Sagittal gait patterns in spastic diplegia

Rodda, Jill; Graham, H Kerr; Carson, Lindsey L.; Galea, Mary P.; Wolfe, Rory

doi:10.1302/0301-620x.86b2.13878

Cited by 335 publications

(282 citation statements)

References 35 publications

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“…In spastic diplegia, this can manifest as crouch gait, jump gait, or a mixed pattern [2]. In hemiplegia, this can present as knee flexion with apparent or true equinus [3]. The knee flexion is due to a variety of factors.…”

Section: Introductionmentioning

confidence: 99%

Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy

Lin¹,

Patrick

Aiona

et al. 2012

Journal of Children's Orthopaedics

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Purpose Children with spastic diplegic and hemiplegic cerebral palsy frequently ambulate with flexed knee gait. There has been concern that hamstring lengthening used to treat this problem may weaken hip extension. This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy. Methods A total of 47 children (67 lower limbs) ranging in age from 5 to 17 years old were included in this study. All subjects underwent a variety of additional surgeries at the time of the hamstring surgery as part of a multilevel treatment plan. All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST). Full gait analysis studies were done for all subjects pre-operatively and 1 year post-operatively. Results There were 25 patients (35 limbs) in the HSL group and 22 patients (32 limbs) in the HST group. There was no significant difference in age, gender, or the time from surgery to post-operative gait analysis between groups. On physical examination, both HSL and HST groups showed improvement in passive knee extension, popliteal angle, and straight leg raise. Maximum knee extension in stance phase was improved in both groups. The maximum hip extension in late stance phase was significantly improved only in the HST group. The peak hip extension power in stance phase showed significant improvement only in the HST group and a significant decrease for the HSL group. Conclusions The findings of this study demonstrated that both the HSL and HST procedures resulted in similar amounts of improvement in passive range of motion of the knee, as well in knee extension in stance during gait at 1 year post-operatively. However, with the HST procedure, there was better preservation of hip extension power and improved hip extension in stance. The HST procedure should be considered when hamstring surgery is performed.

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Section: Introductionmentioning

confidence: 99%

Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy

Lin¹,

Patrick

Aiona

et al. 2012

Journal of Children's Orthopaedics

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“…19 The indications for SEMLS were the presence of fixed musculoskeletal deformities that were considered to be adversely affecting gait and function. 20,21 Operative procedures for each SEMLS prescription were selected by evaluation of the above data, in discussion with the gait laboratory team and the child and parents or carers. 13,17 The selection and conduct of the operative procedures, postoperative care, and rehabilitation have been described in detail elsewhere.…”

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confidence: 99%

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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ABBREVIATIONS FMSFunctional Mobility Scale GPS Gait Profile Score SEMLS Single-event multilevel surgery AIM There are conflicting reports about the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) after orthopaedic surgery. We studied the stability of the GMFCS in children with bilateral spastic CP after single-event multilevel surgery, using the Gait Profile Score (GPS) as the primary outcome measure.METHOD This was a retrospective cohort study of 107 children (46 females, 61 males) with bilateral spastic CP, classified as GMFCS level II or III, who underwent surgery at a single tertiary institution between 1997 and 2008. The mean age at surgery was 10 years 7 months (SD 2y 8mo). The primary outcome measure was the GPS. Changes in GMFCS level were studied at multiple time points before and after intervention.RESULTS Gait dysfunction was partially corrected, with a mean improvement of 28% in the GPS.The GMFCS remained stable and unchanged in 95% of children and improved by one level in 5% of children. The improvement in GPS was three times the minimal clinically important difference. The mean age at final postoperative GPS assessment was 11 years 10 months (SD 2y 10mo) and at final GMFCS assessment was 15 years 7 months (SD 3y 9mo).INTERPRETATION Stability of the GMFCS was confirmed in the majority of children with bilateral spastic CP after single-event multilevel surgery, despite statistically and clinically significant improvements in gait dysfunction and functional mobility. This information is important in realistic goal-setting and in counselling families.The Gross Motor Function Classification System (GMFCS) is a standardized method to classify gross motor function in children with cerebral palsy (CP) from 1 to 18 years of age. 1,2It is a five-level categorical grading system which classifies differences in gross motor function that are meaningful and significant to children with CP and their families.3 Distinctions between GMFCS levels are based on functional limitations with an emphasis on sitting and walking and the need for assistive devices and wheeled mobility. Children may be quickly and easily classified at any given time, such as during a clinic appointment or gait laboratory assessment, by determining which level best corresponds to the child's current gross motor function. A set of age-appropriate descriptive criteria are used and good correlations have been demonstrated between classifications assigned by parents and by health professionals. 1,2,4 Since the original description by Palisano et al. 1 in 1997, the GMFCS has become widely accepted, widely used, and is considered by many to be an essential tool to communicate about gross motor function in CP. 5,6The GMFCS is a valid and reliable classification tool which is expected to be relatively stable over time, with or without intervention. Palisano et al. 3 reported that 73% of 610 children with CP remained at the same GMFCS level at multiple ratings over time , and McCormick et ...

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“…Main concerns have appeared about the validity of classifi cations, which are not based on quantitative data [18]. Th e results of the present study are based on standard gait instrumental kinematic analysis and improvement of gait characteristics have been found in preschool children with CP aft er using NOPS Atlant.…”

Section: Discussionmentioning

confidence: 81%

Influence of 3-month therapy using the neuro-orthopaedic suit Atlant on gait characteristics in preschool children with spastic cerebral palsy

Gapeyeva

Mitt

Ereline

2013

AKUT

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Diff erent kinds of physical therapy are used in medical rehabilitation of neurological patients with motor defi ciency: partial body weight-supported treadmill training, driven gait orthosis, neuromuscular electrical stimulation and neuroorthopaedic suit therapies. Neuro-orthopaedic pneumosuit (NOPS) Atlant (Dynaforce, Russia) creates a muscle framework by dynamic proprioceptive stimulation, stabilizing the trunk and the extremities, reducing pathological synergies and normalizing patient's motor activity. Th e aim of the present study was to investigate the infl uence of 3-month therapy using the NOPS Atlant on gait characteristics in preschool children with spastic form of cerebral palsy (CP). Six CP children with spasticity of lower extremities with (mean±SE) age of 5.2±0.8 years participated in the present study. Children had NOPS Atlant therapy sessions during three months, supervised by an experienced physiotherapist. Th e kinematic and kinetic characteristics of gait were measured using 3-D movement analysis system Elite Clinic (BTS S.p.A., Italy). Aft er 3-month therapy using the NOPS Atlant, signifi cant increase (7.9%) of the stride length of gait was found as compared with the initial data. Children with spastic CP demonstrated signifi cant improvement of range of motion of hip joint abduction, decrease of knee joint external rotation, as well as positive changes in foot progression angle during gait. In conclusion, motor function re-activation during gait in preschool children with spasticity caused by cerebral palsy was noted aft er 3-month therapy using the NOPS Atlant. However, future research is needed to elucidate mechanisms of neurodynamic therapy eff ect on motor ability in children with CP.

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Sagittal gait patterns in spastic diplegia

Cited by 335 publications

References 35 publications

Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy

Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Influence of 3-month therapy using the neuro-orthopaedic suit Atlant on gait characteristics in preschool children with spastic cerebral palsy

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