ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116 S79

electromyographic trace, comparing pre and post therapeutic bilat-erally behavior of the masseter muscle and the anterior portion ofthe temporal muscle during the bilateral masticatory activity.

Patients/materials and methods: Male and female individualsaging between 18 and 40 years old were assessed. All subjects weresubmitted to the EMG assessment. The volunteers were divided infour groups. Group I: 12 young with signs and/or symptoms of myo-genic TMD. They were submitted massage therapy. Group II: 12young with signs and/or symptoms of myogenic TMD. They weresubmitted occlusal splint. Group III: 12 young with signs and/orsymptoms of myogenic TMD. They were submitted massage ther-apy and occlusal splint. Group IV: 12 subjects with normo-occlusionand no history of temporomandibular disorder. They were sub-mitted to the EMG exams, but not to the physiotherapeutic andodontologic treatment. It is important to mention that only partialresults will be presented in this study.

Results: Considering the data obtained and the statistical anal-ysis performed in each studied groups, and noticed that with thetechniques applied on the Groups I, II, III and IV, no significant resultof EMG activity of all the muscles in study was collected. But, theresults point out the difference (p = 0.0026) between the AVS scores,which was taken before and after the treatment (analyzed by theANOVA statistical test).

Discussion and conclusions: There was a significant decreasein pain in Group I, after Group III, after group II and Group IV donot have differences. The data collected in this study demonstratedthat the massage therapy was efficient in decreasing the pain [2].Even though it is not possible to draw a comparison with the liter-ature that deals with the effect of massage therapy in patients withbruxism because this partial results. The physiotherapeutic treat-ment (massage) and odontologic treatment (occlusal splint) andboth treatment together can reduce and eliminate pain. However,the physiotherapeutic and both treatment together can reduce andeliminate pain more.

Further reading

[1] Biasotto-Gonzalez DA, Bérzin F. Electromyographic study of patients with mas-ticatory muscles disorders, physiotherapeutic treatment (massage). BrazilianJournal of Oral Sciences 2004;3(July/September (10)):516–21.

[2] Capellini VK, Souza GS, Faria CRS. Massage Therapy in the management of myo-genic TMD. Journal of Applied Oral Science 2006;14(February (1)).

http://dx.doi.org/10.1016/j.gaitpost.2013.07.167

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Application of neuromuscular electricalstimulation in the management of hip and kneeextensor weakness in children with cerebralpalsy: A pilot study

Neil J. Postans, Andrew P. Roberts

RJAH Orthopaedic Hospital NHS Foundation Trust,ORLAU, Oswestry, UK

Introduction: Weakness of the hip and knee extensors in chil-dren with cerebral palsy (CP) presents a major challenge duringpost surgical rehabilitation and remains a major obstacle to mobil-ity. Neuromuscular electrical stimulation (NMES) can increasestrength [1], but studies in CP have been equivocal [2]. Lack of selec-tive control may prevent CP children from utilizing increases instrength effectively. Electromyography (EMG) triggering requirespractice of volitional control that may enhance motor learning [3].This pilot study investigated the effects of EMG triggered NMESof the gluteal and quadriceps muscle groups on strength and gaitkinematics in six CP children.

Patients/materials and methods: Six subjects were recruited;four female, two male, mean age 10 years 8 months (SD 2 years6 months). Inclusion criteria were; aged 7–14 years, diagnosis ofspastic diplegic cerebral palsy, crouch gait pattern, no orthopaedicsurgery in the last 12 months or botox injections in the last 6months. Subjects acted as their own controls in an ABA studydesign, with baseline, treatment and follow up periods of 12weeks. During treatment, subjects used NMES for up to 30 minper day. EMG triggering required subjects to initiate hip and kneeextension prior to the onset of NMES, and an integrated com-puter game provided biofeedback. Stimulation intensity was setto produce as strong a contraction as was comfortable. Duringbaseline and follow up, patients continued with regular therapy.Dynamometry and 3D gait analysis were performed at the startand end of each phase. The NMES devices logged compliancedata.

Results: There were no significant differences in strength, or inminimum knee and hip flexion during gait, between baseline, treat-ment and follow up. When considered individually, there were noclear trends in the strength measurements for any of the subjects.There was a trend towards improvement in hip and knee extensionfollowing treatment for one subject, which was not maintained atfollow up. One subject showed some deterioration in knee flexionthroughout the duration of the study. Average treatment compli-ance was 31%.

Discussion and conclusions: Compliance with the treatmentprotocol was low (18%) for the subject who showed some improve-ment in gait pattern, indicating that this result was likely to bedue to other variables. This was not replicated amongst other sub-jects for whom compliance was better. The deterioration in gaitfor one subject may have been related to a growth spurt during thestudy period. None of the subjects’ families reported any significantdifficulties in using the equipment, however, the overall compli-ance data suggest daily home based treatment using this protocolmay not be realistic. There are still challenges to overcome if thepotential strengthening effects of NMES are to be replicated in CPchildren.

Further reading

[1] Avramidis K, et al. Effectiveness of electric stimulation of the vastus medi-alis muscle in the rehabilitation of patients after total knee arthroplasty.Archives of Physical Medicine and Rehabilitation 2003;84(December (12)):1850–3.

[2] Kerr C, et al. Electrical stimulation in cerebral palsy: a randomized controlledtrial. Developmental Medicine & Child Neurology 2006;48(11):870–6.

[3] Wulf G. Self-controlled practice enhances motor learning: implications for phys-iotherapy. Physiotherapy 2007;93(2):96–101.

http://dx.doi.org/10.1016/j.gaitpost.2013.07.168

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Changes in surface EMG patterns in childrenwith cerebral palsy during robotic gait trainingin comparison to treadmill training

Marcin Bonikowski, Patrycja Mrozek

Mazovian Neurorehabilitation and PsychiatryCenter, Rehabilitation Department, MovementAnalysis Laboratory, Warsaw, Poland

Introduction: Robotic rehabilitation equipment allows forintensive, goal focused training that does not tire physiotherapists.Latest evidence shows, that such training improves mobility in chil-dren with cerebral palsy (CP) [1].

The aim of the research is to check if training with a roboticdriven gait orthosis (DGO) Lokomat changes muscle activation in

S80 ESMAC 2012 abstract / Gait & Posture 38 (2013) S1–S116

comparison to exercise on a treadmill, and what other trainingparameters can influence it.

Patients/materials and methods: Ten CP children, GMFCS level2 or 3, attended identical training/diagnostic sessions on a roboticdriven gait orthosis (DGO) Lokomat (Hocoma). Examination wasconducted after a 15-min training on DGO, during which bothcomfortable and maximum speed were determined. Next an EMGactivity assessment was conducted during training on the DGO andon a treadmill with a bodyweight-support Levi system. The exam-ination was conducted at comfortable and maximum speeds, with50% and 100% leading force, with 30% bodyweight-support or with-out it. Sagittal video recordings of gait were made, together withsimultaneous surface electromyography recordings of the rectusfemoris m. (RF), semitendinosis m. (ST) using the ME6000 systemwith Megawin software (Mega Electronics Ltd). Eight trials wereconducted on the DGO and four on a treadmill in different combina-tions of bodyweight-support and leading force. In order to calculateaverage levels of EMG, SD, min., max., surface and median, in eachof the trials 20 steps were taken from a 30 s recording and averagedwith RMS.

Results: A significant (p < 0.05) increase EMG activity wasobserved during training on a treadmill in comparison to that onthe Lokomat in all of the trials. Moreover, increase of average EMGlevels was also observed with smaller bodyweight-support andleading force.

Discussion and conclusions: These preliminary results show,that the Lokomat changes muscle activity in comparison to walkingon a treadmill more than just using bodyweight-support. Lowerlevels of muscle activation and less physical effort allow for longtrainings with CP children, GMFCS levels II, III and even IV for whomthe possibilities of gait improvement are greatly limited. This isprobably a factor influencing the treatment.

Reference

[1] Borggraefe I, et al. European Journal of Physical and Rehabilitation Medicine2010.

http://dx.doi.org/10.1016/j.gaitpost.2013.07.169

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Development of muscle tone andelectromygraphic patterns after muscle-tendonsurgery in children with spastic diplegia

Thomas Dreher 1, Reinald Brunner 2, DóraVegvari 1, Daniel Heitzmann 1, Simone Gantz 1,Michael W. Maier 1, Frank Braatz 1, Sebastian I.Wolf 1

1 Heidelberg University Clinics, Department forOrthopedics and Trauma Surgery, Heidelberg,Germany2 University Children’s Hospital Basel, PediatricOrthopaedic Department, Basel, Switzerland

Introduction: During multilevel surgery, muscle-tendonlengthening (MTL) is commonly carried out to correct deformities.However, it is unclear if MTL also modifies muscle tone by reducingtension on the neuro-muscular spindle and if pathologic activationpatterns are changed as an effect of the biomechanical changes.Since investigations addressing muscle tone after MTL are limited[1], we evaluated the effects of MTL on muscle tone and activationpattern at short- and mid-term.

Patients/materials and methods: Forty-two children withspastic diplegia who were treated by multilevel surgery includingMTL of the hamstrings and calf muscles underwent standardizedclinical examination including MAS (modified Ashworth scale),dynamic EMG and 3D gait analysis before (E0), one (E1) and threeyears (E2) after MTL. For muscle activation patterns the norm-distance of dynamic EMG data was analyzed. ANOVA was used(p < 0.05).

Results: Range of motion and joint alignment in clinical exam-ination were found to be significantly improved at E1. However,deterioration of these parameters was noted at E2. MAS was signif-icantly reduced at E1 but showed an increase between E1 and E2(Fig. 1). Joint kinematics were found significantly closer to referencedata at E1 but deteriorated until E2. However, the EMG patterns ofthe surgically addressed biarticular muscles (Fig.2) were not foundto be changed significantly in either follow-up.