Abstract
Many children with spina bifida who require long term and costly clinical management and rehabilitation are seen at the Ontario Crippled Children's Centre (OCCC). The aims of orthopaedic management can best be achieved through an “effective” assessment of each child, which guides the provision of conservative and operative treatment throughout infancy and childhood.
Surgery and orthotic aids are the major ways available to correct or prevent the formation of orthopaedic deformities. At present the only way of assessing an orthosis is to wait and see if it improves function or prevents a deformity.
This paper addresses pilot work undertaken to elucidate the factors which contribute to deformity progression in the lower limbs. The intent was to measure these factors in as cost effective and non-invasive a manner as possible and utilize the information gained in orthotic assessment and development for these children.
The initial goal of the study was to quantify the effect of a prescribed orthosis upon the gait of each child. Some 15 children with a lumbar or sacral level myelomeningocele have been examined in a total of 59 trials. The data collection process involved a three stage protocol implemented by the orthopaedist, physical therapist and engineer. A comprehensive clinical examination, a visual gait assessment from video-tape and an instrumented gait assessment were performed in the OCCC gait laboratory. Assessment criteria were proposed and extracted from the data collected. These criteria were posed after examining the frequency distribution of certain features of gait in the study group. A case study illustrating the application of the assessment is provided.
In examining the performance and influence of an orthosis upon a child's gait situations were identified in which no clear statement of “best” or “better” could be made. The value of the assessment was to point out the trade-offs and relative merits of selected orthotic options. By combining the objectivity of data acquired with gait analysis instrumentation with the subjective, but tangible, skills of the experienced observer, significant improvement in performance of the assessment is likely.
Additional information
Notes on contributors
D. Jones
Joyce Laing works in the Department of Child and Family Psychiatry, Playfield House, Cupar, Fife, and is a Consultant Art Therapist to Psychiatric Hospitals and Prisons and Chairwoman of the Scottish Society of Art and Psychology.
Dr Niculescu Dan, Centrul de Reumatologie, Str. J. (F)ucick no. 5, Bucuresti, Romania
Anni Vilppula, Department of Medicine, Paimio Hospital, Preitilä, Finland
G. Tausch, Department of Rheumatology, Municipal Hospital of Vienna-Lainz, Wolkersbergenstraße 1, A-1130Wien, Austria
Dr Guido Gothoni, Medica Pharmaceutical Company Ltd., P.O. Box 325, SF-00101 Helsinki 10, Finland
A. Elman, Dept. of Rheumatology, Karolinska sjukhuset, Stockholm, Sweden
Hannu Paitälä, Rheumatism Foundation Hospital, Heinola, Finland
Jonas Jonsson, National Bacteriological Laboratory, S-105 21 Stockholm, Sweden