Evaluating the Effect of Crutch-using on Trunk Muscle Loads

As a traditional tool of external assistance, crutches play an important role in society. They have a wide range of applications to help either the elderly and disabled to walk or to treat certain illnesses or for post-operative rehabilitation. But there are many different types of crutches, including shoulder crutches and elbow crutches. How to choose has become an issue that deserves to be debated. Because while crutches help people walk, they also have an impact on the body. Inappropriate choice of crutches or long-term misuse can lead to problems such as scoliosis. Previous studies were mainly experimental measurements or the construction of dynamic models to calculate the load on joints with crutches. These studies focus only on the level of the joints, ignoring the role that muscles play in this process. Although some also take into account the degree of muscle activation, there is still a lack of quantitative analysis. The traditional dynamic model can be used to calculate the load on each joint. However, due to the activation of the muscle, this situation only causes part of the load transmitted to the joint, and the work of the chair will compensate the other part of the load. Analysis at the muscle level allows a better understanding of the impact of crutches on the body. By comparing the levels of activation of the trunk muscles, it was found that the use of crutches for walking, especially a single crutch, can cause a large difference in the activation of the back muscles on the left and right sides, and this difference will cause muscle degeneration for a long time, leading to scoliosis. In this article taking scoliosis as an example, by analyzing the muscles around the spine, we can better understand the pathology and can better prevent diseases. The objective of this article is to analyze normal walking compared to walking with one or two crutches using OpenSim software to obtain the degree of activation of different muscles in order to analyze the impact of crutches on the body

Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation

The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. the patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures and had no relation to the presence of hip dislocation. the authors concluded that reduction of the hip is unnecessary.Northwestern Univ, Childrens Mem Hosp, Sch Med, Chicago, IL 60614 USAEscola Paulista Med, Dept Paediat Orthopaed, BR-04023 São Paulo, BrazilEscola Paulista Med, Dept Paediat Orthopaed, BR-04023 São Paulo, BrazilWeb of Scienc

Laboratorial analysis of the myelomeningocele gait of lower lumbar level and unilateral hip instability

This study examines the influence of unilateral hip dislocation or subluxation in the gait of 20 low-lumbar myelomeningocele patients, community ambulators with AFOs and crutches, utilizing gait analysis. The patients were divided in two groups, Group 1 - 10 patients: complete absence or presence of symmetrical hip contractures (flexion and/or adduction) and Group 2 -10 patients : presence of unilateral or asymmetrical hip contractures. Pelvic and hip kinematics were analyzed to assess the symmetry of them, between the involved and the non-involved side. Gait was considered symmetrical in 7 studies in Group 1 and in 2 studies in Group 2. Assymmetrical gait was found in 3 studies of Group 1 and in 8 studies in Group 2. Gait symmetry was correlated with the absence of hip contractures or bilateral symmetrical hip contractures (Group 1). The asymmetrical pattern was related mainly to the presence of unilateral or unequal hip contractures. This study shows that gait assymetry can not be attributed only to the hip instability but seems to be more related to unequal hip contractures, thus gait symmetry could probably be achieved with the correction of the contractures involved, either by soft tissue or bone procedures.Este estudo examina a influência da instabilidade unilateral do quadril sobre a marcha de pacientes portadores de mielomeningocele, nível lombar baixo e instabilidade unilateral do quadril. Foram estudados através da análise laboratorial de marcha, 20 pacientes deambuladores comunitários utilizando goteiras e muletas, com luxação ou subluxação unilateral do quadril. , Os pacientes foram sub divididos em dois grupos. Grupo 1 (10 pacientes) , que não apresentavam contraturas do quadril (flexão e/ou adução) ou as apresentavam de forma simétrica entre os lados; e Grupo 2 (10 pacientes), que apresentavam contraturas assimétricas de quadril A cinemática do quadril e da pelve foi analisada no sentido de se avaliar a simetria entre o lado envolvido e o oposto. Sete pacientes do Grupo 1 e 2 do Grupo 2 apresentaram marcha simétrica. Marcha assimétrica foi encontrada em 3 pacientes do Grupo 1 e 7 pacientes do Grupo 2. A assimetria na marcha relacionou-se principalmente com a presença de contraturas de quadril unilaterais ou bilaterais mas assimétricas. Demonstrou-se que a assimetria da marcha não pode ser atribuída somente à instabilidade do quadril, mas parece estar mais relacionada com presença de contraturas unilaterais ou assimétricas e cujo tratamento deveria ser o objetivo em detrimento de reduções cirúrgicas do quadril.Universidade de Caxias do Sul Dept. Clínica CirúrgicaChildren's Memorial Hospital Laboratório de Análise de MarchaChildren's Memorial Hospital Laboratório de Análise de Marcha Depto. de OrtopediaUNIFESP-EPM Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL