Case of the week: 12-5-2005

Supplied by Mark Geil, Department of Kinesiology and Health


KS, a 6 y/o girl, DOB 5/1/2000, born 3 months premature. Bilateral lower-limb spasticity prior to Botox injections x 2. In June reported some pain in her left ankle. Mother reports patient drags left foot and inverts it.

Cast 6/16/04 for AFOs to prevent toe walking, pes planovalgus, and spasticity. Received bilateral articulated AFOs with plantarflexion stop, valgus control trimlines, and ankle cross-strap on 7/1/04.

Patient was evaluated for gross motor skills using the Peabody Gross Motor Development Skills Assessment.
Able to demonstrate skills #61-70 (12-14 months level). Patient could not demonstrate skills 71, 73, and 76 nor 79. (Refused and protested stairs. #79 tandem stance not accomplished.) Given patient’s reluctance to the evaluations, she is estimated at best to be in the 15-17 month stage of motor development. She exhibits spastic diplegia that has been aided by AFOs and Botox injections. She also appears to possibly have some visual deficits as she holds her head to one side and studies objects up close. Mother was told the patient is too young for visual testing.

Short –term goals (4-6 weeks): patient will demonstrate the ability to climb stairs with PT’s support utilizing one rail. Patient will demonstrate unsupported stance on one foot enabling her to kick a ball.
Long-term goals (7-12 weeks): Patient will demonstrate ability to walk on balance beam with one hand supported. Patient will demonstrate 2-legged jumping.

In September short-term goal #1 partially met.

Kinematic Analysis

Two analyses were used for kinematic assessment. Conventional analysis used an 8-camera 120 Hz Peak system and Motus 8.2 software. The Motus Kinecalc software was used with human gait processing based on Vaughan et al. For comparison, a second assessment used a single sagittal-view Sony digital video camcorder and Dartfish DartTrainer v2.5.3 software. Dartfish enables digital separation of subject from background for the purpose of superimposing different conditions or producing cloned images of the subject at different portions of the gait cycle, as well as basic 2-D analysis of temporal and spatial parameters and joint angle.
Barefoot Barefoot Kinematics Barefoot (.swf) Barefoot (.swf)
With AFOs 3-D Kinematic analysis with AFOs With AFOs (.swf) AFOs (.swf)

Pelvic Kinematics

Sagittal plane kinematics of the hip, knee, and ankle Other:


2-D Kinematic Analysis and Comparison

Two dimensional analysis is a simple, portable, low-cost alternative to instrumented 3-D motion analysis. Both approaches were used in this case to compare sagittal plane observations. Digital video was recorded using a Sony DV Minicam and analyzed using the Dartfish DartTrainer v2.5.3 software package.

Dartfish can be used to calculate temporal and spatial parameters based on a superimposed clock and distances calibrated to a known distance in a separate video clip.

Barefoot temporal and spatial parameters were calculated based on this video:

Compared to the same parameters calculated from the Peak 3-D analysis, some variability is present, but substantial trial-to-trial and step-to-step variability was noted in this subject.
Dartfish 2-D
Peak 3-D
Right step length (m)
Stride length (m)
0 .51
Mean walking speed (m/s)

The rhythmic changes in temporal and spatial parameters can be visualized when videos from each condition are superimposed. In addition, the changes in loading response due to the shoes and orthoses are evident.

Jump Knee Focus

Video analysis software was used to isolate the left knee during different phases of the gait cycle. Apart from basic visualization, the knee range of motion was  quantified. At initial contact, the left knee in the barefoot condition was measured at 38.9° of flexion. In early stance the knee extended to 2.2° flexion, a range 36.7° for that particular trial. Smaller ranges were quantified in the Peak 3-D analysis, on the order of 20°. (Quantification of joint angles is among the more challenging and possibly erroneous aspects of 2-D analysis.)

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