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The Optimization of Stiffness in Lycra Suits to Enhance Knee Extension and Hamstring Strength in Children with Cerebral Palsy

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The Optimization of Stiffness in Lycra Suits to Enhance Knee Extension and Hamstring Strength in Children with Cerebral Palsy The Optimization of Stiffness in Lycra Suits to Enhance Knee Extension and Hamstring Strength in Children with Cerebral Palsy Gavin Warrington and Christian Waksmunski Cerebral Palsy ● Worldwide, 2 to 4 infants per 1,000 live births are diagnosed with the disorder each year [1]. ● Cerebral palsy has two classifications, spastic and non spastic. ● Spastic CP is the most common form and is marked by hypertonia. https://www.cdc.gov/ncbddd/cp/data.html What is a Lycra Suit? Postural Correction Orthoses (PCO) claims that the lycra suit provides deep, core compression and normalizes muscles tone. It is believed that the elasticity and pressure aids in the improvement of body coordination and gait [13]. Our goal is to prove the biomechanics behind the suits functionality. http://pcodynamic.com/en/produkt/pco-t-11/ Previous Investigations Gait Deficiencies Due to Cerebral Palsy A ● Graph A- Knee remains flexed during load bearing stage (0%-50%) ● Graph B- At 40% gait cycle a healthy gait results in a negative ground reaction force (GRF) while CP remains (>0). B ● Results are due to lack of knee extension and increase in muscular forces and joint stiffness to overcome reduced range of motion. Legend ● Dotted line - control group ● Solid line - cerebral palsy group Previous Investigations by Diane Damiano (Strength Training) ● The objective of Damiano’s research was to determine clinical effectiveness of strength training in children with spastic cerebral palsy [6]. ● The study concluded that the short term strength training program had a positive outcome in children with spastic CP [6]. Previous Investigations by Diane Damiano (Crouch Gait Model) Measured Variables ● W = weight ● 흷WA= peak knee flexion angle during weight acceptance ● 흷LS = knee angle @ contralateral heel strike ● 흷MS= minimum knee flexion angle during stance Previous Investigations by Diane Damiano (Crouch Gait Model) Proposed Research Specific Aims 1) Evaluate the effects of adding an additional stiffness coefficient to the model of gait through the use of a personalized lycra suit for children with cerebral palsy. Does the addition of a stiffness coefficient improve crouch gait efficiency? 2) Measure and record the progression of hamstring strength from lycra suit strength conditioning. http://pcodynamic.com/en/produkt/pco-l-09/ Participant Criteria for Trial Selection The participants of this study will be chosen based on age, gait, weight and Gross Motor Function Classification (GMFCS) level. Criteria Control(n=12) Experimental (n=12) Age 6-12 6-12 Weight 45-92 lbs 45-92 lbs Gait Healthy Crouch Gait GMFCS Healthy Level I or II Equipment for Baseline Testing With the utilization of an isometric torque sensor, initial hamstring strength will be measured and recorded for individuals in the experimental group. http://www.e-kjsb.org/archive/detail/65 Equipment for Baseline Testing https://optitrack.com/products/flex-3/ https://netbeans.org/community/articles/interviews/bio-mechanics.html?print=yes https://www.researchgate.net/figure/Marker-set-protocol-Location-of-reflective-markers -for-the-pelvis-segment-and-lower_fig1_324730233 Baseline Testing ● Gait Analysis using motion capture for control and experimental group ● Musculoskeletal Modeling in OpenSim to compute the following joint kinematics using inverse dynamics ● 흷WA= peak knee flexion angle during weight acceptance ● 흷LS = knee angle @ contralateral heel strike ● 흷MS= minimum knee flexion angle during stance ● Generate Knee Moment vs. Weight Acceptance graph for both groups Optimizing Lycra Suit Stiffness (KL) for Improved Moment ● Modified equation for knee flexion and extension stiffness (KF ) and (KE) including the lycra suit stiffness (KL). ● Identify optimal lycra suit stiffness for a specified weight group to improve the experimental Knee Moment vs. Weight Acceptance graph for the crouch gait group. Experimental and Testing Timeline Subjects wear Repeat motion Subjects wear Repeat motion the suit for >5 capture and the suit for >5 capture and hours a day for isometric hours a day for isometric a total of 6 torque a total of 6 torque weeks measurement weeks measurement Testing will be Testing will be completed two completed two times (suit on times (suit on vs suit off). vs suit off). Expected Results We hypothesize that the suits’ stiffness constant creates an added resistance to muscular moments surrounding the knee which strength conditions the hamstring. Furthermore, the elasticity of the lycra suit can store and return energy during flexion and extension phases of weight acceptance to improve gait efficiency. References 1. CDC. (n.d.). Data and Statistics for Cerebral Palsy | CDC. Retrieved October 1, 2019, from https://www.cdc.gov/ncbddd/cp/data.html. 2. Bax, M. C. (1964), TERMINOLOGY AND CLASSIFICATION OF CEREBRAL PALSY. Developmental Medicine & Child Neurology, 6: 295-297. doi:10.1111/j.1469-8749.1964.tb10791.x 3. Kristie L Bell, Peter SW Davies, Energy expenditure and physical activity of ambulatory children with cerebral palsy and of typically developing children, The American Journal of Clinical Nutrition, Volume 92, Issue 2, August 2010, Pages 313–319, https://doi.org/10.3945/ajcn.2010.29388 4. Alliance, C. P. (n.d.). Spastic Cerebral Palsy. Retrieved October 8, 2019, from https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/types-of-cerebral-palsy/spastic-cerebral-palsy/. 5. Domenico M. Romeo, Alessandro Specchia, Francesca Sini, Sarah Bompard, Alessia Di Polito, Arianna Del Vecchio, Paola Ferrara, Roberto Bernabei, Eugenio Mercuri. “Effects of Lycra suits in children with cerebral palsy,” European Journal of Paediatric Neurology, Volume 22, Issue 5, 2018, Pages 831-836. 6. Damiano, D. L., & Abel, M. F. (1998). Functional outcomes of strength training in spastic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 79(2), 119–125. doi: 10.1016/s0003-9993(98)90287-8 7. Nancy Hylton & Cheryl Allen (1997) The development and use of SPIO Lycra compression bracing in children with neuromotor deficits, Pediatric Rehabilitation, 1:2, 109-116, 8. D.J Rennie, S.F Attfield, R.E Morton, F.J Polak, J Nicholson, “An evaluation of lycra garments in the lower limb using 3-D gait analysis and functional assessment (PEDI),” Gait & Posture, Volume 12, Issue 1, 2000, Pages 1-6, 9. Man, X., & Swan, C. C. (2007). A Mathematical Modeling Framework for Analysis of Functional Clothing. Journal of Engineered Fibers and Fabrics. 10. Angilley, Heather. (2006). Lycra Garments, a single case study. Journal of the Association of Paediatric Chartered Physiotherapists. 14. 11. Knox, V. (2003). The Use of Lycra Garments in Children with Cerebral Palsy: A Report of a Descriptive Clinical Trial. British Journal of Occupational Therapy, 66(2), 71–77. doi: 10.1177/030802260306600205 12. Lerner, Z. F., Damiano, D. L., & Bulea, T. C. (2016). Estimating the Mechanical Behavior of the Knee Joint During Crouch Gait: Implications for Real-Time Motor Control of Robotic Knee Orthoses. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society, 24(6), 621–629. doi:10.1109/TNSRE.2016.2550860 13. PCO. (n.d.). PCO®. Retrieved November 18, 2019, from http://pcodynamic.com/en/produkt/pco-t-11/..
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