The use of a dynamic orthosis in a child with unilateral spastic Cerebral Palsy: effects on gait kinematics

Martins, Maria Elisabete; Cordovil, Rita; Oliveira, Raúl; Pinho, Joana; Vaz, João R

http://hdl.handle.net/10400.26/39830

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Authors

Martins, Maria Elisabete

Abstract(s)

Hemiplegia is a form of spastic Cerebral Palsy in which one side of the body is affected, resulting in an atypical body posture and abnormal gait patterns. The purpose of this case-report was to provide a descriptive analysis of the immediate effects of a dynamic orthosis, the TheraSuit® (TS), in gait kinematics. A 5.88 years old child with left spastic hemiplegia, level II (GMFCS) and gait classification type III, was instructed to walk at a self-selected pace along a 10m walkway in two conditions: 1) BL (Baseline); 2) TS (wearing the TS). Two video-digital cameras (Basler piA1000-48gс GigE) and six infrared cameras (VICON T10), sampled at 100 Hz were used. Spatiotemporal parameters and lower limb joint angles were determined. For the spatiotemporal parameters, the TS reduced gait cadence (BL: 156 +/- 10.1 steps/min; TS: 132 +/- 3.4 steps/min). While the TS showed few changes in terms of the spatiotemporal parameters, the lower limb joint kinematics looked to be more affected towards a more functional gait pattern. The joints' motion looked to be altered throughout the gait cycle. At the initial contact, the TS showed i) a reduction of dorsiflexion on non-paretic side (BL: 10.2 deg +/- 3.4; TS: 9.2 deg +/- 1.5) and plantarflexion on paretic side (BL: -5.8 deg +/- 1.1; TS: 9.3 deg +/- 1.4); ii) a reduced knee flexion angle in both limbs; iii) a reduced hip flexion in the non-paretic limb. During the stance phase, the child was able to decrease the flexion pattern by showing more knee extension in the paretic limb and greater hip extension in both limbs. In the swing phase, a decrease in knee and hip flexion in the non-paretic limb was also verified. This case-report shows that TS seems to be able of changing gait kinematics toward a more functional gait pattern (i.e., reducing hip and knee flexion and the amount of plantarflexion). It was particularly clear at a distal level (i.e., ankle). The TS might be an interesting tool to implement in physical therapy programs. However, further investigation is required to better understand its short and long term effects.