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  • Küçük Resim
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    Clinical and gait analysis of isolated soft tissue release surgery in crouch gait patients
    (2019) Gülenç, Barış; Kuchimov, Shavkat; Temelli, Yener
    Aim: The aim of this study was to evaluate whether isolated soft tissue release operation provides clinical and kinematic improvement in crouch gait, which is one of the major walking problems in cerebral palsy (CP) patients.Material Methods: This retrospective study included 32 limbs of 16 patients aged between 4 and 12 years with crouch gait walking pattern due to cerebral palsy between January 2004 and December 2013. All patients underwent multilevel isolated soft tissue release surgery. The preoperative and postoperative GMFSC level, clinical findings and gait analysis data of the patients were recorded. Pre-operative and post-operative data, which are obtained at post-op 6th month clinical examination and gait analysis, was compared.Results: A total of 114 lower extremity soft tissue segments (mean 7.1 segments) were operated. The most common surgery was medial hamstring lengthening (22). GMFCS score was 2.38±0.5 before operation, 1.69±0.4 at postoperative controls,and popliteal angle decreased from 65.2±11.9 to 60.15 (p <0.05) . There was no significant difference in the range of motion and joint forces of the hips, knees and ankle joints. According to the kinematic data, the minimum hip flexion (15.22±16.45 vs 7.33±14.34 p<0.05), initial contact knee flexion (33.25±14.26 vs 24.46±8.84 p<0.05) and maximum knee flexion in the swing phase (49.5±12 vs 43±11 p<0.05) were declined and midstance foot ankle dorsiflexion (-3.02±1 vs. 3.75±7 p<0.05) was increased. When the temporospatial data were compared, it was observed that cadence (104.71±38.5 vs 89.59±35.31 p <0.05), double support time (161.3±90.2 vs 150.09±81.91 p <0.05) decreased after surgery. While decrease in cadence was statistically significant, there was no significant difference between the double support time periods. However, step length (mm) (655.14±247.7 vs 767.5±307 p <0.05), the walking speed (m/s) (0.656±0.268 vs 0.667±0.267 p>0.05) and step width (mm)(144.41±50.61 147.94±87.8 p> 0.05) increased in postoperative evaluation.Conclusions: Single-session isolated soft tissue release surgeries have borth positive effect on clinical and functional outcomes in selected CP patients with crouch gait walking disorder. Priority should be to correct bone deformities in patients with bone deformity
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    Functional bandaging in children with idiopathic toe-walking
    (NLM (Medline), 2023) Tunçer, Deniz; Akalan, Nazif Ekin; Çalışkan, Meliha Mine; Temelli, Yener; Yiğit, Pakize
    BACKGROUND: Idiopathic toe-walking (ITW) is a persistent gait pattern with no known etiology characterized as premature heel rise or no heel contact. We investigated the effects of functional bandaging in children with ITW on heel contact during stance phase and on gait quality. METHODS: Nineteen children aged 4 to 16 years with ITW and ten age-matched healthy children were included in the study. Elastic adhesive bandages were applied to children with ITW to assist with dorsiflexion. Before bandaging (T0) and immediately (T1) and 1 week (T2) after initial bandaging, the initial contact, loading response, and midstance subphases of gait were analyzed using light pressure sensors and the Edinburgh Visual Gait Score (EVGS). Ten age-matched children with typical gait participated for comparison in T0. The data were analyzed with Friedman and Wilcoxon signed rank tests for within-group comparisons and Mann-Whitney U tests for between-group comparisons. RESULTS: In T0, for the ITW group, no heel contact was observed during stance. In T1, all of the participants achieved heel contact at initial contact and loading response and 56.8% at midstance. In T2, all of the heels continued contact at initial contact and loading response and 54.3% at midstance. The EVGS significantly improved. The Friedman test showed that there were noteworthy improvements between T0-T1 and T0-T2 in video-based observational gait analysis and EVGSs (P < .001), although no difference was found between T1-T2 in video-based observational gait analysis (P = .913) and EVGSs (P = .450). CONCLUSIONS: In children with ITW, dorsiflexion assistive functional bandaging was an effective tool to help achieve heel contact on the ground and improve walking quality for a short period after application. Further studies with longer follow-up and larger sample sizes are required to confirm the long-term therapeutic effects of this promising functional bandaging.