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Motion, gait and function - PhD projects

Idiopathic toe-walking (ITW) in children

- Prevalence, neuropsychiatric symptoms and the effect of Botulinum toxin A treatment.

The research is a multi-professional collaboration between various specialities, such as paediatric neurology, biomechanics, paediatric orthopaedics and physiotherapy.

  • Elucidation of the prevalence of ITW among all 5,5 year old children in Blekinge county.
  • Evaluation of the treatment of ITW by botulinum toxin A (BTX). A 3-D gait analysis study.
  • A prospective randomized study on 54 children with ITW, comparing treatment with plaster of Paris and BTX and plaster of Paris only.
  • Occurrence of neuropsychiatric problems in children with ITW. Evaluation is done with the five to fifteen questionnaire.

Pähr Engström, PhD student

Arthrogryposis Multiplex Congenita

- Ambulation and associated factors in children and adolescents

Children with Arthrogryposis Multiplex Congenita (AMC) often present joint contractures and reduced muscle strength. To enhance or facilitate ambulation various types of orthoses are often used.

We are interested in examining the childrens gait pattern with 3-D gait analysis as well as physical effort during walking by measuring oxygen consumption. Muscle strength in the lower limbs is measured with a digital dynamometer. Parents are asked about their childrens perception of health-related quality of life and how satisfied they and their children are with the orthoses.

The investigation aims to explore the extent of trunk and joint motions with respect to involvement of joints, muscle strength reduction and type of orthoses. We also want to investigate whether physical effort during walking in children with AMC is higher compared to able-bodied children of the same age. In children who commonly use orthoses but are able to walk without orthoses, a comparison will also be made with shoes only.

The results can contribute to increased knowledge about the childs choice of ambulation in daily life and in the community. With increased knowledge about the children and their parents opinion about orthoses, our intension is to contribute to improvement and development of the orthotic field in children with motor disorders

Marie Eriksson, PhD student

Gait deviations - inflammatory joint diseases

Children and adults with inflammatory joint diseases show gait deviations which can be reflected in changes in joint movement, joint moments or with slower walking speed than normal.

These deviations may in the short term be due to inflammation, but for individuals with more chronic disease deformities also plays a role. This PhD project aim to develop appropriate measures to describe these gait deviations, furthermore we aim to evaluate how both objective and self-perceived walking ability is affected by different treatments.

60 adults with Rheumatoid Arthritis (RA), 40 children with Juvenile Idiopathic Arthritis (JIA) and healthy controls are involved. We use three-dimensional gait analysis in combination with questionnaires in order to describe gait patterns and self-perceived walking ability with the following questions:

  • Is the Gait Deviation Index (GDI), an appropriate measure of gait deviations in children and adults with inflammatory joint disease?
  • What is the effect on walking ability in adults with RA after treatment with biologics, and after ankle arthrodesis?
  • What is the effect on walking ability in children with JIA after treatment with corticosteroid injections in the ankle and foot complex?

The project is expected to show how gait deviations in this population, measured with 3D gait analysis, can be quantified by indices and how these indices can be used in both clinical and research settings. Furthermore we aim to add knowledge about how walking ability is affected by different treatments and subsequently contribute to develop these treatments.

Anna-Clara Esbjörnsson, PhD student

Posture in children with bilateral cerebral palsy

In the latest definition of cerebral palsy (CP) has been added that perception, the ability to incorporate and interpret sensory information might affect motor function. There is no description about how and to what extend disturbed perception affects childrens ability to move around.

We see children with CP with pronounced difficulties to achieve voluntary standing. The children most commonly present decreased ability to extend the legs and erect the trunk during standing in. Children also show problem in maintaining posture against gravity during standing and frequently require hand support.

Our main interest is spatial perception and we want to investigate posture during alterations of the childrens near surrounding space as well as the importance of vision.


Approximately 30 children with bilateral spastic CP between 6-17 years of age and a correspondingly number of aged matched typically developing children are included. Posture during standing is recorded with three-dimensional motion analysis under different spatial conditions, with and without vision. Muscle strength in the lower limb muscles is measured with a hand-held dynamometer.

The overall aim is to explore if children who sink into a flexed position during standing have problem maintaining posture due to perceptual difficulties. The findings will also explore the role of muscle-weakness among children with bilateral CP and its importance for the childrens posture.

The results may lead to better understanding in the childrens every day life, to improved physiotherapeutic care and more relevant decision making in other associated fields.

Cecilia Lidbeck, PhD student

Function in patients with hip and knee osteoarthritis

The overall aim of this project is to develop a test kit for functional evaluation of patients with hip or knee osteoarthritis (OA).

An evaluation method, which objectively measure function, is useful when it comes to guide treatment decisions, to document changes in an individuals function and gait over time, after different interventions such as a total joint replacement, and to evaluate outcome of preoperative intervention.

Three-dimensional gait analysis (3D-GA) is an objective assessment of gait and enables a method of measuring joint dynamics during activity. The data gathered from the gait analysis will be processed using the Gait Deviation Index (GDI) and two new indexes will be developed for function. This index summarizes deviation captured by 3-D motion analysis and provides a score on how much an individuals gait or function deviates from normal.

Clinical and self-reported outcome measures will be assessed (EQ-5D, HOOS, KOOS). Since an individual with high functional demands may subjectively rate his/her function as low and vice versa, an individual with low functional demands may subjectively rate his/her similar level of function as high, a combination of both objective and subjective measurements is needed to get a complete picture.

Josefine Eriksson Nalli, PhD student

Knee arthroplasty - a gender perspective

Osteoarthritis is a very common disease among the elderly population with a greater proportion of women. The majority of arthroplasties are also performed on women but few studies have been done on gender differences among patients with osteoarthritis in terms of function, symptoms and expectations.

Severe pain is a major indication for surgery and is usually measured with the visual analogue scale (VAS). In our studies we will use the Pain-O-Meter (POM), which provides a qualitative aspect of pain.

Lack of function in the affected joint is another major indication for surgery. The patients will be asked to perform different functional tests and also fill out self-administered questionnaires. To objectively quantify the grade of osteoarthritis preoperative x-rays of the affected joint will be reviewed according to Kellgren & Lawrences and Ahlbäcks grading scale for osteoarthritis.

  • Knee injury and Osteoarthritis Outcome Score (KOOS)
  • Hip disability and Osteoarthritis Outcome Score (HOOS) and EQ-5D

As a complement to the quantitative studies semi-structured qualitative interviews will be performed to understand the patients expectations on surgery and experiences of the health care system and their disease. Little is known about gender differences in function, complications and quality of life after this kind of extensive surgery.

The overall aim for this thesis is to understand why women are less likely to be content with their replaced joint and what could be done to increase their level of satisfaction.

Josefine Nyvang, PhD student

Paediatric femur shaft fractures

Study 1:

The purpose of the first study is to in a nationwide epidemiology study report incidence of paediatric femur shaft fractures in Sweden during 19872005 by age, gender, cause of injury, severity of injury, and seasonal variation, and to analyse the change in incidence, treatment modalities, and length of hospital stay over time.

Study 2:

The purpose of the second study is to investigate if socioeconomic risk factors for Swedish children in the age 0-14 years who suffered a femur shaft fractures differs compared to a matched control group.

Study 3:

The aim of the third study is to examine long term result after femur shaft fractures in children by comparing the physical results at military subscription for adults (18 years of age) who suffered a femur shaft fracture at the age 0-14 years compared to a matched control group.

Study 4:

The aim of the forth study is to compare the stability of different configuration of titanium elastic nails with end caps and a semi-rigid paediatric looking nail in an oblique femur shaft fracture during physiologic loading, using a synthetic model

Johan von Heideken, PhD student

Biomechanical consequences of foot and ankle injury and deformity: kinematics and muscle function

Motion within the foot and ankle are radically simplified during most gait analyses. During recent years, more accurate and reliable models of foot and ankle motion have been developed.

The aims of the project aims were to further develop the model to model hallux motion, and then to apply the model to adults who had suffered a foot fracture during the prior year. By combining the motion data to results from functional tests, it was found that even if the functional test results were normal or good, residual movement deviation remained in the foot and ankle, indicating that the functional tests alone are not sufficient to fully evaluate function, and should be complemented with objective quantitative motion analysis.

The second focus of the project was on the dynamic functions of the primary ankle muscles the gastrocnemius, soleus and tibialis anterior to produce movement during walking, and how these functions are affected by a simulated malalignment in the subtalar joint. It was found that some muscle functions were enhanced, but more often decreased by the malalignment, i.e., a malalignment will effect these muscles dynamic function during walking.

The concept of dynamic joint stiffness at the ankle during gait was then evaluated. Stiffness is the relationship between muscle moment and ankle motion, and has been characterized before in the literature, but is often non-intuitive and difficult to interpret. Stiffness was studied analytically and divided into its different components, in able-bodies subjects and in a small group of subjects with juvenile idiopathic arthritis and with idiopathic toe-walking, in order to analyze and relate the contributions of the different components. As such, the overall stiffness was made interpretable and more intuitive.

Ruoli Wang, PhD student

Knee function in children with traumatic knee injury evaluation methods and treatment outcome

In recent years, there has been an increase in diagnosed knee injuries in children. In Sweden in 2006, 118 children in ages 10-14 years were diagnosed with knee ligament injury or distortion of the knee joint.

These injuries are associated with long-term symptoms and sequels such as knee joint osteoarthritis in as early in the second or third decade of life. Contrary adults, the literature on knee injuries in children, concerning different treatment and factors influencing outcome of treatment, are sparse. There are currently no good predictive indicators or reputed methods for deciding which treatment to choose. There is a need to describe knee function in children with knee injuries and define different factors influencing treatment outcome in order to plan new treatment strategies and to improve and develop physiotherapy management.

The overall aims of this research program are to develop and evaluate assessment methods used in clinical and research settings in children with traumatic knee injury, and to use these methods to study factors that might influence the treatment outcome in children with Anterior Cruciate Ligament (ACL) injury and traumatic patellar dislocation.

Aims of the thesis

I. Development of patient-relevant questionnaire:

1) Modify the existing version of Knee injury and Osteoarthritis Outcome Score (KOOS), to make it suitable for use in children with traumatic knee injuries. Content validity will be obtained in focus groups.

2) Test the KOOS-c for validity, reliability and responsiveness in a clinical study.

II. Development of clinical tests:

1) Test the intra- and inter-examiner reliability of the quadriceps-angle (q-angle) in healthy children.

2) Describe normal values of the q-angle in healthy children.

3) Test the reliability of a functional test - maximum numbers of knee bending/30 s test

4) Study the correlation between the knee bending/30 s test, the q-angle and joint laxity.

III. Treatment outcome:

1) Study factors influencing treatment outcome considering recurrence rate during a two year follow-up in children with traumatic patellar dislocation. Factors studied will be: gender, hip-, knee and foot kinematics and kinetics, sagittal instability, joint laxity, q-angle, and lower extremity muscle strength.

2) Study factors influencing treatment outcome of non-operative versus operative treatment in children with ACL injury. Factors studied will be: gender, hip-, knee- and foot kinematics and kinetics, sagittal instability, self-reported giving way episodes, joint laxity, q-angle and lower extremity muscle strength.

Maria Örtqvist, PhD student

Contact: Eva Weidenhielm Broström, Physiotherapist, PhD, Assoc Prof, group leader