Post on 29-Jun-2020
Gait Analysis LaboratoryCentro de Rehabilitación Infantil Teletón
Estado de México
Dr. Demetrio Villanueva Ayala
Doctorado en Biomecánica, CINVESTAV
Dr. Juan Carlos Pérez Moreno
Especialista en Medicina de Rehabilitación, Hospital Infantil de México, Federico Gómez
Maestro en Ciencias, IPN
Inaugurated: May thirteen of 1999
Address: Vía Gustavo Baz Núm. 219. Colonia San Pedro Barrientos. Tlalnepantla, Estado de México, C.P. 54010, México.
Phone: (55) 5321-2223 Fax: (55) 5321-2220.
CRIT Estado de México
Gait analysis laboratory
Diagnoses auxiliary
Protocols
• Davis protocol
• Short protocol
• Upper limb protocol
Upper Limb Protocol
Cerebral Palsy: Hemiplegia & Quadriplegia, n= 77
Cerebral palsy (CP)
• Cerebral palsy (CP) describes a group of
disorders of the development of movement
and posture, causing activity limitation, that
are attributed to non-progressive
disturbances that occurred in the developing
fetal or infant brain.
Bax M, Rosembaun P, Leviton A, Golgstein M, Paneth N & Damiano D. Proposed definition and classification of cerebral palsy,
April 2005. Developmental Medicine & Child Neurology 2005, 47: 571–576.
Clinical classification
Berker N, Yalcin S. The help guide to cerebral palsy. Global HELP Organization. 2005.
Anatomical classification
Berker N, Yalcin S. The help guide to cerebral palsy. Global HELP Organization. 2005.
Support
• Hand trajectories became smoother and less
variable with age.
• Immature patterns of reaching were
characterised by increased variability in
younger compared to older children.
• Only children between 8 and 10 years old had
variability similar to adults. • Schneiberg S, Sveistrup H, McFadyen B, McKinley P, Levin MF. The development of coordination for reach-
to-grasp movements in children. Exp Brain Res. 2002 Sep; 146(2): 142-54.
Support
• Clinical assessment does not provide objective and
quantitative evaluation of the upper limb function.
• Based on instrumental gait analysis a upper limb
protocol for three-dimensional motion analysis has
been developed.
• The aim of this study is to evaluate the results of
instrumental upper extremity motion.
Support
• 3-D kinematics detected deficits in timing,
ROM, and proximal compensatory strategies
during upper-limb functional task
performance in children with hemiplegia.
• Mackey AH, Walt SE, Stott NS. Deficits in upper-limb task performance in children with hemiplegic
cerebral palsy as defined by 3-dimensional kinematics. Arch Phys Med Rehabil. 2006 Feb; 87(2):207-15.
• Inclusion criteria:
• Ambulatory children with a diagnosis of
spastic quadriplegic or hemiplegic CP aged
between 6 and 18 years.
• Exclusion criteria included:
• Previous upper limb surgery or botulinum
toxin injections within the last six months
• Any disabilities that would make it difficult for
the child to understand the study or
cooperate fully.
Gross Motor Function Measure (GMFM)
• Palisano et al. (1997) and Wood and Rosenbaum (2000) have
both reported good to excellent interrater reliability for
‘severity’ of gross motor function limitations in children with
CP using the GMFCS.
Modified Tardieu Scale
• The modified Tardieu scale was used in upper
limbs to assess the spasticity over biceps and
triceps muscles.
Upper Limbs
Children with
Neuromusculoskeletal disorders
Main objetives
1. Functional Status
2. Rehabilitation Outcomes
Measurement
RSRE LERH
LS
LH
SUP
Six markers
T1
T2
T3
T4
T1 + T2 + T3 + T4 = 1 cycle (100%)
EMG
Biceps Brachii
Triceps Brachii
4 channels
Elbow joint Elbow joint
Distance (m)
Time (s)
Velocity (m/s)
Distance (m)
Time (s)
Velocity (m/s)
Flexion-Extension (deg)
Angular velocity (deg/s)
Flexion-Extension (deg)
Angular velocity (deg/s)
Hand Hand
EMG
Quadriparesis
Triparesis
Diparesis
Hemiparesis
Monoparesis
Myelomeningocele
Syndromes
N=52
15
3
4
23
4
1
2
Hemiparesis N=23
Age Weight (kg) Height (cm)Mean 7.5 29.3 124.5
SD 5.0 19.5 30.5
Max 16.0 65.00 181.0
Min 1.0 9.00 83.0
Left Hemiparesis 11
Right Hemiparesis 12
Lenght
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0
500
1000
1500
2000
2500
Lenght (m
m)
52 23 12 11
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
Duration
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0
2000
4000
6000
8000
10000
12000
14000
16000
Dura
tion (s)
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
Velocity
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0.16
0.18
0.20Velo
city (m
/s)
Velocity
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
T1
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0
5
10
15
20
25
30
Tra
jecto
ry T
1 (%
)
25.4 %
Relative proportion (%) of cycle of the movement
T1
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
T2
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0
5
10
15
20
25
30Tra
jecto
ry T
2 (%
)
23.5 %
Relative proportion (%) of cycle of the movement
T2
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
T3
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0
5
10
15
20
25
30
Tra
jecto
ry T
3 (%
)
23.6 %
Relative proportion (%) of cycle of the movement
T3
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
T4
GE dx GE sx Hem dx Hem sx Hem dx dx Hem dx sx Hem sx dx Hem sx sx0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
22.5
25.0
27.5
30.0
Tra
jecto
ry T
4
26.6 %
Relative proportion (%) of cycle of the movement
T4
Experimental Group Hemiparesis Right Hemiparesis Left Hemiparesis
R L R L R L R L
Right UL
0 1 2 3 4 5 6 7 8 9 10-400
-300
-200
-100
0
100
200
300
400
Time
An
gu
lar
Velo
cit
y (
Deg
/s)
Left UL
0 2 4 6 8 10 12 14 16-400
-300
-200
-100
0
100
200
300
400
Time
An
gu
lar
Velo
cit
y (
Deg
/s)
Right UL
0 1 2 3 4 5 6 7 8 9 10-400
-300
-200
-100
0
100
200
300
400
Time
An
gu
lar
Velo
cit
y (
Deg
/s)
Left UL
0 2 4 6 8 10 12 14 16-400
-300
-200
-100
0
100
200
300
400
Time
An
gu
lar
Velo
cit
y (
Deg
/s)
After Treatment
Before Treatment
Angular Velocity Joint Elbow
Future Work