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Introduction Idiopathic toe walking (ITW) is a heterogeneous disorder, which is associated with muscle shortening in lower limbs, pain and neurodevelopmental disorders. We try to study the frequency of clinical features in patients with ITW. Patients and methods Out of 100 patients evaluated with toe walking in a pediatric rehabilitation clinic, 77 (24,7% women) patients were diagnosed with ITW by means of TWT questionnaire. Achilles' tendon shortening with Silfverskiold manoeuvre, pain and attention deficit hyperactivity disorder (ADHD) were studied. In the group of patients with pain (n = 30), we studied pain evolution by means of a telephonic interview which assessed intensity, location, school absenteeism and used therapies. Results Out of 77 patients, 44.2% had family history of toe walking. 37.7% and 9.1% showed Achilles' tendon shortening and Knee flexor shortening, respectively. Confirmed diagnosed of ADHD was present in 9.1% and was suspected in 20.8%. The older the patient was, the higher frequency of pain and the lower passive ankle dorsiflexion. Pain has a moderate-severe intensity, was related with school absenteeism in 42.3% of the patients with pain. Pain was located mainly on the calf, the ankle and the foot. It was treated with physiotherapy, oral pain relievers, orthosis and botulinum toxin type A (BTxA). Conclusions Pain in ITW is frequent, have a moderate-severe intensity, interferes in normal life and is referred in older children with lower ankle dorsiflexion. We found a common association between ITW and ADHD which points out ITW as alarm sign of learning problems.

Altres ajuts: We acknowledge the contribution of the children and their families who generously collaborated to build the gait dataset used in this study. We are also grateful to Michael R. Paul for kindly editing the English style of this manuscript. The acquisition and processing of gait data were funded by Escuela de Fisioterapia de la ONCE-UAM, through a private donation, and Agencia de Evaluación de Tecnologías Sanitarias (Instituto de Salud Carlos III), . Cerebral palsy is a physical impairment stemming from a brain lesion at perinatal time, most of the time resulting in gait abnormalities: the first cause of severe disability in childhood. Gait study, and instrumental gait analysis in particular, has been receiving increasing attention in the last few years, for being the complex result of the interactions between different brain motor areas and thus a proxy in the understanding of the underlying neural dynamics. Yet, and in spite of its importance, little is still known about how the brain adapts to cerebral palsy and to its impaired gait and, consequently, about the best strategies for mitigating the disability. In this contribution, we present the hitherto first analysis of joint kinematics data using permutation entropy, comparing cerebral palsy children with a set of matched control subjects. We find a significant increase in the permutation entropy for the former group, thus indicating a more complex and erratic neural control of joints and a non-trivial relationship between the permutation entropy and the gait speed. We further show how this information theory measure can be used to train a data mining model able to forecast the child's condition. We finally discuss the relevance of these results in clinical applications and specifically in the design of personalized medicine interventions.

About 23,000 patients with spasticity voluntarily chose to undergo a multiple myofiberotomy (MMF), which is an alternative technique consisting in sectioning soft tissues in order to relieve restrictions in joint movements. This technique, first employed by Ulzibat (Russia), is performed outside orthodox clinical controls.To perform an external evaluation of the effects of MMF on motor functionality and gait.The study was self-controlled and observation-based and was designed to evaluate the changes in functional variables -Gross Motor Function Classification System, E-dimension of the Gross Motor Function Measure (GMFM) and the Functional Mobility Scale- and 32 gait parameters (measured using analytical instruments) in 22 school-children with spastic diplegia (mean age: 9 years and 6 months; Q1-Q3: 7 years and 11 months to 11 years and 6 months) whose parents opted for an MMF (median of observation: 4 months; range: 3-7 months).The analysis of hierarchical conglomerates used to determine topographic cut patterns in patients revealed that the surgeons applied one of three sets of cuts to each patient. On analysing the three groups of patients, it was observed that one group worsened overall and another underwent a general significant improvement in the E-dimension of the GMFM (difference of median: 4.86%; 95% confidence interval = 0-6.94%) after the MMF. Some of the gait parameters became significantly normalised (left: hip-flexion range, maximum dorsiflexion with support; right: speed, mean pelvic rotation with support and maximum dorsiflexion with support).These findings do not back up or justify the use of MMF as a therapeutic option to treat spasticity. It has to be stressed that this technique must be avoided outside study protocols. Nevertheless, results do lay an objective base that may justify a clinical trial and long-term observation-based studies.Evaluacion externa de los cambios funcionales y la marcha tras una sesion de miofibrotomia multiple en escolares con diplejia espastica.Introduccion. Unos 23.000 pacientes con espasticidad han optado voluntariamente por la miofibrotomia multiple (MFM), una tecnica alternativa consistente en seccionar tejidos blandos para liberar restricciones articulares. Iniciada por Ulzibat (Rusia), se realiza fuera de controles clinicos ortodoxos. Objetivo. Evaluar externamente los efectos de la MFM sobre la funcionalidad motora y la marcha. Pacientes y metodos. Estudio observacional autocontrolado que evalua cambios en variables funcionales –Gross Motor Function Classification System, dimension E de la Gross Motor Function Measure (GMFM) y Functional Mobility Scale– y 32 parametros de marcha (medidos mediante analisis instrumental) en 22 escolares con diplejia espastica (edad mediana: 9 años y 6 meses; Q1-Q3: 7 años y 11 meses a 11 años y 6 meses) cuyos padres optaron por una MFM (mediana de observacion: 4 meses; rango: 3-7 meses). Resultados. El analisis de conglomerados jerarquicos utilizado para determinar patrones topograficos de cortes en los pacientes detecto que los cirujanos aplicaban a cada paciente uno de tres conjuntos de cortes. Analizados los tres grupos de pacientes, se observo que un grupo empeoro globalmente y una mejora significativa general en la dimension E del GMFM (diferencia de mediana: 4,86%; intervalo de confianza al 95% = 0-6,94%) tras la MFM. Algunos parametros de la marcha se normalizaron significativamente (izquierda: rango flexion-cadera, maxima dorsiflexion en apoyo; derecha: velocidad, rotacion pelvica media en apoyo y maxima dorsiflexion en apoyo). Conclusiones. Estos resultados no apoyan ni justifican el uso de la MFM como opcion para el tratamiento de la espasticidad. Insistimos en que esta tecnica debe evitarse fuera de protocolos de estudio. Sin embargo, los resultados asientan una base objetiva para justificar la realizacion de un ensayo clinico y estudios observacionales a largo plazo.

Introducción. Unos 23.000 pacientes con espasticidad han optado voluntariamente por la miofibrotomía múltiple (MFM), una técnica alternativa consistente en seccionar tejidos blandos para liberar restricciones articulares. Iniciada por Ulzibat (Rusia), se realiza fuera de controles clínicos ortodoxos. Objetivo. Evaluar externamente los efectos de la MFM sobre la funcionalidad motora y la marcha. Pacientes y métodos. Estudio observacional autocontrolado que evalúa cambios en variables funcionales –Gross Motor Function Classification System, dimensión E de la Gross Motor Function Measure (GMFM) y Functional Mobility Scale– y 32 parámetros de marcha (medidos mediante análisis instrumental) en 22 escolares con diplejía espástica (edad mediana: 9 años y 6 meses; Q1-Q3: 7 años y 11 meses a 11 años y 6 meses) cuyos padres optaron por una MFM (mediana de observación: 4 meses; rango: 3-7 meses). Resultados. El análisis de conglomerados jerárquicos utilizado para determinar patrones topográficos de cortes en los pacientes detectó que los cirujanos aplicaban a cada paciente uno de tres conjuntos de cortes. Analizados los tres grupos de pacientes, se observó que un grupo empeoró globalmente y una mejora significativa general en la dimensión E del GMFM (diferencia de mediana: 4,86%; intervalo de confianza al 95% = 0-6,94%) tras la MFM. Algunos parámetros de la marcha se normalizaron significativamente (izquierda: rango flexión-cadera, máxima dorsiflexión en apoyo; derecha: velocidad, rotación pélvica media en apoyo y máxima dorsiflexión en apoyo). Conclusiones. Estos resultados no apoyan ni justifican el uso de la MFM como opción para el tratamiento de la espasticidad. Insistimos en que esta técnica debe evitarse fuera de protocolos de estudio. Sin embargo, los resultados asientan una base objetiva para justificar la realización de un ensayo clínico y estudios observacionales a largo plazo, Introduction. About 23,000 patients with spasticity voluntarily chose to undergo a multiple myofiberotomy (MMF), which is an alternative technique consisting in sectioning soft tissues in order to relieve restrictions in joint movements. This technique, first employed by Ulzibat (Russia), is performed outside orthodox clinical controls. Aims. To perform an external evaluation of the effects of MMF on motor functionality and gait. Patients and methods. The study was self-controlled and observation-based and was designed to evaluate the changes in functional variables –Gross Motor Function Classification System, E-dimension of the Gross Motor Function Measure (GMFM) and the Functional Mobility Scale– and 32 gait parameters (measured using analytical instruments) in 22 schoolchildren with spastic diplegia (mean age: 9 years and 6 months; Q1-Q3: 7 years and 11 months to 11 years and 6 months) whose parents opted for an MMF (median of observation: 4 months; range: 3-7 months). Results. The analysis of hierarchical conglomerates used to determine topographic cut patterns in patients revealed that the surgeons applied one of three sets of cuts to each patient. On analysing the three groups of patients, it was observed that one group worsened overall and another underwent a general significant improvement in the E-dimension of the GMFM (difference of median: 4.86%; 95% confidence interval = 0-6.94%) after the MMF. Some of the gait parameters became significantly normalised (left: hip-flexion range, maximum dorsiflexion with support; right: speed, mean pelvic rotation with support and maximum dorsiflexion with support). Conclusions. These findings do not back up or justify the use of MMF as a therapeutic option to treat spasticity. It has to be stressed that this technique must be avoided outside study protocols. Nevertheless, results do lay an objective base that may justify a clinical trial and long-term observation-based studies, Financiado por AETES (PI05/90123)