Skip to main content

Advertisement

SpringerLink
Log in

Assessment of gait improvement surgery in diplegic children using computerised gait analysis

Einschätzung von Operationen zur Gangverbesserung bei Kindern mit spastischer Diparese

  • Originalarbeiten
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: Improvement in diplegic gait after multi-level surgery using kinematic data have been documented. Kinematics provide information on dynamic joint motion. However kinetics, which are essential for differentiating between primary deformities and secondary responses, have not been evaluated so far. This article describes the outcome of multi-level surgery in diplegic patients using relevant clinical, and gait analysis data.

Methods: Gait improvement surgery was performed on twenty-five ambulatory children with diplegic type of cerebral palsy. Multiple soft tissue and bone procedures (mean 7.8) were performed according to defined criteria. Clinical examination findings, kinematic and kinetic data in the sagittal plane were evaluated pre-operatively and at least of 3 years after surgery.

Results: Clinical examination demonstrated a reduction in the range of hip flexion and ankle plantar flexion and in the ankle plantar flexor power after surgery. Significant increases in the stride length and velocity were observed after surgery. Analysis of gait data showed statistically significant improvements in the sagittal plane kinematics and the power generation at the hip and the ankle.

Conclusions: We conclude that well selected surgery improves function of the spastic muscle. The importance of assessing clinical, kinematic, and kinetic data together for proper evaluation of gait is emphasised.

Zusammenfassung

Grundlagen: Die operative Gangverbesserung bei Kindern mit spastischer Diparese durch Mehretageneingriffe in einer Sitzung ist in der Literatur ausreichend dokumentiert. Bisher wurden vor allem Gelenkbewegungen untersucht. Kinetische Parameter wie Gelenkmomente, die zwischen primären Deformitäten und sekundären Kompensationsmechanismen unterscheiden, blieben unberücksichtigt.

Methodik: Bei 25 Kindern mit spastischer Diparese sind operative Eingriffe zur Verbesserung des Gangbildes durchgeführt worden. Die Auswahl der Eingriffe erfolgte nach definierten Kriterien. Klinische Untersuchungen, kinematische und kinetische Parameter aus der instrumentellen Bewegungsanalyse wurden präoperativ und 3 Jahre postoperativ untersucht.

Ergebnisse: Sowohl die Schrittlänge als auch die Ganggeschwindigkeit verbesserten sich signifikant. Die kinematischen und kinetischen Parameter in der Sagittalebene zeigten signifikante Verbesserungen.

Schlußfolgerungen: Alle Kinder haben von der operativen Gangverbesserung profitiert. Die instrumentelle Bewegungsanalyse liefert als Ergänzung zur klinischen Untersuchung in der Auswahl operativer Methoden zur Verbesserung einer spastischen Gangstörung hilfreiche Informationen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abel MF, Damiano DL, Pannunzio M, Jeffrey B: Muscle-tendon surgery in diplegic cerebral palsy: Functional and mechanical changes. J Pediatr Orthop 1999; 19: 366–375.

    Article  PubMed  CAS  Google Scholar 

  2. Abel MF, Damiano DL: Strategies For increasing walking Speed in diplegic cerebral palsy. J Paediatr Orthop 1996; 16: 753–758.

    Article  CAS  Google Scholar 

  3. Baumann JU, Koch HG: Ventrale aponeurotische Verlängerung des Musculus gastrocnemius. Operat Orthop Traumatol 1989; 1: 254–258.

    Article  Google Scholar 

  4. Browne AO, McManus F: One-session surgery for bilateral correction of lower limb deformities in spastic diplegia. J Pediatr Orthop 1987; 7: 259–261.

    PubMed  CAS  Google Scholar 

  5. DeLuca PA, Davis RB, Ounpuu S, Rose S, Sirkin R: Alternations in surgical decision making in patients with cerebral palsy based on three-dimensional gait analysis. J Pediatr Orthop 1997; 17: 608–614.

    Article  PubMed  CAS  Google Scholar 

  6. Gage JR, Fabian D, Hicks R, Tashman S: Pre-and postoperative gait analysis in patients with spastic diplegia: A preliminary report. J Paediatr Orthop 1984; 4: 715–725.

    CAS  Google Scholar 

  7. Gage JR, Perry J, Hicks RR, Koop S, Werntz JR: Rectus femoris transfer to improve knee function of children with cerebral palsy. Dev Med Child Neurol 1987; 29: 159–166.

    Article  PubMed  CAS  Google Scholar 

  8. Gage JR: Gait analysis: An essential tool in the treatment of cerebral palsy. Clin Orthop 1993; 288: 126–134.

    PubMed  Google Scholar 

  9. Hadley N, Chambers C, Scarborough N, Cain T, Rossi D: Knee motion following multiple soft-tissue releases in ambulatory patients with cerebral palsy. J Paediatr Orthop 1992; 12: 324–328.

    CAS  Google Scholar 

  10. Lee EH, Goh JC, Bose K: Value of gait analysis in the assessment of surgery in cerebral palsy. Arch Physl Med Rehabil 1992; 73: 645–646.

    Google Scholar 

  11. Nene AV, Évans GA, Patrick JH: Simultaneous multiple operations for spastic diplegia. Outcome and functional assessment of walking in 18 patients. J Bone Joint Surg 1993; 75-B: 488–494.

    Google Scholar 

  12. Norlin R, Tkaczuk H. One-session surgery for correction of lower extremity deformities in children with cerebral palsy. J Paediatr Orthop 1985; 5: 208–211.

    CAS  Google Scholar 

  13. Norlin R, Tkaczuk H. One-session surgery for correction on the lower limbs in children with cerebral palsy. A five year follow-up. Int Orthop 1992; 16/3: 291–293.

    Google Scholar 

  14. Ounpuu S, Gage JR, Davis RB: Three-dimensional lower extremity joint kinetics in normal paediatric gait. J Pediatr Orthop 1991; 11: 341–349.

    PubMed  CAS  Google Scholar 

  15. Ounpuu S, Muik E, Davis RB, Gage JR, DeLuca PA: Rectus femoris surgery in children with cerebral palsy. Part II: A comparison between the effect of transfer and release of the distal rectus femoris on knee motion. J Pediatr Orthop 1993; (13)3: 331–335.

    Google Scholar 

  16. Ounpuu S, Muik E, Davis RB, Gage JR, DeLuca PA: Rectus femoris surgery in children with cerebral palsy. Part I: The effect of rectus femoris transfer location on knee motion. J Paediatr Orthop 1993; (13)3: 325–330.

    Google Scholar 

  17. Perry J, Hoffer MM, Giovani P, Antonelli D, Greenberg R: Gait analysis of the triceps surae in cerebral palsy: a preoperative and postoperative clinical and electromyographic study. J Bone Joint Surg 1974; 56-A: 511–520.

    Google Scholar 

  18. Perry J, Hoffer MM, Antonelli D, Plut J, Lewis G, Greenberg R: Electromyography Before and After Surgery For Hip Deformity In Children With Cerebral Palsy. A Comparison Of Clinical And Electromyographic Findings. J Bone Joint Surg 1976; 58-A: 201–208.

    Google Scholar 

  19. Rose SA, DeLuca PA, Davis RB, Ounpuu S, Gage JR. Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy. J Pediatr Orthop 1993; Vol. 13,6: 727–732.

    PubMed  CAS  Google Scholar 

  20. Saraph V, Zwick EB, Steinwender G: Fixed equinus in cerebral palsy: Evaluation of ankle function after the Baumann Procedure using gait analysis. Gait (10)1: 69.

  21. Silver RL, Garza J, Rang M: The myth of muscle balance. A study of relative strength and excursions of normal muscles about the foot and ankle. J Bone Joint Surg 1985; 67-B: 452–457.

    Google Scholar 

  22. Sutherland DH, Santi M, Abel MF: Treatment of stiff-knee gait in cerebral palsy: A comparison by gait analysis of distal rectus femoris transfer versus proximal rectus release. J Paediatr Orthop 1990; 10: 433–441.

    CAS  Google Scholar 

  23. Sutherland DH, Zilberfarb JL, Kaufman KR, Wyatt MP, Chambers HG: Psoas Release At The Pelvic Brim: An Ambulatory Patients With Cerebral Palsy: Operative Technique And Functional Outcome. J Paediatr Orthop 1997; 17: 563–570.

    Article  CAS  Google Scholar 

  24. Sutherland DH: Outcome assessment in cerebral palsy: Has walking improved? In Sussman, M.D. (ed): The Diplegic Child American Academy of Orthopaedic Surgeons, Illinois, U.S.A. 1992; 133–145.

  25. Tachdjian MO: The Neuromuscular System: Cerebral Palsy. In Wickland EH (ed): Paediatric Orthopaedics. Philadelphia: W. B. Saunders Company. 1990; 1616–1617.

    Google Scholar 

  26. Thometz J, Simon S, Rosenthal R: The Effect On Gait Of Lengthening Of The Medial Hamstrings: In Cerebral Palsy. J Bone Joint Surg 1989; 71A: 345–353.

    Google Scholar 

  27. Waters RL, Perry J, McDaniels JM, House K: The relative strength of the hamstrings during hip extension. J Bone Joint Surg 1974; 56A: 1592–1597.

    Google Scholar 

  28. Yngve DA, Chambers C: Vulpius and z-lengthening. J Pediatr Orthop 1996; vol 16: 759–764.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Paediatric Orthopaedics, Department of Paediatric Surgery, Karl-Franzens-University, Auenbruggerplatz 34, A-8036, Graz

    G. Steinwender M.D., V. Saraph, E. -B. Zwick, Christiane Uitz & W. Linhart

Authors
  1. G. Steinwender M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Saraph
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. -B. Zwick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christiane Uitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Linhart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Steinwender M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steinwender, G., Saraph, V., Zwick, E.B. et al. Assessment of gait improvement surgery in diplegic children using computerised gait analysis. Acta Chir. Austriaca 32, 237–241 (2000). https://doi.org/10.1007/BF02949371

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02949371

Keywords

Schlüsselwörter

Search

Navigation