Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Current Approaches in Cerebral Palsy, A Focus on Gait Problems 13 articles


Coronal Plane Knee Moments Improve After Correcting External Tibial Torsion in Patients With Cerebral Palsy

Michael Aiona MD, Kosta Calligeros MBBS, BSc, Rosemary Pierce PT

External tibial torsion causes an abnormal axis of joint motion relative to the line of progression with resultant abnormal coronal plane knee moments and affects lever arm function of the foot in power generation at the ankle. However, it is unclear whether surgical correction of the tibial torsion corrects the moments and power.

Rectus Femoris Transfer Improves Stiff Knee Gait in Children With Spastic Cerebral Palsy

Dinesh Thawrani MD, Thierry Haumont MD, Chris Church MS, PT, Larry Holmes PhD, DrPH, Kirk W. Dabney MD, Freeman Miller MD

Stiff knee gait is common among children with ambulatory cerebral palsy (CP). When surgery is indicated, rectus femoris transfer as a primary treatment enhances knee range of motion, reduces time to peak knee flexion, increases peak knee flexion, and reduces toe drag.

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Patricia Maria Moraes Barros Fucs MD, PhD, Celso Svartman MD, Rodrigo Montezuma Cezar Assumpção MD, Helder Henzo Yamada MD, Simone Dota Simis MD

Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity.

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Jacques Riad MD, Christopher M. Modlesky PhD, E. M. Gutierrez-Farewik PhD, Eva Broström PT, PhD

Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity.

Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia

Erich Rutz MD, Elyse Passmore MEng, Richard Baker PhD, H. Kerr Graham MD

Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development.

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

Lisa V. Wagner MHS, OTR/L, Jon R. Davids MD

Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and performance in children with cerebral palsy (CP) must choose from a wide range of tools.

Higher Expression of Myosin Heavy Chain IIx in Wrist Flexors in Cerebral Palsy

Stefan Gantelius MD, Yvette Hedström BS, Eva Pontén MD, PhD

Children with cerebral palsy (CP) use their paretic arm less than normal but have a relative overactivity of wrist flexors, causing an impairing flexed position of the wrist. Voluntary use of a muscle downregulates myosin heavy chain (MyHC) IIx, but it is unclear whether the relative overactivity of wrist flexors and extensors in children with CP affects MyHC expression compared to normal subjects.

Case Reports: The Influence of Selective Voluntary Motor Control on Gait After Hamstring Lengthening Surgery

Evan J. Goldberg PhD, Eileen G. Fowler PhD, PT, William L. Oppenheim MD

Preliminary evidence suggests selective voluntary motor control (SVMC), defined as performance of isolated voluntary joint movement on request, may be an important factor affecting functional movement tasks. Individuals with poor SVMC are unable to dissociate hip and knee synergistic movement during the swing phase of gait and have difficulty extending their knee while the hip is flexing during terminal swing regardless of hamstring length. This pattern may limit their ability to take advantage of hamstring-lengthening surgery (HLS) and may explain a lack of improved stride length postoperatively.

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Ana Presedo MD, Fabrice Megrot PhD, Brice Ilharreborde MD, Keyvan Mazda MD, Georges-François Penneçot MD

Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest the transfer does not generate a knee flexor moment but diminishes knee extension moment in swing and MRI studies show the transferred tendons can be constrained by scarring to underlying muscles. Thus, it is possible knee flexion would be improved by distal rectus release rather than transfer since it would not be adherent to the underlying muscles.

Better Walking Performance in Older Children With Cerebral Palsy

Elisabet Rodby-Bousquet RPT, Gunnar Hägglund MD, PhD

Children with cerebral palsy (CP) often walk with a slower speed and a higher energy cost. Their walking performance and choice of mobility method may vary in different environments. Independent mobility is important for activity and participation.