Abstract
Pelvic retraction during walking is a common finding seen in patients with spastic hemiplegia. However, potential factors related to this condition have not been comprehensively examined in a systemic manner in previous studies. The purpose of this study was to elucidate any clinical and gait parameters related to pelvic retraction in patients with hemiplegic cerebral palsy. A total of 212 independent ambulatory patients were enrolled in the study. Group I consisted of 113 patients who had persistent pelvic retraction, and Group II of 99 with a normal range of pelvic rotation throughout the gait cycle as evidenced by kinematic analysis. A multivariate logistic regression analysis using a clustering technique was performed, with use of eight gait factors and five clinical factors. Decreased ankle dorsiflexion, increased hip internal rotation, increased anterior pelvic tilt, the Winters classification type II, and asymmetrical posturing of the upper extremity during gait were found to be related to pelvic retraction. This is the only study including a broader array of assessment domains of both clinical and gait parameters with a considerably large and homogenous population with hemiplegia. Further studies will be needed to see whether the rectification of those parameters may improve abnormal gait and pelvic retraction in hemiplegia.
Highlights
During normal gait, the ipsilateral pelvis is internally rotated at the initial foot contact owing to forward positioning of the foot, and there is a continuous external rotation of the pelvis to an extent of less than 5 degrees by the time of contralateral foot contact [1]
It is necessary to investigate the effects of unilateral involvement of the entire limbs and the severity of clinical deficits of the ipsilateral limbs on the development of pelvic retraction. The purpose of this present study is to identify any clinical features and gait parameters that may be related to pelvic retraction in patients with spastic hemiplegic cerebral palsy (SHCP)
To the best of our knowledge, this is the only study including a broader array of assessment domains of both clinical and gait parameters with a considerably large and homogenous population with hemiplegia
Summary
The ipsilateral pelvis is internally rotated at the initial foot contact owing to forward positioning of the foot, and there is a continuous external rotation of the pelvis to an extent of less than 5 degrees by the time of contralateral foot contact [1] This normal pelvic movement can be compromised in patients with underlying pathologic conditions. Excessive external rotation of the pelvis during gait, is a common finding seen in patients with cerebral palsy [2]. It produces functional problems and cosmetic concerns due to an asymmetric gait. Several surgical procedures have been introduced to reduce pelvic retraction [6,7]; some improvements of pelvic retraction after derotational osteotomy of the femur were observed, and an increased hip internal rotation associated with an increased femoral anteversion was suggested to be the contributing factor for pelvic retraction in hemiplegia [8,9]
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