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