Joseph J Krzak1, Daniel M Corcos2, Diane L Damiano3, Adam Graf4, Donald Hedeker5, Peter A Smith6, Gerald F Harris7. 1. Midwestern University, Physical Therapy Program, College of Health Sciences, 555 31st Street, Downers Grove, IL, United States; Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States. Electronic address: joekrzak@sbcglobal.net. 2. Northwestern University Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, 645 North Michigan Avenue, Chicago, IL, United States. 3. National Institutes of Health, Functional & Applied Biomechanics Section, 10 Center Drive, Bethesda, MD, United States. 4. Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States. 5. University of Chicago, Department of Public Health Sciences, 5841 South Maryland Avenue, Chicago, IL, United States. 6. Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States; RUSH University Medical Center, Department of Orthopaedic Surgery, College of Medicine, 1611 West Harrison Street, Chicago, IL, United States. 7. Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States; Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 735 North 17th Street, Milwaukee, WI, United States.
Abstract
BACKGROUND: Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. OBJECTIVE: To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. METHODS: In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. RESULTS: PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. CONCLUSION: This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s).
BACKGROUND: Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. OBJECTIVE: To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. METHODS: In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. RESULTS: PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. CONCLUSION: This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s).
Authors: William R Ledoux; Jane B Shofer; Douglas G Smith; Katrina Sullivan; Shane G Hayes; Mathieu Assal; Gayle E Reiber Journal: J Rehabil Res Dev Date: 2005 Sep-Oct
Authors: Stefanos Tsitlakidis; Nicholas A Beckmann; Sebastian I Wolf; Sébastien Hagmann; Tobias Renkawitz; Marco Götze Journal: J Clin Med Date: 2022-05-02 Impact factor: 4.964
Authors: Stefanos Tsitlakidis; Axel Horsch; Felix Schaefer; Fabian Westhauser; Marco Goetze; Sebastien Hagmann; Matthias C M Klotz Journal: J Clin Med Date: 2019-10-11 Impact factor: 4.241
Authors: Stefanos Tsitlakidis; Sarah Campos; Nicholas A Beckmann; Sebastian I Wolf; Sébastien Hagmann; Tobias Renkawitz; Marco Götze Journal: J Clin Med Date: 2022-08-17 Impact factor: 4.964