Dr. Steele, Author at Neuromechanics & Mobility Lab - Page 6 of 14

H Choi, TL Wren, KM Steele (2016) “Gastrocnemius operating length with ankle foot orthoses in cerebral palsy.” Prosthetics & Orthotics International

Dr. Steele JournalArticle, Orthoses July 16, 2016October 12, 2021AFO, Cerebral Palsy, Modeling, Simulation

Example of gastrocnemius operating length from one subject with different AFOs.

Journal article in Prosthetics & Orthotics International:

How does the operating length of the gastrocnemius vary with different common AFOs in children with cerebral palsy?

Background: Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.

Objectives: This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.

Study design: Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.

Methods: We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.

Results: Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.

Conclusion: Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.

Clinical relevance: Determining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.

CL Bennett, K Cen, KM Steele, DK Rosner, (2016) “An intimate laboratory? Prostheses as a tool for experimenting with identity and normalcy.” CHI Human Factors in Computing Systems, ACM

Dr. Steele Handathon, JournalArticle, Orthoses, UbiquitousRehabilitation May 6, 2016October 12, 20213D-printed, AccessEngineering, Exoskeleton, Fabrication, HackingHands, Identity, IntimateLab

Prostheses from the 15th century (medieval metal hand) to the 21st century (3D-printed enable hand).

Peer-review paper at CHI Human Factors in Computing Systems Annual Conference:

Prostheses are more than just a tool to enhance function – they strongly influence perceptions of identity and normalcy.

Abstract: This paper is about the aspects of ability, selfhood, and normalcy embodied in people’s relationships with prostheses. Drawing on interviews with 14 individuals with upper-limb loss and diverse experiences with prostheses, we find people not only choose to use and not use prosthesis throughout their lives but also form close and complex relationships with them. The design of “assistive” technology often focuses on enhancing function; however, we found that prostheses played important roles in people’s development of identity and sense of normalcy. Even when a prosthesis failed functionally, such as was the case with 3D-printed prostheses created by an on-line open-source maker community (e-NABLE), we found people still praised the design and initiative because of the positive impacts on popular culture, identity, and community building. This work surfaces crucial questions about the role of design interventions in identity production, the promise of maker communities for accelerating innovation, and a broader definition of “assistive” technology.

View the video for more information on this work.

EE Bulter, KM Steele, L Torburn, JG Gamble, J Rose (2016) “Clinical motion analyses over eight consecutive years in a child with crouch gait: a case report.” Journal of Medical Case Reports

Dr. Steele JournalArticle, MotorControl April 28, 2016October 12, 2021Cerebral Palsy, Crouch Gait, Pediatric

Journal article in the Journal of Medical Case Reports:

A case study of crouch gait over 8-years in a child with no surgical interventions.

Background: This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions.

Case presentation: A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient’s crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient’s crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient’s maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient’s minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index.

Conclusions: The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient’s clinical motion analyses. Overall, our patient’s crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child’s walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy.

BR Shuman, M Goudriaan, L Bar-On, MH Schwartz, K Desloovere, KM Steele (2016) “Repeatability of muscle synergies within and between days for typically developing children and children with cerebral palsy.” Gait & Posture.

Dr. Steele JournalArticle, MotorControl, Projects, Publications January 28, 2016October 12, 2021Cerebral Palsy, EMG, Gillette, Leuven, Synergy

Journal article in Gait and Posture:

Filtering parameters impact the results from muscle synergy analyses.

Abstract: Muscle synergies are typically calculated from electromyographic (EMG) signals using nonnegative matrix factorization. Synergies identify weighted groups of muscles that are commonly activated together during a task, such as walking. Synergy analysis has become an emerging tool to evaluate neuromuscular control; however, the repeatability of synergies between trials and days has not been evaluated. The goal of this study was to evaluate the repeatability of synergy complexity and structure in unimpaired individuals and individuals with cerebral palsy (CP). EMG data were collected from eight lower-limb muscles during gait for six typically developing (TD) children and five children with CP on two separate days, over three walking speeds. To evaluate synergy complexity, we calculated the total variance accounted for by one synergy (tVAF1). On a given day, the average range in tVAF1 between gait cycles was 18.2% for TD and 19.1% for CP. The average standard deviation in tVAF1 between gait cycles was 4.9% for TD and 5.0% for CP. Average tVAF1 calculated across gait cycles was not significantly different between days for TD or CP participants. Comparing synergy structure, the average (standard deviation) within day correlation coefficients of synergy weights for two or more synergies were 0.89 (0.15) for TD and 0.88 (0.15) for CP. Between days, the average correlation coefficient of synergy weights for two or more synergies was greater than 0.89 for TD and 0.74 for CP. These results demonstrate that synergy complexity and structure averaged over multiple gait cycles are repeatable between days in both TD and CP groups.

SSM Lee, D Gaebler-Spira, LQ Zhang, WZ Rymer, KM Steele, (2016) “Use of shear wave ultrasound elastography to quantify muscle properties in cerebral palsy.” Clinical Biomechanics

Dr. Steele JournalArticle, MotorControl, UbiquitousRehabilitation November 6, 2015October 12, 2021Cerebral Palsy, Muscle, Ultrasonography

Sample ultrasound images from gastrocnemius and tibialis anterior showing greater shear wave velocity on more affected limb.

Journal article in Clinical Biomechanics:

Kat Steele partnered with Sabrina Lee from Northwestern University and the Rehabilitation Institute of Chicago to investigate shearwave ultrasound elastography as a new tool to quantify changes in muscle properties in cerebral palsy.

Abstract: Individuals with cerebral palsy tend to have altered muscle architecture and composition, but little is known about the muscle material properties, specifically stiffness. Shear wave ultrasound elastography allows shear wave speed, which is related to stiffness, to be measured in vivo in individual muscles. Our aim was to evaluate the material properties, specifically stiffness, as measured by shear wave speed of the medial gastrocnemius and tibialis anterior muscles in children with hemiplegic cerebral palsy across a range of ankle torques and positions, and fascicle strains. Shear wave speed was measured bilaterally in the medial gastrocnemius and tibialis anterior over a range of ankle positions and torques using shear wave ultrasound elastography in eight individuals with hemiplegic cerebral palsy. B-mode ultrasound was used to measure muscle thickness and fascicle strain. Shear waves traveled faster in the medial gastrocnemius and tibialis anterior of the more-affected limb by 14% (P = 0.024) and 20% (P = 0.03), respectively, when the ankle was at 90°. Shear wave speed in the medial gastrocnemius increased as the ankle moved from plantarflexion to dorsiflexion (less affected: r² = 0.82, P < 0.001; more-affected: r² = 0.69, P < 0.001) and as ankle torque increased (less affected: r² = 0.56,P < 0.001; more-affected: r² = 0.45, P < 0.001). In addition, shear wave speed was strongly correlated with fascicle strain (less affected: r² = 0.63, P < 0.001; more-affected: r² = 0.53, P < 0.001). The higher shear wave speed in the more-affected limb of individuals with cerebral palsy indicates greater muscle stiffness, and demonstrates the clinical potential of shear wave elastography as a non-invasive tool for investigating mechanisms of altered muscle properties and informing diagnosis and treatment.