Spasticity Effect in Cerebral Palsy Gait

Abstract

A high number of children with cerebral palsy (CP) have spastic gait and consequently abnormalities in joint patterns. Several factors have been contributing to the lack of consensus on the spasticity effect in cerebral palsy gait and would be summarized and discussed in this chapter, e.g., spastic gait patterns are in constant evolution during the process of growth; there are still considerable limitations in the methodologies used to assess spasticity during gait; a wide range of rehabilitation strategies have been explored to control spasticity during gait. Spastic gait patterns are divided in hemiplegic (5 types) and diplegic (4 types) with the most prevalent joint abnormalities described in the sagittal plane. Ashworth, Tardieu, and DAROM scales and Pendulum Tests are widely used to assess spasticity but do not reliably explain the spasticity effects during gait. Orthotics, adequate exercise or handling techniques, botulinum injections, or surgical procedures have been used to manage spasticity effects.

An Analytical Insight Into How Walking Speed and Spatial and Temporal Symmetry Are Related to Ankle Dysfunctions in Children With Hemiplegic Cerebral Palsy

“…Spasticity effect on the walking in children with hCP has been clearly stated in the literature, 20,21 but further investigations might be needed to explore the relationship between dynamic spasticity and walking speed. Previous studies evaluated spasticity passively at resting state, whereas the effect of spasticity during functional tasks such as walking (i.e., dynamic spasticity) has not yet clearly verified.…”

Medical Rehabilitation in Patient with Cerebral Palsy Spastic Diplegic GMFCS IV MACS I CFCS IV EDACS II

“…Spastic gait patterns are divided in hemiplegic (5 types) and diplegic (4 types) with the most prevalent joint abnormalities described in the sagittal plane. 9 Equine foot is one of the most common deformities in patients with CP. Equine foot in children has many causes, including spasticity, altered motor control, muscle contractures, contractures of the ankle joint, and muscle weakness.…”

“…11 The methods and therapeutics that address spasticity and CP gait are numerous; some of them are well established for a long time with different degrees of success (orthopedic surgery, stretching, botulinum toxin A, orthotics), while some are more recent yet promising (selective dorsal rhizotomy, intrathecal baclofen, virtual reality, and transcranial magnetic stimulation). 9 Spasticity has positive effects such as extensor tone in the limbs that helps standing, preserve muscle bulk, preserve bone density. However, it also has negative effects such as masks contraction in the antagonist, difficulty in movement, abnormal posture, difficulty in sitting and transfers, inhibition of muscle growth, that lead to contractures, difficulty in hygiene and dressing, pressure sores, and pain.…”