Upper Extremity Kinetics during Lofstrand Crutch-Assisted Gait in Children

Complete biomechanical analysis helps evaluate the motion during various gait patterns for the upper and lower extremities. Extensive studies have been performed to evaluate unassisted gait patterns, but very little has been accomplished for studying assisted motion. Children with pathologies such as osteogenesis imperfecta, spinal cord injury, and cerebral palsy use assistive devices such as anterior and posterior walkers, canes, Lofstrand and axillary crutches for ambulation purposes. Statistics show that there are currently about 566,000 crutch users in the United States. The long-term crutch users in this population can suffer various upper limb pathologies associated with extensive upper extremity (UE) loading. Better knowledge of UE dynamics in crutch users may ultimately help to prevent injuries due to excessive loading or inappropriate gait patterns. These evaluations may ultimately assist in pre-treatment planning and post-treatment rehabilitation. Currently, there is no validated system for the assessment of UE joint kinetics during Lofstrand crutch-assisted gait in children. To address these needs two aims will be accomplished: 1. A novel crutch system will be designed and validated to accurately evaluate the UE joint kinetics in children and young adults. 2. A kinetic model will be demonstrated for the newly developed crutch system during Lofstrand crutch-assisted gait in children with spinal cord injury, cerebral palsy and osteogenesis imperfecta

Motion Analysis of the Upper Extremities During Lofstrand Crutch-Assisted Gait in Children with Orthopaedic Disabilities

Background This paper presents a review of current state-of-the-art dynamic systems for quantifying the kinematics and kinetics of the joints of the upper extremities during Lofstrand crutch-assisted gait. The reviewed systems focus on the rehabilitation of children and adults with myelomeningocele (MM), cerebral palsy (CP), spinal cord injury (SCI), and osteogenesis imperfecta (OI). Forearm crutch systems have evolved from models with single- to multi-sensor hardware systems that can incorporate an increasing number of segments that are in compliance with the standards of the International Society of Biomechanics (ISB). Methods The initial system developed by our group was a single, six-axis, sensor-crutch design with an accompanying ISB-compliant, inverse dynamics model. The model consisted of seven upper body segments and two crutch segments. After thorough validation of the software and hardware, it was tested using nine children with MM. The join dynamics of the shoulder, elbow, and wrist were assessed during reciprocal and swing-through gait. Results The dynamic metrics of the upper extremeties, including the mean, range, and maximum force and moment, were found to be significantly different depending on the gait pattern. Joint forces were found to be the greatest during swing-through gait, with inferior forces reaching 50% of body weight. In order to improve upon the initial system, our group developed a four-sensor crutch system that measures the contributions of the crutch-cuff kinetics. The inverse dynamics model was enhanced by including crutch-cuff and sensor segments that also follow the ISB modeling standards. This system was used to model subjects with CP, SCI, and OI. Maximum joint forces were measured in the subject with CP, while maximum moments were measured in the subject with SCI. The subject with OI presented the smallest joint forces and moments. Discussion These novel model systems may be used to improve the quantification of joint dynamics during Lofstrand crutch-assisted gait. These methods may ultimately improve the identification of the risk factors for joint pathology and subsequent therapeutic planning and rehabilitation paradigms

Reciprocal Inhibition Post-stroke is Related to Reflex Excitability and Movement Ability

Objective Decreased reciprocal inhibition (RI) of motor neurons may contribute to spasticity after stroke. However, decreased RI is not a uniform observation among stroke survivors, suggesting that this spinal circuit may be influenced by other stroke-related characteristics. The purpose of this study was to measure RI post-stroke and to examine the relationship between RI and other features of stroke. Methods RI was examined in 15 stroke survivors (PAR) and 10 control subjects by quantifying the effect of peroneal nerve stimulation on soleus H-reflex amplitude. The relationship between RI and age, time post-stroke, lesion side, walking velocity, Fugl-Meyer, Ashworth, and Achilles reflex scores was examined. Results RI was absent and replaced by reciprocal facilitation in 10 of 15 PAR individuals. Reciprocal facilitation was associated with low Fugl-Meyer scores and slow walking velocities but not with hyperactive Achilles tendon reflexes. There was no relationship between RI or reciprocal facilitation and time post-stroke, lesion side, or Ashworth score. Conclusions Decreased RI is not a uniform finding post-stroke and is more closely related to walking ability and movement impairment than to spasticity. Significance Phenomena other than decreased RI may contribute to post-stroke spasticity