Abstract
Objective. A comparison of plantar pressure distribution in hemiplegic children with a healthy
control group was performed to illustrate the link between the changing dynamics during
the stance phase and the degree of deficiency.
Design. Twenty three healthy control subjects and two groups of six hemiplegic children
with minor and major spasticity were tested.
Background. In previous studies, it was shown that the musculoskeletal dysfunction due to spasticity
disturbed the hemiplegic gait pattern, for example reduced walking speed and step
length. However, plantar pressure measurements which would help to understand the
pathological gait mechanisms have not been studied.
Methods. The stance phase parameters measured included spatio-temporal data and the relative
impulse measurements during consecutive gait cycles. The relative impulses under eight
plantar areas were determined with an in-shoe plantar pressure measurement device.
Results. Each group had a specific plantar pressure distribution profile that varied with
the degree of deficiency. The most significant differences were found beneath the
midfoot, the first metatarsal head and the hallux.
Conclusion. The neuromuscular disorders and foot deformities due to the cerebral lesion modified
the contact of the foot with the ground, and led to specific plantar pressure distribution
profiles. The equinovarus, with clawed-toe deformity due to greater spasticity, seemed
to be an important factor in disturbances of the terminal stance phase. However, the
spastic hemiplegic subjects seemed to adopt a gait pattern required for optimal stability.
Relevance From previous work, comparable data were available only for the hemiparetic adult
patients. In-shoe pressure data from spastic hemiplegic children can provide detailed
information specific to each region of contact for the support of diagnosis, a clinical
decision or the prescription of appropriate footwear, braces or othoses. Both peak
pressure and local impulse have proven to be valuable for the understanding of foot
function, lower extremity dysfunctions and walking strategies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dynamic plantar pressure distribution measurements in hemiparetic patients.Clin. Biomech. 1997; 12: 60-65
- Pressure distribution patterns under the feet of children in comparison with adults.Foot Ankle. 1991; 11: 306-311
- Plantar pressure distribution patterns of young school children in comparison to adults.Foot Ankle. 1994; 15: 35-40
- Plantar dynamics of hemiplegic gait: a methodological approach.Gait Posture. 1996; 4: 297-305
- Hemiplegic gait: analysis of temporal variables.Arch. Phys. Med. Rehabil. 1983; 64: 583-587
- Gait patterns in spastic hemiplegia in children and young adults.J. Bone Joint Surg. Am. 1987; 69: 437-441
- Gait patterns in children with hemiplegic spastic cerebral palsy.J. Pediatr. Orthop. 1996; 5: 247-251
- Preliminary trial of carisoprodol in multiple sclerosis.Practitioner. 1964; 192: 540-542
Schumacher, DPF. Final report: checking the measuring technical characteristics of the Parotec pressure distribution measuring system. 1995, TÜV Product Service, Munich, Germany
Parotec system instruction manual, Paromed Medizintechnik GmbH. 1997, Neubeuern, Germany
- Comparison of an in-shoe pressure measurement device to a force plate: concurrent validity of center of pressure measurements.Gait Posture. 2000; 12: 128-133
Milani TL, Hennig EM. Day-to-day variability of pressure distribution measurements during walking and running. In: Proceedings of the Sixth Biennal Conference of the Canadian Society for Biomechanics, August 16–19, 1990, Quebec, Canada
- Foot pressure patterns during gait.J. Biomed. Eng. 1985; 7: 120-126
- Intraday reliability of ground reaction force data.Hum. Mov. Sci. 1988; 7: 73-85
- Variability of temporal distance measurements in pathological gait studies.Gait Posture. 1996; 4: 169
- Is the objective assessment of cerebral palsy gait reproducible?.J. Pediatr. Orthop. 1994; 14: 705-708
- Reliability of pressure measurements: the EMED F system.Clin. Biomech. 1991; 61: 14-18
- Reliability of an in-shoe pressure measurement system during treadmill walking.Foot Ankle Int. 1996; 17: 204-209
- In shoe plantar pressure measurement: a review.The foot. 1992; 2: 185-194
- A new approach to movement control in children with cerebral palsy.Phys. Ther. Pract. 1993; 2: 19-29
- Mechanical energy patterns in gait of cerebral palsied children with hemiplegia.Phys. Ther. 1987; 67: 1348-1354
- Human walking.Williams & Wilkins, Baltimore, MD1981
- Optimisation of energy expenditure during walking.Eur. J. Appl. Phys. Occupat. Phys. 1974; 33: 293-306
- Spasticity: disordered motor control.in: Feldman R.G. Young R.R. Koella W.P. Symposium synopsis. Year Book Medical Publishers, Chicago1980
- La marche humaine: kinésiologie dynamique, biomécanique et pathomécanique.Masson, Paris1989
- Neurophysiology of lower-limb function in hemiplegic children.Dev. Med. Child Neurol. 1991; 33: 1037-1047
Rémy-Néris O, Denys K, Azouvi K, Jouffroy A, Faivre S, Laurans A, et al. Spasticité. Encycl Méd Chir, Kinésithérapie-Médecine Physique-Réadaptation. 1997;26-011-A-10
- Approche thérapeutique de la spasticité chez l'enfant.Ann. Réadaptation Méd. Phys. 1993; 36: 387-390
- La spasticité des membres inférieurs chez l'adulte.Neurochirurgia. 1998; 44: 167-174
- A clinical guide to assess the role of lower limb extensor overactivity in hemiplegic gait disorders.Stroke. 1999; 30: 580-585
- Effect of walking speed on plantar pressure patterns and hindfoot angular motion.Gait Posture. 1994; 2: 191-197
- Pathophysiology of gait in children with cerebral palsy.Electroencephalogr. Clin. Neurophysiol. 1982; 53: 538-548
- Spastic hemiplegia of the upper extremity in children.Hand Clin. 1998; 14: 119-134
- Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion.Muscle Nerve. 1997; 20: S1-S13
- Muscles alive, their functions revealed by electromyography.Williams & Wilkins, Baltimore1979
Article info
Publication history
Accepted:
April 3,
2002
Received:
July 19,
2001
Identification
Copyright
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
