Progress in neuromuscular disorders

Abstract

The value of gait analysis as a tool for evaluation is affirmed by the number of articles that report its use in gait evaluation. Physical examination measures alone have limited value. Numerous gait analysis parameters have been identified and reported as valid. Joint angular velocity distinguishes normal from spastic gait. Gait analysis can distinguish between idiopathic toe-walkers and children with cerebral palsy. Gait analysis can evaluate the effects of orthotics, lower extremity surgery, and postoperative therapy on gait. Botulinum toxin, intrathecal baclofen, and rhizotomy are all reported as being effective in spasticity management. The role of each still requires further definition. Cerebral palsy hip dysplasia can be effectively managed with aggressive surgical intervention. Pain relief in long-standing cerebral palsy hip dislocations can be achieved with either prosthetic replacement or proximal femoral resection. Pelvic obliquity may occur in Duchenne muscular dystrophy after fusion of lumbar curves to L5. Functional outcome measures show significant benefit of spinal fusion in patients with Duchenne muscular dystrophy. Circular frame limb lengthening is well tolerated in spina bifida without increased risk. Patients with lower-level myelomeningocele have a delayed onset of walking. Elbow surgery in arthrogryposis effectively improves function and restores range of motion.