Akademik Veri Yönetim Sistemi
Demirbüken İ. (Yürütücü)
Yükseköğretim Kurumları Destekli Proje, 2016 - 2018
Introduction
Children with motor development problems generally have difficulties to sustain a static standing position, especially due to genu recurvatum deformity [1]. Shoe modification through adjustment of heel height is the most commonly used strategy in the treatment of genu recurvatum deformity. However, studies are limited concerning how external biomechanical changes influence the alignment of the body segments on different plans [2]. Therefore, the purpose of this study was to investigate the effects of shoe modification on postural alignment of children with motor development problem.
2. Research question
Does increasing heel height during standing position effect on postural alignment in children with cerebral palsy?
3. Methods
Fifteen children (mean weight 284kg, mean height 1246cm) aged between 4 and 14 have participated in the study. Goniometric measurements in upright position were used to normalize body alignments of children to determine proper heel height within the scope of shoe modification. Reducing knee hyperextension to 5 degrees was a key point as genu recurvatum is defined as knee extension greater than 5 degrees. Proper shoe modification was determined specific to each subject. Postural alignment from anterior, posterior and lateral views was assessed by using Posturography (PosturePrintTM, Biotonix, Canada) before and immediately after shoe modifications. Markers were placed to anatomical reference points of subjects and photographic assessments were performed by the system. Wilcoxon signed
rank test was used to analyze the data.
4. Results
Our findings demonstrated statistically significant differences between with and without shoe modifications in pelvis horizontal angle (p=0.007) and foot rotation angle (p=0.008). Although there were differences in all other angles, it was not statistically significant (p < 0.05).
5. Discussion
Our results showed that lifting the heels have effects on pelvis and ankle position in static conditions. These differences may have appeared related to heel lift effect of the ground reactive forces acting on the joints of the lower limb. Therefore clinicians should be cautious in recommending heel lift as a treatment for genu recurvatum since modifying shoe may lead to different impacts on postural chain in anterior, posterior andlateral planes, especially inthelower limbs. This studyhelpstounderstand thebiomechanicalbehaviorofpostureduring static conditions in different segments and views. Further studies may involve larger sample size or dynamic conditions.
References
[1] P. Rosenbaum, N. Paneth, A. Leviton, M. Goldstein, M. Bax, D. Damiano, et al., A report: the definition and classification of cerebral palsy April 2006, Dev. Med. Child Neurol. Suppl. 109 (February) (2007) 8–142. [2] A. Bartonek, C.M. Lidbeck, R. Pettersson, E.B. Weidenhielm, M. Eriksson, E. Gutierrez-Farewik, Influence of heel lifts during standing in children with motor disorders, Gait Posture 34 (3) (2011) 426–431.