Spine Biomechanics During Gait Following Lower Extremity Treatment in Different Patient Groups

University Children's Hospital Basel20 enrolled

Overview

Measuring spine dynamics is a necessity in order to better understand gait deviations throughout the whole body and to evaluate treatment effects on spinal movement during gait. However, the full body marker sets that are typically used in opto-electronic 3D gait analyses either disregard the spine entirely or regard it as a rigid structure. Therefore, the purpose of this study is to use an enhanced trunk marker set in order to evaluate the biomechanical effects of lower extremity treatments on spine dynamics in patients with different pathologies. It has been hypothesized that 1. the enhanced trunk marker set is a reliable method for the measurement of spine dynamics during gait in patients with deviations occurring secondary to leg length inequality. 2. the enhanced trunk marker set is a reliable method for the measurement of spine dynamics during gait in patients that present both primary and secondary deviations such as seen in hemiplegic and diplegic cerebral palsy. 3. treatment by means of either a shoe insole or a modified shoe with sole lift on the shorter side has an effect on spine dynamics during gait in patients with leg length inequality. 4. treatment by means of an ankle foot orthosis to control the foot position has an effect on spine dynamics during gait in patients with hemiplegic and diplegic cerebral palsy. To verify the hypotheses, instrumented gait analyses with a standard full body marker set and the enhanced trunk marker set will be carried out before and immediately after an orthotic lower extremity treatment in the respective patient group.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Interventions

Ankle foot orthosisOTHER

Ankle foot orthoses are a common treatment method to control the foot position during walking and to prevent ankle plantar flexion contractures in cerebral palsy patients.

Shoe insoleOTHER

The heel of the shorter leg of the patient is lifted by a shoe insole. This procedure is commonly applied with leg length differences of up to 20mm.

Modified shoe with sole liftOTHER

The heel of the shorter leg of the patient is lifted by building up the sole of the shoe (shoe sole lift). This procedure is commonly applied with leg length differences of 20mm and more.

Eligibility

Sex: ALLMin age: 10 YearsMax age: 18 Years

Medical Language ↔ Plain English

Leg length inequality patients: Inclusion Criteria: * Diagnosed structural leg length inequality (minimum 1% of body height) * Several different aetiologies (except neurological) * Able to walk a distance of minimum 50 meters without any assistive device Exclusion Criteria: * Leg length inequality due to neurological aetiology * Structural deformities of the spine * Obesity (\> 95th BMI-per-age percentile) * Injuries of the locomotor system which led to persistent deformities Hemiplegic cerebral palsy patients: Inclusion Criteria: * Diagnosed hemiplegic cerebral palsy (Gross Motor Function Classification System for Cerebral Palsy (GMFCS): Levels I and II) * Able to walk a distance of minimum 50 meters barefoot and without any assistive device Exclusion Criteria: * Structural deformities of the spine * Any previous surgical and casting treatments as well as botulinumtoxin treatments within preceding 6 months. * Obesity (\> 95th BMI-per-age percentile) * Injuries of the locomotor system which led to persistent deformities Diplegic cerebral palsy patients: Inclusion Criteria: * Diagnosed diplegic cerebral palsy (Gross Motor Function Classification System for Cerebral Palsy (GMFCS): Levels I and II) * Able to walk a distance of minimum 50 meters barefoot and without any assistive device Exclusion Criteria: * Structural deformities of the spine * Any previous surgical and casting treatments as well as botulinumtoxin treatments within preceding 6 months. * Obesity (\> 95th BMI-per-age percentile) * Injuries of the locomotor system which led to persistent deformities

Outcomes

Primary Outcomes

Reliability of the enhanced trunk marker set for the measurement of spinal kinematics in patients with leg length inequality and cerebral palsy during gait.

Parameters include lumbar, thoracic and cervical spine curvature angles in the sagittal and frontal planes and segmental rotation angles in the transverse plane.

Time frame: Data will be collected between April 2013 and June 2015. Each patient will be measured before and immediately after an orthotic treatment (both measurements within 1 hour).

Immediate changes in spinal kinematics in patients with leg length inequality and cerebral palsy during gait following an orthotic lower extremity treatment.

Parameters include lumbar, thoracic and cervical spine curvature angles in the sagittal and frontal planes and segmental rotation angles in the transverse plane.

Time frame: Data will be collected between April 2013 and June 2015. Each patient will be measured before and immediately after the orthotic treatment (both measurements within 1 hour).

Secondary Outcomes

Immediate changes in spatio-temporal gait parameters and kinematics and kinetics of peripheral joints in patients with leg length inequality and cerebral palsy during gait following an orthotic lower extremity treatment.

Parameters include gait speed, cadence and single and double limb support as well as angles, torques and powers of peripheral joints in all three planes.