Correction of Severe Crouch Gait in Patients With Spastic Diplegia With Use of Multilevel Orthopaedic Surgery

Rodda, Jill; Graham, H Kerr; Nattrass, Gary; Galea, Mary P.; Baker, Richard; Wolfe, Rory

doi:10.2106/00004623-200612000-00013

Cited by 164 publications

(97 citation statements)

References 39 publications

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“…The impact of being overweight or obese on the development of particular detrimental gait patterns such as crouch gait also warrants further study. This gait pattern involves increased knee flexion and consequently patellar femoral forces; obesity is already linked to knee pain and joint degradation for the adult population, and it could be hypothesised that obesity could further impact on the integrity of the knee joint in these children. Further research is required to investigate the effect of BMI and the outcome of gait corrective surgery to understand the impact on the rehabilitation period and to be able to predict the outcomes and support families in planning the procedure and undertaking rehabilitation after surgery.…”

Section: Discussionmentioning

confidence: 99%

Body mass index in ambulatory children with cerebral palsy: A cohort study

Pascoe

Thomason

Graham

et al. 2016

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 99%

Body mass index in ambulatory children with cerebral palsy: A cohort study

Pascoe

Thomason

Graham

et al. 2016

J Paediatrics Child Health

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“…In younger children, spasticity is very prominent, resulting in toe‐walking and equinus gait patterns [7]. In older children and adolescents, weakness of antigravity muscles frequently results in various types of flexed knee gait including crouch gait [8,9].…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Botulinum toxin assessment, intervention and after‐care for lower limb spasticity in children with cerebral palsy: international consensus statement

Love

Novak

Kentish

et al. 2010

Euro J of Neurology

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179

215

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Botulinum neurotoxin type-A (BoNT-A) has been used in association with other interventions in the management of spasticity in children with cerebral palsy (CP) for almost two decades. This consensus statement is based on an extensive review of the literature by an invited international committee. The use of BoNT-A in the lower limbs of children with spasticity caused by CP is reported using the American Academy of Neurology Classification of Evidence for therapeutic intervention. Randomized clinical trials have been grouped into five areas of management, and the outcomes are presented as treatment recommendations. The assessment of children with CP and evaluation of outcomes following injection of BoNT-A are complex, and therefore, a range of measures and the involvement of a multidisciplinary team is recommended. The committee concludes that injection of BoNT-A in children with CP is generally safe although systemic adverse events may occur, especially in children with more physical limitations (GMFCS V). The recommended dose levels are intermediate between previous consensus statements. The committee further concludes that injection of BoNT-A is effective in the management of lower limb spasticity in children with CP, and when combined with physiotherapy and the use of orthoses, these interventions may improve gait and goal attainment.

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“…Many patients benefit from treatments for crouch gait, including hamstrings lengthening surgeries [1–4], tibial derotation osteotomies [5–7], and multi-level surgery [8, 9]; however, treatment outcomes are unpredictable.…”

Section: Introductionmentioning

confidence: 99%

Can biomechanical variables predict improvement in crouch gait?

2011

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Many patients respond positively to treatments for crouch gait, yet surgical outcomes are inconsistent and unpredictable. In this study, we developed a multivariable regression model to determine if biomechanical variables and other subject characteristics measured during a physical exam and gait analysis can predict which subjects with crouch gait will demonstrate improved knee kinematics on a follow-up gait analysis. We formulated the model and tested its performance by retrospectively analyzing 353 limbs of subjects who walked with crouch gait. The regression model was able to predict which subjects would demonstrate ‘improved’ and ‘unimproved’ knee kinematics with over 70% accuracy, and was able to explain approximately 49% of the variance in subjects’ change in knee flexion between gait analyses. We found that improvement in stance phase knee flexion was positively associated with three variables that were drawn from knowledge about the biomechanical contributors to crouch gait: i) adequate hamstrings lengths and velocities, possibly achieved via hamstrings lengthening surgery, ii) normal tibial torsion, possibly achieved via tibial derotation osteotomy, and iii) sufficient muscle strength.

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Correction of Severe Crouch Gait in Patients With Spastic Diplegia With Use of Multilevel Orthopaedic Surgery

Cited by 164 publications

References 39 publications

Body mass index in ambulatory children with cerebral palsy: A cohort study

Body mass index in ambulatory children with cerebral palsy: A cohort study

Botulinum toxin assessment, intervention and after‐care for lower limb spasticity in children with cerebral palsy: international consensus statement

Can biomechanical variables predict improvement in crouch gait?

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