Noninvasive diagnostic methods for perceptual and motor disabilities in children with cerebral palsy

The field of neuroorthopedics centers on chronic diseases demanding close clinical monitoring. We shall use several examples to show how the various noninvasive diagnostic instruments can be used to obtain insight into the central nervous system as well as into the musculoskeletal system and its morphology. The choice of the most appropriate method depends on the problem; that is, whether the method is to be applied for clinical use or for basic research. In this report we introduce various technical examination methods that are being used successfully in the fields of pediatrics, orthopedics, and neurology. The major examination instrument in pediatric diagnostics is sonography, which is being used in this report as a research instrument for the biomechanics of the musculoskeletal system, but which also gives insight into neurofunctional sequences. In orthopedics, pedography is used for diagnosing deformities of the feet. In neuroorthopedics for children pedography acts as a functional monitor for apraxia and thus allows, for example, a classification of the degree of neurological malfunctions in the lower extremities. The 3D bodyscan is used to minimize x-raying in patients with neurogenic scoliosis. This report introduces examples of the application of MRI and fMRI for basic research. The biometric measuring methods introduced provide precise data in the areas of diagnostics and monitoring and are highly valuable for further neuroorthopedic basic research. In future we expect the ever-evolving technical measuring methods to enable a deeper understanding of the primary neurological causes of and the implications for patients with cerebral palsy and other neuroorthopedic conditions. This may allow the development of new forms of therapy not necessarily predictable today

METHODOLOGICAL CHALLENGES FOR BIOMECHANICAL APPOACHES IN WINTER SPORTS

Many research questions related to performance or to injury prevention require biomechanical approaches and study plans that provide the best achievable compromise between internal and external validity. This is especially true for winter sport activities like skiing or snowboarding which cannot adequately be reproduced under laboratory conditions. The keynote presentation will illustrate how these methodological challenges have been addressed to answer three research questions related to injury prevention and the development of safety gear in winter sports: (1) the loading of the hip joint at different skiing manoeuvers (to answer the question if skiing is recommendable sport for people with hip replacement), (2) the effectiveness of wrist guards for the prevention of wrist or lower arm fractures in snowboarding (3) the development of algorithms for mechatronic ski bindings with the target to reduce the unchanged high rate of knee injuries

A NON-INVASIVE METHOD TO INVESTIGATE FOOT BONE KINEMATICS

The purpose of this study was to investigate whether image correlation photometry in combination with an inverse dynamics foot model is capable of investigating foot bone kinematics. Thus an explorative test setup with one participant was used to acquire the motion data with ARAMISTM (GOM, Braunschweig, Germany). The motion data enabled a customized inverse dynamics foot model to reproduce the recorded motion and simulate intrinsic movement. Navicular drop was 10.5mm and maximal motion angle did not exceed 23°. The calculated results of navicular drop, range of motion and course of angle over time are promising in comparison to studies using bone pins

Complementary limb motion estimation for the control of active knee prostheses

To restore walking after transfemoral amputation, various actuated exoprostheses have been developed, which control the knee torque actively or via variable damping. In both cases, an important issue is to find the appropriate control that enables user-dominated gait. Recently, we suggested a generic method to deduce intended motion of impaired or amputated limbs from residual human body motion. Based on interjoint coordination in physiological gait, statistical regression is used to estimate missing motion. In a pilot study, this complementary limb motion estimation (CLME) strategy is applied to control an active knee exoprosthesis. A motor-driven prosthetic knee with one degree of freedom has been realized, and one above-knee amputee has used it with CLME. Performed tasks are walking on a treadmill and alternating stair ascent and descent. The subject was able to walk on the treadmill at varying speeds, but needed assistance with the stairs, especially to descend. The promising results with CLME are compared with the subject's performance with her own prosthesis, the C-Leg from Otto Boc

Piano training in youths with hand motor impairments after damage to the developing brain

Damage to the developing brain may lead to impairment of the hand motor function and negatively impact on patients' quality of life. Development of manual dexterity and finger and hand motor function may be promoted by learning to play the piano. The latter brings together music with the intensive training of hand coordination and fine finger mobility. We investigated if learning to play the piano helped to improve hand motor skills in 18 youths with hand motor disorders resulting from damage during early brain development. Participants trained 35-40 minutes twice a week for 18 months with a professional piano teacher. With the use of a Musical Instrument Digital Interface piano, the uniformity of finger strokes could be objectively assessed from the timing of keystrokes. The analysis showed a significant improvement in the uniformity of keystrokes during the training. Furthermore, the youths showed strong motivation and engagement during the study. This is nevertheless an open study, and further studies remain needed to exclude effects of growth and concomitant therapies on the improvements observed and clarify which patients will more likely benefit from learning to play the piano