Case of the week - 8/02/2001

from Labor fuer Gang- und Bewegungsanalyse Orthopaedisches Spital Speising,Vienna, Austria

A 14 year old boy with diplegic cerebral palsy, pre & post tendon-lengthening surgery

This child underwent bilateral achilles tendon lengthening at 4 years, and was analysed prior to further surgery.

Two further analyses were then performed at 6 and 12 months post-op. He also underwent intensive physical therapy during this time.

Surgery performed:

Physical examination

 
pre-op
6 mo. post-op
 12 mo. post-op
Degrees
Right
 Left Right Left Right Left
Hip flex/ext 130-0-15 130-0-25 100-10-0 100-10-0 120-0-0 110-0-0
Hip abduction  30 15 35 30 45 45
Hip adduction normal normal 20 30 30 30
Hip abductor power 4 3 4 3 4 3
Knee flex/ext 140-0-5 140-5-0 115-0-0 145-10-0 110-0-0 120-0-0
Rectus spasticity ++ + ++ ++ + +
Hamstrings spasticity ++ + ++ + + +
Femoral anteversion 60 60 50 50 50 50
Tibial torsion  5 external 5 external 12 15 15 15
Ankle dorsi/plant
(knee at 90)		 10-0-30 5-0-30 10-0-30 10-0-30 15-0-40 20-0-40
Ankle dorsi/plant
(knee at 0)		 0-5-35 0-30-35 0-0-30 0-5-30 0-0-45 0-0-45
Triceps clonus ++ ++ ++ + ++ +

Movies
 
 
pre-op
6 mo. post-op
 12 mo. post-op
 
sagittal
 frontal
sagittal
 frontal
sagittal
 frontal
movie format
AVI
AVI
AVI
AVI
AVI
AVI
 
 left side front view left side front view left side front view
  right side rear view right side rear view right side rear view

Temporal-Spatial Parameters... summary chart

pre-op
6 mo. post-op
 12 mo. post-op
Right Left Right Left Right Left
Velocity (cm/s) 97 93 116.83 111.89
Cadence (steps/min) 104 106 109.36 107.76
Step Length (cm) 49.8 58.8 62.40 66.26 62.91 63.03
Stride Length (cm) 106 109 129.4 126.08
Step Width (cm) 14.8 14.8 14.11 15.08
Stance (%) 69 59 64.99 57.40 63.18 56.73
Double Support (%) 12.1 14.5 11.2 10.2 11.6 9.3

3D Biomechanical Analysis (EVa6, Orthotrak, Motion Analysis Corp.) &  Dynamic EMG (Noraxon)

pre
post-op
3D Joint Kinematics Upper-body Kinematics 3D Joint Kinematics, right 3D Joint Kinematics, left  Upper-body Kinematics Summary chart
Joint Kinetics Joint Kinetics, right  Joint Kinetics, left  Summary chart
Right EMG Left EMG Right EMG,  6 mo. post-op Left EMG,  6 mo. post-op Right EMG,  12 mo. post-op Left EMG  12 mo. post-op

What people said prior to the post-operative analyses...

... points for discussion:

What people said after that ...

Case supplied by Mag.AndreasKranzl
from Orthopaedisches Spital Speising, Labor fuer Gang- und Bewegungsanalyse,Speisinger Strasse 109, 1130 Wien, Austria.

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