after MTL. For the evaluation of muscle activation patterns the norm-distance of dynamic EMG data was analyzed. Range of motion and joint alignment in clinical examination were found to be significantly improved one year after MTL. However, deterioration of these parameters was noted after three years. Muscle tone was significantly reduced one year postoperatively but showed an increase after three years. Joint kinematics were found significantly closer to reference data of age matched controls initially after surgery, but deteriorated until three years postoperatively. However, the EMG patterns of the muscles which were surgically addressed were found to be unchanged in either follow-up. These findings suggest that despite the influence of MTS on biomechanics and physiology (muscle tone reduction and improvements of joint mobility and gait pattern) MTS does not change abnormal patterns of muscle activation. Recurrence of increased muscle tone and deterioration of kinematic parameters three years after surgery may be attributed to these persistent pathologic activation patterns. © 2012 Elsevier B.V. Source


Rutz E.,University Childrens Hospital Basle | Rutz E.,Hugh Williamson Gait Laboratory | Rutz E.,Murdoch Childrens Research Institute | Passmore E.,Hugh Williamson Gait Laboratory | And 5 more authors.
Clinical Orthopaedics and Related Research | Year: 2012

Background: Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development. Questions/purposes: We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery. Patients and Methods: We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months). Results: The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV. Conclusions: Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons®. Source


Rutz E.,University Childrens Hospital Basle | Rutz E.,Murdoch Childrens Research Institute | Gaston M.S.,University Childrens Hospital Basle | Camathias C.,University Childrens Hospital Basle | Brunner R.,University Childrens Hospital Basle
Journal of Pediatric Orthopaedics | Year: 2012

BACKGROUND: In patients with cerebral palsy and other neuromuscular disorders, correction of a fixed knee flexion deformity is thought to be crucial for the improvement of gait. The distal femoral extension osteotomy (DFO) is one method to achieve this goal. The standard implant for fixation of the 2 fragments in DFO is the conventional AO blade plate. The aim of this study was to report the outcome of using the new LCP Pediatric Condylar 90-Degree Plate for DFO. METHODS: Thirty-eight patients undergoing 63 DFOs were included. The mean age was 16.3±4.4 years (range, 4 to 27 y) at the time of surgery. Thirty-two patients had a diagnosis of cerebral palsy and 6 patients had other neuromuscular disorders including myelomeningocoele and arthrogryposis. Thirteen patients had unilateral procedures and 25 had bilateral procedures. RESULTS: The mean duration of the surgical intervention was 67.9±26.5 minutes (range, 30 to 180 min) and the mean blood loss was 100.0±42.1 mL (range, 50 to 250 mL). In 84% of the cases, large-fragment (5.0 mm) implants were used. The mean extension correction in 84% of the patients (n=53) was 22.8±10.3 degrees (range, 5 to 50 degrees). In this series, there were 2 complications in 63 osteotomies (3%). Radiologic follow-up of the cohort was until the time of plate removal (14.2±4.3 mo; range, 6 to 26 mo). Three months after the index operation, all osteotomies were radiologically consolidated. At this time and at plate removal, there were no malunions or nonunions in this cohort. Clinical follow-up of the cohort was performed until the end of the study (mean 35.5±6.7 mo; range, 22 to 46 mo). At the end of the study, 59 plates (94%) had been removed. CONCLUSIONS: The new LCP Pediatric Condylar 90-Degree Plate provides stable and safe fixation of distal femoral correction osteotomies in patients with neuromuscular disorders. LEVEL OF EVIDENCE: Level IV. Copyright © 2012 by Lippincott Williams & Wilkins. Source

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