Stop Tip-toeing Around Toe-walking

University Children's Hospital Basel46 enrolled

Overview

The purpose of this study is to explore the interplay among nervous-, musculoskeletal-, and psychological systems and how they impact toe-walking behavior, and vice versa. Sub-Project 1 is to analyze the feasibility of the developed virtual reality (VR) environment, in 10 TD and sCP children respectively. It is assess the effects of VR immersion on predefined static and dynamic stability parameters. Sub-Project 2: After adjustments have been made following Sub-Project 1 regarding the study procedure, technical factors or the parameters of interest etc., the optimized study procedure is implemented in Sub-Project 2 (20 to 25 TD will be included). Sub-Project 3: After adjustments have been made following Sub-Project 1 regarding the study procedure, technical factors or the parameters of interest etc., the optimized study procedure is implemented in Sub-Project3 (20 to 25 sCP will be included)

The interplay between the nervous-, musculoskeletal-, and psychological systems and their impact on resulting walking patterns are poorly understood. Children that toe-walk often show poorer levels of static and dynamic stability, leading to a lower quality of life compared to typically develop-ing children (TD). Current research suggests multifactorial adaptations in central and/or peripheral nervous as well as the musculoskeletal system contribute to and result from toe-walk-ing. The purpose of this study is to explore the interplay among nervous-, musculoskeletal-, and psychological systems and how they impact toe-walking behavior, and vice versa. The effect of psychological factors (via the use of a custom-designed virtual reality environment) on static vs. dynamic stability, motor control, coordination (indirect assessment of central nervous system function) as well as reflex control (Hoffmann-reflex, H-reflex, performance of peripheral nervous system) is investigated.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Interventions

Static stability measurementDIAGNOSTIC_TEST

The child stands barefoot on dual force platforms in two (CP: three) different conditions: barefoot and with shoes (CP: and with orthosis). Each condition is recorded three times each lasting for 30s, and 30s rest between them. Both conditions are recorded with and without wearing a headset. The order of conditions (within each Virtual Reality ("VR)-condition") is randomized. For each condition, the child rests in a comfortable position for 20s with the heels on the same level and arms hanging at their sides. Between both "VR-conditions", the child rests for 120 s.

Dynamic stability measurementDIAGNOSTIC_TEST

The child walks at their normal walking speed on a 10-m walkway in two (CP: three) different conditions: barefoot and with shoes (CP: and with orthosis). For each condition, at least six error-free trials are recorded. Errors in data may occur due to hidden or lost markers during walking or software interruptions. Both conditions are recorded with and without wearing a headset. The order of conditions (within each "VR-condition") is randomized.

Eligibility

Sex: ALLMin age: 7 YearsMax age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria for TD children: * between the age of 7 and 18 years * who are typically developing * able to stand and walk alone without using assistance or assistive devices * able to place their feet flat on the force platforms * with enough German language skills to follow the instructions Inclusion Criteria for sCP children: * between the age of 7 and 18 years * with the diagnosis of spastic CP or CP similar (both unilateral and bilateral), functionally classified level I or II according to the Gross Motor Function Classification System (GMFCS) * being able to stand and walk alone without assistance or assistive devices * able to place their feet flat on the force platforms * with enough German language skills to follow the instructions Exclusion Criteria for TD children: * severe visual, cognitive, or auditory impairments that would interfere with the study instructions and the VR immersion * any vestibular problems (e.g. severe motion sickness) * history of epilepsy, pace-marker or/and electrical pumps (due to possible interference with electrical stimulation) * prior experience of VR to ensure a comparable baseline between subjects Exclusion Criteria for sCP children: * severe visual, cognitive, or auditory impairments that would interfere with the study instructions and the VR immersion * severe knee flexion gait (\>45°) * walking capacity \<50m * botulinum toxin type A treatment (past 6 months) * orthopedic surgery of upper or lower extremities (past 12 months) * any vestibular problems (e.g. severe motion sickness or dizziness) * history of epilepsy, pace-marker or/and electrical pumps (due to possible interference with electrical stimulation) * prior experience of VR as they may already be adapted to VR.

Outcomes

Primary Outcomes

Static stability assessed by Center of Pressure (COP) shifts in anterior-posterior and mediolateral directions under each limb

COP shifts in anterior-posterior and mediolateral directions under each limb are assessed via the use of two force plates embedded in the floor (Kistler Instrumente AG, Winterthur, Switzerland, sample rate 1500 Hz) (mean value of three repetitions)