Gait Improvement Surgery Research Articles

Foot deformities in children with cerebral palsy.

The present article describes common foot deformities in children with cerebral palsy and discusses treatment options for each of those deformities. Bracing is a useful treatment to correct foot deformities during gait. Surgical correction of foot deformities is typically performed as a part of multilevel single-event gait improvement surgery that has increasingly become the standard of care for ambulatory children with cerebral palsy. Foot realignment may improve knee function during stance, probably because of change of lever arm. Foot deformities are common among children with cerebral palsy. The three most common among them are equinus, planovalgus and equinovarus/equinocavovarus. Treatment consists of orthotics, physical therapy, spasticity reduction treatment and surgical correction. Guidelines for treatment are individualized and multifactorial. Important considerations include the child's level of function, the severity and flexibility of the deformity, the presence or absence of pain and skin irritation, and the changes in alignment observed over time.

Gait improvement surgery in ambulatory children with diplegic cerebral palsy

Background and purpose — Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery.Patients and methods — 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6–19) years. On average, 5.7 (1–11) procedures per child were performed. Outcome measures were evaluation of gait quality using the gait profile score (GPS) and selected kinematic parameters, functional level using the functional mobility scale (FMS), and the degree of parental satisfaction.Results — The mean GPS improved from 20.7° (95% CI: 19–23) preoperatively to 15.4° (95% CI: 14–17) 5 years postoperatively. There was no significant change in GPS between 1 and 5 years. The individual kinematic parameters at the ankle, knee, and hip improved statistically significantly, as did gait function (FMS). The mean parental satisfaction, on a scale from 0 to 10, was 7.7 (2–10) points. There was a need for additional surgical procedures in 14 children; this was more frequent in those who had the index operation at an early age.Interpretation — The main finding was that orthopedic surgery based on preoperative GA gave marked improvements in gait function and quality, which were stable over a 5-year period. Nevertheless, additional orthopedic procedures were necessary in almost half of the children and further follow-up with GA for more than 1 year postoperatively is recommended in children with risk factors for such surgery.

Gait Improvement Surgery in Diplegic Children

Gait improvement surgery in ambulatory children with cerebral palsy performed as single-event multilevel surgery is today a well-established modality of treatment, but follow-up studies are lacking. Preoperative and follow-up gait analysis data of 32 diplegic children who underwent single-event multilevel surgery for gait improvement between 1995 and 1998 were evaluated retrospectively. Relevant sagittal plane kinematic parameters of the hip, knee, and ankle joint and time-distance parameters were considered for outcome measures in this study. Postoperative gait analysis was performed three times in all the cases: after discontinuation of the dynamic AFOs (mean 1.0 +/- 0.3 years), after discontinuation of the night splints (mean 2.3 +/- 0.7 years), and at least 1.5 years after discontinuation of physiotherapy and splints (mean 4.4 +/- 1.1 years). The aim of the study was to ascertain whether the improvements in gait function were maintained over these examinations. The authors found that gait function continued to change over 1, 2, and 3 years of follow-up. A general decrease in gait function was measurable in this collective between the first postoperative and the second postoperative evaluations. The results indicate that evaluation of gait improvement surgery in cerebral palsy performed at a minimum of 3 years after surgery would give the most predictive outcome of treatment.

Leg lengthening as part of gait improvement surgery in cerebral palsy: an evaluation using gait analysis

Eleven children with hemiplegic or an asymmetric diplegic cerebral palsy who had a preoperative leg length discrepancy of more than 2.5 cm underwent gait improvement surgery which included leg length equalisation. Sagittal plane kinematics and kinetics before and about 3 years after surgery for the lengthened limb and contralateral limb were evaluated. Preoperatively the unaffected limb had excessive stance phase flexion at the hip and knee, and dorsal flexion at the ankle joint. These changes could be partially reversed to produce a kinematic gait pattern comparable to age matched normal controls on the uninvolved side after equalisation of leg length.

Multilevel Surgery in Spastic Diplegia: Evaluation by Physical Examination and Gait Analysis in 25 Children

Gait improvement surgery was performed on 25 ambulatory children with the diplegic type of cerebral palsy. Multiple soft tissue and bony procedures were performed (mean 8.2 procedures) according to criteria defined on the basis of physical examination and gait analysis. Relevant physical examination findings and kinematic and kinetic data in the sagittal plane were evaluated before surgery and at least 3 years after surgery. Physical examination showed a reduction in the ankle plantar-flexor power and in the range of hip flexion and ankle plantarflexion after surgery. Analysis of gait data showed significant improvements in the sagittal plane kinematics and the power generation at the hip and the ankle. At the knee joint there was maintenance of power of the flexor and extensor group of muscles on physical examination, with significant improvements in the kinematics after surgery. The authors conclude that well-selected surgery improves function of the spastic muscle. The importance of assessing clinical, kinematic, and kinetic data together for proper evaluation of gait is stressed.

Conservative Management of Dynamic Equinus in Diplegic Children Treated by Gait Improvement Surgery

Conservative Management of Dynamic Equinus in Diplegic Children Treated by Gait Improvement Surgery

Conservative Management of Dynamic Equinus in Diplegic Children Treated by Gait Improvement Surgery

Conservative Management of Dynamic Equinus in Diplegic Children Treated by Gait Improvement Surgery

Conservative Management of Dynamic Equinus in Diplegic Children Treated by Gait Improvement Surgery

Multilevel surgery for gait improvement was performed on twelve ambulatory children with diplegic type of cerebral palsy and dynamic equinus deformity. Dynamic equinus deformities were defined as those who had an equinus at initial contact during preoperative gait analysis, and where the equinus deformity was correctable passively during physical examination. Ankle function was evaluated by clinical examination and gait analysis before surgery, and at least 3 years after surgery. The ankle showed an increase in dorsal flexion at initial contact, at single stance and in swing. There was an increase in dorsal flexion at the beginning of push-off, without a decrease in the range of motion of the ankle during push-off. Ankle moments demonstrated significant improvement in the maximum flexor moment in the second half of single stance. There was a change from abnormal generation of the energy in mid-stance to the normal pattern of energy absorption. Positive work during push-off was significantly increased. Conservative management of dynamic equinus deformities combined with multilevel surgery to correct other deformities of the locomotion system resulted in significant improvements in ankle function during gait.

Propulsive Function During Gait in Diplegic Children: Evaluation after Surgery for Gait Improvement

Propulsive Function During Gait in Diplegic Children: Evaluation after Surgery for Gait Improvement

Propulsive Function During Gait in Diplegic Children: Evaluation after Surgery for Gait Improvement

Seventeen patients with diplegic cerebral palsy were assessed by clinical examination and three-dimensional gait analysis before and after surgery to improve gait. Selection of surgical procedures was according to a fixed set of selection criteria. The average postoperative follow-up was 3.8 years (range, 2.6-5.7 years). Clinical examination revealed an improved range of motion for the ankle and no reduction in the power grade at the hip, knee and ankle after surgery. Kinematic parameters showed improved knee extension in stance and significant changes towards a normal ankle motion pattern postoperatively. Kinetic evaluation demonstrated that most of the total power during walking was generated at the hip, with the ankle contributing a small part. After surgery, patients walked faster with an increased power generation at the hip during first double support and at the ankle during push off. Power generation at the hip in stance is pointed out to be an important mechanism for propulsion during walking.

Propulsive Function During Gait in Diplegic Children: Evaluation after Surgery for Gait Improvement

Summary: Seventeen patients with diplegic cerebral palsy were assessed by clinical examination and three-dimensional gait analysis before and after surgery to improve gait. Selection of surgical procedures was according to a fixed set of selection criteria. The average postoperative follow-up was 3.8 years (range, 2.6-5.7 years). Clinical examination revealed an improved range of motion for the ankle and no reduction in the power grade at the hip, knee and ankle after surgery. Kinematic parameters showed improved knee extension in stance and significant changes towards a normal ankle motion pattern postoperatively. Kinetic evaluation demonstrated that most of the total power during walking was generated at the hip, with the ankle contributing a small part. After surgery, patients walked faster with an increased power generation at the hip during first double support and at the ankle during push off. Power generation at the hip in stance is pointed out to be an important mechanism for propulsion during walking.

Fixed and dynamic equinus in cerebral palsy: evaluation of ankle function after multilevel surgery.

Multilevel surgery for gait improvement was performed on 29 ambulatory children with diplegic cerebral palsy. Patients were divided into two groups based on the presence of dynamic equinus (12 cases) and fixed equinus deformity (17 cases). Dynamic equinus deformities were not corrected surgically, and fixed deformities were corrected by intramuscular gastrosoleus lengthening. Ankle function was evaluated by clinical examination and gait analysis before surgery and a minimum of 3 years after surgery. Positive changes in ankle function were observed in both the groups. Conservative management of dynamic equinus deformities resulted in significant improvements in ankle function. Intramuscular lengthening of fixed equinus deformities does not cause a weakening of the muscle and improves static and dynamic function of the ankle.

Assessment of gait improvement surgery in diplegic children using computerised gait analysis

Background: Improvement in diplegic gait after multi-level surgery using kinematic data have been documented. Kinematics provide information on dynamic joint motion. However kinetics, which are essential for differentiating between primary deformities and secondary responses, have not been evaluated so far. This article describes the outcome of multi-level surgery in diplegic patients using relevant clinical, and gait analysis data.