Jacques RIAD, John HENLEY, Freeman MILLER

Spastik hemiplejik beyin felcinde ayak izi ve ayağı ilerletme açısı ayak bileği güç üretiminde rol oynuyor mu?

Amaç: Bu çalışmada, spastik hemiplejik beyin felçli (BF) çocuklarda ayak basınç paterninin ve ayağı ilerletme açısının ayak bileği eklemi kaynaklı güç üretimiyle ilişkisi araştırıldı. Çalışma planı: Çalışmaya bağımsız yürüyebilen BF’li 35 çocuk (13 kız, 22 erkek; ort. yaş 8.8; dağılım 4.0-19.8) alındı. Tüm hastalarda üçboyutlu yürüme analizi ve pedobarograﬁk ölçümler yapıldı. Pedobarograﬁ verileri ayağı beş segmente bölerek değerlendirildi. Sonuçlar: Ayak bileği kaynaklı ortalama güç üretimi hemiplejik tarafta 7.6 watt/kg, tutulu olmayan tarafta 15.9 watt/kg bulundu (p=0.000). Pedobarograﬁde hemiplejik tarafta anlamlı derecede daha düşük topuk basıncı/itme gücü (8.0 ve 24.7; p=0.000), topuk kaldırma zamanı (basma fazının %32.1’i ve %61.9’u; p=0.000) ve medial önayak segmenti basıncı (40.8 ve 52.2; p=0.009) elde edildi. Hastalar hemiplejik taraftaki ayak bileğinden üretilen güce göre iki gruba ayrıldı (

Anahtar Kelimeler:

Ayak deformitesi, Basınç, Yük verme, Ayak bileği eklemi, Beyin felci, Çocuk, Yürüyüş şekli, Hemipleji

Does footprint and foot progression matter for ankle power generation in spastic hemiplegic cerebral palsy?

Objectives: We investigated how foot pressure pattern and foot progression relate to power generation from the ankle joint in children with spastic hemiplegic cerebral palsy (CP). Methods: The study included 35 children (13 girls, 22 boys; mean age of 8.8 years; range 4 to 19.8) with CP, all having independent ambulation. The children underwent three-dimensional gait analysis and a set of pedobarographic data were obtained. The pedo- barographs were analyzed by dividing the foot into ﬁve segments. Results: The mean power generation from the ankle was 7.6 watts/ kg on the hemiplegic side, and 15.9 watts/kg on the uninvolved side (p=0.000). Based on the pedobarographic data, hemiplegic feet exhibited signiﬁcantly less heel pressure/impulse (8.0 vs. 24.7; p=0.000), time to heel rise (32.1% of stance phase vs. 61.9%; p=0.000), and decreased pressure of the medial forefoot segment (40.8 vs. 52.2; p=0.009). The children were divided into two groups depending on the ankle power generated on the hemiplegic side (<8.0 watts/kg and ≥8.0 watts/kg). Those with an ankle power generation of ≥8.0 watts/kg had signiﬁcantly longer step length (49 cm vs. 41 cm; p=0.001) and increased velocity (109 cm/sec vs. 89 cm/sec; p=0.000) in gait analysis, and in pedobarographic measurements, increased heel impulse (11.6 vs. 4.4; p=0.047), time to heel rise (46.6% vs. 17.1%; p=0.000), and less varus/valgus positioning (11.1° vs. -34.6°; p=0.013). In bivariate correlation analysis, ankle power generation on the hemiplegic side demonstrated a signiﬁcant association with time to heel rise (r=0.574; p=0.000) and varus/valgus positioning (r=0.420; p=0.017), and almost a signiﬁcant association with heel pressure (r=0.342; p=0.052). Conclusion: Deviations in the pedobarographic data are reﬂected in the power generation of the ankle joint and can be of help in decision making of treatment in spastic hemiplegic CP. We speculate that efforts to normalize the heel segment pattern may result in decreased power generation differences.

Keywords:

Foot Deformities, Pressure, Weight-Bearing, Ankle Joint, Cerebral Palsy, Child, Gait, Hemiplegia,

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