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Investigating muscle function in children with foot deformities due to cerebral palsy: Development and application of a personalized musculoskeletal foot model

van den Heuvel, Gaia (author)

Children with cerebral palsy (CP) commonly have bony deformities of the foot, which lead to pain and gait problems. One of the causes of such a deformity is an imbalance in muscle forces around the foot. In turn, the bony deformity can also alter muscle function, due to, for example, altered muscle moment arm lengths. In this study, the altered...

master thesis 2023

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Towards automated video-based assessment of dystonia in dyskinetic cerebral palsy: A novel approach using markerless motion tracking and machine learning

Haberfehlner, Helga (author), van de Ven, Shankara S. (author), van der Burg, Sven A. (author), Huber, Florian (author), Georgievska, Sonja (author), Aleo, Ignazio (author), Harlaar, J. (author), Bonouvrié, Laura A. (author), van der Krogt, Marjolein M. (author), Buizer, Annemieke I. (author)

Introduction: Video-based clinical rating plays an important role in assessing dystonia and monitoring the effect of treatment in dyskinetic cerebral palsy (CP). However, evaluation by clinicians is time-consuming, and the quality of rating is dependent on experience. The aim of the current study is to provide a proof-of-concept for a machine...

journal article 2023

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Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness

de Miguel-Fernández, Jesús (author), Lobo-Prat, Joan (author), Prinsen, Erik (author), Font-Llagunes, Josep M. (author), Marchal Crespo, L. (author)

Background: In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review,...

review 2023

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Predicting Gait Patterns of Children With Spasticity by Simulating Hyperreflexia

Veerkamp, Kirsten (author), Carty, Christopher P. (author), Waterval, Niels F.J. (author), Geijtenbeek, T. (author), Buizer, Annemieke I. (author), Lloyd, David G. (author), Harlaar, J. (author), van der Krogt, Marjolein M. (author)

Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was...

journal article 2023

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Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy

Flux, Eline (author), Bar-On, Lynn (author), Buizer, Annemieke I. (author), Harlaar, J. (author), van der Krogt, Marjolein M. (author)

Background: Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. Research question: Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven...

journal article 2023

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Home‐Based Measurements of Dystonia in Cerebral Palsy Using Smartphone‐Coupled Inertial Sensor Technology and Machine Learning: A Proof‐of‐Concept Study

Den Hartog, Dylan (author), van der Krogt, Marjolein M. (author), van der Burg, Sven (author), Aleo, Ignazio (author), Gijsbers, Johannes (author), Bonouvrié, Laura A. (author), Harlaar, J. (author), Buizer, Annemieke I. (author), Haberfehlner, Helga (author)

Accurate and reliable measurement of the severity of dystonia is essential for the indication, evaluation, monitoring and fine‐tuning of treatments. Assessment of dystonia in children and adolescents with dyskinetic cerebral palsy (CP) is now commonly performed by visual evaluation either directly in the doctor’s office or from video...

journal article 2022

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Automatic gait event detection in paediatric pathological gait

Sansgiri, Sailee (author)

<b>Introduction: </b>Spatio-temporal parameters (STP), calculated from 3D gait analysis, are frequently used for treatment planning and evaluation in Cerebral Palsy (CP). To calculate these parameters, accurate determination of gait events (i. e. initial contact (IC) and foot off (FO)) is essential. Previous research on the performance of...

master thesis 2021

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Calf muscle model parameters in children with cerebral palsy compared to typically developing children

Mackenbach, Caroline (author)

Background: In children with cerebral palsy(CP), muscle-tendon structures are altered. While interventions exist to treataltered structures, the selection of the most suitable treatment is verycomplex with highly variable outcomes. Musculoskeletal models have thepotential to support clinical decision making. However, a known...

master thesis 2021

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Exergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial

Meyns, Pieter (author), Blanckaert, Ian (author), Bras, Chloé (author), Jacobs, Nina (author), Harlaar, J. (author), van de Pol, Laura (author), Plasschaert, Frank (author), Van Waelvelde, Hilde (author), Buizer, Annemieke I. (author)

Purpose: Previous studies investigating the effectiveness of exergame balance-training (using video-games) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic...

journal article 2021

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Towards validation and standardization of automatic gait event identification algorithms for use in paediatric pathological populations

Visscher, Rosa M.S. (author), Sansgiri, Sailee (author), Freslier, Marie (author), Harlaar, J. (author), Brunner, Reinald (author), Taylor, William R. (author), Singh, Navrag B. (author)

Background: To analyse and interpret gait patterns in pathological paediatric populations, accurate determination of the timing of specific gait events (e.g. initial contract – IC, or toe-off – TO) is essential. As currently used clinical identification methods are generally subjective, time-consuming, or limited to steps with force platform...

journal article 2021

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Functional assessment of stretch hyperreflexia in children with cerebral palsy using treadmill perturbations

Flux, Eline (author), van der Krogt, Marjolein M. (author), Harlaar, J. (author), Buizer, Annemieke I. (author), Sloot, Lizeth H. (author)

Background: As hyperactive muscle stretch reflexes hinder movement in patients with central nervous system disorders, they are a common target of treatment. To improve treatment evaluation, hyperactive reflexes should be assessed during activities as walking rather than passively. This study systematically explores the feasibility,...

journal article 2021

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Generic scaled versus subject-specific models for the calculation of musculoskeletal loading in cerebral palsy gait: Effect of personalized musculoskeletal geometry outweighs the effect of personalized neural control

Kainz, Hans (author), Wesseling, M.G.H. (author), Jonkers, Ilse (author)

Background: Musculoskeletal modelling is used to assess musculoskeletal loading during gait. Linear scaling methods are used to personalize generic models to each participant's anthropometry. This approach introduces simplifications, especially when used in paediatric and/or pathological populations. This study aimed to compare results from...

journal article 2021

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Applying Stretch to Evoke Hyperreflexia in Spasticity Testing: Velocity vs. Acceleration

Sloot, Lizeth H. (author), Weide, Guido (author), van der Krogt, Marjolein M. (author), Desloovere, Kaat (author), Harlaar, J. (author), Buizer, Annemieke I. (author), Bar-On, Lynn (author)

In neurological diseases, muscles often become hyper-resistant to stretch due to hyperreflexia, an exaggerated stretch reflex response that is considered to primarily depend on the muscle's stretch velocity. However, there is still limited understanding of how different biomechanical triggers applied during clinical tests evoke these reflex...

journal article 2021

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Gastrocnemius Medialis Muscle Geometry and Extensibility in Typically Developing Children and Children With Spastic Paresis Aged 6–13 Years

Weide, Guido (author), Huijing, Peter A. (author), Bar-On, Lynn (author), Sloot, Lizeth (author), Buizer, Annemieke I. (author), Becher, Jules G. (author), Harlaar, J. (author), Jaspers, Richard T. (author)

Gait of children with spastic paresis (SP) is frequently characterized by a reduced ankle range of motion, presumably due to reduced extensibility of the triceps surae (TS) muscle. Little is known about how morphological muscle characteristics in SP children are affected. The aim of this study was to compare gastrocnemius medialis (GM) muscle...

journal article 2020

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Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking

Meyns, P. (author), Kerkum, Y. L. (author), Brehm, M. A. (author), Becher, J. G. (author), Buizer, A. I. (author), Harlaar, J. (author)

In children with cerebral palsy (CP), rigid ventral shell ankle-foot orthoses (vAFOs) are often prescribed to reduce excessive knee flexion in stance and lower the energy cost of walking (ECW). However, how vAFOs affect ECW is a complex issue, as vAFOs may have an impact on lower limb biomechanics, upper body movements, and balance. Besides,...

journal article 2020

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Foot flexibility confounds the assessment of triceps surae extensibility in children with spastic paresis during typical physical examinations

Weide, Guido (author), Huijing, Peter A. (author), Becher, Jules G. (author), Jaspers, Richard T. (author), Harlaar, J. (author)

Accurate assessment of the talo-crural (ankle) joint angle at physical examination is important for assessing extensibility of m. triceps surae (TS) in children with spastic cerebral paresis (SCP). The main aim of this study was to quantify foot flexibility during standardized measurements of TS muscle-tendon complex extensibility (i.e. based...

journal article 2020

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The effect of mono- versus multi-segment musculoskeletal models of the foot on simulated triceps surae lengths in pathological and healthy gait

Zandbergen, Marit A. (author), Schallig, Wouter (author), Stebbins, Julie A. (author), Harlaar, J. (author), van der Krogt, Marjolein M. (author)

Background: Estimating muscle-tendon complex (MTC) lengths is important for planning of soft tissue surgery and evaluating outcomes, e.g. in children with cerebral palsy (CP). Conventional musculoskeletal models often represent the foot as one rigid segment, called a mono-segment foot model (mono-SFM). However, a multi-segment foot model ...

journal article 2020

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Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with Botulinum NeuroToxin-A, serial casting, and physiotherapy

Weide, Guido (author), Sloot, Lizeth (author), Oudenhoven, Laura (author), Jaspers, Richard T. (author), Harlaar, J. (author), Buizer, Annemieke (author), Bar-On, Lynn (author)

Comprehensive instrumented muscle and joint assessments should be considered when prescribing Botulinum NeuroToxin-A (BoNT-A) treatment in spastic paresis. In a child with spastic paresis, comprehensive evaluation following treatment with BoNT-A, serial casting, and physiotherapy showed that short-term improvements in gait occurred without...

journal article 2019

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Factors associated with long-term improvement of gait after selective dorsal rhizotomy

Oudenhoven, Laura M. (author), van der Krogt, Marjolein M. (author), Romei, Marianna (author), van Schie, Petra E.M. (author), van de Pol, Laura A. (author), van Ouwerkerk, Willem J.R. (author), Harlaar, J. (author), Buizer, Annemieke I. (author)

Objective: To identify factors associated with long-term improvement in gait in children after selective dorsal rhizotomy (SDR). Design: Retrospective cohort study. Setting: University medical center. Participants: Children (N=36) (age 4-13y) with spastic diplegia of Gross Motor Function Classification System (GMFCS) level I (n=14), II (n=15)...

journal article 2019

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How normal is normal: Consequences of stride to stride variability, treadmill walking and age when using normative paediatric gait data

Oudenhoven, Laura Maria (author), Booth, Adam Thomas Crawford (author), Buizer, Annemieke Irene (author), Harlaar, J. (author), van der Krogt, Marjolein Margaretha (author)

journal article 2019