Gait improvement surgery in ambulatory children with diplegic cerebral palsy

Abstract

Background and purpose Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery.Patients and methods 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6–19) years. On average, 5.7 (1–11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction.Results The mean GPS improved from 20.7° (95% CI: 19–23) preoperatively to 15.4° (95% CI: 14–17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2–10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age.Interpretation The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.

Changes in the kinematic parameters of gait in children with cerebral palsy after multilevel interventions with the initial patterns of true equinus gait and jump gait

“…The method of choice for triceps lengthening in cerebral palsy is fasciotomy of the calf muscles, which, according to a computer analysis of gait, is accompanied by an improvement in the kinematic parameters of the ankle joint without the development of crouch gait in the long term [52,57,59,60]. It is this effect that was observed in our study, gait parameters and foot kinematics improved in all patients without pathological flexion in the knee joint in the long-term period.…”

“…[55], Terjesen T. et al [60], the improvement / normalization of ankle joint motion was not accompanied by compensatory changes in the kinematic parameters of the hip and knee joints. In our study, we noted an improvement in the parameters of movements in the hip and knee joints, regarding this situation as a remote effect of improving the kinematics of the ankle joints and correction of foot deformities.…”

A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity

“…To sum up, the GCH System 2.0 offers effectiveness in quantifying partial weight-bearing loads applied to the crutches in gait training according to each patient´s particular conditions. Consequently, it is a useful tool to control assisted gait, to obtain accuracy of loads exerted on the crutches and unloadings on the injuried lower limb, to carry out objective progressions [ 17 , 36 ] and to establish new treatment protocols, involving higher quality in the functional gait recovery [ 37 ]. Eliminating the subjectivity present in the treatment and raising the accuracy implies a shorter duration and reduction in relapses and sequelae.…”

Single‐Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy

“…Regardless of the treatment plan that is implemented, motion analysis can assess the outcome of the interventions (Table ) . Postoperative motion analysis is usually conducted one year after the surgery.…”