Transverse Plane Gait Problems in Children With Cerebral Palsy

Abstract

Transverse plane deviations are significant contributors to pathologic gait in children with cerebral palsy (CP). Due to limitations in neuromuscular control, balance, strength and coordination, transverse plane gait deviations are poorly tolerated in these children. Transverse plane malalignment results in lever arm dysfunction and can be seen with either intoeing or out-toeing. Frequent causes of transverse plane problems and lever arm dysfunction include long bone (femoral and/or tibial) torsion, pelvic rotation, and pes varus or valgus. Computerized motion analysis facilitates accurate identification of transverse plane abnormalities. This article addresses appropriate identification and treatment of transverse plane gait deviations in children with CP.

A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia

“…1,2,8,15,16 As would be expected from clinical experience, the current study in a large population of ambulatory children with spastic diplegia found a high prevalence of transverse plane kinematic anomalies. A previous study from Wren et al 4 identified 14 specific gait anomalies in children with CP and their respective prevalence.…”

“…Transverse plane deviations change the orientation and the length of muscular lever-arm, thus contributing to abnormal moments. 1,2 Although mechanisms and causes of lower limbs torsional profiles in children with cerebral palsy (CP) are well known, the assessment of kinematic prevalence and the description of lower limb transverse plane deviations in children with spastic diplegia have not been established. Numerous studies investigating rotational malalignment have been reported but studies are variable regarding CP type (data from hemiplegic, diplegic, and quadriplegic patients were analyzed collectively), are usually focused on specific lower limb levels, or take various kinematic plane deviations into considerations.…”

Predictive Simulation Generates Human Adaptations during Loaded and Inclined Walking

“…Although human walking is predominantly a sagittal plane motion, additional degrees of freedom in the coronal and transverse planes allow the pelvis to rotate around the stance leg contributing to a longer stride [ 46 ] and permit the ankle to rotate providing additional ground clearance for the foot during the swing phase [ 47 ]. Models with coronal and transverse plane muscles would permit three-dimensional predictive simulations and provide the capability to simulate pathological gaits that are characterized by significant out-of-plane motion [ 48 , 49 ]. While 3D muscle-driven predictive models exist [ 17 , 31 ], future studies could investigate if explicit reflex control laws can be developed for non-sagittal muscles and if they can improve the quality of the predictions.…”

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

“…Rotational deformities of the tibia may cause functional gait impairments, commonly requiring correction with surgery, especially in the presence of neuromuscular diseases such as CP. 10 , 12 , 13 Several reports have shown that TDO is an effective treatment option for the correction of rotational deformities of the tibia in children with CP, but significant complications have been reported. 8 , 9 We achieved an average of 22.3° improvement in the thigh-foot angle (TFA) through supramalleolar osteotomy with minimally invasive plate osteosynthesis, without any significant complication.…”