Case of the week - 01/09/98


This case is to be presented for discussion at the European Society for Movement Analysis in Children Annual Meeting in Belfast, 24th-26th September 1998.

Discussion is welcomed before the event. Address any comments to CGA ([n/a]).

Case KA is a 6½ year old girl with mild Spastic Diplegia with asymmetrical involvement. She is an independent ambulator complaining of a (L) in-toeing gait with occasional tripping. She walks with a ‘jump-knee’ pattern bilaterally with a tendency to hyper-extension on the (L).

In the past she has been treated with serial casting for a tight (L) tendo-achilles with temporary benefit, has used a (L) DAFO and AFO which were discontinued because they increased internal rotation on this side, and has been considered for a (L) TA release by the referring Orthopaedic Surgeon. She currently uses a (L) night splint only.

On examination she has no fixed deformities at the hips or knees and no fixed equinus. There is mildly increased femoral anteversion (L) > (R). Duncan Ely test is mildly positive (L) > (R) and popliteal angles are within normal limits. There is mild tendo-achilles tightness of the (L) ankle which is correctable to plantigrade and a slightly adducted forefoot correctable to neutral. The (L) peronei are weak. Ankle clonus is positive on the (L) side only. Generally she has good muscle strength and excellent selective control.
  R.O.M (R) R.O.M (L) Strength (R) Strength (L)
Hip flexion  FR FR 5 4
Hip Extension (Thomas test) -ve -ve 4 4
Hip abduction (hip ext/knee flex) 60 60    
Hip abduction (hip ext/knee ext) 50 50 4 4
Hip internal rotation 70 90    
Hip external rotation 30 20    
Knee flexion FR FR 5 5
Knee extension 0 0 4 4
Popliteal angle 30 30    
Dorsiflexion (knee flexed) 10 0 4 3+/4
Dorsiflexion (knee extended) 10 0    
Forefoot inversion     4 4
Forefoot eversion     4 2
Duncan Ely (Fast) +ve +ve    
Ankle Clonus -ve +ve    

Temporal Parameters:
Left Right
cadence (steps(min):  147 147
speed (m/s): 1.03 1.01
step length (m): 0.44  0.39

Movies (PC users get the QuickTime plug-ins here - right mouse-click "Save Link as..." - Windows 95/NT and 3.1)

The movies will open in new browser windows so you can view them simultaneously with analysis.
movie format  QuickTime QuickTime
  left side front view
  right side rear view
3D Kinematics right and left

3D Kinematics repeatability left ... 3D Kinematic repeatability right

3D Kinetics right and  left

EMG left ... EMG right

... points for discussion:

What people said...

Case supplied by Richard Baker
Case prepared by Mag. Andreas Kranzl 

Email your comments to [n/a]

Maintained by DDr. Chris Kirtley, Andreas Kranzl 
Last modified on Wednesday, 13-August 1998.


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