Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

Nojoud AlHakeem; Elizabeth Anne Ouellette; Francesco Travascio; Shihab Asfour

doi:10.3389/fbioe.2020.00116

Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

Front Bioeng Biotechnol. 2020 Feb 21:8:116. doi: 10.3389/fbioe.2020.00116. eCollection 2020.

Authors

Nojoud AlHakeem¹, Elizabeth Anne Ouellette^{2

3}, Francesco Travascio^{4

5

6}, Shihab Asfour¹

Affiliations

¹ Biomechanics Research Laboratory, Department of Industrial Engineering, University of Miami, Coral Gables, FL, United States.
² Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Coral Gables, FL, United States.
³ Department of Orthopedics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States.
⁴ Musculoskeletal Biomechanics Laboratory, University of Miami, Coral Gables, FL, United States.
⁵ Mount Sinai Medical Center, Max Biedermann Institute for Biomechanics, Miami Beach, FL, United States.
⁶ Department of Orthopaedic Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States.

Abstract

Background: Spasticity of the upper extremity often occurs after injury to the upper motor neurons (UMN). This condition can greatly interfere with the hand positioning in space and the functional use of the arm, affecting many daily living activities including walking. As gait and balance involve the coordination of all segments of the body, the control of upper limbs movement is necessary for smooth motion and stability. The purpose of this study was to assess the effects of surgical interventions on upper extremity spasticity to gait patterns in three spastic patients, as a way to assess the effect on patient's mobility.

Methods: Three patients with an anoxic brain injury, upper extremity spasticity, and an altered gait participated in this study. A specific treatment plan based on the patient was tailored by the orthopedic hand surgeon to help release the contractures and spastic muscles. Three-dimensional gait analysis was performed before surgery, 3, 6, and 12 months postoperatively. During each experimental session, the patient walked at a self-selected pace in a straight line across four force plates embedded into the floor (Kistler^®). Motion data were acquired using Vicon^® Motion Capturing System. Spatiotemporal measurements as well as bilateral kinematics of the hip, knee and ankle were studied. The results from matched non-disabled controls were included as reference.

Results: Overtime, clinical assessment displayed recovery in hand functions and restored sensation in the fingers. Gait analysis results demonstrated overall improvements in spatiotemporal parameters, specifically in cadence and walking speed. Improvements in kinematics of the lower limbs were also evident.

Conclusion: The results of this study indicated that, within a timeframe of one year, gait patterns improved in all patients. These observations suggest that, over time, upper limb surgery has the potential to improve the biomechanics of gait in spastic patients.

Keywords: cerebral palsy; gait analysis; motion capturing; stroke; ulnar nerve.