Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지

An Analysis of Factors Affecting Vertical and Horizontal Obstacle Crossing in Independently Ambulatory Children With Spastic Cerebral Palsy

독립보행이 가능한 강직성 뇌성마비 아동들의 수직 및 수평 장애물 통과에 영향을 미치는 요인 분석

  • Lee, Su-Jin (Dept. of Rehabilitation Center, Youseong Wellness Hospital) ;
  • Oh, Duck-Won (Dept. of Physical Therapy, College of Natural Science, Daejeon University)
  • 이수진 (유성 웰니스 병원) ;
  • 오덕원 (대전대학교 자연과학대학 물리치료학과)
  • Received : 2011.05.03
  • Accepted : 2011.07.27
  • Published : 2011.09.17
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Abstract

This study aimed to evaluate factors related to the ability of ambulatory patients with cerebral palsy (CP) to walk over vertical and horizontal obstacles. Twenty patients with spastic CP who were able to walk independently for at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1, 4, and 8 cm in height or width; total of 6 conditions). A 'fail' was recorded when either the lower limbs or the walking device contacted the obstacle. Linear regression analyses were used to determine the effects of age, sex, walking devices, eyeglasses, subtype (hemiplegia or diplegia), ankle foot orthoses, functional level, and score of body mass index on the ability of obstacle crossing. Fifteen participants (75%) failed to adequately clear the foot or walking device over obstacles in at least 1 condition. The chance of failure in crossing vertical obstacle was affected by the use of ankle foot orthoses, eyeglasses, gender, and CP subtype (p<.05). The failure rate crossing horizontal obstacle was affected by CP subtype. These findings suggest that rehabilitation procedures should (1) consider the clinical characteristics of patients in order to prepare them to be more independent while performing daily activities, and (2) incorporate environmental conditions that patients encounter at home and in the community.

Keywords

References

  1. 대한소아재활의학회, 소아재활의학. 서울, 군자출판사, 2006.
  2. 안승철, 우리 아이 머리에선 무슨 일이 일어나고 있을까? 서울, 궁리출판사, 2009.
  3. 윤범철, 김순자, 김종만 등. 신경계 질환별 물리치료. 서울, 현문사, 2003.
  4. 정통령, 황승욱, 이정운 등. 체질량지수와 이상체중을 이용한 비만도 판정기준간의 일치도 비교: 서울지역 일개 건강증진센터 수신자를 대상으로. 가정의학학회지. 2011;22(12):1765-1771
  5. Amatachaya S, Thaweewannakij T, Adirek-udomrat J, et al. Factors related to obstacle crossing in independent ambulatory patients with spinal cord injury. J Spinal Cord Med. 2010;33(2):144-149.
  6. Berger W. Characteristics of locomotor control in children with cerebral palsy. Nerosci Biobehav Rev. 1998;22:579-582. https://doi.org/10.1016/S0149-7634(97)00047-X
  7. Chou LS, Draganich LF, Song SM. Minimum energy trajectories of the swing ankle when stepping over obstacles of different heights. J Biomech. 1997;30:115-120. https://doi.org/10.1016/S0021-9290(96)00111-X
  8. Chou LS, Kaufman KR, Brey RH, et al. Motion of the Whole body's center of mass when stepping over obstacles of different heights. Gait Posture. 2001;13(1):17-26. https://doi.org/10.1016/S0966-6362(00)00087-4
  9. Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol. 2003;45:652-657.
  10. Farnandes T. Independent mobility for children with disabilities. Int J Ther Rehabil. 2006;13(7):320-333.
  11. Forssberg H. A neural control model for human locomotion development: implications for therapy. Med Sport Sci. 1992;36:174-181.
  12. Fowler EG, Kolobe TH, Damiano DL, et al. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: Section on pediatrics research summit proceedings. Phys Ther. 2007:87(11):1495-1510. https://doi.org/10.2522/ptj.20060116
  13. Gage JR, Deluca PA, Renshaw TS, Gait analysis: Principles and applications. J Bone Joint Surg Am. 1995;77(10):1617-1623.
  14. Gunel MK, Tarsuslu T, Mutlu A, et al, Investigation of interobserver reliability of the Gillette functional assessment questionnaire in children with spastic diparetic cerebral palsy. Acta Orthop Traumatol Turc. 2010;44(1):63-69. https://doi.org/10.3944/AOTT.2010.2218
  15. Hayek S, Hemo Y, Chamis S, et al. The effect of community-prescribed ankle-foot orthoses on gait parameters in children with spastic cerebral palsy, J Child Orthop. 2007;1(6):325-332. https://doi.org/10.1007/s11832-007-0055-z
  16. Holsbeeke L, Kelelaar M, Schoemaker MM, et al. Capacity, capability, and performance: Different constructs or three of a kind? Arch Phys Med Rehabil. 2009;90(5):849-855. https://doi.org/10.1016/j.apmr.2008.11.015
  17. Johnson A. Prevalence and characteristics of children with cerebral palsy in Europe, Dev Med Child Neurol. 2002;44(9):633-640.
  18. Law LS, Webb CY. Gait adaptation of children with cerebral palsy compared with control children when stepping over an obstacle. Dev Med Child Neurol. 2005:47(5):321-328. https://doi.org/10.1017/S0012162205000617
  19. Lawman HG, Wilson DK, Van Horn ML, et al. The relationship between psychosocial correlates and physical activity in underserved adolescent boys and girls in tl,e ACT trial. J Phys Act Health. 2011;8(2):253-261. https://doi.org/10.1123/jpah.8.2.253
  20. Leonard C, Moritani T, Hirschfeld H, et al. Deficits in reciprocal inhibitions of children with cerebral palsy as revealed by H reflex testing. Dev Med Child Neurol. 1990;32:971-984.
  21. Liao HF, Jeng SF, Lai JS, et al. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol. 1997;39(2):106-112.
  22. Palisano RJ, Tieman BL, Walter SD, et al. Effect of environmental setting on mobility methods of children with cerebral palsy. Dev Med Child Neurol 2003;45(2):113-120.
  23. Palisano RJ, Kang LJ, Chiarello LA, et al, Social and community participation of children and youth with cerebral palsy is associated with age and gross motor function classification. Phys Ther. 2009;89(12):1304-1314. https://doi.org/10.2522/ptj.20090162
  24. Paul SM, Siegel KL, Malley J, et al. Evaluating interventions to improve gait in cerebral palsy: A meta-analysis of spatiotemporal measures. Dev Med Child Neurol. 2007:49(7):542-549. https://doi.org/10.1111/j.1469-8749.2007.00542.x
  25. Petrarca M, Di Rosa G, Cappa P, et. al. Stepping over obstacles of different heights: Kinematic and kinetic strategies of leading limb in hemiplegic children. Gait Posture. 2006:24(3):331-341. https://doi.org/10.1016/j.gaitpost.2005.10.010
  26. Rodby-Bousquet E, Hagglund G. Use of manual and powered wheelchair in children with cerebral palsy: A cross-sectional study. BMC Pediatr. 2010;10:59. https://doi.org/10.1186/1471-2431-10-59
  27. Rosenbaum P, Paneth N, Leviton A, et al. A report: The definition and classification of cerebral palsy. Dev Med Child Neurol Suppl. 2007;109:8-14.
  28. Said CM, Goldie PA, Patla AE, et al. Effect of stroke on step characteristics of obstacle crossing. Arch Phys Med Rehabil. 2001;82(12):1712-1719. https://doi.org/10.1053/apmr.2001.26247
  29. Said CM. Goldie PA, Culham E, et al. Control of lead and trail limbs during obstacle crossing following stroke. Phys Ther. 2005;85(5):413-427.
  30. Salminen AL, Brandt A, Samuelsson K, et al. Mobility devices to promote activity and participation: A systematic review. J Rehabil Med. 2009;41(9):697-706. https://doi.org/10.2340/16501977-0427
  31. Shumway-Cook A, Patla AE, Stewart A, et al. Environmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther. 2002:82(7):670-681.
  32. Tefft D, Guerette P, Furumasu J. Cognitive predictors of young children's readiness for powered mobility. Dev Med Child Neurol. 1999:41(10):665-670. https://doi.org/10.1017/S0012162299001371
  33. Trefler E, Fitzgerald SG, Hobson DA, et al. Outcomes of wheelchair systems intervention with residents of long-term care facilities. Assist Technol. 2004;16(1):18-27. https://doi.org/10.1080/10400435.2004.10132071
  34. van der Heide JC, Hadders-Algra M. Postural muscle dyscoordination in children with cerebral palsy. Neural Plast. 2005:12(2-3):197-203.
  35. White H, Jenkins J, Neace WP, et al. Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: A retrospective study. Dev Med Child Neurol. 2002;44(4):227-232. https://doi.org/10.1017/S0012162201001992
  36. Williams EN, Carroll SG, Reddihough DS, et al. Investigation of the timed 'up & go' test in children. Dev Med Child Neurol. 2005;47(8):518-524. https://doi.org/10.1017/S0012162205001027
  37. Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance? Neural Plast. 2005;12(2-3):211-219. https://doi.org/10.1155/NP.2005.211