CP Gait Dysfunction in Children PDF
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Emory University
2020
Benjamin M. Rogozinski
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Summary
This document discusses gait dysfunction in children with cerebral palsy, focusing on the central nervous system and musculoskeletal impairments. It covers different gait patterns, classifications, and treatment options. The document also examines skeletal deformities and lever deficiencies related to gait and classifies gait patterns in spastic hemiplegia and spastic diplegia from a management algorithm perspective.
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Gait Dysfunction in Children with Cerebral Palsy Benjamin M. Rogozinski Assistant Professor Division of Physical Therapy School of Medicine Emory University CP Gait Dysfunction...
Gait Dysfunction in Children with Cerebral Palsy Benjamin M. Rogozinski Assistant Professor Division of Physical Therapy School of Medicine Emory University CP Gait Dysfunction Central Nervous System Delayed CNS Maturation Decreased pre-synaptic inhibition – spasticity Modified Ashworth Scale / Tardiue Scale Decreased motor planning Diminished Selective Control - Isolation / Timing / Overflow Increased co-contraction of agonists/antagonists Persistent Primitive Reflexes- hardwired motor synergies CP Gait Dysfunction Musculoskeletal system Impairments related to postural dysfunction in gait in children with CP include: Muscle deformity and weakness Skeletal Deformity Mal-alignment Lever deficiency CP Gait Dysfunction Muscle Deformity STRUCTURAL SYSTEM Endoskeleton CP Gait Dysfunction Skeletal Deformity CP Gait Dysfunction Skeletal deformity Lever deficiency Hip/Femur Neck-Shaft Angle Antetorsion CP Gait Dysfunction Skeletal deformity Lever deficiency Tibia Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm Rodda, J., 2001 Type 1 Hemiplegia Characterized by: Foot drop in swing phasePoor selective control of dorsiflexion Orthotics Management PLSO Hinged/AAFO Plantar Flexion in Mid & Terminal Swing – “Drop Foot” Dorsiflexor weakness or Agonist/antagonist imbalance Yields poor pre-positioning of the foot at IC 90 Flexion Secondary changes 60 Knee are typically seen 30 in knee kinematics Extension Knee flexion at IC -15 may be secondary Dorsiflex 30 “Drop foot” Ankle 10 -10 Plantar Flex -30 0 25 50 75 100 % Gait Cycle Posterior Leaf Spring: PLSO Indications: Mild, Dynamic Equinus St/Sw Weak Dorsiflexors (drop foot) Contraindications: Knee Flexion Contractures Significantly Compromised PFK/ Couple Fixed Equinus Deformity Phillips, D. AACPDM Conference (2002) Posterior Leaf Spring AFO Midswing Posterior Leaf Spring AFO – Initial Contact Type 2 Hemiplegia (Type 2A and 2B) *most common type of hemiplegia Gastroc-soleus spasticity and/or contracture Leads to true equinus in stance phase Impaired dorsiflexor function Leads to PF in swing phase Plantar flexion-knee extension couple Leads to knee recurvatum Orthotic Management: PLSO Hinged/AAFO SAFO??? Recurvatum Gait Treatment Options Type 3 Hemiplegia Stiff Knee Gait Gastroc-soleus spasticity and/or contracture Impaired dorsiflexion in swing Orthotic management SAFO Hinged/AAFO Depending on PFK couple integrity and pre-/post-surgical outcomes STIFF KNEE Functional limitation – Impaired foot clearance Compensatory movements – Circumduction – External rotation – Contralateral vaulting Type 4 Hemiplegia Proximal involvement Sagittal plane: anterior pelvic tilt, hip flexion, stiff knee flexion Transverse plane: hip IR Coronal plane: hip adduction Orthotic Management SAFO Hinged/AAFO Depending on PFK couple integrity Rodda, J., 2001 1. True Equinus Gastroc spasticity dominates Leads to ankle PF and hip/knee extension May be masked by knee recurvatum Orthotic Management? SAFO AAFO 2. Jump Gait Hamstring, hip flexor, and gastroc spasticity / tightness Leads to equinus, hip/knee flexion, anterior pelvic tilt (increased lumbar lordosis) Stiff knee (no dynamic ROM) Limitations in Hams and RF Orthotic Management?? SAFO FRAFO 3. Apparent Equinus Normal ankle ROM Excessive hip and knee flexion in stance Appears to be in equinus Child walks on toes, but ankle is not truly in excessive PF Common in older children Apparent equinus decreases as hip and knee flexion increase Orthotic Management SAFO AAFO FRAFO 4. Crouch Gait Excessive DF, knee flexion, hip flexion Usually in more severe diplegia cases Usually iatrogenic Can result in painful secondary impairments Orthotic Management SAFO FRAFO Crouch Gait Crouch Knee Treatment Options