Publications by authors named "Catia Miyuki Kawamura"

10 Publications

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Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial.

Trials 2021 Jul 19;22(1):463. Epub 2021 Jul 19.

Neurology/Neuroscience program, Federal University of São Paulo - UNIFESP, Botucatu street, 862 - 5° floor Edifico Ciências Biomédicas, São Paulo, Brazil.

Background: Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance.

Objective: To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke.

Methods: The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups.

Results: Data collection is currently on-going and results are expected in 2021.

Discussion: LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities.

Trial Registration: www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".
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http://dx.doi.org/10.1186/s13063-021-05424-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287769PMC
July 2021

Comparison between semitendinosus transfer to distal femur and medial hamstrings surgical lengthening for treatment of flexed knee gait in cerebral palsy.

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(1):2309499020910978

Engineering Department, Gait Laboratory, Association for the Care of Disabled Children, São Paulo, Brazil.

Purpose: Hamstrings surgical lengthening (HSL) has been frequently used for the treatment of flexed knee gait in cerebral palsy; however, recurrence of knee flexion deformity (KFD) and increase of anterior pelvic tilt (APT) were reported in a long-term follow-up.

Research Question: The aim of this study was to compare semitendinosus transfer to distal femur (STTX) and semitendinosus surgical lengthening (STL) regarding the reduction of KFD and the increase of APT after flexed knee gait treatment.

Methods: One hundred and eleven patients were evaluated and they were divided into two groups according to surgical procedures at knees: group A (65 patients/130 knees), including patients who received medial HSL as part of multilevel approach; group B (46 patients/92 knees), represented by patients who underwent orthopedic surgery including an STTX instead of STL.

Results: Fixed knee flexion deformity (FKFD) decreased only in group B (from 6.79° to 2.96°, < 0.001) after intervention. In kinematics, APT increased from 16.38° to 19.03° in group A ( = 0.003), while group B also increased from 15.26° to 20.59° ( < 0.001). The minimum knee flexion in stance phase (MKFS) reduced from 25.34° to 21.65° ( = 0.016) in group A and from 31° to 19.57° ( < 0.001) in group B. In the comparison between groups A and B, the increase of APT ( = 0.028) and reduction of FKFD ( < 0.001), popliteal angle ( 0.001), bilateral popliteal angle ( = 0.003) and MKFS ( 0.006) were higher after STTX than STL.

Conclusion: In the present study, patients who received STTX exhibited more improvement of knee extension at clinical examination and during gait than those who underwent to STL; however, STTX was not effective to prevent the increase of APT after flexed knee gait treatment.
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http://dx.doi.org/10.1177/2309499020910978DOI Listing
December 2020

The effect of the Majestro-Frost procedure on internal hip rotation during gait in patients with cerebral palsy.

Gait Posture 2018 10 18;66:32-37. Epub 2018 Aug 18.

Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.

Background: Muscle imbalance is related to persistent internal hip rotation (IHR) after femoral derotation osteotomy (FDO) in cerebral palsy (CP). The aim of this study was to evaluate the effect of the Majestro-Frost soft tissue procedure (MFP), which potentially addresses muscle imbalance, on IHR in CP patients during walking.

Methods: A retrospective study of an existing database (medical records and gait laboratory data) was conducted and a search was performed using the following inclusion criteria: (1) diagnosis of spastic CP, (2) GMFCS levels I-III; (3) mean IHR during stance phase higher than 11° at baseline; (4) individuals who received single event multilevel orthopedic surgery in the lower limbs and had three-dimensional gait analyses (3DGA) before and after the intervention. Patients who underwent a FDO were excluded. Eighty-three individuals were considered for the study and they were divided into two groups: No MFP (45 patients who did not receive a MFP) and MFP (36 patients who underwent a MFP). A full clinical examination and 3DGA, with kinematics calculated according to a standard software procedure (Plugin Gait), were performed before and after the intervention, and the results were compared.

Results: The studied groups matched regarding demographic data and GMFCS distribution. The mean follow-up time was more than 20 months on both groups. The increase of clinical external hip rotation (EHR) on physical examination was observed only in the MFP group (from 26.4° to 33°, p = 0.002). During gait analysis, IHR decreased from 21.2° to 4.5° in the MFP group (p < 0.001) and from 16.9° to 7.9° in the No MFP group (p < 0.001). The reduction of IHR during gait was more significant in the MFP group (p = 0.001).

Significance: In the present study, patients who underwent a MFP showed more reduction of IHR during gait than those which did not undergo a MFP.
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http://dx.doi.org/10.1016/j.gaitpost.2018.08.014DOI Listing
October 2018

The increase of anterior pelvic tilt after crouch gait treatment in patients with cerebral palsy.

Gait Posture 2018 06 5;63:165-170. Epub 2018 May 5.

Pediatric Orthopedic Surgeon, Gait Laboratory and Cerebral Palsy Clinic, AACD, São Paulo, Brazil.

Background: The increase of anterior pelvic tilt (APT) has been described after the treatment of crouch gait in cerebral palsy (CP). The ideal treatment option for flexed knee gait in CP should provide knee extension improvement in the stance phase without generating the increase of APT.

Research Question: The purpose of this study was to compare three different approaches used for the treatment of crouch gait in CP [distal femur extension osteotomy (DFEO), patellar tendon shortening (PTS) and the combination of DFEO +PTS] regarding the increase of APT after the interventions.

Methods: The inclusion criteria were: (1) diagnosis of spastic diplegic CP, (2) GMFCS levels I-III, (3) patients who underwent DFEO and/or PTS and (4) with complete documentation in the gait laboratory before and after the intervention. The included patients were divided into 3 groups, according to the procedures performed for crouch gait treatment: PTS (19 patients), DFEO (54 patients) and PTS + DFEO (22 patients).

Results: During stance phase, knee flexion decreased from 41.6 to 13.6 in the PTS group (p < 0.001), from 46.0 to 30.7 in the DFEO group (p < 0.001) and from 52.3 to 29.5 in the PTS + DFEO group (p < 0.001). APT increased 14 (p < 0.001) in the PTS group, 7.1° (p < 0.001) in the DFEO group and 6.6 (p < 0.001) in the PTS + DFEO group after surgical intervention. The PTS group presented a more significant deterioration of pelvic tilt than the DFEO (p = 0.002) and PTS + DFEO (p = 0.001) groups. The increase of APT was higher when HSL was also performed in the PTS + DFEO group (p = 0.016).

Significance: The increase of APT was observed in all studied groups, but it was more significant for those who underwent a PTS. The inclusion of HSL in the surgical plan was related a higher increase of APT in the PTS + DFEO group.
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http://dx.doi.org/10.1016/j.gaitpost.2018.05.002DOI Listing
June 2018

Correlation between physical examination and three-dimensional gait analysis in the assessment of rotational abnormalities in children with cerebral palsy.

Einstein (Sao Paulo) 2018 26;16(1):eAO4247. Epub 2018 Apr 26.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.
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http://dx.doi.org/10.1590/s1679-45082018ao4247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063750PMC
May 2018

DOES RECTUS FEMORIS TRANSFER INCREASE KNEE FLEXION DURING STANCE PHASE IN CEREBRAL PALSY?

Acta Ortop Bras 2016 Jan-Feb;24(1):27-31

. Associação de Assistência à Criança Deficiente (AACD), Gait Laboratory, São Paulo, SP, Brazil.

Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP).

Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment.

Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001).

Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.
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http://dx.doi.org/10.1590/1413-785220162401145765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775485PMC
April 2016

Most frequent gait patterns in diplegic spastic cerebral palsy.

Acta Ortop Bras 2014 ;22(4):197-201

Associação de Assistência à Criança Deficiente, São Paulo, SP, Brazil, Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brazil.

Objective: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures.

Methods: ONE THOUSAND EIGHT HUNDRED AND FIVE PATIENTS WERE DIVIDED IN SEVEN GROUPS REGARDING OBSERVED GAIT PATTERNS: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified.

Results: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others.

Conclusions: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.
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http://dx.doi.org/10.1590/1413-78522014220400942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167043PMC
December 2014

Outcomes of correction of internal hip rotation in patients with spastic cerebral palsy using proximal femoral osteotomy.

Gait Posture 2012 Jun 15;36(2):201-4. Epub 2012 Mar 15.

Association for the Care of Disabled Children, São Paulo (SP), Brazil.

Internal hip rotation (IHR) is the major cause of intoeing gait in patients with cerebral palsy (CP). Femoral derotation osteotomy (FDO) is the preferred treatment to correct excessive anteversion, however the condition may persist or recur postoperatively. Retrospective clinical and kinematic evaluation of 75 spastic diplegic CP patients was conducted for a mean duration of 22 months following proximal FDO. The patients were divided into two groups depending on the correction or persistence of IHR evident at kinematics after surgery. If corrected, mean patient follow-up was extended to 53 months. Outcomes were analyzed using Two Proportions Equality, Mann-Whitney and Wilcoxon tests. IHR persisted in 33.3% of cases at mean follow-up of 22 months and subtrochanteric femur osteotomy was more frequent in this group (p=0.033). Thirty-five of the fifty-four patients with first-round gait correction were monitored during the extended follow-up. Those for whom IHR recurred (9.5%) had undergone FDO at a comparatively younger age. Patient gender, operations prior to or at the time of femoral osteotomy, topographic classification, GMFCS level, or the extent of preoperative clinical and kinematic abnormalities had no apparent influence on persistence or recurrence of abnormal gait.
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http://dx.doi.org/10.1016/j.gaitpost.2012.02.015DOI Listing
June 2012

The relation of triceps surae surgical lengthening and crouch gait in patients with cerebral palsy.

J Pediatr Orthop B 2010 May;19(3):226-30

Association for the Care of Disabled Children (AACD), University of Santo Amaro, São Paulo, Brazil.

To investigate the effect of earlier triceps surae (TS) surgical lengthening at knee kinematics in the stance phase in patients with cerebral palsy (CP). One thousand and thirty-nine participants from an eligible total of 1750 children with CP were referred to gait analysis laboratory from January 2000 to April 2007. Inclusion criteria were the diagnosis of diparetic spastic CP levels I to III (GMFCS) and complete kinematics documentation. Patients with an asymmetrical knee pattern at kinematics and with different types of TS management among sides were excluded. The patients were divided into two groups according to the mean minimum knee flexion (MMKF) in stance phase: group A (n=253) MMKF > or =30 degrees and group B (n=786) MMKF less than 30 degrees . For each group, the occurrence of following procedures for TS in the past: (i) earlier surgery, (ii) gastrocnemius lengthening (zone I), (iii) gastrocnemius and soleus lengthening (zone II), and (iv) calcaneous tendon lengthening (zone III), was investigated. A chi test was applied to check if the number of procedures performed was different between groups. The level of significance was defined as P value of less than 0.05. The number of patients with no earlier surgeries at TS was higher in group B (51.8%) than in group A (39.1%), and this difference was significant (P<0.01). In addition, the number of procedures at the calcaneous tendon was more elevated in group A (36.8%) than in group B (27%), and this finding was statistically significant as well (P<0.02). The percentage of surgical lengthening at zones I and II was very similar between the groups A and B. This study has shown that patients without earlier surgical procedures at TS are more susceptible to reach better extension of the knees in the stance phase. Patients in a crouch gait had a higher number of calcaneous tendon lengthening performed in the past than patients with a more normal knee extension in the stance phase.
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http://dx.doi.org/10.1097/BPB.0b013e3283387cdbDOI Listing
May 2010

Comparison between visual and three-dimensional gait analysis in patients with spastic diplegic cerebral palsy.

Gait Posture 2007 Jan 23;25(1):18-24. Epub 2006 Jan 23.

Gait Laboratory, AACD Rehabilitation Center, São Paulo, Brazil.

Fifty patients with spastic diplegic cerebral palsy were included in this retrospective study which compared visual assessment of gait to three-dimensional (3D) gait analysis. Inter-observer variability was evaluated as well. Inclusion criteria comprehended independent ambulation (i.e. without assistive devices or orthoses). All subjects went through 3D gait analysis at the Gait Analysis Laboratory of the AACD Hospital. Four observers, viewing videotaped gait cycles, evaluated 10 specific points of interest of the cycle: hip flexion at terminal stance; knee flexion at initial contact; knee extension at terminal stance; knee flexion at initial swing; ankle dorsiflexion at initial contact; pelvic obliquity at mid stance; hip adduction at loading response; pelvic rotation; hip rotation at mid stance and foot progression angle, in relation to the lower limb, at mid stance. Their evaluation was then compared to the 3D kinematics data. A statistical analysis of the results was performed using kappa and McNemar's test in order to determine inter-observer and visual/3D analysis agreement. Results showed that inter-observer agreement was high but on the other hand, only two points of the gait cycle (knee flexion at initial contact and pelvic obliquity) were shown to have been similarly evaluated visually and with the 3D analysis. In conclusion, this study indicates that only knee flexion at initial contact and pelvic obliquity appear to be reliably evaluated on a visual basis alone. Visual observation is therefore inadequate for the evaluation of the other eight selected points of the gait cycle which require some form of quantitative assessment.
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http://dx.doi.org/10.1016/j.gaitpost.2005.12.005DOI Listing
January 2007
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