Muscle Function in Deformed & Surgically Altered Limbs

描述：(申请人提供)这项工作的目标是建立一个 治疗蹲着步态的科学基础，这是最常见的动作之一 脑性瘫痪儿童的异常。蹲着的步态是典型的 膝关节持续屈曲，通常伴有过度屈膝 髋关节的屈曲、内收和内旋。这是一种效率极低的 运动方式；如果不矫正，往往会导致骨骼畸形， 骨关节炎，以及敏感的、终生的身体缺陷。肌肉骨骼 为了改善膝关节伸展，经常会进行手术。 然而，很难预测哪些患者将受益于 这些手术，部分是因为导致膝盖过度的因素 屈曲是未知的。这项研究将导致对蹲下的动态模拟 步态可以识别患者的潜在生物力学来源 常见运动异常及功能后果的预测 干预措施。 目标1-3将严格检查几个关于蹲步的假设原因， 包括腿筋和腰大肌痉挛，髋关节无力， 膝关节、脚踝伸肌、股骨和胫骨畸形。转发 将创建动态模拟，以再现实验测量的结果 45例脑性瘫痪患者的运动学和动力学研究。一系列 将分析不同复杂性的模拟，以确定哪些 假想的蹲下步态的原因导致每个受试者的膝盖僵硬 屈曲。目标4将评估我们的动态分析对指导的效用 通过确定受试者是否有好的(差的)结果来做出治疗决定 当实施的干预措施与我们的结果一致(不一致)时 模拟。这项工作将提供更好的指导方针来决定 患者应接受手术延长腿筋和/或腰大肌。 肌肉矫正蹲姿，哪些患者可能受益更多 从其他治疗，如加强运动或支撑。 尽管多关节运动异常，如蹲下步态 异常复杂，动态模拟的发展阐明了 在正常、受损和手术改变的患者中，肌肉如何参与运动 这里提出的肢体是实现以下目标的重要和必要的下一步 设计更有效的治疗方法。

DESCRIPTION: (provided by applicant) The goal of this work is to establish a scientific basis for treating crouch gait, one of the most common movement abnormalities among children with cerebral palsy. Crouch gait is characterized by persistent flexion of the knee, which is usually accompanied by excessive flexion, adduction and internal rotation of the hip. It is a highly inefficient means of locomotion; if not corrected it often leads to bone deformities, osteoarthritis, and senous, life-long physical limitations. Musculoskeletal surgeries are frequently performed in an effort to improve knee extension. However, it is extremely difficult to predict which patients will benefit from these procedures, in part, because the factors that cause excessive knee flexion are not known. This study will result in dynamic simulations of crouch gait that can identify the underlying biomechanical sources of patients' movement abnormalities and predict the functional consequences of common interventions. Aims 1-3 will rigorously examine several hypothesized causes of crouch gait, including spasticity of the hamstrings and psoas muscles, weakness of the hip, knee, and ankle extensors, and deformities of the femur and tibia. Forward dynamic simulations will be created that reproduce experimentally measured movement kinematics and kinetics of 45 subjects with cerebral palsy. A series of simulations of varying complexity will be analyzed to determine which of the hypothesized causes of crouch gait contribute to each subject's persistent knee flexion. Aim 4 will evaluate the utility of our dynamic analyses for guiding treatment decisions by determining whether subjects have good (poor) outcomes when interventions are performed that agree (disagree) with the results of our simulations. This work will provide improved guidelines for deciding which patients should undergo surgical lengthening of the hamstrings and/or psoas muscles to correct crouch gait, and which patients are likely to benefit more from other treatments, such as strengthening exercises or bracing. Although multijoint movement abnormalities such as crouch gait are exceptionally complex, the development of dynamic simulations that elucidate how muscles contribute to movements in normal, impaired, and surgically altered limbs, as proposed here, is an important and necessary next step toward designing more effective treatments.