Jessica Rose

All Publications

• Validation of Inertial Measurement Units for Analyzing Golf Swing Rotational Biomechanics. Sensors (Basel, Switzerland) Kim, S. E., Burket Koltsov, J. C., Richards, A. W., Zhou, J., Schadl, K., Ladd, A. L., Rose, J. 2023; 23 (20)

  Abstract

  Training devices to enhance golf swing technique are increasingly in demand. Golf swing biomechanics are typically assessed in a laboratory setting and not readily accessible. Inertial measurement units (IMUs) offer improved access as they are wearable, cost-effective, and user-friendly. This study investigates the accuracy of IMU-based golf swing kinematics of upper torso and pelvic rotation compared to lab-based 3D motion capture. Thirty-six male and female professional and amateur golfers participated in the study, nine in each sub-group. Golf swing rotational kinematics, including upper torso and pelvic rotation, pelvic rotational velocity, S-factor (shoulder obliquity), O-factor (pelvic obliquity), and X-factor were compared. Strong positive correlations between IMU and 3D motion capture were found for all parameters; Intraclass Correlations ranged from 0.91 (95% confidence interval [CI]: 0.89, 0.93) for O-factor to 1.00 (95% CI: 1.00, 1.00) for upper torso rotation; Pearson coefficients ranged from 0.92 (95% CI: 0.92, 0.93) for O-factor to 1.00 (95% CI: 1.00, 1.00) for upper torso rotation (p < 0.001 for all). Bland-Altman analysis demonstrated good agreement between the two methods; absolute mean differences ranged from 0.61 to 1.67 degrees. Results suggest that IMUs provide a practical and viable alternative for golf swing analysis, offering golfers accessible and wearable biomechanical feedback to enhance performance. Furthermore, integrating IMUs into golf coaching can advance swing analysis and personalized training protocols. In conclusion, IMUs show significant promise as cost-effective and practical devices for golf swing analysis, benefiting golfers across all skill levels and providing benchmarks for training.

  View details for DOI 10.3390/s23208433

  View details for PubMedID 37896527

  View details for PubMedCentralID PMC10611231

• The swing performance Index: Developing a single-score index of golf swing rotational biomechanics quantified with 3D kinematics. Frontiers in sports and active living Zhou, J. Y., Richards, A., Schadl, K., Ladd, A., Rose, J. 2022; 4: 986281

  Abstract

  Golf swing generates power through coordinated rotations of the pelvis and upper torso, which are highly consistent among professionals. Currently, golf performance is graded on handicap, length-of-shot, and clubhead-speed-at-impact. No performance indices are grading the technique of pelvic and torso rotations. As an initial step toward developing a performance index, we collected kinematic metrics of swing rotational biomechanics and hypothesized that a set of these metrics could differentiate between amateur and pro players. The aim of this study was to develop a single-score index of rotational biomechanics based on metrics that are consistent among pros and could be derived in the future using inertial measurement units (IMU).Golf swing rotational biomechanics was analyzed using 3D kinematics on eleven professional (age 31.0 ± 5.9 years) and five amateur (age 28.4 ± 6.9 years) golfers. Nine kinematic metrics known to be consistent among professionals and could be obtained using IMUs were selected as candidate variables. Oversampling was used to account for dataset imbalances. All combinations, up to three metrics, were tested for suitability for factor analysis using Kaiser-Meyer-Olkin tests. Principal component analysis was performed, and the logarithm of Euclidean distance of principal components between golf swings and the average pro vector was used to classify pro vs. amateur golf swings employing logistic regression and leave-one-out cross-validation. The area under the receiver operating characteristic curve was used to determine the optimal set of kinematic metrics.A single-score index calculated using peak pelvic rotational velocity pre-impact, pelvic rotational velocity at impact, and peak upper torso rotational velocity post-impact demonstrated strong predictive performance to differentiate pro (mean ± SD:100 ± 10) vs. amateur (mean ± SD:82 ± 4) golfers with an AUC of 0.97 and a standardized mean difference of 2.12.In this initial analysis, an index derived from peak pelvic rotational velocity pre-impact, pelvic rotational velocity at impact, and peak upper torso rotational velocity post-impact demonstrated strong predictive performance to differentiate pro from amateur golfers. Swing Performance Index was developed using a limited sample size; future research is needed to confirm results. The Swing Performance Index aims to provide quantified feedback on swing technique to improve performance, expedite training, and prevent injuries.

  View details for DOI 10.3389/fspor.2022.986281

  View details for PubMedID 36619352

  View details for PubMedCentralID PMC9816382

• Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review. Frontiers in physiology Greve, K. R., Joseph, C. F., Berry, B. E., Schadl, K., Rose, J. 2022; 13: 951899

  Abstract

  Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.

  View details for DOI 10.3389/fphys.2022.951899

  View details for PubMedID 36111153

• Neonatal Brain Microstructure and Machine-Learning-Based Prediction of Early Language Development in Children Born VeryPreterm. Pediatric neurology Vassar, R., Schadl, K., Cahill-Rowley, K., Yeom, K., Stevenson, D., Rose, J. 2020

  Abstract

  BACKGROUND: Very-low-birth-weight preterm infants have a higher rate of language impairments compared with children born full term. Early identification of preterm infants at risk for language delay is essential to guide early intervention at the time of optimal neuroplasticity. This study examined near-term structural brain magnetic resonance imaging (MRI) and white matter microstructure assessed on diffusion tensor imaging (DTI) in relation to early language development in children born very preterm.METHODS: A total of 102 very-low-birth-weight neonates (birthweight≤1500g, gestational age ≤32-weeks) were recruited to participate from 2010 to 2011. Near-term structural MRI was evaluated for white matter and cerebellar abnormalities. DTI fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were assessed. Language development was assessed with Bayley Scales of Infant-Toddler Development-III at 18 to 22months adjusted age. Multivariate models with leave-one-out cross-validation and exhaustive feature selection identified three brain regions most predictive of language function. Distinct logistic regression models predicted high-risk infants, defined by language scores >1 S.D. below average.RESULTS: Of 102 children, 92 returned for neurodevelopmental testing. Composite language score mean±S.D. was 89.0±16.0; 31 of 92 children scored <85, including 15 of 92 scoring<70, suggesting moderate-to-severe delay. Children with cerebellar asymmetry had lower receptive language subscores (P=0.016). Infants at high risk for language impairments were predicted based on regional white matter microstructure on DTI with high accuracy (sensitivity, specificity) for composite (89%, 86%), expressive (100%, 90%), and receptive language (100%, 90%).CONCLUSIONS: Multivariate models of near-term structural MRI and white matter microstructure on DTI may assist in identification of preterm infants at risk for language impairment, guiding early intervention.

  View details for DOI 10.1016/j.pediatrneurol.2020.02.007

  View details for PubMedID 32279900

• Editorial: Neurologic Correlates of Motor Function in Cerebral Palsy: Opportunities for Targeted Treatment. Frontiers in human neuroscience Rose, J., Papadelis, C., Gaebler-Spira, D. 2020; 14: 615397

  View details for DOI 10.3389/fnhum.2020.615397

  View details for PubMedID 33328944

• Neonatal white matter tract microstructure and 2-year language outcomes after preterm birth. NeuroImage. Clinical Dubner, S. E., Rose, J. n., Bruckert, L. n., Feldman, H. M., Travis, K. E. 2020; 28: 102446

  Abstract

  To determine whether variability in diffusion MRI (dMRI) white matter tract metrics, obtained in a cohort of preterm infants prior to neonatal hospital discharge, would be associated with language outcomes at age 2 years, after consideration of age at scan and number of major neonatal complications.30 children, gestational age 28.9 (2.4) weeks, underwent dMRI at mean post menstrual age 36.4 (1.4) weeks and language assessment with the Bayley Scales of Infant Development-III at mean age 22.2 (1.7) months chronological age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for 5 white matter tracts. Hierarchical linear regression assessed associations between tract FA, moderating variables, and language outcomes.FA of the left inferior longitudinal fasciculus accounted for 17% (p = 0.03) of the variance in composite language and FA of the posterior corpus callosum accounted for 19% (p = 0.02) of the variance in composite language, beyond that accounted for by post-menstrual age at scan and neonatal medical complications. The number of neonatal medical complications moderated the relationship between language and posterior corpus callosum FA but did not moderate the association in the other tract.Language at age 2 is associated with white matter metrics in early infancy in preterm children. The different pattern of associations by fiber group may relate to the stage of brain maturation and/or the nature and timing of medical complications related to preterm birth. Future studies should replicate these findings with a larger sample size to assure reliability of the findings.

  View details for DOI 10.1016/j.nicl.2020.102446

  View details for PubMedID 33035964

• Prediction of Gait Impairment in Toddlers Born Preterm From Near-Term Brain Microstructure Assessed With DTI, Using Exhaustive Feature Selection and Cross-Validation. Frontiers in human neuroscience Cahill-Rowley, K., Schadl, K., Vassar, R., Yeom, K. W., Stevenson, D. K., Rose, J. 2019; 13: 305

  Abstract

  To predict gait impairment in toddlers born preterm with very-low-birth-weight (VLBW), from near-term white-matter microstructure assessed with diffusion tensor imaging (DTI), using exhaustive feature selection, and cross-validation.Near-term MRI and DTI of 48 bilateral and corpus callosum regions were assessed in 66 VLBW preterm infants; at 18-22 months adjusted-age, 52/66 participants completed follow-up gait assessment of velocity, step length, step width, single-limb support and the Toddle Temporal-spatial Deviation Index (TDI). Multiple linear models with exhaustive feature selection and leave-one-out cross-validation were employed in this prospective cohort study: linear and logistic regression identified three brain regions most correlated with gait outcome.Logistic regression of near-term DTI correctly classified infants high-risk for impaired gait velocity (93% sensitivity, 79% specificity), right and left step length (91% and 93% sensitivity, 85% and 76% specificity), single-limb support (100% and 100% sensitivity, 100% and 100% specificity), step width (85% sensitivity, 80% specificity), and Toddle TDI (85% sensitivity, 75% specificity). Linear regression of near-term brain DTI and toddler gait explained 32%-49% variance in gait temporal-spatial parameters. Traditional MRI methods did not predict gait in toddlers.Near-term brain microstructure assessed with DTI and statistical learning methods predicted gait impairment, explaining substantial variance in toddler gait. Results indicate that at near term age, analysis of a set of brain regions using statistical learning methods may offer more accurate prediction of outcome at toddler age. Infants high risk for single-limb support impairment were most accurately predicted. As a fundamental element of biped gait, single-limb support may be a sensitive marker of gait impairment, influenced by early neural correlates that are evolutionarily and developmentally conserved. For infants born preterm, early prediction of gait impairment can help guide early, more effective intervention to improve quality of life.• Accurate prediction of toddler gait from near-term brain microstructure on DTI.• Use of machine learning analysis of neonatal neuroimaging to predict gait.• Early prediction of gait impairment to guide early treatment for children born preterm.

  View details for DOI 10.3389/fnhum.2019.00305

  View details for PubMedID 31619977

  View details for PubMedCentralID PMC6760000

• Prediction of Gait Impairment in Toddlers Born Preterm From Near-Term Brain Microstructure Assessed With DTI, Using Exhaustive Feature Selection and Cross-Validation FRONTIERS IN HUMAN NEUROSCIENCE Cahill-Rowley, K., Schadl, K., Vassar, R., Yeom, K. W., Stevenson, D. K., Rose, J. 2019; 13

  View details for DOI 10.3389/fnhum.2019.00305

  View details for Web of Science ID 000486616900001

• A Scoping Review of Neuromuscular Electrical Stimulation to Improve Gait in Cerebral Palsy: The Arc of Progress and Future Strategies FRONTIERS IN NEUROLOGY Mooney, J. A., Rose, J. 2019; 10

  View details for DOI 10.3389/fneur.2019.00887

  View details for Web of Science ID 000482051800001

• The Pediatric Temporal-spatial Deviation Index: quantifying gait impairment for children with cerebral palsy. Developmental medicine and child neurology Zhou, J. Y., Zhang, K., Cahill-Rowley, K., Lowe, E., Rose, J. 2019

  Abstract

  AIM: To develop an easily-administered metric to quantify gait impairment in children and to assess its use in children with cerebral palsy (CP).METHOD: The Pediatric Temporal-spatial Deviation Index (TDI) was developed from gait data collected from 75 typically developing children (37 males, 38 females; mean age 9y 4mo; interquartile range [IQR] 8-10y) and 17 children diagnosed with spastic CP (nine males, eight females; mean age 9y 9mo; IQR 9-11y), inGross Motor Function Classification System (GMFCS) levels I to III, aged 7 to 11years. Children walked on a pressure-sensitive mat. Children with CP also completed 3D gait analysis. The Kaiser-Meyer-Olkin test of sampling adequacy was used for temporal-spatial feature selection. Principal components obtained from temporal-spatial gait parameters quantified deviation from typically developing gait. Deviation was normalized to a Pediatric TDI score mean (standard deviation [SD]) of 100 (10). The Pediatric TDI for children with CP was compared to 3D motion capture-based Gait Deviation Index (GDI).RESULTS: The Pediatric TDI was significantly lower for children with CP compared to typically developing children (p<0.001), correlated with average GDI (r=0.610, p=0.009), and demonstrated sensitivity (0.78) and specificity (0.88) to gait function, assessed with GDI.INTERPRETATION: The Pediatric TDI is an easily administered, revealing gait metric that can be used in children with CP in pediatric clinics and for research. Detection of gait abnormalities in the clinic can expedite diagnosis and treatment. What this paper adds The Pediatric Temporal-spatial Deviation Index (TDI) is a single-score index of gait deviation, based on nine parameters. The Pediatric TDI was more revealing than single temporal-spatial gait parameters. The Pediatric TDI is quick and simple to administer in the clinic.

  View details for DOI 10.1111/dmcn.14271

  View details for PubMedID 31206183

• Prediction of cognitive and motor development in preterm children using exhaustive feature selection and cross-validation of near-term white matter microstructure. NeuroImage. Clinical Schadl, K., Vassar, R., Cahill-Rowley, K., Yeom, K. W., Stevenson, D. K., Rose, J. 2018; 17: 667-679

  Abstract

  Advanced neuroimaging and computational methods offer opportunities for more accurate prognosis. We hypothesized that near-term regional white matter (WM) microstructure, assessed on diffusion tensor imaging (DTI), using exhaustive feature selection with cross-validation would predict neurodevelopment in preterm children.Near-term MRI and DTI obtained at 36.6 ± 1.8 weeks postmenstrual age in 66 very-low-birth-weight preterm neonates were assessed. 60/66 had follow-up neurodevelopmental evaluation with Bayley Scales of Infant-Toddler Development, 3rd-edition (BSID-III) at 18-22 months. Linear models with exhaustive feature selection and leave-one-out cross-validation computed based on DTI identified sets of three brain regions most predictive of cognitive and motor function; logistic regression models were computed to classify high-risk infants scoring one standard deviation below mean.Cognitive impairment was predicted (100% sensitivity, 100% specificity; AUC = 1) by near-term right middle-temporal gyrus MD, right cingulate-cingulum MD, left caudate MD. Motor impairment was predicted (90% sensitivity, 86% specificity; AUC = 0.912) by left precuneus FA, right superior occipital gyrus MD, right hippocampus FA. Cognitive score variance was explained (29.6%, cross-validated Rˆ2 = 0.296) by left posterior-limb-of-internal-capsule MD, Genu RD, right fusiform gyrus AD. Motor score variance was explained (31.7%, cross-validated Rˆ2 = 0.317) by left posterior-limb-of-internal-capsule MD, right parahippocampal gyrus AD, right middle-temporal gyrus AD.Search in large DTI feature space more accurately identified neonatal neuroimaging correlates of neurodevelopment.

  View details for DOI 10.1016/j.nicl.2017.11.023

  View details for PubMedID 29234600

  View details for PubMedCentralID PMC5722472

• Neuromuscular correlates of motor function in cerebral palsy: towards targeted treatment. Developmental medicine and child neurology Rose, J. 2018

  View details for PubMedID 30294935

• A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Schiariti, V., Fowler, E., Brandenburg, J. E., Levey, E., Mcintyre, S., Sukal-Moulton, T., Ramey, S. L., Rose, J., Sienko, S., Stashinko, E., Vogtle, L., Feldman, R. S., Koenig, J. I. 2018; 60 (10): 976-+

  View details for DOI 10.1111/dmcn.13723

  View details for Web of Science ID 000443805000011

• Golf Swing Rotational Velocity: The Essential Follow-Through. Annals of rehabilitation medicine Steele, K. M., Roh, E. Y., Mahtani, G., Meister, D. W., Ladd, A. L., Rose, J. 2018; 42 (5): 713–21

  Abstract

  OBJECTIVE: To evaluate if shoulder and pelvic angular velocities differ at impact or peak magnitude between professional and amateur golfers. Golf swing rotational biomechanics are a key determinant of power generation, driving distance, and injury prevention. We hypothesize that shoulder and pelvic angular velocities would be highly consistent in professionals.METHODS: Rotational velocities of the upper-torso and pelvis throughout the golf swing and in relation to phases of the golf swing were examined in 11 professionals and compared to 5 amateurs using three-dimensional motion analysis.RESULTS: Peak rotational velocities of professionals were highly consistent, demonstrating low variability (coefficient of variation [COV]), particularly upper-torso rotational velocity (COV=0.086) and pelvic rotational velocity (COV=0.079) during down swing. Peak upper-torso rotational velocity and peak X-prime, the relative rotational velocity of uppertorso versus pelvis, occurred after impact in follow-through, were reduced in amateurs compared to professionals (p=0.005 and p=0.005, respectively) and differentiated professionals from most (4/5) amateurs. In contrast, peak pelvic rotational velocity occurred in down swing. Pelvic velocity at impact was reduced in amateurs compared to professionals (p=0.019) and differentiated professionals from most (4/5) amateurs.CONCLUSION: Golf swing rotational velocity of professionals was consistent in pattern and magnitude, offering benchmarks for amateurs. Understanding golf swing rotational biomechanics can guide swing modifications to help optimize performance and prevent injury.

  View details for PubMedID 30404420

• A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations. Developmental medicine and child neurology Schiariti, V., Fowler, E., Brandenburg, J. E., Levey, E., Mcintyre, S., Sukal-Moulton, T., Ramey, S. L., Rose, J., Sienko, S., Stashinko, E., Vogtle, L., Feldman, R. S., Koenig, J. I. 2018; 60 (10): 976-986

  Abstract

  To increase the efficiency and effectiveness of clinical research studies, cerebral palsy (CP) specific Common Data Elements (CDEs) were developed through a partnership between the National Institute of Neurological Disorders and Stroke (NINDS) and the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). International experts reviewed existing NINDS CDEs and tools used in studies of children and young people with CP. CDEs were compiled, subjected to internal review, and posted online for external public comment in September 2016. Guided by the International Classification of Functioning, Disability and Health framework, CDEs were categorized into six domains: (1) participant characteristics; (2) health, growth, and genetics; (3) neuroimaging; (4) neuromotor skills and functional assessments; (5) neurocognitive, social, and emotional assessments; and (6) engagement and quality of life. Version 1.0 of the NINDS/AACPDM CDEs for CP is publicly available on the NINDS CDE and AACPDM websites. Global use of CDEs for CP will standardize data collection, improve data quality, and facilitate comparisons across studies. Ongoing collaboration with international colleagues, industry, and people with CP and their families will provide meaningful feedback and updates as additional evidence is obtained. These CDEs are recommended for NINDS-funded research for CP.This is the first comprehensive Common Data Elements (CDEs) for children and young people with CP for clinical research. The CDEs for children and young people with CP include common definitions, the standardization of case report forms, and measures. The CDE guides the standardization for data collection and outcome evaluation in all types of studies with children and young people with CP. The CDE ultimately improves data quality and data sharing.

  View details for DOI 10.1111/dmcn.13723

  View details for PubMedID 29542813

• Temporal-spatial reach parameters derived from inertial sensors correlate to neurodevelopment in toddlers born preterm JOURNAL OF BIOMECHANICS Cahill-Rowley, K., Rose, J. 2018; 72: 17–22

  Abstract

  Temporal-spatial reach parameters are revealing of upper-limb function in children with motor impairments, but have not been quantified in a toddler population. This work quantitatively characterizes temporal-spatial reach in typically-developing (TD) and very-low-birth-weight (VLBW) preterm toddlers, who are at increased risk of motor impairment. 47 children born VLBW (<1500 g birth-weight; ≤32 weeks gestation) and 22 TD children completed a reaching assessment at 18-22 months of age, adjusted for prematurity. Inertial sensors containing accelerometers, gyroscopes and magnetometers were fixed to toddlers' wrists while they reached for a cube. Reach time, path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration were derived from inertial-sensor and high-speed video data. Preterm children also received the Bayley Scales of Infant Development-3rd Edition (BSID-III). Compared to TD toddlers, preterm toddlers had significantly different reach path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration. Among preterm toddlers, decreased reach time (rho = -.346, p = .018), decreased time to peak velocity (r = -.390, p = .007), and increased peak acceleration (r = .298, p = .044) correlated to higher BSID-III fine motor scores. Toddlers with below-average fine motor scores had significantly higher peak and contact velocity. Preterm toddlers demonstrated substantial differences in temporal-spatial reach parameters compared to TD toddlers, and evidence indicated several reach parameters were revealing of function and may be useful as a clinical assessment.

  View details for PubMedID 29519674

• Prediction of cognitive and motor development in preterm children using exhaustive feature selection and cross-validation of near-term white matter microstructure NEUROIMAGE-CLINICAL Schadl, K., Vassar, R., Cahill-Rowley, K., Yeom, K. W., Stevenson, D. K., Rose, J. 2018; 17: 667–79

  View details for DOI 10.1016/j.nicl.2017.11.023

  View details for Web of Science ID 000426180300071

• Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation ARTIFICIAL ORGANS Rose, J., Cahill-Rowley, K., Butler, E. E. 2017; 41 (11): E233–E239

  Abstract

  Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait.

  View details for PubMedID 29148138

• Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability NEURAL REGENERATION RESEARCH Kwon, Y., Rose, J., Kim, A., Son, S. 2017; 12 (9): 1465–71

  Abstract

  The corticoreticular tract (CRT) is known to be involved in walking and postural control. Using diffusion tensor tractography (DTT), we investigated the relationship between the CRT and gait dysfunction, including trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed (TD) children were recruited. Fifteen patients with gait dysfunction (bilateral trunk instability) were included in the group A, and the other 15 patients with gait dysfunction (unilateral trunk instability) were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical manifestations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

  View details for PubMedID 29089992

  View details for PubMedCentralID PMC5649467

• Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment FRONTIERS IN HUMAN NEUROSCIENCE Zhou, J., Butler, E. E., Rose, J. 2017; 11

  Abstract

  Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.

  View details for DOI 10.3389/fnhum.2017.00103

  View details for Web of Science ID 000396768400001

  View details for PubMedID 28367118

• Temporal-spatial reach parameters derived from inertial sensors: Comparison to 3D marker-based motion capture. Journal of biomechanics Cahill-Rowley, K., Rose, J. 2017; 52: 11-16

  Abstract

  Reaching is a well-practiced functional task crucial to daily living activities, and temporal-spatial measures of reaching reflect function for both adult and pediatric populations with upper-extremity motor impairments. Inertial sensors offer a mobile and inexpensive tool for clinical assessment of movement. This research outlines a method for measuring temporal-spatial reach parameters using inertial sensors, and validates these measures with traditional marker-based motion capture. 140 reaches from 10 adults, and 30 reaches from nine children aged 18-20 months, were recorded and analyzed using both inertial-sensor and motion-capture methods. Inertial sensors contained three-axis accelerometers, gyroscopes, and magnetometers. Gravitational offset of accelerometer data was measured when the sensor was at rest, and removed using sensor orientation measured at rest and throughout the reach. Velocity was calculated by numeric integration of acceleration, using a null-velocity assumption at reach start. Sensor drift was neglected given the 1-2s required for a reach. Temporal-spatial reach parameters were calculated independently for each data acquisition method. Reach path length and distance, peak velocity magnitude and timing, and acceleration at contact demonstrated consistent agreement between sensor- and motion-capture-based methods, for both adult and toddler reaches, as evaluated by intraclass correlation coefficients from 0.61 to 1.00. Taken together with actual difference between method measures, results indicate that these functional reach parameters may be reliably measured with inertial sensors.

  View details for DOI 10.1016/j.jbiomech.2016.10.031

  View details for PubMedID 28010947

• The Change of Intra-cerebral CST Location during Childhood and Adolescence; Diffusion Tensor Tractography Study FRONTIERS IN HUMAN NEUROSCIENCE Kwon, Y. M., Kwon, H. G., Rose, J., Son, S. M. 2016; 10

  Abstract

  Objectives: Corticospinal tract (CST) is the most important tract in motor control. However, there was no study about the change of CST location with aging. In this study, using diffusion tensor tractography (DTT), we attempted to investigate the change of CST location at cortex, corona radiata (CR) and posterior limb of internal capsule (IC) level with aging in typically developing children. Methods: We recruited 76 healthy pediatric subjects (range; 0-19 years). According to the result of DTT, the location of CST at cortex level was classified as follows; prefrontal cortex (PFC), PFC with Premotor cortex (PMC), PMC, PMC with primary motor cortex (M1), M1, M1 with Primary sensory cortex (S1). Anterior-posterior location (%) of CSTs at CR and IC level was also assessed. Results: DTT results about CSTs of 152 hemispheres from 76 subjects were obtained. The most common location of CST projection was M1 area (58.6%) including PMC with M1 (25.7%), M1 (17.8%), and M1 with S1 (15.1%). The mean age of the projection of CST showed considerably younger at anterior cortex than posterior; (PFC; 4.12 years, PFC with PMC; 6.41 years, PMC; 6.72 years, PMC with M1; 9.75 years, M1; 9.85 years, M1 with S1; 12.99 years, S1; 13.75 years). Spearman correlation showed positive correlation between age and the location of CST from anterior to posterior brain cortex (r = 0.368). Conclusion: We demonstrated that the location of CST projection is different with aging. The result of this study can provide the scientific insight to the maturation study in human brain.

  View details for DOI 10.3389/fnhum.2016.00638

  View details for Web of Science ID 000390048100001

  View details for PubMedID 28066209

  View details for PubMedCentralID PMC5167720

• Toddle temporal-spatial deviation index: Assessment of pediatric gait. Gait & posture Cahill-Rowley, K., Rose, J. 2016; 49: 226-231

  Abstract

  This research aims to develop a gait index for use in the pediatric clinic as well as research, that quantifies gait deviation in 18-22 month-old children: the Toddle Temporal-spatial Deviation Index (Toddle TDI). 81 preterm children (≤32 weeks) with very-low-birth-weights (≤1500g) and 42 full-term TD children aged 18-22 months, adjusted for prematurity, walked on a pressure-sensitive mat. Preterm children were administered the Bayley Scales of Infant Development-3rd Edition (BSID-III). Principle component analysis of TD children's temporal-spatial gait parameters quantified raw gait deviation from typical, normalized to an average(standard deviation) Toddle TDI score of 100(10), and calculated for all participants. The Toddle TDI was significantly lower for preterm versus TD children (86 vs. 100, p=0.003), and lower in preterm children with <85 vs. ≥85 BSID-III motor composite scores (66 vs. 89, p=0.004). The Toddle TDI, which by design plateaus at typical average (BSID-III gross motor 8-12), correlated with BSID-III gross motor (r=0.60, p<0.001) and not fine motor (r=0.08, p=0.65) in preterm children with gross motor scores ≤8, suggesting sensitivity to gross motor development. The Toddle TDI demonstrated sensitivity and specificity to gross motor function in very-low-birth-weight preterm children aged 18-22 months, and has been potential as an easily-administered, revealing clinical gait metric.

  View details for DOI 10.1016/j.gaitpost.2016.06.040

  View details for PubMedID 27454230

• Temporal-spatial gait parameters and neurodevelopment in very-low-birth-weight preterm toddlers at 18-22 months. Gait & posture Cahill-Rowley, K., Rose, J. 2016; 45: 83-89

  Abstract

  Children born preterm with very-low birth-weight (VLBW) have increased risk of motor impairment. Early identification of impairment guides treatment to improve long-term function. Temporal-spatial gait parameters are an easily-recorded assessment of gross motor function. The objective of this study was to characterize preterm toddlers' gait and its relationship with neurodevelopment. Velocity, cycle time, step width, step length and time asymmetry, %stance, %single-limb support, and %double-limb support were calculated for 81 VLBW preterm and 43 typically-developing (TD) toddlers. Neurodevelopment was assessed with Bayley Scales of Infant Development-3rd Edition (BSID-III) motor composite and gross motor scores. Mean step width (p=.009) was wider in preterm compared to TD toddlers. Preterm toddlers with <85 BSID-III motor composite scores, indicating mild-to-moderate delay, had significantly increased step width, step length asymmetry, and step time compared to TD toddlers. Step time was also significantly longer for lower-scoring compared to higher-scoring (≥85 BSID-III motor composite scores) preterm toddlers, suggesting that step time may be particularly sensitive to gradations of motor performance. Velocity, cycle time, step length asymmetry, %stance, step length, and step time significantly correlated with BSID-III gross motor scores, suggesting that these parameters may be revealing of gross motor function. The differences in gait between lower-scoring preterm toddlers and TD toddlers, together with the correlations between gait and BSID-III motor scores, suggest that temporal-spatial gait parameters may be useful in building a clinically-relevant, easily-conducted assessment of toddler gross motor development.

  View details for DOI 10.1016/j.gaitpost.2016.01.002

  View details for PubMedID 26979887

• Neonatal Biomarkers of Inflammation: Correlates of Early Neurodevelopment and Gait in Very-Low-Birth-Weight Preterm Children AMERICAN JOURNAL OF PERINATOLOGY Rose, J., Vassar, R., Cahill-Rowley, K., Hintz, S. R., Stevenson, D. K. 2016; 33 (1): 71-78

  Abstract

  Neonatal biomarkers of inflammation were examined in relation to early neurodevelopment and gait in very-low-birth-weight (VLBW) preterm children. We hypothesized that preterm infants exposed to higher levels of neonatal inflammation would demonstrate lower scores on Bayley Scales of Infant Toddler Development, 3rd ed. (BSID-III) and slower gait velocity at 18 to 22 months adjusted age.A total of 102 VLBW preterm infants (birthweight [BW] ≤ 1,500 g, gestational age [GA] ≤ 32 weeks) admitted to neonatal intensive care unit [NICU] were recruited. Neonatal risk factors examined were GA at birth, BW, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, sepsis, and serum C-reactive protein (CRP), albumin, and total bilirubin over first 2 postnatal weeks. At 18 to 22 months, neurodevelopment was assessed with BSID-III and gait was assessed with an instrumented mat.Children with neonatal CRP ≥ 0.20 mg/dL (n = 52) versus < 0.20 mg/dL (n = 37) had significantly lower BSID-III composite cognitive (92.0 ± 13.1 vs. 100.1 ± 9.6, p = 0.002), language (83.9 ± 16.0 vs. 95.8 ± 14.2, p < 0.001), and motor scores (90.0 ± 13.2 vs. 98.8 ± 10.1, p = 0.002), and slower gait velocity (84.9 ± 19.0 vs. 98.0 ± 22.4 cm/s, p = 0.004). Higher neonatal CRP correlated with lower cognitive (rho =  - 0.327, p = 0.002), language (rho =  - 0.285, p = 0.007), and motor scores (rho =  - 0.257, p = 0.015), and slower gait (rho =  - 0.298, p = 0.008). Multivariate analysis demonstrated neonatal CRP ≥ 0.20 mg/dL significantly predicted BSID-III cognitive (adjusted R(2) = 0.104, p = 0.008), language (adjusted R(2) = 0.124, p = 0.001), and motor scores (adjusted R(2) = 0.122, p = 0.004).Associations between low-level neonatal inflammation and neurodevelopment suggest early biomarkers that may inform neuroprotective treatment for preterm children.

  View details for DOI 10.1055/s-0035-1557106

  View details for Web of Science ID 000367556500010

• Biomechanical and Clinical Correlates of Stance-Phase Knee Flexion in Persons With Spastic Cerebral Palsy. PM & R : the journal of injury, function, and rehabilitation Rha, D. W., Cahill-Rowley, K., Young, J., Torburn, L., Stephenson, K., Rose, J. 2016; 8 (1): 11-8; quiz 18

  Abstract

  To identify biomechanical and clinical parameters that influence knee flexion (KF) angle at initial contact (IC) and during single limb stance phase of gait in children with spastic cerebral palsy (CP) who walk with flexed-knee gait.Retrospective analysis of gait kinematics and clinical data collected from 2010-2013.Motion & Gait Analysis Laboratory at Lucile Packard Children's Hospital, Stanford, CA.Gait analysis data from persons with spastic CP (Gross Motor Function Classification System [GMFCS] I-III) who had no prior surgery were analyzed. Participants exhibiting KF ≥20° at IC were included; the more-involved limb was analyzed.Outcome measures were analyzed with respect to clinical findings, including passive range of motion, Selective Motor Control Assessment for the Lower Extremity (SCALE), gait kinematics, and musculoskeletal models of muscle-tendon lengths during gait.KF at IC (KFIC) and minimum KF during single-limb support (KFSLS) were investigated.Thirty-four participants met the inclusion criteria, and their data were analyzed (20 males and 14 females, mean age 10.1 years, range 5-20 years). Mean KFIC was 34.4 ± 8.4 degrees and correlated with lower SCALE score (ρ = -0.530, P = .004), later peak KF during swing (ρ = 0.614, P < .001), and shorter maximal muscle length of the semimembranosus (ρ = -0.359, P = .037). Mean KFSLS was 18.7 ± 14.9 and correlated to KF contracture (ρ = 0.605, P < .001) and shorter maximal muscle length of the semimembranosus (ρ = -0.572, P < .001) and medial gastrocnemius (ρ = -0.386, P = .024). GMFCS correlated more strongly to KFIC (ρ = 0.502, P = .002) than to KFSLS (ρ = 0.371, P = .031). Linear regression found that both the SCALE score (P = .001) and delayed timing of peak KF during swing (P = .001) independently predicted KFIC. KF contracture (P = .026) and maximal length of the semimembranosus (P = .043) independently predicted KFSLS.Correlates of KFIC differed from those for KFSLS and suggest that impaired selective motor control and later timing of swing-phase KF influence knee position at IC, whereas KF contracture and muscle lengths influence minimal KF in single-limb support, findings with important treatment implications.

  View details for DOI 10.1016/j.pmrj.2015.06.003

  View details for PubMedID 26079863

• Biomechanical and Clinical Correlates of Stance-Phase Knee Flexion in Persons With Spastic Cerebral Palsy PM&R Rha, D., Cahill-Rowley, K., Young, J., Torburn, L., Stephenson, K., Rose, J. 2016; 8 (1): 11-18

  Abstract

  To identify biomechanical and clinical parameters that influence knee flexion (KF) angle at initial contact (IC) and during single limb stance phase of gait in children with spastic cerebral palsy (CP) who walk with flexed-knee gait.Retrospective analysis of gait kinematics and clinical data collected from 2010-2013.Motion & Gait Analysis Laboratory at Lucile Packard Children's Hospital, Stanford, CA.Gait analysis data from persons with spastic CP (Gross Motor Function Classification System [GMFCS] I-III) who had no prior surgery were analyzed. Participants exhibiting KF ≥20° at IC were included; the more-involved limb was analyzed.Outcome measures were analyzed with respect to clinical findings, including passive range of motion, Selective Motor Control Assessment for the Lower Extremity (SCALE), gait kinematics, and musculoskeletal models of muscle-tendon lengths during gait.KF at IC (KFIC) and minimum KF during single-limb support (KFSLS) were investigated.Thirty-four participants met the inclusion criteria, and their data were analyzed (20 males and 14 females, mean age 10.1 years, range 5-20 years). Mean KFIC was 34.4 ± 8.4 degrees and correlated with lower SCALE score (ρ = -0.530, P = .004), later peak KF during swing (ρ = 0.614, P < .001), and shorter maximal muscle length of the semimembranosus (ρ = -0.359, P = .037). Mean KFSLS was 18.7 ± 14.9 and correlated to KF contracture (ρ = 0.605, P < .001) and shorter maximal muscle length of the semimembranosus (ρ = -0.572, P < .001) and medial gastrocnemius (ρ = -0.386, P = .024). GMFCS correlated more strongly to KFIC (ρ = 0.502, P = .002) than to KFSLS (ρ = 0.371, P = .031). Linear regression found that both the SCALE score (P = .001) and delayed timing of peak KF during swing (P = .001) independently predicted KFIC. KF contracture (P = .026) and maximal length of the semimembranosus (P = .043) independently predicted KFSLS.Correlates of KFIC differed from those for KFSLS and suggest that impaired selective motor control and later timing of swing-phase KF influence knee position at IC, whereas KF contracture and muscle lengths influence minimal KF in single-limb support, findings with important treatment implications.

  View details for DOI 10.1016/j.pmrj.2015.06.003

  View details for Web of Science ID 000368267500002

• Neonatal Biomarkers of Inflammation: Correlates of Early Neurodevelopment and Gait in Very-Low-Birth-Weight Preterm Children. American journal of perinatology Rose, J., Vassar, R., Cahill-Rowley, K., Hintz, S. R., Stevenson, D. K. 2016; 33 (1): 71-8

  Abstract

  Neonatal biomarkers of inflammation were examined in relation to early neurodevelopment and gait in very-low-birth-weight (VLBW) preterm children. We hypothesized that preterm infants exposed to higher levels of neonatal inflammation would demonstrate lower scores on Bayley Scales of Infant Toddler Development, 3rd ed. (BSID-III) and slower gait velocity at 18 to 22 months adjusted age.A total of 102 VLBW preterm infants (birthweight [BW] ≤ 1,500 g, gestational age [GA] ≤ 32 weeks) admitted to neonatal intensive care unit [NICU] were recruited. Neonatal risk factors examined were GA at birth, BW, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, sepsis, and serum C-reactive protein (CRP), albumin, and total bilirubin over first 2 postnatal weeks. At 18 to 22 months, neurodevelopment was assessed with BSID-III and gait was assessed with an instrumented mat.Children with neonatal CRP ≥ 0.20 mg/dL (n = 52) versus < 0.20 mg/dL (n = 37) had significantly lower BSID-III composite cognitive (92.0 ± 13.1 vs. 100.1 ± 9.6, p = 0.002), language (83.9 ± 16.0 vs. 95.8 ± 14.2, p < 0.001), and motor scores (90.0 ± 13.2 vs. 98.8 ± 10.1, p = 0.002), and slower gait velocity (84.9 ± 19.0 vs. 98.0 ± 22.4 cm/s, p = 0.004). Higher neonatal CRP correlated with lower cognitive (rho =  - 0.327, p = 0.002), language (rho =  - 0.285, p = 0.007), and motor scores (rho =  - 0.257, p = 0.015), and slower gait (rho =  - 0.298, p = 0.008). Multivariate analysis demonstrated neonatal CRP ≥ 0.20 mg/dL significantly predicted BSID-III cognitive (adjusted R(2) = 0.104, p = 0.008), language (adjusted R(2) = 0.124, p = 0.001), and motor scores (adjusted R(2) = 0.122, p = 0.004).Associations between low-level neonatal inflammation and neurodevelopment suggest early biomarkers that may inform neuroprotective treatment for preterm children.

  View details for DOI 10.1055/s-0035-1557106

  View details for PubMedID 26212060

• Clinical motion analyses over eight consecutive years in a child with crouch gait: a case report. Journal of medical case reports Butler, E. E., Steele, K. M., Torburn, L., Gamble, J. G., Rose, J. 2016; 10: 157-?

  Abstract

  This case report provides a unique look at the progression of crouch gait in a child with cerebral palsy over an 8-year time period, through annual physical examinations, three-dimensional gait analyses, and evaluation of postural balance. Our patient received regular botulinum toxin-A injections, casting, and physical therapy but no surgical interventions.A white American boy with spastic diplegic cerebral palsy was evaluated annually by clinical motion analyses, including physical examination, joint kinematics, electromyography, energy expenditure, and standing postural balance tests, from 6 to 13 years of age. These analyses revealed that the biomechanical factors contributing to our patient's crouch gait were weak plantar flexors, short and spastic hamstrings, moderately short hip flexors, and external rotation of the tibiae. Despite annual recommendations for surgical lengthening of the hamstrings, the family opted for non-surgical treatment through botulinum toxin-A injections, casting, and exercise. Our patient's crouch gait improved between ages 6 and 9, then worsened at age 10, concurrent with his greatest body mass index, increased plantar flexor weakness, increased standing postural sway, slowest normalized walking speed, and greatest walking energy expenditure. Although our patient's maximum knee extension in stance improved by 14 degrees at 13 years of age compared to 6 years of age, peak knee flexion in swing declined, his ankles became more dorsiflexed, his hips became more internally rotated, and his tibiae became more externally rotated. From 6 to 9 years of age, our patient's minimum stance-phase knee flexion varied in an inverse relationship with his body mass index; from 10 to 13 years of age, changes in his minimum stance-phase knee flexion paralleled changes in his body mass index.The motor deficits of weakness, spasticity, shortened muscle-tendon lengths, and impaired selective motor control were highlighted by our patient's clinical motion analyses. Overall, our patient's crouch gait improved mildly with aggressive non-operative management and a supportive family dedicated to regular home exercise. The annual clinical motion analyses identified changes in motor deficits that were associated with changes in the child's walking pattern, suggesting that these analyses can serve to track the progression of children with spastic cerebral palsy.

  View details for DOI 10.1186/s13256-016-0920-9

  View details for PubMedID 27301473

• Neonatal brain microstructure correlates of neurodevelopment and gait in preterm children 18-22 mo of age: an MRI and DTI study PEDIATRIC RESEARCH Rose, J., Cahill-Rowley, K., Vassar, R., Yeom, K. W., Stecher, X., Stevenson, D. K., Hintz, S. R., Barnea-Goraly, N. 2015; 78 (6): 700-708

  Abstract

  Near-term brain structure was examined in preterm infants in relation to neurodevelopment. We hypothesized that near-term macrostructural brain abnormalities identified using conventional magnetic resonance imaging (MRI), and white matter (WM) microstructure detected using diffusion tensor imaging (DTI), would correlate with lower cognitive and motor development and slower, less-stable gait at 18-22 mo of age.One hundred and two very-low-birth-weight preterm infants (≤1,500 g birth weight; ≤32 wk gestational age) were recruited prior to routine near-term brain MRI at 36.6 ± 1.8 wk postmenstrual age. Cerebellar and WM macrostructure was assessed on conventional structural MRI. DTI was obtained in 66 out of 102 and WM microstructure was assessed using fractional anisotropy and mean diffusivity (MD) in six subcortical brain regions defined by DiffeoMap neonatal atlas. Neurodevelopment was assessed with Bayley-Scales-of-Infant-Toddler-Development, 3rd-Edition (BSID-III); gait was assessed using an instrumented mat.Neonates with cerebellar abnormalities identified using MRI demonstrated lower mean BSID-III cognitive composite scores (89.0 ± 10.1 vs. 97.8 ± 12.4; P = 0.002) at 18-22 mo. Neonates with higher DTI-derived left posterior limb of internal capsule (PLIC) MD demonstrated lower cognitive and motor composite scores (r = -0.368; P = 0.004; r = -0.354; P = 0.006) at 18-22 mo; neonates with higher genu MD demonstrated slower gait velocity (r = -0.374; P = 0.007). Multivariate linear regression significantly predicted cognitive (adjusted r(2) = 0.247; P = 0.002) and motor score (adjusted r(2) = 0.131; P = 0.017).Near-term cerebellar macrostructure and PLIC and genu microstructure were predictive of early neurodevelopment and gait.

  View details for DOI 10.1038/pr.2015.157

  View details for PubMedID 26322412

• Biomechanical and clinical correlates of swing-phase knee flexion in individuals with spastic cerebral palsy who walk with flexed-knee gait. Archives of physical medicine and rehabilitation Rha, D., Cahill-Rowley, K., Young, J., Torburn, L., Stephenson, K., Rose, J. 2015; 96 (3): 511-517

  Abstract

  To identify clinical and biomechanical parameters that influence swing-phase knee flexion and contribute to stiff-knee gait in individuals with spastic cerebral palsy (CP) and flexed-knee gait.Retrospective analysis of clinical data and gait kinematics collected from 2010 to 2013.Motion and gait analysis laboratory at a children's hospital.Individuals with spastic CP (N=34; 20 boys, 14 girls; mean age ± SD, 10.1±4.1y [range, 5-20y]; Gross Motor Function Classification System I-III) who walked with flexed-knee gait ≥20° at initial contact and had no prior surgery were included; the more-involved limb was analyzed.Not applicable.The magnitude and timing of peak knee flexion (PKF) during swing were analyzed with respect to clinical data, including passive range of motion and Selective Control Assessment of the Lower Extremity, and biomechanical data, including joint kinematics and hamstring, rectus femoris, and gastrocnemius muscle-tendon length during gait.Data from participants demonstrated that achieving a higher magnitude of PKF during swing correlated with a higher maximum knee flexion velocity in swing (ρ=.582, P<0.001) and a longer maximum length of the rectus femoris (ρ=.491, P=.003). In contrast, attaining earlier timing of PKF during swing correlated with a higher knee flexion velocity at toe-off (ρ=-.576, P<.001), a longer maximum length of the gastrocnemius (ρ=-.355, P=.039), and a greater peak knee extension during single-limb support phase (ρ=-.354, P=.040).Results indicate that the magnitude and timing of PKF during swing were independent, and their biomechanical correlates differed, suggesting important treatment implications for both stiff-knee and flexed-knee gait.

  View details for DOI 10.1016/j.apmr.2014.09.039

  View details for PubMedID 25450128

• Movement disorders due to bilirubin toxicity. Seminars in fetal & neonatal medicine Rose, J., Vassar, R. 2015; 20 (1): 20-25

  Abstract

  Advances in the care of neonatal hyperbilirubinemia have led to a decreased incidence of kernicterus. However, neonatal exposure to high levels of bilirubin continues to cause severe motor symptoms and cerebral palsy (CP). Exposure to moderate levels of unconjugated bilirubin may also cause damage to the developing central nervous system, specifically the basal ganglia and cerebellum. Brain lesions identified using magnetic resonance imaging following extreme hyperbilirubinemia have been linked to dyskinetic CP. Newer imaging techniques, such as diffusion tensor imaging or single-photon emission computed tomography, allow quantification of more subtle white matter injury following presumed exposure to unbound bilirubin, and may explain more subtle movement disorders. New categories of bilirubin-induced neurologic dysfunction, characterized by subtle bilirubin encephalopathy following moderate hyperbilirubinemia, have been implicated in long-term motor function. Further research is needed to identify subtle impairments resulting from moderate-severe neonatal hyperbilirubinemia, to understand the influence of perinatal risk factors on bilirubin toxicity, and to develop neuroprotective treatment strategies to prevent movement disorders due to bilirubin toxicity.

  View details for DOI 10.1016/j.siny.2014.11.002

  View details for PubMedID 25524299

• Identification of Neonatal White Matter on DTI: Influence of More Inclusive Thresholds for Atlas Segmentation PLOS ONE Vassar, R. L., Barnea-Goraly, N., Rose, J. 2014; 9 (12)

  View details for DOI 10.1371/journal.pone.0115426

  View details for Web of Science ID 000346607100075

  View details for PubMedID 25506943

• The 2014 ABJS Nicolas Andry Award: The Puzzle of the Thumb: Mobility, Stability, and Demands in Opposition CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Ladd, A. L., Crisco, J. J., Hagert, E., Rose, J., Weiss, A. C. 2014; 472 (12): 3605-3622

  Abstract

  The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and occupation may predispose individuals to OA.What evidence links ligament structure, forces, and motion to progressive CMC disease? Specifically: (1) Do unique attributes of the bony and ligamentous anatomy contribute to OA? (2) Can discrete joint load patterns be established that contribute to OA? And (3) can thumb motion that characterizes OA be measured at the fine and gross level?We addressed the morphology, load, and movement of the human thumb, emphasizing the CMC joint in normal and arthritic states. We present comparative anatomy, gross dissections, microscopic analysis, multimodal imaging, and live-subject kinematic studies to support or challenge the current understanding of the thumb CMC joint and its predisposition to disease.The current evidence suggests structural differences and loading characteristics predispose the thumb CMC to joint degeneration, especially related to volar or central wear. The patterns of degeneration, however, are not consistently identified, suggesting influences beyond inherent anatomy, repetitive load, and abnormal motion.Additional studies to define patterns of normal use and wear will provide data to better characterize CMC OA and opportunities for tailored treatment, including prevention, delay of progression, and joint arthroplasty.

  View details for Web of Science ID 000344647200003

  View details for PubMedCentralID PMC4397810

• The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability, and demands in opposition. Clinical orthopaedics and related research Ladd, A. L., Crisco, J. J., Hagert, E., Rose, J., Weiss, A. C. 2014; 472 (12): 3605-3622

  Abstract

  The paradoxical demands of stability and mobility reflect the purpose and function of the human thumb. Its functional importance is underscored when a thumb is congenitally absent, injured, or afflicted with degenerative arthritis. Prevailing literature and teaching implicate the unique shape of the thumb carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and occupation may predispose individuals to OA.What evidence links ligament structure, forces, and motion to progressive CMC disease? Specifically: (1) Do unique attributes of the bony and ligamentous anatomy contribute to OA? (2) Can discrete joint load patterns be established that contribute to OA? And (3) can thumb motion that characterizes OA be measured at the fine and gross level?We addressed the morphology, load, and movement of the human thumb, emphasizing the CMC joint in normal and arthritic states. We present comparative anatomy, gross dissections, microscopic analysis, multimodal imaging, and live-subject kinematic studies to support or challenge the current understanding of the thumb CMC joint and its predisposition to disease.The current evidence suggests structural differences and loading characteristics predispose the thumb CMC to joint degeneration, especially related to volar or central wear. The patterns of degeneration, however, are not consistently identified, suggesting influences beyond inherent anatomy, repetitive load, and abnormal motion.Additional studies to define patterns of normal use and wear will provide data to better characterize CMC OA and opportunities for tailored treatment, including prevention, delay of progression, and joint arthroplasty.

  View details for DOI 10.1007/s11999-014-3901-6

  View details for PubMedID 25171934

• Etiology of impaired selective motor control: emerging evidence and its implications for research and treatment in cerebral palsy. Developmental medicine and child neurology Cahill-Rowley, K., Rose, J. 2014; 56 (6): 522-528

  Abstract

  Selective motor control (SMC) impairment involves movement patterns dominated by flexor or extensor synergies that interfere with functional movements in children with cerebral palsy (CP). Emerging evidence on neural correlates of impaired SMC has important implications for etiology and for the treatment for children with CP. Early evidence on the microstructure of brain white matter assessed with diffusion tensor imaging in adult patients after stroke suggests that the rubrospinal tract may compensate for injury to the corticospinal tract. Furthermore, the observed changes on diffusion tensor imaging corresponded to the degree of SMC impairment. The rubrospinal tract may provide imperfect compensation in response to corticospinal tract injury, resulting in diminished SMC. Cortical mapping evidence in stroke patients indicates that loss of SMC is also associated with increased overlap of joint representation in the sensorimotor cortices. The severity of SMC impairment can be assessed with the recently developed Selective Control Assessment of the Lower Extremity, a validated observation-based measure designed for children with spastic CP. Recent advances in neuroimaging and assessment of SMC provide an opportunity to better understand the etiology and impact of impaired SMC, which may ultimately guide strategic treatment for children with CP.

  View details for DOI 10.1111/dmcn.12355

  View details for PubMedID 24359183

• Brain microstructural development at near-term age in very-low-birth-weight preterm infants: An atlas-based diffusion imaging study. NeuroImage Rose, J., Vassar, R., Cahill-Rowley, K., Guzman, X. S., Stevenson, D. K., Barnea-Goraly, N. 2014; 86: 244-256

  Abstract

  At near-term age the brain undergoes rapid growth and development. Abnormalities identified during this period have been recognized as potential predictors of neurodevelopment in children born preterm. This study used diffusion tensor imaging (DTI) to examine white matter (WM) microstructure in very-low-birth-weight (VLBW) preterm infants to better understand regional WM developmental trajectories at near-term age. DTI scans were analyzed in a cross-sectional sample of 45 VLBW preterm infants (BW≤1500g, GA≤32weeks) within a cohort of 102 neonates admitted to the NICU and recruited to participate prior to standard-of-care MRI, from 2010 to 2011, 66/102 also had DTI. For inclusion in this analysis, 45 infants had DTI, no evidence of brain abnormality on MRI, and were scanned at PMA ≤40weeks (34.7-38.6). White matter microstructure was analyzed in 19 subcortical regions defined by DiffeoMap neonatal brain atlas, using threshold values of trace <0.006mm(2)s(-1) and FA >0.15. Regional fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were calculated and temporal-spatial trajectories of development were examined in relation to PMA and brain region location. Posterior regions within the corona radiata (CR), corpus callosum (CC), and internal capsule (IC) demonstrated significantly higher mean FA values compared to anterior regions. Posterior regions of the CR and IC demonstrated significantly lower RD values compared to anterior regions. Centrally located projection fibers demonstrated higher mean FA and lower RD values than peripheral regions including the posterior limb of the internal capsule (PLIC), cerebral peduncle, retrolenticular part of the IC, posterior thalamic radiation, and sagittal stratum. Centrally located association fibers of the external capsule had higher FA and lower RD than the more peripherally-located superior longitudinal fasciculus (SLF). A significant relationship between PMA-at-scan and FA, MD, and RD was demonstrated by a majority of regions, the strongest correlations were observed in the anterior limb of the internal capsule, a region undergoing early stages of myelination at near-term age, in which FA increased (r=.433, p=.003) and MD (r=-.545, p=.000) and RD (r=-.540, p=.000) decreased with PMA-at-scan. No correlation with PMA-at-scan was observed in the CC or SLF, regions that myelinate later in infancy. Regional patterns of higher FA and lower RD were observed at this near-term age, suggestive of more advanced microstructural development in posterior compared to anterior regions within the CR, CC, and IC and in central compared to peripheral WM structures. Evidence of region-specific rates of microstructural development was observed. Temporal-spatial patterns of WM microstructure development at near-term age have important implications for interpretation of near-term DTI and for identification of aberrations in typical developmental trajectories that may signal future impairment.

  View details for DOI 10.1016/j.neuroimage.2013.09.053

  View details for PubMedID 24091089

• Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants. NeuroImage. Clinical Rose, J., Vassar, R., Cahill-Rowley, K., Stecher Guzman, X., Hintz, S. R., Stevenson, D. K., Barnea-Goraly, N. 2014; 5: 169-177

  Abstract

  Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age. Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin. Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = -.322, p = .009; r= -.381, p= .002), lower mean albumin (r = -.276, p= .029; r= -.385, p= .002), and lower mean bilirubin (r = -.293, p= .020; r= -.337 p= .007). Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopmental impairment and inform neuroprotective treatment for VLBW preterm infants.

  View details for DOI 10.1016/j.nicl.2014.05.013

  View details for PubMedID 25068107

• Motor systems and postural instability. Handbook of clinical neurology Vassar, R. L., Rose, J. 2014; 125: 237-251

  Abstract

  Acute alcohol intoxication and chronic alcohol dependence alter the neurologic control of posture and motor function. Ethanol delays the conduction of electric signals from the central nervous system to the muscles controlling posture and impairs the integration of sensory inputs required for maintaining vertical stance. Consequently, alcohol intoxication delays the ability to detect postural changes and enact the appropriate response. Common signs of acute alcohol intoxication include spinocerebellar and vestibulocerebellar ataxia, oculomotor changes, and increased reliance on visuospatial clues. Chronic alcoholism results in postural tremors and excessive sway during quiet stance that can persist even after sobriety is achieved. Underlying neurologic changes due to chronic alcoholism have been found to be associated with these characteristic postural changes and include decreased volume of the anterior superior vermis of the cerebellum, decreased connectivity within the corpus callosum, and overall cortical atrophy. Severity of motor impairments and other symptoms from alcoholism relate to a variety of factors, including duration of alcoholism, age, sex, and other health determinants and comorbidities. Imaging studies highlight the potential for partial recovery from neurologic and motor deficits caused by alcoholism. Emerging evidence on the motor and neurologic changes caused by alcohol dependence may allow for improved treatment and prevention of the morbidities associated with alcoholism.

  View details for DOI 10.1016/B978-0-444-62619-6.00015-X

  View details for PubMedID 25307579

• Identification of neonatal white matter on DTI: influence of more inclusive thresholds for atlas segmentation. PloS one Vassar, R. L., Barnea-Goraly, N., Rose, J. 2014; 9 (12)

  Abstract

  Semi-automated diffusion tensor imaging (DTI) analysis of white matter (WM) microstructure offers a clinically feasible technique to assess neonatal brain development and provide early prognosis, but is limited by variable methods and insufficient evidence regarding optimal parameters. The purpose of this research was to investigate the influence of threshold values on semi-automated, atlas-based brain segmentation in very-low-birth-weight (VLBW) preterm infants at near-term age.DTI scans were analyzed from 45 VLBW preterm neonates at near-term-age with no brain abnormalities evident on MRI. Brain regions were selected with a neonatal brain atlas and threshold values: trace <0.006 mm2/s, fractional anisotropy (FA)>0.15, FA>0.20, and FA>0.25. Relative regional volumes, FA, axial diffusivity (AD), and radial diffusivity (RD) were compared for twelve WM regions.Near-term brain regions demonstrated differential effects from segmentation with the three FA thresholds. Regional DTI values and volumes selected in the PLIC, CereP, and RLC varied the least with the application of different FA thresholds. Overall, application of higher FA thresholds significantly reduced brain region volume selected, increased variability, and resulted in higher FA and lower RD values. The lower threshold FA>0.15 selected 78±21% of original volumes segmented by the atlas, compared to 38±12% using threshold FA>0.25.Results indicate substantial and differential effects of atlas-based DTI threshold parameters on regional volume and diffusion scalars. A lower, more inclusive FA threshold than typically applied for adults is suggested for consistent analysis of WM regions in neonates.

  View details for DOI 10.1371/journal.pone.0115426

  View details for PubMedID 25506943

  View details for PubMedCentralID PMC4266649

• The Pediatric Upper Limb Motion Index and a temporal-spatial logistic regression: Quantitative analysis of upper limb movement disorders during the Reach & Grasp Cycle JOURNAL OF BIOMECHANICS Butler, E. E., Rose, J. 2012; 45 (6): 945-951

  Abstract

  This study describes a novel pediatric upper limb motion index (PULMI) for children with cerebral palsy (CP). The PULMI is based on three-dimensional kinematics and provides quantitative information about upper limb motion during the Reach & Grasp Cycle. We also report key temporal-spatial parameters for children with spastic, dyskinetic, and ataxic CP. Participants included 30 typically-developing (TD) children (age=10.9±4.1 years) and 25 children with CP and upper limb involvement (age=12.3±3.7 years), Manual Ability Classification System (MACS) levels I-IV. The PULMI is calculated from the root-mean-square difference for eight kinematic variables between each child with CP and the average TD values, and scaled such that the TD PULMI is 100±10. The PULMI was significantly lower among children with CP compared to TD children (Wilcoxon Z=-5.06, p<.0001). PULMI scores were significantly lower among children with dyskinetic CP compared to spastic CP (Z=-2.47, p<.0135). There was a strong negative correlation between PULMI and MACS among children with CP (Spearman's rho=-.78, p<.0001). Temporal-spatial values were significantly different between CP and TD children: movement time (Z=4.06, p<.0001), index of curvature during reach (Z=3.68, p=.0002), number of movement units (Z=3.72, p=.0002), angular velocity of elbow extension during reach (Z=-3.96, p<.0001), and transport(1):reach peak velocities (Z=-2.48, p=.0129). A logistic regression of four temporal-spatial parameters, the Pediatric Upper Limb Temporal-Spatial Equation (PULTSE), correctly predicted 19/22 movement disorder subtypes (spastic versus dyskinetic CP). The PULMI, PULTSE, and key temporal-spatial parameters of the Reach & Grasp Cycle offer a quantitative approach to analyzing upper limb function in children with CP.

  View details for DOI 10.1016/j.jbiomech.2012.01.018

  View details for Web of Science ID 000302980600006

  View details for PubMedID 22304845

• Rotational Biomechanics of the Elite Golf Swing: Benchmarks for Amateurs JOURNAL OF APPLIED BIOMECHANICS Meister, D. W., Ladd, A. L., Butler, E. E., Zhao, B., Rogers, A. P., Ray, C. J., Rose, J. 2011; 27 (3): 242-251

  Abstract

  The purpose of this study was to determine biomechanical factors that may influence golf swing power generation. Three-dimensional kinematics and kinetics were examined in 10 professional and 5 amateur male golfers. Upper-torso rotation, pelvic rotation, X-factor (relative hip-shoulder rotation), O-factor (pelvic obliquity), S-factor (shoulder obliquity), and normalized free moment were assessed in relation to clubhead speed at impact (CSI). Among professional golfers, results revealed that peak free moment per kilogram, peak X-factor, and peak S-factor were highly consistent, with coefficients of variation of 6.8%, 7.4%, and 8.4%, respectively. Downswing was initiated by reversal of pelvic rotation, followed by reversal of upper-torso rotation. Peak X-factor preceded peak free moment in all swings for all golfers, and occurred during initial downswing. Peak free moment per kilogram, X-factor at impact, peak X-factor, and peak upper-torso rotation were highly correlated to CSI (median correlation coefficients of 0.943, 0.943, 0.900, and 0.900, respectively). Benchmark curves revealed kinematic and kinetic temporal and spatial differences of amateurs compared with professional golfers. For amateurs, the number of factors that fell outside 1-2 standard deviations of professional means increased with handicap. This study identified biomechanical factors highly correlated to golf swing power generation and may provide a basis for strategic training and injury prevention.

  View details for PubMedID 21844613

• Physiologic Correlates of T'ai Chi Chuan JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Iuliano, B., Grahn, D., Cao, V., Zhao, B., Rose, J. 2011; 17 (1): 77-81

  Abstract

  T'ai chi chuan, the ancient Chinese martial art, is practiced by millions of people worldwide and is an activity of moderate intensity that involves slow, circular movements. Evidence of substantial health benefits of t'ai chi chuan is emerging, however, the physiologic mechanisms are not well-understood. T'ai chi chuan masters routinely report sensing qi or internal energy flow, particularly in the hands. The purpose of this case study was to determine whether physiologic responses normally associated with thermoregulation are activated during a basic t'ai chi chuan exercise.Trials consisted of three focus periods and one withdraw period (during which the subject withdrew internal energy in the hands), each followed by a rest period. Measurements included infrared-thermography (IR), thermocoupled temperature measures, and laser Doppler flowmetry.Substantial increases in local palmar and face surface temperatures were observed with IR thermography during focus periods and substantial decreases were observed during the withdraw period. Fingertip surface baseline temperatures were 31.1°C for one trial, increased by 1.8°C during the focus period, and then decreased by 4.9°C during the withdraw period. A twofold increase in blood flow through fingertip regions paralleled changes in fingertip surface temperatures during focus periods.Changes in regional blood flow and surface temperatures closely paralleled onsets of focus, rest, and withdraw periods and appear to be volitional activations of known vasomotor mechanisms underlying non-hairy skin regions such as the hands and face. Changes in blood flow through these vascular structures are generally autonomic thermoregulatory responses, not normally under voluntary control, but may also represent a relaxation response.

  View details for DOI 10.1089/acm.2009.0710

  View details for Web of Science ID 000286594500015

  View details for PubMedID 21222533

• Definition and Classification of Hyperkinetic Movements in Childhood MOVEMENT DISORDERS Sanger, T. D., Chen, D., Fehlings, D. L., Hallett, M., Lang, A. E., Mink, J. W., Singer, H. S., Alter, K., Ben-Pazi, H., Butler, E. E., Chen, R., Collins, A., Dayanidhi, S., Forssberg, H., Fowler, E., Gilbert, D. L., Gorman, S. L., Gormley, M. E., Jinnah, H. A., Kornblau, B., Krosschell, K. J., Lehman, R. K., MacKinnon, C., Malanga, C. J., Mesterman, R., Michaels, M. B., Pearson, T. S., Rose, J., Russman, B. S., Sternad, D., Swoboda, K. J., Valero-Cuevas, F. 2010; 25 (11): 1538-1549

  Abstract

  Hyperkinetic movements are unwanted or excess movements that are frequently seen in children with neurologic disorders. They are an important clinical finding with significant implications for diagnosis and treatment. However, the lack of agreement on standard terminology and definitions interferes with clinical treatment and research. We describe definitions of dystonia, chorea, athetosis, myoclonus, tremor, tics, and stereotypies that arose from a consensus meeting in June 2008 of specialists from different clinical and basic science fields. Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. Chorea is an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments. Athetosis is a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture. Myoclonus is a sequence of repeated, often nonrhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles. Tremor is a rhythmic back-and-forth or oscillating involuntary movement about a joint axis. Tics are repeated, individually recognizable, intermittent movements or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement. Stereotypies are repetitive, simple movements that can be voluntarily suppressed. We provide recommended techniques for clinical examination and suggestions for differentiating between the different types of hyperkinetic movements, noting that there may be overlap between conditions. These definitions and the diagnostic recommendations are intended to be reliable and useful for clinical practice, communication between clinicians and researchers, and for the design of quantitative tests that will guide and assess the outcome of future clinical trials.

  View details for DOI 10.1002/mds.23088

  View details for Web of Science ID 000281346400003

  View details for PubMedID 20589866

  View details for PubMedCentralID PMC2929378

• Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children GAIT & POSTURE Butler, E. E., Ladd, A. L., Lamont, L. E., Rose, J. 2010; 32 (3): 301-306

  Abstract

  The objective of this study was to characterize normal temporal-spatial patterns during the Reach & Grasp Cycle and to identify upper limb motor deficits in children with cerebral palsy (CP). The Reach & Grasp Cycle encompasses six sequential tasks: reach, grasp cylinder, transport to self (T(1)), transport back to table (T(2)), release cylinder, and return to initial position. Three-dimensional motion data were recorded from 25 typically developing children (11 males, 14 females; ages 5-18 years) and 12 children with hemiplegic CP (2 males, 10 females; ages 5-17 years). Within-day and between-day coefficients of variation for the control group ranged from 0 to 0.19, indicating good repeatability of all parameters. The mean duration of the Cycle for children with CP was nearly twice as long as controls, 9.5±4.3s versus 5.1±1.2s (U=37.0, P=.002), partly due to prolonged grasp and release durations. Peak hand velocity occurred at approximately 40% of each phase and was greater during the transport (T(1), T(2)) than non-transport phases (reach, return) in controls (P<.001). Index of curvature was lower during transport versus non-transport phases for all children. Children with CP demonstrated an increased index of curvature during reach (U=46.0, P=.0074) and an increased total number of movement units (U=16.5, P<.0001) compared to controls, indicating less efficient and less smooth movements. Total duration of the Reach & Grasp Cycle (rho=.957, P<.0001), index of curvature during reach and T(1) (rho=.873, P=.0002 and rho=.778, P=.0028), and total number of movement units (rho=.907, P<.0001) correlated strongly with MACS score. The consistent normative data and the substantial differences between children with CP and controls reflect utility of the Reach & Grasp Cycle for quantitative evaluation of upper limb motor deficits.

  View details for DOI 10.1016/j.gaitpost.2010.05.013

  View details for PubMedID 20558067

• Three-dimensional kinematics of the upper limb during a Reach and Grasp Cycle for children GAIT & POSTURE Butler, E. E., Ladd, A. L., Louie, S. A., Lamont, L. E., Wong, W., Rose, J. 2010; 32 (1): 72-77

  Abstract

  The ability to reach, grasp, transport, and release objects is essential for activities of daily living. The objective of this study was to develop a quantitative method to assess upper limb motor deficits in children with cerebral palsy (CP) using three-dimensional motion analysis. We report kinematic data from 25 typically developing (TD) children (11 males, 14 females; ages 5-18 years) and 2 children with spastic hemiplegic CP (2 females, ages 14 and 15 years) during the Reach and Grasp Cycle. The Cycle includes six sequential tasks: reach, grasp cylinder, transport to mouth (T(1)), transport back to table (T(2)), release cylinder, and return to initial position. It was designed to represent a functional activity that was challenging yet feasible for children with CP. For example, maximum elbow extension was 43+/-11 degrees flexion in the TD group. Consistent kinematic patterns emerged for the trunk and upper limb: coefficients of variation at point of task achievement for reach, T(1), and T(2) for trunk flexion-extension were (.11, .11, .11), trunk axial rotation (.06, .06, .06), shoulder elevation (.13, .11, .13), elbow flexion-extension (.25, .06, .23), forearm pronation-supination (.08, .10, .11), and wrist flexion-extension (.25, .21, .22). The children with CP demonstrated reduced elbow extension, increased wrist flexion and trunk motion, with an increased tendency to actively externally rotate the shoulder and supinate the forearm during T(1) compared to the TD children. The consistent normative data and clinically significant differences in joint motion between the CP and TD children suggest the Reach and Grasp Cycle is a repeatable protocol for objective clinical evaluation of functional upper limb motor performance.

  View details for DOI 10.1016/j.gaitpost.2010.03.011

  View details for PubMedID 20378351

• Mechanisms of Postural Control in Alcoholic Men and Women: Biomechanical Analysis of Musculoskeletal Coordination During Quiet Standing ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Sullivan, E. V., Rose, J., Pfefferbaum, A. 2010; 34 (3): 528-537

  Abstract

  Excessive sway during quiet standing is a common sequela of chronic alcoholism even with prolonged sobriety. Whether alcoholic men and women who have remained abstinent from alcohol for weeks to months differ from each other in the degree of residual postural instability and biomechanical control mechanisms has not been directly tested.We used a force platform to characterize center-of-pressure biomechanical features of postural sway, with and without stabilizing conditions from touch, vision, and stance, in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. Groups were matched in age (49.4 years), general intelligence, socioeconomic status, and handedness. Each alcoholic group was sober for an average of 75 days.Analysis of postural sway when using all 3 stabilizing conditions versus none revealed diagnosis and sex differences in ability to balance. Alcoholics had significantly longer sway paths, especially in the anterior-posterior direction, than controls when maintaining erect posture without balance aids. With stabilizing conditions the sway paths of all groups shortened significantly, especially those of alcoholic men, who demonstrated a 3.1-fold improvement in sway path difference between the easiest and most challenging conditions; the remaining 3 groups, each showed a approximately 2.4-fold improvement. Application of a mechanical model to partition sway paths into open-loop and closed-loop postural control systems revealed that the sway paths of the alcoholic men but not alcoholic women were characterized by greater short-term (open-loop) diffusion coefficients without aids, often associated with muscle stiffening response. With stabilizing factors, all 4 groups showed similar long-term (closed loop) postural control. Correlations between cognitive abilities and closed-loop sway indices were more robust in alcoholic men than alcoholic women.Reduction in sway and closed-loop activity during quiet standing with stabilizing factors shows some differential expression in men and women with histories of alcohol dependence. Nonetheless, enduring deficits in postural instability of both alcoholic men and alcoholic women suggest persisting liability for falling.

  View details for DOI 10.1111/j.1530-0277.2009.01118.x

  View details for Web of Science ID 000275142100017

  View details for PubMedID 20028360

  View details for PubMedCentralID PMC2858249

• Physiological and Focal Cerebellar Substrates of Abnormal Postural Sway and Tremor in Alcoholic Women BIOLOGICAL PSYCHIATRY Sullivan, E. V., Rose, J., Pfefferbaum, A. 2010; 67 (1): 44-51

  Abstract

  Posturography analysis of static balance reveals marked sway and tremor in sober alcoholic men related to anterior vermis volume but can be attenuated by simple visual or tactile cues or alterations in stance. Whether alcoholic women, whose ataxia can persist with prolonged sobriety, exhibit the same physiological signature of balance instability and relation to cerebellar vermian volume as alcoholic men or can benefit from stabilizing factors is unknown.Groups comprised 15 alcohol-dependent women, alcohol-free (median 3 months) and 29 control women. Groups were matched in age, demographic features, and finger movement speed and underwent balance platform testing and magnetic resonance imaging scanning.Alcoholic women exhibited excessive sway path length (.6 SD), more dramatic in the anterior-posterior than medial-lateral direction. Truncal tremor, measured as peak sway velocity frequency, was disproportionately great in the 5 Hz to 7 Hz band of alcoholics. Control subjects and alcoholics exhibited sway and tremor reduction with visual, tactile, or stance-stabilizing conditions, which aided both groups equally well; thus, alcoholic women never achieved normal stability. Smaller anterior vermian volumes selectively correlated with longer sway path and higher 5 Hz to 7 Hz peak sway velocity.Sway and tremor abnormalities and the selective relations between greater sway and 5 Hz to 7 Hz tremor and smaller volumes of the anterior vermis had not heretofore been described in abstinent alcoholic women. Reduction in sway and tremor with stabilizing factors indicate that adaptive mechanisms involving sensorimotor integration can be invoked to compensate for vermian-related dysfunction.

  View details for DOI 10.1016/j.biopsych.2009.08.008

  View details for Web of Science ID 000272858600006

  View details for PubMedID 19782966

  View details for PubMedCentralID PMC2794976

• Selective motor control in spastic cerebral palsy DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J. 2009; 51 (8): 578-579

  View details for Web of Science ID 000268029100004

  View details for PubMedID 19627331

• Neonatal brain structure on MRI and diffusion tensor imaging, sex, and neurodevelopment in very-low-birthweight preterm children DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Butler, E. E., Lamont, L. E., Barnes, P. D., Atlas, S. W., Stevenson, D. K. 2009; 51 (7): 526-535

  Abstract

  The neurological basis of an increased incidence of cerebral palsy (CP) in preterm males is unknown. This study examined neonatal brain structure on magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) at term-equivalent age, sex, and neurodevelopment at 1 year 6 months on the basis of the Amiel-Tison neurological examination, Gross Motor Function Classification System, and Bayley Scales of Infant Development in 78 very-low-birthweight preterm children (41 males, 37 females; mean gestational age 27.6 wks, SD 2.5; mean birthweight 1021 g, SD 339). Brain abnormalities on MRI and DTI were not different between males and females except in the splenium of the corpus callosum, where males had lower DTI fractional anisotropy (p=0.025) and a higher apparent diffusion coefficient (p=0.013), indicating delayed splenium development. In the 26 infants who were at higher risk on the basis of DTI, males had more abnormalities on MRI (p=0.034) and had lower fractional anisotropy and a higher apparent diffusion coefficient in the splenium (p=0.049; p=0.025) and right posterior limb of the internal capsule (PLIC; p=0.003; p=0.033). Abnormal neurodevelopment was more common in males (n=9) than in females (n=2; p=0.036). Children with abnormal neurodevelopment had more abnormalities on MRI (p=0.014) and reduced splenium and right PLIC fractional anisotropy (p=0.001; p=0.035). In children with abnormal neurodevelopment, right PLIC fractional anisotropy was lower than left (p=0.035), whereas in those with normal neurodevelopment right PLIC fractional anisotropy was higher than left (p=0.001). Right PLIC fractional anisotropy correlated to neurodevelopment (rho=0.371, p=0.002). Logistic regression predicted neurodevelopment with 94% accuracy; only right PLIC fractional anisotropy was a significant logistic coefficient. Results indicate that the higher incidence of abnormal neurodevelopment in preterm males relates to greater incidence and severity of brain abnormalities, including reduced PLIC and splenium development.

  View details for DOI 10.1111/j.1469-8749.2008.03231.x

  View details for PubMedID 19459915

• Postural sway reduction in aging men and women: Relation to brain structure, cognitive status, and stabilizing factors NEUROBIOLOGY OF AGING Sullivan, E. V., Rose, J., Rohlfing, T., Pfefferbaum, A. 2009; 30 (5): 793-807

  Abstract

  Postural stability becomes compromised with advancing age, but the neural mechanisms contributing to instability have not been fully explicated. Accordingly, this quantitative physiological and MRI study of sex differences across the adult age range examined the association between components of postural control and the integrity of brain structure and function under different conditions of sensory input and stance stabilization manipulation. The groups comprised 28 healthy men (age 30-73 years) and 38 healthy women (age 34-74 years), who completed balance platform testing, cognitive assessment, and structural MRI. The results supported the hypothesis that excessive postural sway would be greater in older than younger healthy individuals when standing without sensory or stance aids, and that introduction of such aids would reduce sway in both principal directions (anterior-posterior and medial-lateral) and in both the open-loop and closed-loop components of postural control even in older individuals. Sway reduction with stance stabilization, that is, standing with feet apart, was greater in men than women, probably because older men were less stable than women when standing with their feet together. Greater sway was related to evidence for greater brain structural involutional changes, indexed as ventricular and sulcal enlargement and white matter hyperintensity burden. In women, poorer cognitive test performance related to less sway reduction with the use of sensory aids. Thus, aging men and women were shown to have diminished postural control, associated with cognitive and brain structural involution, in unstable stance conditions and with diminished sensory input.

  View details for DOI 10.1016/j.neurobiolaging.2007.08.021

  View details for Web of Science ID 000265018700012

  View details for PubMedID 17920729

  View details for PubMedCentralID PMC2684797

• Oral baclofen increases maximal voluntary neuromuscular activation of ankle plantar flexors in children with spasticity due to cerebral palsy JOURNAL OF CHILD NEUROLOGY van Doornik, J., Kukke, S., McGill, K., Rose, J., Sherman-Levine, S., Sanger, T. D. 2008; 23 (6): 635-639

  Abstract

  Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary ability to activate ankle plantar flexor muscles using the ratio of the surface electromyographic signal during isometric maximal voluntary contraction to the M-wave during supramaximal electrical stimulation of the tibial nerve and tested muscle strength using maximal isometric plantar flexion torque. Mean maximal voluntary neuromuscular activation increased from 1.13 +/- 1.02 to 1.60 +/- 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.

  View details for DOI 10.1177/0883073807313046

  View details for Web of Science ID 000256033800006

  View details for PubMedID 18281622

• Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: Section on pediatrics research summit proceedings PHYSICAL THERAPY Fowler, E. G., Kolobe, T. H., Damiano, D. L., Thorpe, D. E., Morgan, D. W., Brunstrom, J. E., Coster, W. J., Henderson, R. C., Pitetti, K. H., Rimmer, J. H., Rose, J., Stevenson, R. D. 2007; 87 (11): 1495-1510

  Abstract

  Inadequate physical fitness is a major problem affecting the function and health of children with cerebral palsy (CP). Lack of optimal physical activity may contribute to the development of secondary conditions associated with CP such as chronic pain, fatigue, and osteoporosis. The purpose of this article is to highlight the content and recommendations of a Pediatrics Research Summit developed to foster collaborative research in this area. Two components of physical fitness-muscle strength and cardiorespiratory fitness-were emphasized. Although there is evidence to support the use of physical fitness interventions, there are many gaps in our current knowledge. Additional research of higher quality and rigor is needed in order to make definitive recommendations regarding the mode, intensity, frequency, and duration of exercise. Outcome measurements have focused on the body functions and structures level of the International Classification of Functioning, Disability and Health (ICF), and much less is known about effects at the activities and participation levels. Additionally, the influence of nutritional and growth factors on physical fitness has not been studied in this population, in which poor growth and skeletal fragility have been identified as serious health issues. Current intervention protocols and outcome measurements were critically evaluated, and recommendations were made for future research.

  View details for DOI 10.2522/ptj.20060116

  View details for Web of Science ID 000250803300009

  View details for PubMedID 17895351

• Neonatal microstructural development of the internal capsule on diffusion tensor imaging correlates with severity of gait and motor deficits DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Mirmiran, M., Butler, E. E., Lin, C. Y., Barnes, P. D., Kermoian, R., Stevenson, D. K. 2007; 49 (10): 745-750

  Abstract

  Neonatal microstructural development in the posterior limbs of the internal capsule (PLIC) was assessed using diffusion tensor imaging (DTI) fractional anisotropy (FA) in 24 very-low-birthweight preterm infants at 37 weeks' gestational age and compared with the children's gait and motor deficits at 4 years of age. There were 14 participants with normal neonatal FA values (seven females, seven males; born at 27.6 weeks [SD 2.3] gestational age; birthweight 1027g [SD 229]) and 10 participants with low FA values in the PLIC (four females, six males; born at 28.4 weeks [SD 2.0] gestational age; birthweight 1041g [SD 322]). Seven of the 10 children with low FA and none of the children with normal FA had been diagnosed with CP by the time of gait testing. Among children with low neonatal FA, there was a strong negative correlation between FA of the combined left and right side PLIC and log NI (r=-0.89, p=0.001) and between FA and GMFCS (r=-0.65, p=0.04) at 4 years of age. There was no correlation between FA and gait NI or GMFCS at 4 years of age among children with normal neonatal FA. This preliminary study suggests neonatal DTI may be an important predictor of the severity of future gait and motor deficits.

  View details for PubMedID 17880643

• Definition and classification of negative motor signs in childhood PEDIATRICS Sanger, T. D., Chen, D., Delgado, M. R., Gaebler-Spira, D., Hallett, M., Mink, J. W., Disorders, T. C. 2006; 118 (5): 2159-2167

  Abstract

  In this report we describe the outcome of a consensus meeting that occurred at the National Institutes of Health in Bethesda, Maryland, March 12 through 14, 2005. The meeting brought together 39 specialists from multiple clinical and research disciplines including developmental pediatrics, neurology, neurosurgery, orthopedic surgery, physical therapy, occupational therapy, physical medicine and rehabilitation, neurophysiology, muscle physiology, motor control, and biomechanics. The purpose of the meeting was to establish terminology and definitions for 4 aspects of motor disorders that occur in children: weakness, reduced selective motor control, ataxia, and deficits of praxis. The purpose of the definitions is to assist communication between clinicians, select homogeneous groups of children for clinical research trials, facilitate the development of rating scales to assess improvement or deterioration with time, and eventually to better match individual children with specific therapies. "Weakness" is defined as the inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint. "Reduced selective motor control" is defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of a voluntary posture or movement. "Ataxia" is defined as an inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints. "Apraxia" is defined as an impairment in the ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity. "Developmental dyspraxia" is defined as a failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness, or involuntary motor activity.

  View details for DOI 10.1542/peds.2005-3016

  View details for Web of Science ID 000241731700042

  View details for PubMedID 17079590

• Postural equilibrium during pregnancy: Decreased stability with an increased reliance on visual cues 26th Annual Meeting of the Society-for-Maternal-Fetal-Medicine Butler, E. E., Colon, I., Druzin, M. L., Rose, J. MOSBY-ELSEVIER. 2006: 1104–8

  Abstract

  The purpose of this study was to determine whether there are changes in postural equilibrium during pregnancy and to examine whether the incidence of falls increases during pregnancy.Static postural balance measures were collected from 12 pregnant women at 11 to 14, 19 to 22, and 36 to 39 weeks gestation and at 6 to 8 weeks after delivery and from 12 nulligravid control subjects who were matched for age, height, weight, and body mass index. Subjects were asked to stand quietly on a stable force platform for 30 seconds with eyes open and closed. Path length and average radial displacement were computed on the basis of the average of 3 trials for each condition. The women were asked at each session if they had sustained a fall in the previous 3 months.Postural stability remained relatively stable during the first trimester; however, second and third trimester and postpartum values for path length and average radial displacement with eyes open and closed were increased significantly compared with the control subjects, which indicates diminished postural balance. The difference between the eyes open and closed values of path length increased as pregnancy progressed. Although 25% of pregnant women sustained falls, none of the control subjects had fallen in the past year.These data suggest that postural stability declines during pregnancy and remains diminished at 6 to 8 weeks after delivery. The study also indicates that there is an increased reliance on visual cues to maintain balance during pregnancy.

  View details for DOI 10.1016/j.ajog.2006.06.015

  View details for Web of Science ID 000241123500034

  View details for PubMedID 16846574

• Effect of vision, touch and stance on cerebellar vermian-related sway and tremor: A quantitative physiological and MRI study CEREBRAL CORTEX Sullivan, E. V., Rose, J., Pfefferbaum, A. 2006; 16 (8): 1077-1086

  Abstract

  Postural balance is impaired in individuals with pathology of the anterior superior vermis of the cerebellum. Chronic alcoholism, with its known vermian pathology, provides a viable model for studying the relationship between cerebellar pathology and postural stability. Decades of separate study of recovering alcoholics and post-mortem neuroanatomical analysis have demonstrated vermian pathology but few studies have used quantitative posturography, acquired concurrently with quantitative neuroimaging, to establish whether this brain structure-function relationship is selective in vivo. Here, 30 healthy men and 39 chronic alcoholic men, abstinent from alcohol for several months, underwent MRI for volumetric quantitation of the cerebellar vermis and three comparison brain regions, the cerebellar hemispheres, supratentorial cortex and corpus callosum. All subjects also participated in an experiment involving a force platform that measured sway path length and tremor during static standing balance under four sensory conditions and two stance conditions. Three novel findings emerged: (i) sway path length, a physiological index of postural control, was selectively related to volume of the cerebellar vermis and not to any comparison brain region in the alcoholics; (ii) spectral analysis revealed sway prominence in the 2-5 Hz band, another physiological sign of vermian lesions and also selectively related to vermian volume in the alcoholics; and (iii) despite substantial postural sway in the patients, they successfully used vision, touch and stance to normalize sway and reduce tremor. The selective relationship of sway path to vermian but not lateral cerebellar volume provides correlational evidence for functional differentiation of these cerebellar regions. Improvement to virtual normal levels in balance and reduction in sway and tremor with changes in vision, touch and stance provide evidence that adaptive mechanisms recruiting sensorimotor integration can be invoked to compensate for underlying cerebellar vermian-related dysfunction.

  View details for DOI 10.1093/cercor/bhj048

  View details for Web of Science ID 000238906300003

  View details for PubMedID 16221930

• Neuromuscular activation and motor-unit firing characteristics in cerebral palsy DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., McGill, K. C. 2005; 47 (5): 329-336

  Abstract

  Muscle strength, neuromuscular activation, and motor-unit firing characteristics (firing rate, recruitment, and short-term synchronization) were assessed during voluntary contractions of the medial gastrocnemius (GAS) and tibialis anterior (TA) muscles of 10 participants with spastic diplegic or hemiplegic cerebral palsy (CP). The participants (six females, four males; age range 6 to 37y) walked with equinus gait at Gross Motor Function Classification System levels II to III. These were compared with 10 age-matched controls (five females; age range 7 to 35y). Neuromuscular activation was estimated by the ratio of surface electromyogram amplitude to M-wave amplitude elicited by supramaximal electrical nerve stimulation. Participants with CP produced significantly less torque (normalized by leg length) compared with controls (TA: mean 2.3, SD 1.6 vs mean 8.9, SD 3.4Nm/m; GAS mean 13.7, SD 7.1 vs mean 28.6, SD 5.1Nm/m, p < 0.001). Neuromuscular activation during maximum voluntary contraction was significantly reduced in the participants with CP compared with controls (mean 2.4, SD 1.5 vs mean 9.7, SD 2.7Nm/m for TA; mean 1.04, SD 0.41 vs mean 3.1, SD 1.2Nm/m for GAS, p < 0.001). When compared at the same submaximal level of neuromuscular activation, motor-unit recruitment and firing rates were not different between the groups, although short-term synchronization in TA was reduced in the participants with CP. These data indicate that weakness, known to be an important component of the motor deficit in CP, has a strong central component. Although the relation between recruitment and firing rate remained substantially intact at the low and moderate force contractions tested, results suggest that the participants with CP were unable to recruit higher threshold motor units or to drive lower threshold motor units to higher firing rates.

  View details for DOI 10.1017/S0012162205000629

  View details for Web of Science ID 000228793300008

  View details for PubMedID 15892375

• Classification and definition of disorders causing hypertonia in childhood PEDIATRICS Sanger, T. D., Delgado, M. R., Gaebler-Spira, D., Hallett, M., Mink, J. W. 2003; 111 (1)

  Abstract

  This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms "spasticity," "dystonia," and "rigidity" as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.A consensus agreement was obtained on the best current definitions and their application in clinical situations."Spasticity" is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. "Dystonia" is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. "Rigidity" is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.

  View details for Web of Science ID 000180135200015

  View details for PubMedID 12509602

• Postural balance in children with cerebral palsy DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Wolff, D. R., Jones, V. K., Bloch, D. A., Oehlert, J. W., Gamble, J. G. 2002; 44 (1): 58-63

  Abstract

  Postural control deficits have been suggested to be a major component of gait disorders in cerebral palsy (CP). Standing balance was investigated in 23 ambulatory children and adolescents with spastic diplegic CP, ages 5 to 18 years, and compared with values of 92 children without disability, ages 5 to 18 years, while they stood on a force plate with eyes open or eyes closed. The measurements included center of pressure calculations of path length per second, average radial displacement, mean frequency of sway, and Brownian random motion measures of the short-term diffusion coefficient, and the long-term scaling exponent. In the majority of children with CP (14 of 23) all standing balance values were normal. However, approximately one-third of the children with CP (eight of 23) had abnormal values in at least two of the six center of pressure measures. Thus, mean values for path length, average radial displacement, and diffusion coefficient were higher for participants with CP compared with control individuals with eyes open and closed (p<0.05). Mean values for frequency of sway and the long-term scaling exponent were lower for participants with CP compared with control participants (p<0.05). Increased average radial displacement was the most common (nine of 23) postural control deficit. There was no increase in abnormal values with eyes closed compared with eyes open for participants with CP, indicating that most participants with CP had normal dependence on visual feedback to maintain balance. Identification of those children with impaired standing balance can delineate factors that contribute to the patient's gait disorder and help to guide treatment.

  View details for Web of Science ID 000173138000009

  View details for PubMedID 11811652

• Electromyographic test to differentiate mild diplegic cerebral palsy and idiopathic toe-walking JOURNAL OF PEDIATRIC ORTHOPAEDICS Policy, J. F., Torburn, L., Rinsky, L. A., Rose, J. 2001; 21 (6): 784-789

  Abstract

  The purpose of this study was to determine whether children with mild spastic diplegic cerebral palsy (CP) could be differentiated from those with idiopathic toe-walking (ITW) based on an obligatory coactivation during voluntary contraction of the quadriceps or gastrocnemius. Twenty-four subjects participated in this study, eight children with mild spastic diplegia CP, eight with ITW, and eight age-matched controls. Measurements included passive range of motion and surface electromyographic recordings of the lateral quadriceps and lateral gastrocnemius. Electromyographic recordings were obtained during resisted knee extension with knee flexed 30 degrees, isometric quadriceps contraction with knee extended (quad set), active plantarflexion, and during gait. The range-of-motion values were not different between the CP and ITW subjects, with the exception of the popliteal angle, which was greater in subjects with CP, with an overlap in values. Gait electromyography showed premature firing of gastrocnemius in swing in both groups of subjects compared with controls. During resisted knee extension and quad set, the mean duration of gastrocnemius coactivation in subjects with CP was high: 86% and 86% compared with 20% and 35% for the subjects with ITW and 0.4% and 3% for controls, respectively. Voluntary plantarflexion did not consistently elicit coactivation of the quadriceps. The results suggest that electromyographic testing of resisted knee extension and quad set to identify gastrocnemius coactivation can help differentiate patients with mild CP from those with ITW.

  View details for Web of Science ID 000171936500016

  View details for PubMedID 11675555

• Electromyographic differentiation of diplegic cerebral palsy from idiopathic toe walking: Involuntary coactivation of the quadriceps and gastrocnemius JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Martin, J. G., Torburn, L., Rinsky, L. A., Gamble, J. G. 1999; 19 (5): 677-682

  Abstract

  Clinical differentiation of patients with mild diplegic cerebral palsy (CP) and idiopathic toe walking (ITW) can be difficult. However, an involuntary extensor pattern may be a distinguishing sign. The purpose of this study was to determine if selected gait parameters or patterns of electromyogram (EMG) timing of quadriceps, gastrocnemius, and tibialis anterior during knee extension while sitting can distinguish between these patients. The hypothesis was that EMG testing for selective control of the quadriceps and gastrocnemius could differentiate patients with diplegic CP from normal controls and from patients with ITW. We evaluated 10 control, eight CP, and eight ITW subjects. Measurements included walking speed, energy expenditure index (EEI), ankle position during stance, and EMG of the quadriceps, gastrocnemius, and tibialis anterior during gait and during knee extension while sitting. Dynamic EMG timing during gait showed significant differences in the mean onset of the gastrocnemius between subjects with CP and ITW, but there was considerable overlap. More consistent differences were found during active and active-resisted knee extension while sitting. Mean values for gastrocnemius EMG timing recorded as a percentage of duration of quadriceps EMG while sitting were 0 and 0.4% for controls, 0 and 3.9% for ITW subjects, and 84.3% and 93.4% for CP subjects. Patterns of EMG timing of the quadriceps and gastrocnemius during knee extension while sitting can help to differentiate patients with mild diplegic CP from those with ITW.

  View details for Web of Science ID 000082295100025

  View details for PubMedID 10488875

• The motor unit in cerebral palsy DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., McGill, K. C. 1998; 40 (4): 270-277

  View details for Web of Science ID 000073310200009

  View details for PubMedID 9593500

• Postural balance measurements for children and adolescents JOURNAL OF ORTHOPAEDIC RESEARCH Wolff, D. R., Rose, J., Jones, V. K., Bloch, D. A., Oehlert, J. W., Gamble, J. G. 1998; 16 (2): 271-275

  Abstract

  Measurements of standing balance were determined for 92 children and adolescents, 5-18 years old, while they stood on a force plate with eyes open or eyes closed. The measurements included center-of-pressure calculations for path length per second, average radial displacement, anterior-posterior and mediolateral amplitudes, area per second, mean frequency of sway, Brownian random motion measure of short-term diffusion coefficient, and long-term scaling exponent. All balance parameters improved from youngest to oldest subjects, and the parameters improved when measured with the subjects' eyes open compared with closed. The mean values for data from three trials varied by only 5% when compared with the mean values from 10 trials. Data from this study suggest that force-plate center-of-pressure data can be used to determine differences in standing balance between children and adolescents of different ages and those with movement and balance abnormalities.

  View details for PubMedID 9621902

• MUSCLE PATHOLOGY AND CLINICAL MEASURES OF DISABILITY IN CHILDREN WITH CEREBRAL-PALSY JOURNAL OF ORTHOPAEDIC RESEARCH Rose, J., Haskell, W. L., Gamble, J. G., Hamilton, R. L., Brown, D. A., Rinsky, L. 1994; 12 (6): 758-768

  Abstract

  We performed a histologic and morphometric study of spastic muscle from 10 children with diplegic cerebral palsy, comparing muscle structure with the gait parameters of energy expenditure index and dynamic electromyography. Variations in fiber area within and between fiber types were increased significantly in children with cerebral palsy. In each of the control subjects, the combined coefficient of variation for type-1 and type-2 fiber area was less than 25% and the average was 17%; in the subjects with cerebral palsy, the combined coefficient of variation was more than 25% and the average was 36% (p < or = 0.004). The average difference between the mean area of type-1 and type-2 fibers was 26.7 +/- 18.9% for subjects with cerebral palsy and 4.2 +/- 2.4% for control subjects (p < or = 0.004). There was a 67% predominance of one fiber type in the subjects with cerebral palsy compared with a 55% predominance in the control subjects (p < or = 0.03). The difference between the total area of type-1 and type-2 fibers was 57% in the subjects with cerebral palsy and 17% in the control subjects (p < or = 0.002). There was a significant correlation between the combined coefficient of variation of fiber area and the energy expenditure index (r = 0.77, p < or = 0.03). The difference between the mean area of type-1 and type-2 fibers correlated with prolongation of electromyographic activity (r = 0.69, p < or = 0.05). No abnormalities in fiber ultrastructure were found in the subjects with cerebral palsy. Children with cerebral palsy had abnormal variation in the size of muscle fibers and altered distribution of fiber types. The values for variation in fiber area correlated with the energy expenditure index and with prolongation of electromyographic activity during walking.

  View details for Web of Science ID A1994PW53900002

  View details for PubMedID 7983551

• A COMPARISON OF OXYGEN PULSE AND RESPIRATORY EXCHANGE RATIO IN CEREBRAL-PALSIED AND NONDISABLED CHILDREN ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Rose, J., Haskell, W. L., Gamble, J. G. 1993; 74 (7): 702-705

  Abstract

  Energy expended while walking is increased for children with cerebral palsy compared to nondisabled children. This study compared oxygen uptake, oxygen pulse, and the respiratory exchange ratio (RER) in children with cerebral palsy and nondisabled children walking on a treadmill. Resting oxygen uptake and oxygen pulse values were not different in the two groups. At a given walking speed, oxygen uptake, oxygen pulse, and RER were higher for subjects with cerebral palsy. At a given level of submaximal oxygen uptake, oxygen pulse and RER values were not different in subjects with cerebral palsy compared to nondisabled children. It was concluded that the cardiorespiratory response to walking at submaximal level of work is not significantly different for children with cerebral palsy.

  View details for Web of Science ID A1993LM07900006

  View details for PubMedID 8328890

• THE ENERGY-EXPENDITURE INDEX - A METHOD TO QUANTITATE AND COMPARE WALKING ENERGY-EXPENDITURE FOR CHILDREN AND ADOLESCENTS JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Gamble, J. G., Lee, J., LEE, R., Haskell, W. L. 1991; 11 (5): 571-578

  Abstract

  We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.

  View details for PubMedID 1918341

• ENERGY-EXPENDITURE INDEX OF WALKING FOR NORMAL-CHILDREN AND FOR CHILDREN WITH CEREBRAL-PALSY DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Gamble, J. G., Burgos, A., Medeiros, J., Haskell, W. L. 1990; 32 (4): 333-340

  Abstract

  Energy expenditure indices (EEI) based on oxygen uptake and heart rate were used to compare the economy of walking at various speeds by normal and cerebral-palsied children. At low walking speeds, EEI values were high, indicating poor economy. At higher speeds the EEI values decreased until a range of maximum economy was reached. For normal children who were capable of walking beyond this range at higher speeds, the EEI increased again. This pattern was noted for both oxygen-uptake and heart-rate indices. Mean EEI values based on oxygen uptake and heart rate for normal children were significantly lower and occurred at faster walking speeds than values for children with cerebral palsy. EEI based on either oxygen uptake or heart rate can be used clinically to provide objective information to help evaluate the influence on gait function of surgical intervention, ambulatory aids or orthotics.

  View details for Web of Science ID A1990CV23200008

  View details for PubMedID 2332124

• ENERGY-COST OF WALKING IN NORMAL-CHILDREN AND IN THOSE WITH CEREBRAL-PALSY - COMPARISON OF HEART-RATE AND OXYGEN-UPTAKE JOURNAL OF PEDIATRIC ORTHOPAEDICS Rose, J., Gamble, J. G., Medeiros, J., Burgos, A., Haskell, W. L. 1989; 9 (3): 276-279

  Abstract

  The rate of oxygen uptake can be used to assess energy expenditure during walking, but the necessary instrumentation is cumbersome, expensive, and usually unavailable in the clinical setting. Heart rate is an easily measured parameter, but its use as an index of energy expenditure in children has not been validated previously. We found that the relationship between oxygen uptake and heart rate was linear throughout a wide range of walking speeds for both children with cerebral palsy and normal children. There was no significant difference between the slope or the gamma-intercept of the lines for the two groups. These findings validate the use of heart rate as an index of energy expenditure for normal children and for children with cerebral palsy.

  View details for Web of Science ID A1989U380200004

  View details for PubMedID 2723046

• BACK PAIN AND SPINAL DEFORMITY IN CYSTIC-FIBROSIS AMERICAN JOURNAL OF DISEASES OF CHILDREN Rose, J., Gamble, J., Schultz, A., LEWISTON, N. 1987; 141 (12): 1313-1316

  Abstract

  Back pain is a common complaint of individuals with cystic fibrosis (CF). We studied back pain in our patient population in three ways: a questionnaire, an orthopedic evaluation, and a survey of chest roentgenograms. Forty-seven patients with CF reported back pain as compared with seven controls. Patients with CF showed decreased muscle strength and mobility in the trunk, chest, and shoulders. The incidence of structural kyphosis was only 8.7%, but many had vertebral wedging. Much of the back pain may be due to postural abnormalities or to vertebral wedging, not fixed structural kyphosis.

  View details for Web of Science ID A1987L008900035

  View details for PubMedID 2961252

• A comprehensive exercise program for persons with cystic fibrosis. Journal of pediatric nursing Rose, J., Jay, S. 1986; 1 (5): 323-334

  View details for PubMedID 3639937

• ENERGY-COST INDEX AS AN ESTIMATE OF ENERGY-EXPENDITURE OF CEREBRAL-PALSIED CHILDREN DURING ASSISTED AMBULATION DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Rose, J., Medeiros, J. M., Parker, R. 1985; 27 (4): 485-490

  Abstract

  The energy expenditure of cerebral-palsied children ambulating with bilateral quad canes and wheeled walkers was estimated, using average heart rate and speed of walking. An energy cost index (average number of heart rates per unit distance walked) was derived to allow for varying speeds among patients. Children were then categorized into those who had a lower energy cost index when using quad canes and those who had a lower index when using walkers. This made it possible to offer treatment recommendations based on objective data.

  View details for Web of Science ID A1985APC2200009

  View details for PubMedID 4029518