Characteristics of body balance disorder in children with unilateral lower limb shortening
- Authors: Nikityuk I.E.1, Kononova E.L.2, Garkavenko Y.E.3,4
-
Affiliations:
- The Turner Scientific Research Institute for Children's Orthopedics
- The Turner Scientific Research Institute for Children's Orthopedics
- The Turner Scientific Research Institute for Children’s Orthopedics
- North-Western State Medical University n.a. I.I. Mechnikov
- Issue: Vol 7, No 3 (2019)
- Pages: 45-54
- Section: Original Study Article
- URL: https://bakhtiniada.ru/turner/article/view/11208
- DOI: https://doi.org/10.17816/PTORS7345-54
- ID: 11208
Cite item
Abstract
Background. In modern orthopedics, the problem of unilateral shortening of the lower limbs in children is extremely important. In the process of child growth, there occurs progression of the shortened segment, which leads to anatomical asymmetry of the lower limbs and an increase in the imbalance of the limb load. Secondary deformities of the pelvis and spine aggravate the patient’s disability. The features of abnormal postural balance of the body depending on the etiology of the disease, such as congenital or acquired, as well as the degree of preservation of motor stereotypes in children with unilateral shortening of the lower limbs, are still understudied.
Aim. The aims of this work are to study postural stability in children with unilateral shortening of the lower limbs and to assess the disorders of body balance depending on the etiology of the lesion.
Materials and methods. The standard stabilometric values of 11 healthy children (average age, 11.9 ± 0.73 years) were determined (group 1), as well as the statokinesiogram parameters in 22 patients with unilateral shortening of the lower limb. The second group included 11 children (average age, 11.9 ± 1.05 years) with congenital shortening of the lower limb (average shortening, 4.8 ± 0.8 cm). The third group also consisted of 11 children (average age, 12.2 ± 0.78 years), but with acquired shortening of the lower limb (average shortening, 4.5 ± 0.38 cm). Statistical research included correlation analysis.
Results. A significant decrease in the stability of the vertical balance was observed in both groups of patients, which was demonstrated by pronounced deviations from the nominal values of stabilometric parameters, compared with healthy children: an increased center of pressure displacement, large values of the statokinesiogram area, and the length of the pressure displacement path. It was possible to determine the state of adaptive postural mechanisms for assessing the formation of the degree of adequacy of the motor strategy in patients with unilateral shortening of the lower limb, depending on the etiology of the lesion, owing to the method of stabilometry.
Conclusion. An appropriate adaptive motor stereotype has been formed in patients with acquired shortening of the lower limb; in the new conditions, the system for ensuring postural balance is stabilized. There is a different strategy for maintaining posture stability characterized by a nonoptimal motor stereotype in patients with congenital shortening of the lower limb. The stabilometric assessment of the asymmetry of the lower limb load is a promising method for studying the formation of compensatory mechanisms for controlling the locomotion system, which is important when planning rehabilitation measures.
Full Text
##article.viewOnOriginalSite##About the authors
Igor E. Nikityuk
The Turner Scientific Research Institute for Children's Orthopedics
Author for correspondence.
Email: femtotech@mail.ru
ORCID iD: 0000-0001-5546-2729
Elizaveta L. Kononova
The Turner Scientific Research Institute for Children's Orthopedics
Email: yelisaveta@yandex.ru
ORCID iD: 0000-0001-7624-013X
MD, PhD, Senior Research Associate of the Laboratory of Physiological and Biomechanical Research
Russian Federation, Saint-PetersburgYuriy E. Garkavenko
The Turner Scientific Research Institute for Children’s Orthopedics; North-Western State Medical University n.a. I.I. Mechnikov
Email: yurijgarkavenko@mail.ru
ORCID iD: 0000-0001-9661-8718
Leading Research Associate of the Department of Bone Pathology; MD, PhD, D.Sc., Professor of the Chair of Pediatric Traumatology and Orthopedics
Russian Federation, Saint PetersburgReferences
- Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. Radiographics. 2017;37(6):1791-1812. https://doi.org/10.1148/rg.2017170029.
- Никитюк И.Е., Попов И.В., Полянский В.А., Дудкин В.И. Структура хряща метаэпифизарных пластинок роста в условиях полной изоляции от клеточно-гуморальных воздействий при пересадке в мягкие ткани (экспериментальное исследование) // Морфология. – 2007. – Т. 131. – № 3. – С. 45–49. [Nikityuk IE, Popov IV, Polyanskiy VA, Dudkin VI. Structure of metaepiphyseal growth plate cartilage as influenced by total isolation from cellular and humoral influences after its transplantation into soft tissues (an experimental study). Morfologiia. 2007;131(3):45-49. (In Russ.)]
- Щуров В.А., Новиков К.И., Мурадисинов С.О. Влияние разновысокости нижних конечностей на биомеханические параметры ходьбы // Российский журнал биомеханики. – 2011. – Т. 15. – № 4. – C. 102–107. [Shchurov VA, Novikov KI, Muradisinov SO. Vliyanie raznovysokosti nizhnikh konechnostey na biomekhanicheskie parametry khod’by. Rossiyskiy zhurnal biomekhaniki. 2011;15(4):102-107. (In Russ.)]
- Guevara JM, Moncayo MA, Vaca-Gonzalez JJ, et al. Growth plate stress distribution implications during bone development: a simple framework computational approach. Comput Methods Programs Biomed. 2015;118(1):59-68. https://doi.org/10.1016/j.cmpb.2014.10.007.
- Kilby MC, Newell KM. Intra- and inter-foot coordination in quiet standing: footwear and posture effects. Gait Posture. 2012;35(3):511-516. https://doi.org/10.1016/j.gaitpost.2011.11.018.
- Казенников О.В., Киреева Т.Б., Шлыков В.Ю. Поддержание вертикальной позы человека при асимметричной нагрузке на ноги и односторонней фиксации коленного сустава // Физиология человека. – 2018. – Т. 44. – № 1. – С. 49–55. [Kazennikov OV, Kireeva TB, Shlykov VY. Maintenance of human vertical posture upon asymmetric leg loading and fixation of the knee joint of one leg. Fiziol Cheloveka. 2018;44(1):49-55. (In Russ.)]. https://doi.org/10.7868/S013116461801-0014.
- Aruin AS, Kanekar N. Effect of a textured insole on balance and gait symmetry. Exp Brain Res. 2013;231(2):201-208. https://doi.org/10.1007/s00221-013-3685-z.
- Boonstra TA, Schouten AC, van Vugt JP, et al. Parkinson’s disease patients compensate for balance control asymmetry. J Neurophysiol. 2014;112(12):3227-3239. https://doi.org/10.1152/jn.00813.2013.
- Никитюк И.Е., Гаркавенко Ю.Е., Кононова Е.Л. Особенности опорной функции нижних конечностей у детей с последствиями поражения проксимального отдела бедра острым гематогенным остеомиелитом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2018. – Т. 6. – № 1. – С. 14–22. [Nikityuk IE, Garkavenko YE, Kononova EL. Special aspects of the support function of lower limbs in children with the consequences of unilateral lesion of the proximal femur with acute hematogenous osteomyelitis. Pediatric traumatology, orthopaedics and reconstructive surgery. 2018;6(1):14-22. (In Russ.)]. https://doi.org/10.17816/PTORS6114-22.
- Kumar SN, Omar B, Joseph LH, et al. Evaluation of limb load asymmetry using two new mathematical models. Glob J Health Sci. 2014;7(2):1-7. https://doi.org/10.5539/gjhs.v7n2p1.
- Шеин А.П., Сайфутдинов М.С., Криворучко Г.А. Локальные и системные реакции сенсомоторных структур на удлинение и ишемию конечностей. – Курган: ДАММИ, 2006. – 284 с. [Shein AP, Sayfutdinov MS, Krivoruchko GA. Lokal’nye i sistemnye reaktsii sensomotornykh struktur na udlinenie i ishemiyu konechnostey. Kurgan: DAMMI; 2006. 284 p. (In Russ.)]
- Грибанов А.В., Шерстенникова А.К. Физиологические механизмы регуляции постурального баланса человека (обзор) // Журнал медико-биологических исследований. – 2013. – № 4. – С. 20–29. [Gribanov AV, Sherstennikova AK. Physiological mechanisms of human postural balance regulation (review). Medical and biological sciences. 2013;(4):20-29. (In Russ.)]
- Скворцов Д.В. Диагностика двигательной патологии инструментальными методами: анализ походки, стабилометрия. – М.: Т.М. Андреева, 2007. – 640 с. (Skvortsov DV. Diagnostika dvigatel’noy patologii instrumental’nymi metodami: analiz pokhodki, stabilometriya. Moscow: T.M. Andreeva; 2007. 640 p. (In Russ.))
- Казенников О.В., Киреева Т.Б., Шлыков В.Ю. Влияние структуры опорной поверхности под стопой на поддержание вертикальной позы при разном распределении нагрузки между ногами // Физиология человека. – 2016. – Т. 42. – № 4. – С. 61–68. [Kazennikov OV, Kireeva TB, Shlykov VY. Influence of the structure of the support surface under the sole on vertical posture during standing with different body weight distributions between legs. Fiziol Cheloveka. 2016;42(4):61-68. (In Russ.)]. https://doi.org/10.7868/S0131164616040044.
- Wilson EL, Madigan ML, Davidson BS, Nussbaum MA. Postural strategy changes with fatigue of the lumbar extensor muscles. Gait Posture. 2006;23(3):348-354. https://doi.org/10.1016/j.gaitpost.2005.04.005.
- Айдаров В.И., Скворцов А.П. Формирование правильного двигательного стереотипа ходьбы у пациентов с дефицитом локомоторных функций нижних конечностей // Практическая медицина. – 2013. – Т. 2. – № 1–2. – С. 12–13. [Aydarov VI, Skvortsov AP. Formation of correct movement pattern of walking in patients with a deficiency of locomotor functions of the lower limbs. Prakticheskaya meditsina. 2013;2(1-2):12-13. (In Russ.)]
- Казенников О.В., Киреева Т.Б., Шлыков В.Ю. Особенности поддержания вертикальной позы при неравномерной нагрузке на ноги // Физиология человека. – 2013. – Т. 39. – № 4. – С. 65–73. [Kazennikov OV, Kireeva TB, Shlykov VY. Characteristics of the maintenance of the vertical posture during standing with an asymmetrical load on the legs. Fiziol Cheloveka. 2013;39(4):65-73. (In Russ.)]. https://doi.org/10.7868/S0131164613030119.
- Щеколова Н.Б., Лихачева Л.В. Динамика биомеханических и электромиографических изменений при консервативном лечении детей с идиопатическим укорочением нижних конечностей // Пермский медицинский журнал. – 2013. – Т. 30. – № 1. – С. 73–78. [Schekolova NB, Likhacheva LV. Dynamics of biomechanical and electromyographic changes in conservative treatment of children with idiopathic low limb shortening. Permskii meditsinskii zhurnal. 2013;30(1):73-78. (In Russ.)]
- Бальсевич В.К. Очерки по возрастной кинезиологии человека. – М.: Советский спорт, 2009. – 220 с. [Bal’sevich VK. Ocherki po vozrastnoy kineziologii cheloveka. Moscow: Sovetskiy sport; 2009. 220 p. (In Russ.)]
- Абдуразаков У.А., Абдуразаков А.У., Юлдашев А.Ж. Асимметрия тела человека: внешние проявления и взаимосвязь с заболеваниями опорно-двигательной системы // Вестник Алматинского государственного института усовершенствования врачей. – 2016. – № 4. – С. 28–31. [Abdurazakov UA, Abdurazakov AU, Yuldashev AZh. Asymmetry of a body of the person, external manifestations and interrelation with diseases of musculoskeletal system. Vestnik Almatinskogo gosudarstvennogo instituta usovershenstvovaniya vrachey. 2016;(4):28-31. (In Russ.)]
- Михайлов В.П., Кузьмичев А.А., Ковтун М.В., Полосухин А.Д. Миофасциальные болевые синдромы и возможности их немедикаментозной коррекции // Хирургия позвоночника. – 2010. – № 4. – С. 55–60. [Mikhaylov VP, Kuz’michev AA, Kovtun MV, Polosukhin AD. The role of myofascial structures in the development of pain syndromes and their drug-free correction. Spine surgery. 2010;(4):55-60. (In Russ.)]
Supplementary files
