Management of crouch gait in ambulatory children with spastic diplegic cerebral palsy

Abstract

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Spastic CP is characterized by increased tone (not necessarily constantly) and/or pathological reflexes (hyper-reflexia or pyramidal signs). Crouch gaita gait pattern characterized by excessive knee flexion in terminal swing and stance, is a frequently observed gait deviation among children with cerebral palsy. Varying degrees of biomechanicaldysfunction, differences in tone and spasticity, thestrength ratio of agonist to antagonist, inappropriatemuscle activity, and abnormal external force applicationall influence gait function and efficiency. To prepare treatment plans and accurately assess outcomes of treatment of children with cerebral palsy, a balanced combination of medical history, detailed physical examination, functional assessment, imaging, observational gait analysis, computerized gait analysis, and assessment of patient and family goals must be interpreted. Management of the patient with cerebralpalsy depends upon the restoration of muscle balance, properalignment of joints and establishment of correct posture in theline of gravity. No therapeutic program can succeed withoutattaining these goals. Single event multilevel surgery (SEMLS) has become thestandard treatment to improve gait in ambulatory patients withspastic diplegic cerebral palsy. SEMLS reduces total hospitalizationtimes, subsequent surgeries, and the recurrences of deformitiesand increases the efficiency of postoperative rehabilitation.