Factors associated with pelvic asymmetry in transverse plane during gait in patients with cerebral palsy

Abstract

The purpose of this study was to describe the patterns of pelvic rotational asymmetry in the transverse plane and identify the possible factors related to this problem. One thousand and forty-five patients with cerebral palsy (CP) and complete documentation in the gait laboratory were reviewed in a retrospective study. Pelvic asymmetry in the transverse plane was observed in 52.7% of the patients; and to identify the possible causes of pelvic retraction, clinical (Thomas test, popliteal angle, and gastrocnemius tightness) and dynamic parameters (mean rotation of the hip in stance, minimum hip flexion, minimum knee flexion, and peak ankle dorsiflexion) were evaluated. The association between these parameters and pelvic retraction was assessed statistically. The results showed that 75.7% of patients with asymmetric pattern of the pelvis had clinical diagnosis of diplegic spastic CP. Among the patients with asymmetrical CP, the most common pattern was pelvic retraction on the affected side. The relationship between pelvic retraction and internal hip rotation was stronger in patients with asymmetrical diplegic CP than in those with hemiplegic (P<0.001) or symmetrical diplegic CP (P = 0.014). All of the patients exhibited a significant association among clinical parameters (Thomas test, popliteal angle, and gastrocnemius tightness) and pelvic retraction. In conclusion, pelvic retraction seems to be a multifactorial problem, and the etiology can change according to topographic classification, which must be taken into account during the decision-making process in patients with CP.

Transverse plane rotation of the foot and transverse hip and pelvic kinematics in diplegic cerebral palsy

“…This is in contrast to hemiplegic patients where it is known that the hip and pelvis shared an inverse relationship [3,4]. However it should be noted overall that the pelvic motion during this phase is not of a large scale as the values are clustered around 58 of change (Fig.…”

“…Other characteristic irregular gait patterns in CP are hip internal rotation and pelvic retraction (external rotation) [2]. Pelvic retraction is commonly seen as a compensation for the increased internal hip rotation [3,4]. These proximal deviations at hip level may however be secondary to distal deformities at foot level or abnormal muscular activity lower in the limb.…”

Predictors of pelvic retraction in children with cerebral palsy derived from gait parameters and clinical testing

“…Surgical correction of femoral torsion for internally rotated gait on most of the diplegic patients showed no significant changes in pelvic rotation [3] whereas in another study excessive pelvic retraction returned to normal values following FDRO [8]. This improvement in pelvic rotation is supported by two retrospective gait laboratory studies [2,12]. This discrepancy in results might be explained by the fact that surgical correction of femoral rotation is often combined with soft-tissue procedures such as muscletendon lengthening.…”

“…Based on literature review and biomechanical considerations from what was discussed in Section 1, 5 potential predictors of dynamic gait data were chosen: peak hip external rotation angles [2,3,8,10,12], peak hip extension [2,11], peak ankle dorsiflexion [9,11], knee stiffness at initial contact [9] (measured by reduced knee absorption energy at initial contact) and ankle generation energy at push-off (mechanical energy is calculated as the integral of the power curve). In addition, to further determine whether pelvic retraction during gait has a dynamic or static cause, the corresponding 5 clinical parameters were analyzed in a separate predictor analysis: ankle dorsiflexion, hip extension, midpoint between internal and external hip rotation as well as ankle and knee strength.…”

“…This could be another reason for the discrepancy in results. In hemiplegic, and in asymmetric diplegic patients were one leg is more affected than the other [6,8,12], both legs should not be evaluated independent of each other because of compensations for weakness of the less involved leg [13]. Since the pelvis is a single segment, increased protraction on one the stronger side may cause increased retraction on the contralateral side.…”