Effect of a metatarsal stimulus on the loading response in the gait of children with hemiplegic cerebral palsy

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Effect of a metatarsal stimulus on the loading response in the gait of children with hemiplegic cerebral palsy

 

Author: Wong, Kin-on Dicky
Title: Effect of a metatarsal stimulus on the loading response in the gait of children with hemiplegic cerebral palsy
Degree: M.Sc.
Year: 1999
Subject: Cerebral palsied children -- Rehabilitation
Gait disorders in children
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: 49 leaves : ill. ; 31 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1479340
URI: http://theses.lib.polyu.edu.hk/handle/200/2337
Abstract: Toe-walking, with forefoot contact during loading, is one of the common gait abnormalities in children with hemiplegic cerebral palsy. Moreover, this equinus gait may occur in the absence of a static deformity (so-called dynamic equinus). The purposes of this study were: 1) to investigate the effect of a mechanical metatarsal stimulus on the loading response in children with hemiplegic cerebral palsy; 2) to investigate the relationship between the dynamic range of ankle motion and the loading force impulses. Gait analysis was performed on 7 hemiplegic cerebral palsy children with dynamic equinus, using a single force platform and video camcorder to capture kinematics in the sagittal plane. Domestic shirt buttons were attached to sole over the first and second metatarso-phalangeal joints of the hemiplegic foot to act as the mechanical stimulus. The resulting deviation of the mean centre of pressure (MCOP) in standing was used to quantify the intensity of the stimulus. Kinematic and kinetic measurements were obtained before and after the application of the stimulus. The results showed: (1) the peak vertical ground reaction force (VGRF) and peak fore-aft shear force were decreased significantly on the hemiplegic side after the stimulus was applied (p<0.01 and p<0.05, respectively). The contra-lateral (healthy) limb also showed significant reduction of the VGRF. (2) the dropping impulse on the hemiplegic side, and the braking impulse on the contra-lateral side were reduced following application of the stimulus (p<0.01 and p<0.05, respectively). (3) stance duration was prolonged on the hemiplegic side (p=0.009), and shortened on the contra-lateral side(p<0.05) on applying the stimulus, with a consequent improvement in gait symmetry. (4) dynamic range of motion of the hemiplegic ankle was significantly increased (p<0.001). (5) an inverse correlation was noted between the dynamic range of ankle motion and the dropping impulse (r=-0.82, p<0.0l). Two patterns of dynamic gait patterns were identified. The dropping impulse appears to be a useful measure of the severity of dynamic equinus in hemiplegic gait. Further electromyographic studies are suggested, to elucidate the mechanism of the metatarsal stimulation in relieving the dynamic equinus.

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