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D H Sutherland

Publications and source records attributed to D H Sutherland.

At least 19 recordsLinked to original sources
PubMed2005

The evolution of clinical gait analysis part III--kinetics and energy assessment.

Historically, clinical applications of measurements of force and energy followed electromyography and kinematics in temporal sequence. This sequence is mirrored by the order of topics included in this trilogy on the Evolution of Clinical Gait Analysis, with part I [Sutherland DH. The evolution of clinical gait analysis part I: kinesiological EMG. Gait Posture 2001;14:61-70.] devoted to Kinesiological EMG and part II [Sutherland DH. The evolution of clinical gait analysis part II - kinematics. Gait Posture 2002;16(2):159-179.] to Kinematics. This final review in the series will focus on kinetics as it relates to gait applications. Kinematic measurements give the movements of the body segments, which can be compared with normal controls to identify pathological gait patterns, but they do not deal with the forces controlling the movements. As a major goal of scientifically minded clinicians is to understand the biomechanical forces producing movements, the objective measurement of ground reaction forces is essential. The force plate (platform) is now an indispensable tool in a state-of-the-art motion analysis laboratory. Nonetheless, it is not a stand-alone instrument as both kinematic and EMG measurements are needed for maximum clinical implementation and interpretation of force plate measurements. The subject of energy assessment is also given mention, as there is a compelling interest in whether walking has been made easier with intervention. The goals of this manuscript are to provide a historical background, recognize some of the important contributors, and describe the current multiple uses of the force plate in gait analysis. The widespread use of force plates for postural analyses is an important and more recent application of this technology, but this review will be restricted to measurements of gait rather than balance activities. Finally, this manuscript presents my personal perspective and discusses the developments and contributors that have shaped my thoughts and actions, and which I have found to be particularly noteworthy or intriguing. Just as in parts I and II, emphasis has been placed on the early development. All subtopics and important contributors, in this third and certainly most challenging of the review papers, have not been included. Some may find that my perceptions are incomplete. I accept responsibility for all deficiencies, as none were intended. Letters to selected contributors and their responses reveal how each contributor built on the work of others. The level of cooperation and sharing by these early investigators is extraordinary. Had they wished to withhold information about their own work, clinical gait analysis would have been severely delayed.

Biomechanical Phenomena↗
PubMed2003

Clinical utility of the Duncan-Ely test for rectus femoris dysfunction during the swing phase of gait.

The Ely Test (or Duncan-Ely test) has been accepted as a clinical tool to assess rectus femoris spasticity by passively flexing the knee rapidly while the patient lies prone in a relaxed state. In this retrospective review, patients' dynamic knee range of motion (ROM) during gait and an electromyogram (EMG) were compared with the results of the Ely test. Data for 70 patients (44 males, 26 females; 104 limbs) were included. Mean age of patients was 13 years, SD 9 years, range 4 years 5 months to 54 years. All patients were diagnosed with cerebral palsy (spastic diplegia, n = 42; spastic quadriplegia, n = 15, and hemiplegia, n = 13). All patients were ambulatory (50 independent, 20 with assistive devices). A standard matrix was used to calculate sensitivity and specificity of the Ely test as well as its positive and negative predictive value. For the gait variables examined (decreased dynamic knee ROM, timing of peak knee flexion, and abnormal EMG in swing) the sensitivity of the Ely test ranged from 56 to 59% and the specificity ranged from 64 to 85%. For the same variables the positive predictive value ranged from 91 to 98% and the negative predictive value ranged from 4 to 19%. The Ely test was shown to have a good positive predictive value (i.e. the certainty about the presence of rectus spasticity in patients with a positive Ely test result) for rectus femoris dysfunction during gait.

Adolescent↗
PubMed2002

The evolution of clinical gait analysis. Part II kinematics.

Kinematics is treated as a single topic in this manuscript and the emphasis is on early history, just as it was in Part I, Electromyography. Needless to say, neither kinematics nor electromyography, nor kinetics and energy (the latter to be included in Part III) are stand-alone components of clinical gait analysis. The only reason for this selective format is that it lessens my task to be able to write about one subject at a time. One of the consequences of this arbitrary separation is that some contributors, who have enriched more than one portion of clinical gait analysis, are highlighted only in the area in which they have contributed the most. I began with Kinesiological Electromyography in Part I because the earliest stirrings of the dream of clinical gait analysis were expressed in the development of KEMG (kinesiological electromyography). The early investigators realized that very little could be said about the dynamic action of muscles without KEMG. Next, in chronological order, came kinematics. I have been an active participant and eyewitness, and take full responsibility for attempting to write an early history at a time when most of the contributors are still alive. Ordinarily, history is written much later, in order to fully grasp the significance of individual contributions in the tapestry of the whole. As stated in Part I, Electromyography, the emphasis has been placed on the early history. The application of motion analysis to sports medicine, and sports medicine functional analysis, is covered only lightly here, and this should not be interpreted as minimizing its importance. The literature on this subject is now quite voluminous and it would not be possible to cover it adequately in this manuscript. Later historical writings may differ significantly and will hopefully give more recognition to pioneers in later generations: those physicians, engineers, physical therapists and kinesiologists who are lifting the level of clinical gait analysis and directing their energies in expanding clinical directions. It is hoped that this manuscript will prompt additional manuscripts, as well as letters to the editor of Gait and Posture on the content of this review paper.

Biomechanical Phenomena↗
PubMed2001

The evolution of clinical gait analysis part l: kinesiological EMG.

In 1996, I was asked by Roy Davis, President of the Gait and Clinical Movement Analysis Society, to be the presidential guest speaker at the Birmingham, AL, annual society meeting and present a talk on the development of clinical gait analysis. Following my presentation, James Gage, Editor-in-Chief for Gait and Posture, and David Winter, Associate Editor for review articles requested a manuscript for publication. To address this task I have the advantage of being a participant throughout this exciting era and of personally knowing most of the people mentioned in this manuscript. To prepare for this assignment, I wrote letters and/or made phone calls to them. Their replies to my inquiries, plus their publications, provide documentation for this review paper. The opinions expressed, for better or worse, are my own. Due to space limitations, only a partial list of the many that have contributed is presented and I regret that not all of the important contributors have been included. In some instances they will be found in Part II and Part III. Hopefully, later publications on this subject will correct the omissions. Emphasis has been given to the earliest years and to walking gait. The subject of upper extremity analysis has not been included, though studies of subjects with upper extremity motion problems are carried out in many motion laboratories including our own. A further disclaimer is that the flood of more recent publications does not receive equal coverage. History is being written daily as clinical gait analysis gains momentum. We have barely scratched the surface of the development and potential contributions of clinical gait analysis.

Electromyography↗
PubMed1999

Double-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy.

The purpose of this study was to quantify the gait of subjects receiving two injections of either botulinum A toxin or saline vehicle into the gastrocnemius muscle(s). The study group consisted of cerebral palsy patients who walked with an equinus gait pattern. This study was a randomized, double-blinded, parallel clinical trial of 20 subjects. All were studied by gait analysis before and after the injections. There were no adverse effects. Peak ankle dorsiflexion in stance and swing significantly improved in subjects who received the drug and not in controls. Results of this double blind study give support to the short term efficacy of botulinum toxin A to improve gait in selected patients with cerebral palsy.

Ankle Joint↗
PubMed1999

Femoral anteversion and neck-shaft angle in children with cerebral palsy.

A database of femoral anteversion and neck-shaft angle was compiled of measurements made by the trigonometric fluoroscopic method of 147 patients (267 hips) with cerebral palsy. The angles of femoral anteversion were similar at early ages between healthy children and children with cerebral palsy. However, as the age of the children increased, those with cerebral palsy showed little change in anteversion angle, whereas the healthy children had progressively decreasing angles of femoral anteversion as they approached adulthood. The neck-shaft angle was increased significantly in children with cerebral palsy compared with the angles of healthy children. Patients who were ambulatory were shown to have an increased angle of femoral anteversion and a decreased neck-shaft angle compared with nonambulatory patients. There was no significant difference in angles among the various distributions of involvement, including patients with diplegia, hemiplegia, and quadriplegia.

Activities of Daily Living↗
PubMed1999

Optimization and application of a wrap-spring clutch to a dynamic knee-ankle-foot orthosis.

A dynamic knee-brace system (DKBS) has been designed which provides stance phase stability and swing phase freedom. A wrap-spring clutch controls knee flexion. Clutch optimization was performed minimizing clutch length. Kinematic tests on a normal subject using the DKBS document nearly normal dynamic knee flexion during swing (38 degrees versus 53 degrees for normal).

Braces↗
PubMed1999

Automatic control design for a dynamic knee-brace system.

A self-contained electronically controlled dynamic knee-brace system (DKBS) has been designed and tested which allows knee flexion during swing phase, but restricts flexion during the stance phase of gait. Cardiovascular energy measurements indicate that DKBS use allowed a more energy efficient gait.

Adult↗
PubMed1993

Energy cost of ambulation with different methods of foot and ankle immobilization.

In order to measure the energy cost of immobilization of the foot and ankle during ambulation, 14 healthy male volunteers exercised while wearing various immobilization devices. Oxygen consumption, oxygen cost, cardiac output, minute ventilation, heart rate, stroke volume, stride length, and stride frequency were determined at a steady state of exercise as the subjects walked on a treadmill at 80 m/min (equivalent to the comfortable walking speed of approximately 3 mi/h). Each subject was tested with three different types of immobilization devices: a short leg walking cast, a prefabricated lower leg orthosis, and a rigid-soled surgical shoe. The results were compared with those for the same men ambulating without an immobilization device. Ambulation with the short leg walking cast and the prefabricated lower leg orthosis required significantly more energy in comparison with control values (all p values < 0.006) in terms of oxygen cost, cardiac index, oxygen consumption, and minute ventilation. However, when the rigid-soled surgical shoe was worn, energy consumption as measured by all parameters was not significantly increased compared with control values. Comparison of the findings for the short leg walking cast and the prefabricated lower leg orthosis showed no significant differences in any parameter of energy consumption. Stride length, however, was significantly shorter in the short leg walking cast compared with all immobilizers tested.

Adult↗
PubMed1993

Common gait abnormalities of the knee in cerebral palsy.

Gait abnormalities in children with cerebral palsy are the consequence of contractures across joints, muscle spasticity, and phasically inappropriate muscle action. Though abnormalities involving one of the major joints of the lower extremity will usually have consequences on the function of the other joints, it is possible to recognize certain primary disorders at each joint. The most common gait abnormalities of the knee in patients with cerebral palsy occur in the sagittal plane. Based on the experience gained from performing gait analysis on more than 588 patients with cerebral palsy, four primary gait abnormalities of the knee have been identified: jump knee, crouch knee, stiff knee, and recurvatum knee. In this review, each abnormality is described by its motion analysis laboratory profile (physical examination, motion parameters, electromyography [EMG] data, and force plate data). The most common etiologies and the consequences for gait of each disorder are also considered. Appreciation of the most common pathologic patterns of gait should facilitate accurate and detailed analysis of the individual patient with gait abnormalities.

Biomechanical Phenomena↗
PubMed1993

Varus foot in cerebral palsy: an overview.

In cerebral palsy, imbalance of the invertor and evertor muscles can result in varus alignment of the foot. The primary functional problems of varus foot are weightbearing instability and/or difficulty in foot clearance in swing phase. Additional problems include difficulties in shoe fitting, abnormal shoe wear, and unacceptable cosmesis. Gait studies have shed some light on the alterations of the muscle activity that can cause this problem but have fallen short of providing clear guidelines for treatment of this common problem. Confusion exists because dynamic electromyography does not give definitive information about the quantity of muscle tension and because the analyses have not included movement measurements that distinguish between the movements that occur in the hind foot and forefoot. Technical limitations that have made it impossible to obtain this information are rapidly disappearing, and the way is opening up for biomechanical studies of foot and ankle function that will allow greater precision in the selection of surgical treatment for varus foot.

Biomechanical Phenomena↗
PubMed1990

Fascia lata and early spica casting as adjuncts in closure of bladder exstrophy.

Correction of the skeletal defect seen in the exstrophy complex consists of reconstitution of the pelvic ring. Long-term success depends upon the formation of a fibrous union between the pubes. When this union does not occur diastasis of the pubis results. Long-term urological success appears to be related to adequate pubic approximation. We used fascia lata to construct an anterior pelvic ligament between the pubic bones in 7 patients. In the 6 patients for whom followup is available the fascia lata has persisted and appears to be viable histologically on biopsy specimens obtained at a subsequent operation. Because the fascia lata holds the pubis together so well we have been able to cease Bryant's traction in children by 2 weeks and place them into a cast. This has resulted in early discharge from the hospital in all patients. For these reasons we believe that fascia lata is a useful adjunct in the armamentarium of materials used to reapproximate the pubis.

Bladder Exstrophy↗
PubMed1989

The effect of surface and internal electrodes on the gait of children with cerebral palsy, spastic diplegic type.

The purpose of this study was to determine whether surface and internal fine-wire electromyography electrodes had an effect on gait. The subjects for the experiments were 38 children with the spastic diplegic type of cerebral palsy. The children were filmed using the high-speed cinematographic technique while they walked (a) with no electrodes (unencumbered), (b) with only surface electrodes, and (c) with internal electrodes. Single stance time, step length, cadence, and walking velocity were compared with analysis of variance and Bonferroni t tests. The results included a significant decrease in cadence (-6.3% of unencumbered walking; p less than 0.05) when comparing walking with surface electrodes with walking without any electrodes. The internal electrodes caused significant decreases from normal walking in the following parameters: step length for both the measured leg (-18.6%; p less than 0.005) and the nonmeasured leg (-18.0%; p less than 0.005), cadence (-7.9%; p less than 0.02), and walking velocity (-23.5%; p less than 0.005). Internal electrodes caused significant decreases as compared with surface electrodes in the step length for both the measured leg (15.7%; p less than 0.01) and the nonmeasured leg (15.6%; p less than 0.005) and walking velocity (19.7%; p less than 0.005). Single stance phase did not change significantly in any of the comparisons. It appears that the addition of the surface electrode apparatus does change the normal gait of a subject, causing a large decrease in cadence. The measurement of gait with internal electrodes causes further change in gait, resulting in large decreases in step length and walking velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Stress fracture of the femoral shaft in children: report of two cases and discussion.

Stress fractures of the femur in children are unusual. This report describes the findings of two recent cases in children. Because of the potential for confusion with malignant lesions, it is hoped that these two illustrative cases will encourage the inclusion of a stress fracture diagnosis in femoral lesions in children. Also described is a CT scan finding which may be unique to stress fractures.

Child, Preschool↗
PubMed1981

Anterior tibial transfer to the os calcis with Achilles tenodesis for calcaneal deformity in myelomeningocele.

Seven children aged 3.0 to 5.8 years underwent bilateral simultaneous transfer of the anterior tibial muscle to the os calcis combined with Achilles tenodesis. All patients underwent pre- and postoperative gait analysis. Results indicated decreased knee flexion in stance and decreased ankle dorsiflexion in stance resulting in a more upright posture in all patients. Electromyography revealed prolongation of firing time in both stance and swing phase of the gait cycle. Polypropylene ankle-foot orthoses, used to protect the transfers in the postoperative period, improved step length, single limb support, and walking velocity in all patients. Three patients underwent force plate analysis to calculate work output. The reduction in work from 1.578 to 0.628 joules/kg/m suggested a favorable reduction in the work required to ambulate following surgery. No equinus deformity developed as a consequence of the Achilles tenodesis. These preliminary findings suggest the combined procedure restored a more optimal balance to the foot and ankle. Postoperative orthotic support was beneficial for protection of the corrected alignment as well as long-term function.

Achilles Tendon↗
PubMed1981

The pathomechanics of gait in Duchenne muscular dystrophy.

Forty-six separate gait studies were analysed for 21 ambulatory patients with Duchenne muscular dystrophy. Three groups were defined on the basis of significant gait variables: early, transitional and late. Disease progression can be predicted with 91 per cent accuracy by three gait variables: cadence, dorsiflexion in swing, and anterior pelvic tilt. The patients in the early group manifested a positive Gower's sign but gait changes were subtle, being principally slightly increased hip flexion in swing, decreased dorsiflexion in swing and reduction in cadence. The force line moved in front of the knee center early in single-limb support. In the transitional stage, anterior pelvic tilt was exaggerated, cadence was further reduced, and foot drop in swing phase was increased. Shoulder sway was noted as a compensation for gluteus medius weakness. The base of support widened. The force line remained behind the hip joint and in front of the knee joint throughout single-limb support. In the late stage, work output increased, cadence continued to drop, shoulder sway increased further, and there was a wider base of support. The force line remained very close to the center of the hip and in front of the knee at all times during single-limb support. The authors' conclusions are: (1) the earliest postural change in gait is increased lumbar lordosis secondary to gluteus maximus weakness, and at this time the quadriceps are relatively competent; (2) quadriceps insufficiency was the key factor in gait deterioration. It appeared in the transitional stage and was characterized by exaggerated anterior pelvic tilt, restricted hip extension in stance phase, equinus posturing, and maintenance of the force line in front of the knee throughout single-limb support. Long-leg bracing is indicated when these signs of quadriceps insufficiency are noted.

Biomechanical Phenomena↗