Advertisement

Stance Phase Problems in Cerebral Palsy (Strength)

Living reference work entry

Abstract

Normal human gait results from a combination of several complex coordinated activities. The variable loss of control that is associated with cerebral palsy (CP) lesions can cause multiple interruptions in the gait cycle. To understand and properly evaluate pathologic gait patterns and to provide proper medical remedies for gait impairments due to CP, the clinician must understand the normal gait cycle. Instrumented gait analysis is a tool that provides detailed information and quantitative measurements throughout the gait cycle to evaluate individual gait patterns that help surgeons plan appropriate interventions. There are several prevailing abnormal gait patterns associated with spastic CP. These patterns are categorized into those affecting stance vs swing phases of gait. The patterns at the knee most often responsible for impeding the gait cycle by causing stance phase instability are crouch gait and back-kneeing in sagittal plane kinematic. Patterns such as back-kneeing cause knee hyperextension which is especially bad for delaying push-off and propelling forward; crouch knee gait causes dropping down into hip and knee flexion. These two types of gait patterns require different types of intervention due to differing muscle responses. Identification of the correct gait pattern in cerebral palsy is required to create the correct management algorithm.

Keywords

Cerebral palsy Stance phase Crouch gait Back-knee Ankle-foot orthosis Knee-ankle-foot orthosis Ground reaction force 

Abbreviations

AFO

Ankle-foot orthosis

CP

Cerebral palsy

GRAFO

Ground reaction ankle-foot orthosis

HAT

Head, arm, trunk

KAFO

Knee-ankle-foot orthosis

References

  1. Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Delp SL (2006) The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. Gait Posture 23(3):273–81. Epub 2005 Jun 17Google Scholar
  2. Bell KJ et al (2002) Natural progression of gait in children with cerebral palsy. J Pediatr Orthop 22(5):677–682Google Scholar
  3. Damiano DL, Kelly LE, Vaughn CL (1995) Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. Phys Ther 75(8):658–667. discussion 668–71CrossRefGoogle Scholar
  4. Damiano DL et al (2009) Can strength training predictably improve gait kinematics? A pilot study on the effects of hip and knee extensor strengthening on lower-extremity alignment in cerebral palsy. Phys Ther 90(2):269–279MathSciNetCrossRefGoogle Scholar
  5. Delp SL et al (1996) Hamstrings and psoas lengths during normal and crouch gait: implications for muscle-tendon surgery. J Orthop Res 14(1):144–151CrossRefGoogle Scholar
  6. Dreher T et al (2012) Development of knee function after hamstring lengthening as a part of multilevel surgery in children with spastic diplegia. J Bone Joint Surg 94(2). doi:10.2106/jbjs.j.00890Google Scholar
  7. Gage JR (1993) Gait analysis. An essential tool in the treatment of cerebral palsy. Clin Orthop Relat Res 288:126–134Google Scholar
  8. Hicks J et al (2007) The effect of excessive tibial torsion on the capacity of muscles to extend the hip and knee during single-limb stance. Gait Posture 26(4):546–552CrossRefGoogle Scholar
  9. Johnson DC, Damiano DL, Abel MF (1997) The evolution of gait in childhood and adolescent cerebral palsy. J Pediatr Orthop 17(3):392–396Google Scholar
  10. Kadhim M, Miller F (2014) Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait Posture 39(2):793–798CrossRefGoogle Scholar
  11. Kane K, Kyra K, John B (2010) Comparison of ground reaction and articulated ankle-foot orthoses in a child with lumbosacral myelomeningocele and tibial torsion. J Prosthetics Orthot 22(4):222–229CrossRefGoogle Scholar
  12. Kedem P, Scher DM (2016) Evaluation and management of crouch gait. Curr Opin Pediatr 28(1):55–59CrossRefGoogle Scholar
  13. Kerkum YL et al (2015) The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS One 10(11):e0142878CrossRefGoogle Scholar
  14. Klotz MCM et al (2013) Reduction in primary genu recurvatum gait after aponeurotic calf muscle lengthening during multilevel surgery. Res Dev Disabil 34(11):3773–3780CrossRefGoogle Scholar
  15. Klotz MCM et al (2014) The association of equinus and primary genu recurvatum gait in cerebral palsy. Res Dev Disabil 35(6):1357–1363MathSciNetCrossRefGoogle Scholar
  16. Miller F (2005) Cerebral palsy. Springer Science & Business Media, New YorkGoogle Scholar
  17. Novacheck TF et al (2009) Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique. J Bone Joint Surg 91(Suppl 2):271–286CrossRefGoogle Scholar
  18. Perry J, Antonelli D, Ford W (1975) Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg 57(7):961–967CrossRefGoogle Scholar
  19. Rethlefsen S et al (1999) The effects of fixed and articulated ankle-foot orthoses on gait patterns in subjects with cerebral palsy. J Pediatr Orthop 19(4):470–474CrossRefGoogle Scholar
  20. Rethlefsen SA et al (2013) Repeat hamstring lengthening for crouch gait in children with cerebral palsy. J Pediatr Orthop 33(5):501–504CrossRefGoogle Scholar
  21. Rodda JM et al (2004) Sagittal gait patterns in spastic diplegia. J Bone Joint Surg 86(2):251–258CrossRefGoogle Scholar
  22. Rodda JM et al (2006) Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery. J Bone Joint Surg 88(12):2653–2664Google Scholar
  23. Rogozinski BM, Davids JR, Davis RB 3rd, Jameson GG, Blackhurst DW (2009) The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy. J Bone Joint Surg Am 91(10):2440–2447CrossRefGoogle Scholar
  24. Scianni A et al (2009) Muscle strengthening is not effective in children and adolescents with cerebral palsy: a systematic review. Aust J Physiother 55(2):81–87CrossRefGoogle Scholar
  25. Simon SR et al (1978) Genu recurvatum in spastic cerebral palsy. Report on findings by gait analysis. J Bone Joint Surg Am 60(7):882–894CrossRefGoogle Scholar
  26. Wren TAL, Rethlefsen S, Kay RM (2005) Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery. J Pediatr Orthop 25(1):79–83Google Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of Orthopedics and TraumatologyAdnan Menderes University Faculty of MedicineAydınTurkey

Personalised recommendations