Article

The use of quantitative models for evaluating upper extremity (UE) dynamics in
children with myelomeningocele (MM) is limited. A biomechanical model for
assessment of UE dynamics during Lofstrand crutch-assisted gait in children with
MM is presented. This pediatric model may be a valuable tool for clinicians to
characterize crutch-assisted gait, which may advance treatment monitoring, crutch
prescription, and rehabilitation planning for children with MM. Nine subjects
with L3 or L4 level myelodysplasia (mean+/-S.D. age: 11.1+/-3.8 years) were
analyzed during forearm crutch-assisted gait: (1) reciprocal gait and (2)
swing-through gait. Three-dimensional (3D) dynamics of the UE were acquired and
the Pediatric Outcomes Data Collection Instrument (PODCI) was administered.
The goal of this study was to determine if meaningful differences occur between gait
patterns in UE kinematics and kinetics, and if correlations exist between
dynamics and functional outcomes. Temporal-distance parameters showed significant
differences between reciprocal and swing-through gait in stride length, and
stance duration. All joint ranges of motion were greater during swing-through
gait. Thorax, elbow and crutch ranges of motion were found to be significantly
different between gait patterns. Kinetic results demonstrated significant
differences between reciprocal and swing-through gait, bilaterally, at all joints
for the force variables of mean superior/inferior force, range of force, and
maximum inferior force. Functional outcomes were strongly correlated with joint
dynamics. Accurate quantitative assessment is essential for preventing injury in
long-term crutch users. This study has potential for improving clinical
intervention strategies and therapeutic planning of ambulation for children with MM.

Langue : ANGLAIS