Upper extremity dynamics during Lofstrand crutch-assisted gait in children with myelomeningocele.

BACKGROUND/OBJECTIVE We present a 3-dimensional biomechanical model of the upper extremities to characterize joint dynamics during 2 patterns of Lofstrand crutch-assisted gait in children with myelomeningocele. The upper extremity model incorporates recommendations by the International Society of Biomechanics. METHODS A Vicon motion analysis system (14 cameras) captured the marker patterns. Instrumented crutches measured reaction forces. Five subjects with L3 or L4 level myelodysplasia (aged 9.8 +/- 1.6 years) were analyzed during reciprocal and swing-through Lofstrand crutch-assisted gait. RESULTS The mean walking speed, cadence, and stride length were greatest during swing-through gait. Although the gait patterns had different morphologies, the thorax and elbows remained in flexion, the wrists remained in extension, and the shoulders demonstrated both flexion and extension throughout the gait cycles. Swing-through gait showed larger ranges of motion for all joints than reciprocal gait. Peak crutch forces were highest during swing-through gait. The model was effective in detecting significant differences in upper extremity joint dynamics between reciprocal and swing-through crutch-assisted gait in children with myelomeningocele. CONCLUSIONS Results support continued testing. Future work should include clinical and functional assessment in a correlated study of dynamics and function. Knowledge from the study may be useful in treatment planning and intervention.