Abstract
Purpose
Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices.
Methods
Fifteen children with AMC, mean age 12.4 (4.3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee–ankle–foot orthoses with locked knee joints, Group 2 used ankle–foot orthoses or knee–ankle–foot orthoses with open knee joints and Group 3 used no orthoses.
Results
The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values.
Conclusions
Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants.
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References
Hall JG (1997) Arthrogryposis multiplex congenita: etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B 6:159–166
Thompson GH, Bilenker RM (1985) Comprehensive management of arthrogryposis multiplex congenita. Clin Orthop Relat Res 194:6–14
Bevan WP, Hall JG, Bamshad M, Staheli LT, Jaffe KM, Song K (2007) Arthrogryposis multiplex congenita (amyoplasia): an orthopaedic perspective. J Pediatr Orthop 27:594–600
Darin N, Kimber E, Kroksmark AK, Tulinius M (2002) Multiple congenital contractures: birth prevalence, etiology, and outcome. J Pediatr 140:61–67
Staheli LT (1998) Lower extremity management. In: Staheli LT, Hall JG, Jaffe KM, Paholke DO (eds) Arthrogryposis: a text atlas. Cambridge University Press, Cambridge, pp 55–73
Guidera KJ, Drennan JC (1985) Foot and ankle deformities in arthrogryposis multiplex congenita. Clin Orthop Relat Res 194:93–98
Carlson WO, Speck GJ, Vicari V, Wenger DR (1985) Arthrogryposis multiplex congenita. A long-term follow-up study. Clin Orthop Relat Res 194:115–123
Staheli LT (1998) Orthopedic management principles. In: Staheli LT, Hall JG, Jaffe KM, Paholke DO (eds) Arthrogryposis: a text atlas. Cambridge University Press, Cambridge, pp 27–43
Kroksmark AK, Kimber E, Jerre R, Beckung E, Tulinius M (2006) Muscle involvement and motor function in amyoplasia. Am J Med Genet A 140:1757–1767
Hoffer MM, Swank S, Eastman F, Clark D, Teitge R (1983) Ambulation in severe arthrogryposis. J Pediatr Orthop 3:293–296
Hahn G (1985) Arthrogryposis. Pediatric review and habilitative aspects. Clin Orthop Relat Res 140:104–114
Sells JM, Jaffe KM, Hall JG (1996) Amyoplasia, the most common type of arthrogryposis: the potential for good outcome. Pediatrics 97:225–231
Donohoe M (2006) Arthrogryposis multiplex congenita. In: Campbell SK, Vander Linden DW, Palisano RJ (eds) Physical therapy for children, 3rd edn. Saunders Elsevier Inc., St. Louis, pp 381–400
Florence J (1977) The orthotic management of arthrogryphosis. Prosthet Orthot Int 1:111–113
Bartonek Å, Eriksson M, Gutierrez-Farewik EM (2007) Effects of carbon fibre spring orthoses on gait in ambulatory children with motor disorders and plantarflexor weakness. Dev Med Child Neurol 49:615–620
Bartonek Å, Saraste H (2001) Factors influencing ambulation in myelomeningocele: a cross-sectional study. Dev Med Child Neurol 43:253–260
Danielsson AJ, Bartonek Å, Levey E, McHale K, Sponseller P, Saraste H (2008) Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. J Child Orthop 2:45–54
Hislop HJ (2007) Daniels and Worthingham’s muscle testing: techniques of manual examination, 8th edn. Saunders Elsevier Inc., St. Louis
Davis RB, Õunpuu S, Tyburski D, Gage JR (1991) A gait analysis data collection and reduction technique. Hum Mov Sci 10:575–587
Graubert CS, Chaplin DL, Jaffe KM (1998) Physical and occupational therapy. In: Staheli LT, Hall JG, Jaffe KM, Paholke DO (eds) Arthrogryposis: a text atlas. Cambridge University Press, Cambridge, pp 87–113
Gutierrez EM, Bartonek Å, Haglund-Åkerlind Y, Saraste H (2003) Characteristic gait kinematics in persons with lumbosacral myelomeningocele. Gait Posture 18:170–177
Murray C, Fixsen JA (1997) Management of knee deformity in classical arthrogryposis multiplex congenita (amyoplasia congenita). J Pediatr Orthop B 6:186–191
Ponseti IV (1996) Congenital clubfoot. Fundamentals of treatment. Oxford University Press Inc., New York
Fassier A, Wicart P, Dubosset J, Seringe R (2009) Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity. J Child Orthop 3:383–390. doi:10.1007/s11832-009-0187-4
Dillon ER, Bjornson KF, Jaffe KM, Hall JG, Song K (2009) Ambulatory activity in youth with arthrogryposis: a cohort study. J Pediatr Orthop 29:214–217
Acknowledgments
We would like to thank the children and their parents for participating in the study. This study was supported by the Norrbacka-Eugenia Foundation.
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Eriksson, M., Gutierrez-Farewik, E.M., Broström, E. et al. Gait in children with arthrogryposis multiplex congenita. J Child Orthop 4, 21–31 (2010). https://doi.org/10.1007/s11832-009-0234-1
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DOI: https://doi.org/10.1007/s11832-009-0234-1