How closely do surgeons follow gait analysis recommendations and why?

Gait laboratory recommendations for surgery were compared with actual surgeries performed in 30 consecutive patients.The agreement between the procedures performed and those recommended by the gait laboratory averaged 93.2 ± 13.4% overall and 86.0 ± 18.3% excluding patients referred by the gait laboratory physician. For 23 patients (77%), the recommended surgeries exactly matched the surgeries ultimately performed. In the other patients, seven procedures that had not been recommended were performed, and seven procedures that had been recommended were not performed. Explanations for the differences included preoperative clinical or radiographic evaluation, intraoperative assessment, changes in function between gait analysis and surgery, and patient/family request

Prevalence of Specific Gait Abnormalities in Children With Cerebral Palsy Influence of Cerebral Palsy Subtype, Age, and Previous Surgery

Abstract: The authors retrospectively reviewed a series of 492 consecutive cerebral palsy patients undergoing computerized motion analysis. The prevalence of 14 specific gait abnormalities was evaluated and compared based on involvement (hemiplegia, diplegia, or quadriplegia), age, and history of previous surgery (lower extremity orthopaedic surgery or rhizotomy). Stiff knee in swing, equinus, and intoeing were all seen in more than 50% of the subjects in each of the hemiplegic, diplegic, and quadriplegic groups. Increased hip flexion and crouch were also present in more than 50% of the subjects in the diplegic and quadriplegic groups, and hip adduction occurred in more than 50% of the quadriplegic subjects. The likelihood of having stiff knee in swing, out-toeing, calcaneus deformity, and crouch increased with prior surgery. The likelihood of having rotational malalignment of the leg (internal hip rotation with out-toeing), calcaneus, out-toeing, varus and valgus foot deformities, and hip internal rotation increased with age. These findings provide important information for counseling ambulatory children with cerebral palsy and their families

Normalizing lowerextremity strength data for children without disability using allometric scaling.

The traditional method for normalizing quantitative strength data is to divide force or torque by body mass. We have previously shown that this method is not appropriate for able-bodied children and young adults and that normalization using allometric scaling is more effective. The purpose of the current study was to evaluate the effectiveness of applying existing normalization equations for lower extremity strength to children, adolescents, and young adults with cerebral palsy (CP) and, if appropriate, to develop CP-specific normalization equations using allometric scaling. We measured the maximum torque generated during hip abduction/adduction, knee extension/flexion, and ankle dorsiflexion/plantar flexion in 96 subjects with spastic diplegia CP ages 4-23 years. Traditional mass normalization (Torque/ Mass 1.0 ) and allometric scaling equations from children without disability (Torque/Mass 1.6 for hip and knee; Torque/Mass 1.4 for ankle) were not effective in eliminating the influence of body mass. Normalization using CP-specific allometric scaling equations was effective using both muscle-specific and common (Torque/Mass 0.8 for ankle plantar flexors; Torque/Mass 1.4 for all others) scaling relationships. For the first time, normalization equations have been presented with demonstrated effectiveness in adjusting strength measures for body size in a group of children, adolescents, and young adults with CP

Increased Asymmetry of Trunk, Pelvis, and Hip Motion during Gait in Ambulatory Children with Spina Bifida

Spina bifida (SB) is caused by incomplete neural tube closure and results in multiple impairments, including muscle weakness. The severity of muscle weakness depends on the neurologic lesion level. Though typically symmetric, there can be asymmetries in neurologic lesion level, motor strength, skeletal structures, and body composition that affect patients’ gait and function. Using body segment and joint motion obtained through 3D computerized motion analysis, we evaluated asymmetry and range of motion at the hip, pelvis, and trunk in the frontal and transverse planes during gait in 57 ambulatory children with SB and 48 typically developing controls. Asymmetry and range of hip, pelvis, and trunk motion in the frontal and transverse planes were significantly greater for patients with mid-lumbar and higher level lesions compared with those having sacral/low-lumbar level lesions and controls without disability (p ≤ 0.01). Crutch use decreased asymmetry of trunk rotation in mid-lumbar level patients from 10.5° to 2.6° (p ≤ 0.01). Patients with asymmetric involvement (sacral level on one side and L3-4 on the other) functioned similarly to sacral level patients, suggesting that they may be better categorized using their stronger side rather than their weaker side as is traditional. The information gained from this study may be useful to clinicians when assessing bracing and assistive device needs for patients with asymmetric SB involvement

Interpretation of Calcaneus Dual-Energy X-Ray Absorptiometry Measurements in the Assessment of Osteopenia and Fracture Risk

ABSTRACT Dual-energy X-ray absorptiometry (DXA) of the calcaneus is useful in assessing bone mass and fracture risk at other skeletal sites. However, DXA yields an areal bone mineral density (BMD) that depends on both bone apparent density and bone size, potentially complicating interpretation of the DXA results. Information that is more complete may be obtained from DXA exams by using a volumetric density in addition to BMD in clinical applications. In this paper, we develop a simple methodology for determining a volumetric bone mineral apparent density (BMAD) of the calcaneus. For the whole calcaneus, BMAD ‫؍‬ (BMC)/A DXA 3/2 , where BMC and A DXA are, respectively, the bone mineral content and projected area measured by DXA. We found that A DXA 3/2 was proportional to the calcaneus volume with a proportionality constant of 1.82 ؎ 0.02 (mean ؎ SE). Consequently, consistent with theoretical predictions, BMAD was proportional to the true volumetric apparent density () of the bone according to the relationship ‫؍‬ 1.82 BMAD. Also consistent with theoretical predictions, we found that BMD varied in proportion to V 1/3 , where V is the bone volume. We propose that the volumetric apparent density, estimated at the calcaneus, provides additional information that may aid in the diagnosis of osteopenia. Areal BMD or BMD 2 may allow estimation of the load required to fracture a bone. Fracture risk depends on the loading applied to a bone in relation to the bone's failure load. When DXA is used to assess osteopenia and fracture risk in patients, it may be useful to recognize the separate and combined effects of applied loading, bone apparent density, and bone size. (J Bone Miner Res 2000;15:1573-1578

Athlete Identity and Mental Health of Student Athletes during COVID-19

The purpose of our study is to evaluate athletic identity (AI) and mental health measures of youth and young adult athletes during the COVID-19 pandemic. This cross-sectional study recruited athletes aged 11–25 years from universities, high schools, and middle schools in California and New York. Participants were emailed a link to an anonymous, cross-sectional electronic survey. The measure included the athletic identity measurement scale (AIMS), the Patient Health Questionnaire-4 (PHQ-4), and demographic variables. Chi-square, Fisher’s Exact Test, and linear regression were used to examine the relationships between AI, symptoms of anxiety, and symptoms of depression by age, gender, and race. The survey was completed by 653 participants. AI was stratified by tertiary percentiles. The odds of positively scoring for symptoms of anxiety were 60% higher for participants in college compared with high school (OR: 1.60, 95% CI: [1.09, 2.35]). Conversely, the odds of scoring positively for symptoms of depression were 68% higher for participants in high school compared to college (OR: 1.68, 95% CI: [1.09, 2.59]). The odds of scoring positively for symptoms of depression were higher for athletes who scored as high AI, compared to those who scored as moderate (OR: 1.72, 95% CI: [1.11, 2.68]) or low (OR: 1.93, 95% CI: [1.20, 3.12]). The odds of scoring positively for symptoms of anxiety on the PHQ-4 were 3.2 times higher for participants who identified as female (OR: 3.19, 95% CI: [2.31, 4.41]), and the odds of scoring positively for symptoms of depression were 2.4 times higher for participants who identified as female (OR: 2.35, 95% CI: [1.56, 3.54]). Female athletes experienced symptoms of depression and anxiety at significantly higher rates than male athletes during the COVID-19 pandemic. High school students experienced fewer symptoms of anxiety, but greater symptoms of depression as compared to the collegiate group, while college students experienced greater odds of symptoms of anxiety. Athletes in the high AI group were more likely to report symptoms of depression than moderate or low identity groups. Female athletes reported lower AI than male athletes, but still had greater symptoms of anxiety and depression

Sexual Dimorphism and the Origins of Human Spinal Health.

Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan

Vertebral cross-sectional growth: A predictor of vertebral wedging in the immature skeleton.

The degree of vertebral wedging, a key structural characteristic of spinal curvatures, has recently been found to be negatively related to vertebral cross-sectional area (CSA). The purpose of this longitudinal study was to examine the relation between vertebral cross-sectional growth and vertebral wedging progression within the immature lumbar spine. Using magnetic resonance imaging (MRI), we analyzed the potential association between increases in lumbar vertebral CSA and changes in L5 vertebral wedging in 27 healthy adolescent girls (ages 9-13 years) twice within a two-year period. Vertebral CSA growth was negatively associated with changes in posteroanterior vertebral wedging (r = -0.61; p = 0.001). Multiple regression analysis showed that this relation was independent of gains in age, height, and weight. When compared to the 14 girls whose vertebral wedging progressed, the 13 subjects whose vertebral wedging decreased had significantly greater vertebral cross-sectional growth (0.39 ± 0.25 vs. 0.75 ± 0.23 cm2; p = 0.001); in contrast, there were no significant differences in increases in age, height, or weight between the two groups. Changes in posteroanterior vertebral wedging and the degree of lumbar lordosis (LL) positively correlated (r = 0.56, p = 0.002)-an association that persisted even after adjusting for gains in age, height, and weight. We concluded that in the immature skeleton, vertebral cross-sectional growth is an important determinant of the plasticity of the vertebral body; regression of L5 vertebral wedging is associated with greater lumbar vertebral cross-sectional growth, while progression is the consequence of lesser cross-sectional growth