Kinematic and Kinetic Gait Parameters Can Distinguish between Idiopathic and Neurologic Toe-Walking

The differentiation between mild forms of toe-walking (equinus) in cerebral palsy (CP) and idiopathic toe-walking (ITW) is often clinically challenging. This study aims to define kinematic and kinetic parameters using 3D gait analysis to facilitate and secure the diagnosis of “idiopathic toe-walking”. We conducted a retrospective controlled stratified cohort study. 12 toe-walking subjects per group diagnosed as ITW or CP were included and stratified according to age, gender and maximal dorsiflexion in stance. We collected kinematic and kinetic data using a three-dimensional optical motion analysis system with integrated floor force plates. Pairwise comparison between ITW and CP gait data was performed, and discriminant factor analysis was conducted. Both groups were compared with typically developing peers (TD). We found kinematic and kinetic parameters having a high discriminatory power and sensitivity to distinguish between ITW and CP groups (e.g., knee angle at initial contact (91% sensitivity, 73% specificity) and foot progression angle at midstance (82% sensitivity, 73% specificity)). The strength of this study is a high discriminatory power between ITW and CP toe-walking groups. Described kinematic parameters are easy to examine even without high-tech equipment; therefore, it is directly transferable to everyday praxis.

Natural and experimental salinomycin poisoning associated with the use of florfenicol in pigs

ABSTRACT: This study describes the spontaneous and experimental salinomycin poisoning associated with the use of florfenicol and warns about the effects of the administration of antibiotics to animals that receive ionophores in the feed as growth promoters. A batch with 1,200 finishing pigs fed a diet containing 30ppm of salinomycin received florfenicol (60ppm via feed) to control respiratory diseases. Twenty-seven pigs had difficulty walking, tip-toe walking, muscle tremors, and anorexia seven days after the start of treatment. Twenty-two animals died, 10 recovered, and two were sent to the Laboratory of Animal Pathology of CAV-UDESC to be necropsied. The experimental reproduction of the disease was carried out to clarify the possible influence of florfenicol on salinomycin poisoning using 12 pigs divided into four groups with three animals each, treated for 16 days with diets containing no additives (Group 1), 50ppm of salinomycin (Group 2), 40ppm of florfenicol (Group 3), and 50ppm of salinomycin and 40ppm of florfenicol (Group 4). Only animals in Group 4 became ill. The clinical disease was reproduced from the ingestion of 24.67mg/kg/LW of salinomycin and 19.74mg/kg/LW of florfenicol. Both natural and experimental salinomycin poisoning associated with the use of florfenicol caused a condition of myopathy characterized in histology by hyaline degeneration and floccular necrosis of skeletal fibers, with macrophage infiltrate, associated with the figures of regeneration in skeletal muscles and multifocal areas of the proliferation of fibroblasts, being more intense in the longissimus dorsi and semimembranosus muscles. Therefore, florfenicol can cause the accumulation of ionophore salinomycin in the animal organism, resulting in a condition of toxic myopathy.

A Bilingual Child Diagnosed With Autism Spectrum Disorder (ASD)

Silvia and Antonio Juarez described their 4-year-old son Emanuel as often happy. Emanuel came from a bilingual home and spoke both Spanish and English. His favorite activities were reading and playing with his iPad over-and-over again. Reading was a favorite pasttime and something that the Juarez's felt he did well. While he was described as “loving to engage people,” it was not clear that his efforts were successful nor was it clear that they were reciprocated. Briefly observing Emanuel's interaction with his parents, it was noted Emanuel used echolalic phrases and engaged in repetitive and restricted behaviors, toe walking, and finger flicking. These behaviors were noted to be unusual and warranted further evaluation. The Juarez's primary concern was regarding Emanuel's “talking and being able to hold a conversation.” Through speech and language therapy, the family expected that Emanuel's communication skills would improve, and he would be able to participate in conversations and talk in sentences.

Development of a Core Set of Outcome Measures for Use During Treatment of Children With Idiopathic Toe Walking: A Delphi Study and Online Parent Survey

Introduction There is diversity in outcome measures used during monitoring and treatment of the exclusionary diagnosis idiopathic toe walking (ITW) in children. This diversity makes synthesis of treatment effects difficult. The primary aim of this research was to develop a core set of outcome measures identified by health professionals for use when undertaking treatment with children who have ITW. The secondary aims were to understand if parents agreed with this core set, and if parents believed they could undertake any of these measures in the absence of the clinician. Methods Study 1 was the development of consensus and agreement through the modified Delphi technique with 10 expert health professionals. The first round gathered questions and assessments for consensus, the second and third round enabled agreement with these questions and assessments. Study 2 was an online survey where parents of children who toe walked were invited to provide opinions on the importance of these measures and if they believed they may be able to collect the data about their child without the health professional being present. Results Ten health professionals provided 21 questions and assessments in Round 1 to measure treatment effectiveness for ITW in children. Following consensus and agreement by health professionals over the three rounds, there were nine questions and assessments presented to parent participants in Study 2. There were 34 parents who provided information about their satisfaction with toe walking assessments and treatments. There 27 parents provide detailed responses about the outcome questions and assessments, most parents in support of the core set identified by the experts. Parents also expressed a willingness to self-complete questions or be taught assessments to monitor their child’s progress. Conclusion This research developed a core set of questions and measures clinicians, and researchers could implement during health care provision and any research of children with ITW. Use of these measures will enable consistent data collection regardless of the setting and provide the foundation for large data pooling in future treatment research.

Toe Walking as the Initial Symptom of a Spinocerebellar Ataxia 13 in a Patient Presenting with a Mutation in the KCNC3 Gene

This article at hand described a 4-year-old patient who initially presented with the symptoms of toe walking. As part of the diagnostic process, the patient was genetically tested to find the cause of the gait anomaly. The genetic test found a mutation in the KCNC3 gene. The variant c.1268G > A; p.Arg423His was found in a heterozygotic state. This variant is frequently described as a cause for spinocerebellar ataxia type 13 (SCA13) in the literature. Apart from toe walking as the most pronounced symptom, the patient displayed an instable gait with frequent falls and delayed speech development. The genetic test to determine the cause of the gait anomaly successfully diagnosed the patient with a previously undiscovered SCA13 and subsequently enabled the recommendation of personalized further treatment.