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      Application of a tri-axial accelerometry-based portable motion recorder for the quantitative assessment of hippotherapy in children and adolescents with cerebral palsy

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          Abstract

          [Purpose] This case series aims to evaluate the effects of hippotherapy on gait and balance ability of children and adolescents with cerebral palsy using quantitative parameters for physical activity. [Subjects and Methods] Three patients with gait disability as a sequela of cerebral palsy (one female and two males; age 5, 12, and 25 years old) were recruited. Participants received hippotherapy for 30 min once a week for 2 years. Gait parameters (step rate, step length, gait speed, mean acceleration, and horizontal/vertical displacement ratio) were measured using a portable motion recorder equipped with a tri-axial accelerometer attached to the waist before and after a 10-m walking test. [Results] There was a significant increase in step length between before and after a single hippotherapy session. Over the course of 2 year intervention, there was a significant increase in step rate, gait speed, step length, and mean acceleration and a significant improvement in horizontal/vertical displacement ratio. [Conclusion] The data suggest that quantitative parameters derived from a portable motion recorder can track both immediate and long-term changes in the walking ability of children and adolescents with cerebral palsy undergoing hippotherapy.

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          Most cited references21

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          A report: the definition and classification of cerebral palsy April 2006.

          For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.
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            Cerebral palsy: clinical care and neurological rehabilitation.

            Cerebral palsy (CP) is defined as motor impairment that limits activity, and is attributed to non-progressive disturbances during brain development in fetuses or infants. The motor disorders of CP are frequently accompanied by impaired cognition, communication, and sensory perception, behavioural abnormalities, seizure disorders, or a combination of these features. CP is thought to affect three to four individuals per 1000 of the general population. The incidence, prevalence, and most common causes of CP have varied over time because of changes in prenatal and paediatric care. Medical management of children and adults involves care from primary-care physicians with input from specialists in neurology, orthopaedics, and rehabilitation medicine. Physicians should also work in conjunction with rehabilitation therapists, educators, nurses, social care providers, and schoolteachers. The focus of rehabilitation treatment has recently shifted to neurological rehabilitation in response to increasing evidence for neuroplasticity. This approach aims to improve development and function by capitalising on the innate capacity of the brain to change and adapt throughout the patient's life. As the life expectancy of individuals with CP approaches that of the general population, therapies must be developed that address the needs of adults ageing with disability. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Analysis of stroke patient walking dynamics using a tri-axial accelerometer.

              The purpose of this study was to describe the characteristics of stroke patient gait using the acceleration signals which were obtained during walking. Sixty-three stroke hemiplegic patients and 21 age-matched healthy elderly individuals took part in this study. A wireless tri-axial accelerometer, fixed to a belt at the level of the L3 spinous process, was used to measure trunk acceleration. Subjects were instructed to walk at a self-selected, comfortable walking speed. The acceleration signal was sampled at the rate of 200 Hz. Gait parameters and functional recovery tests were also evaluated. We analyzed the correlation between the gait parameters, functional recovery and acceleration. Acceleration was utilized as the root mean square (RMS), normalized RMS by velocity and average step length, as a measure of gait smoothness, and autocorrelation (AC) as a measure of stride similarity and regularity. The raw RMS and AC values of the stroke were significantly lower than the matched healthy elderly (p<0.01) in all axes. In contrast, the stroke patients' normalized RMS values were higher than the controls (p<0.05) in all axes. These results suggest that accelerometry gait parameters can discriminate between the stroke patients and the control group. The values of normalized RMS correlated with the smoothness or dynamics of the walking pattern, which reflects motor recovery and gait abilities. This study suggests that normalized RMS of accelerometer recordings from the trunk is valid in objectively measuring walking movements as an index of treatment outcome for patients in rehabilitation.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                28 October 2016
                October 2016
                : 28
                : 10
                : 2970-2974
                Affiliations
                [1) ] Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Japan
                [2) ] Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Japan
                [3) ] LSI Medience Corporation, Japan
                [4) ] Holistic Betterment and Wellness Through Riding PIROUETTE, Japan
                [5) ] Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
                [6) ] Teikyo University Faculty of Medical Technology, Japan
                Author notes
                [* ]Corresponding author. Tatsushi Mutoh, Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University: 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan. (E-mail address: tmutoh@ 123456tiara.ocn.ne.jp )
                [a]

                Co-first authors

                Article
                jpts-2016-521
                10.1589/jpts.28.2970
                5088162
                27821971
                b3860809-f8ac-443e-92c1-b9177cb7decd
                2016©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 09 May 2016
                : 27 June 2016
                Categories
                Case Study

                cerebral palsy,hippotherapy,gait analysis
                cerebral palsy, hippotherapy, gait analysis

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