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3-D lower extremity bone morphology in ambulant children with cerebral palsy and its relation to gait - 18/05/21

Doi : 10.1016/j.rehab.2019.03.001 
Rodolphe Bailly a, c, , Mathieu Lempereur b, c, d, Christelle Pons a, b, c, d, Laetitia Houx a, b, c, Matthias Thepaut a, b, c, Bhushan Borotikar c, d, Raphael Gross e, f, Sylvain Brochard a, b, c, d
a Paediatric Physical and Rehabilitation Department, Ildys Fondation, Ty Yann Establishment, 29200 Brest, France 
b Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France 
c National Institute of Health and Medical Research (Inserm) UMR 1101, Medical Data Treatment (LaTIM), 29200 Brest, France 
d Western Britany University, 29200 Brest, France 
e Physical and Rehabilitation Medicine Department, University Hospital of Nantes, 44200 Nantes, France 
f Laboratory “Motricité, Interactions, Performance” (EA 4334), UFR STAPS, University of Nantes, 44300 Nantes, France 

Corresponding author. Paediatric Physical and Rehabilitation Department, Ildys Fondation, Ty Yann Establishment, rue Alain-Colas, 29200 Brest, France.Paediatric Physical and Rehabilitation Department, Ildys Fondation, Ty Yann Establishmentrue Alain-ColasBrest29200France

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Highlights

Little is known about the 3-D morphology of lower-extremity bones in children with cerebral palsy (CP) and the association with gait deviations.
CP had a greater effect on bone shape than bone size.
Neck shaft angle was greater for unilateral CP limbs and femoral torsion was greater for bilateral CP limbs.
Bone shape was more complex and deformities were more 3-D for bilateral than unilateral CP limbs.
Few bone parameters were correlated with the Gait Deviation Index in any group.

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Abstract

Changes in lower-extremity bone morphology are potential mid- to long-term secondary consequences of cerebral palsy (CP), affecting activity. Little is known about the 3-D morphology of lower-extremity bones in children with CP and the association with gait deviations. The main aim of this study was to describe and compare 3-D lower-extremity bone morphology in ambulant children with unilateral or bilateral CP. Secondary aims were to determine whether certain bone parameters were related to the unilateral or bilateral CP and to quantify the association between bone parameters and gait deviations. Among 105 ambulant children with CP (aged 3 to 17 years), 48 had bilateral CP (Bilat-CP) and 57 had unilateral CP (Unilat-CP); the unaffected limb of children with Unilat-CP was used as control limbs. Fifteen bone parameters were calculated by EOS® biplanar radiography, and the Gait Deviation Index (GDI) was calculated by 3-D gait analysis. Data were compared by descriptive and comparative statistical analysis (Anova, principal component analysis [PCA] and focused-PCA). Mean (SD) neck shaft angle was significantly greater for Unilat-CP than control limbs (134.9° [5.9] vs. 131.3° [5]). Mean mechanical tibial angle was significantly smaller (85.8° [6.7] vs. 89° [4.6]) and mean femoral torsion was significantly greater (29.4° [1.6] vs. 19.1° [11.8]) for Bilat-CP than control limbs. On PCA of the main determinants of 3-D bone morphology, bone shape was more complex with Bilat-CP, with changes in all 3 dimensions of space, than Unilat-CP and control limbs. Few bone parameters were correlated with the GDI in any limbs. In ambulant children with CP, femoral and tibial growth are not affected by the condition. The unilateral or bilateral nature of CP must be considered during treatment to prevent bone deformities and bone morphology affecting gait quality.

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Keywords : Cerebral palsy, Lower extremity, Gait, Child, 3-D morphology


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© 2019  Publié par Elsevier Masson SAS.
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Vol 64 - N° 3

Article 101254- mai 2021 Retour au numéro
Article précédent Article précédent
  • Characteristics of newly acquired gait in toddlers with unilateral cerebral palsy: Implications for early rehabilitation
  • Anca Irina Grigoriu, Mathieu Lempereur, Sandra Bouvier, Liliana Padure, Sylvain Brochard
| Article suivant Article suivant
  • Criterion validity of assessment methods to estimate body composition in children with cerebral palsy: A systematic review
  • D.A.C. Snik, N.M. de Roos

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