Premium
Activity and participation outcomes in children with hemiplegia following functional electrical stimulation neuroprosthesis use
Author(s) -
K DUNNING
Publication year - 2015
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.2_12886
Subject(s) - neuroprosthetics , functional electrical stimulation , physical medicine and rehabilitation , stimulation , medicine , electric stimulation therapy , physical therapy , psychology , neuroscience
physical examination (i.e. thigh-foot-angle, transmalleolar axis in extension and flexion), and abnormal kinematics (knee rotation and foot progression angles) as determined in the gait laboratory. Materials/Methods: Twenty patients with 29 limbs were prospectively entered for study. CT scans of the proximal and distal tibiofibular articulations were obtained pre-operatively and at 6 weeks and 1 year postoperatively. Measurements of tibia and fibula torsion were then performed. Qualitative assessment of proximal and distal joint congruency was also performed. Statistical analysis included variance (ANOVA) testing as well as post-hoc comparisons. Adjustments were made for multiple comparisons and the mean significant difference was set at a 0.05 level. Results: The internal tibia torsion group (ITT, 19 limbs) showed significant changes for the tibia from pre-op to post-op to 1 year time points (means 13.21°, 31.05°, 34.84°). The fibula in the ITT group also showed statistical difference at the 3 time points ( 36.77°, 26.77°, 18.54°). The external tibia torsion group (ETT, 10 limbs) showed significant differences from pre-op to post-op in the tibia, but not from post-op to 1 year (54°, 19.3°, 23.3°). The fibula in the ETT group did not change significantly between preand post-op, but did change significantly between post-op and 1 year ( 9.8°, 16.9°, 30.7°). Nine of 10 proximal tibiofibular joints in the ETT group were found to be subluxated at 6 weeks. At 1 year, all 9 of these joints had reduced. Conclusions/Significance: Correction of ITT by isolated distal tibial external rotation osteotomy results in acute external fibular torsion. The acute fibular torsion remodels over time to accommodate the corrected tibial torsional alignment and reduce the strain associated with the plastic deformity. Correction of ITT by isolated distal tibial external rotation osteotomy is safe and effective for deformities requiring up to approximately 40 degrees of correction. Rigid internal fixation is recommended to prevent loss of realignment due to the acute torsional forces applied to the fibula. Correction of ETT by isolated distal tibial internal rotation osteotomy results in subluxation of the proximal tibiofibular articulation in almost all cases. Subsequent torsional remodeling in the fibula resulted in correction of the subluxation in all cases. The clinical significance of the subluxation of the proximal tibiofibular joint subluxation is not clear and requires further study.