Gradual serial extension weight bearing casting protocol improves knee range of motion and sagittal plane kinematics in children with cerebral palsy, crouch gait and knee flexion contractures

Purpose Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS). Our purpose was to compare ADFH alone versus ADFH with PTS for treatment of fixed knee flexion contractures and crouched gait in children with cerebral palsy (CP). Methods Retrospective review of pre- and postoperative gait analysis data for children with CP who underwent ADFH alone, or ADFH with PTS. Data were analysed using linear mixed models to control for covariates. Results In total, 25 participants (42 limbs) were included, 17 male and eight female, mean age at surgery 12.9 (sd 1.9) years. Both groups experienced significant improvement in popliteal angle, knee extension range of motion (ROM) and knee extension in stance phase. Greater improvement was seen for all variables in the ADFH/PTS group, mainly due to greater popliteal angle and knee flexion during gait preoperatively in that group (p ≤ 0.02) rather than the procedure performed (p ≥ 0.19). There was no difference between groups postoperatively. Rate of contracture resolution was 0.5° to 1.0° per month, faster in larger contractures (p = 0.02). Conclusions ADFH with and without PTS is effective in improving knee extension in skeletally immature patients with CP, correcting contractures at a rate of 0.5° to 1.0° per month. Combined ADFH and PTS surgery may be preferable in patients with larger contractures of up to 30° to 35°. Level of evidence III

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Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy

International Orthopaedics ◽

10.1007/s00264-021-05035-z ◽

2021 ◽

Author(s):

Supitchakarn Cheewasukanon ◽

Phatcharapa Osateerakun ◽

Noppachart Limpaphayom

Keyword(s):

Cerebral Palsy ◽

Knee Flexion ◽

Flexion Contracture ◽

Surgical Correction ◽

Knee Flexion Contracture ◽

Children With Cerebral Palsy

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Reliability of Heel-Height Measurement for Documenting Knee Extension Deficits

The American Journal of Sports Medicine ◽

10.1177/03635465020300040501 ◽

2002 ◽

Vol 30 (4) ◽

pp. 479-482 ◽

Cited By ~ 15

Author(s):

Theodore F. Schlegel ◽

Martin Boublik ◽

Richard J. Hawkins ◽

J. Richard Steadman

Keyword(s):

Range Of Motion ◽

Knee Flexion ◽

Cruciate Ligament ◽

Flexion Contracture ◽

Height Measurement ◽

Height Difference ◽

Thigh Circumference ◽

Flexion Contractures ◽

Heel Height ◽

Knee Flexion Contracture

Background Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated. Hypothesis Differences in thigh circumference measurements and whether the patient's patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture. Study Design Prospective cohort study. Methods Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction. Results A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture. Conclusion Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10°.

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Effectiveness of Virtual Reality and Visual Feedback on Balance and Leg Function in Children with Cerebral Palsy

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i18.748 ◽

2019 ◽

Vol 1 (18) ◽

Author(s):

Arūnė Dūdaitė ◽

Vilma Juodžbalienė

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Postural Control ◽

Range Of Motion ◽

Visual Feedback ◽

Lower Limb ◽

Dynamic Balance ◽

Control Group ◽

Children With Cerebral Palsy ◽

Stretching Exercises

Research background. Virtual reality and visual feedback improve motor performance, motor function and balance, so we want to fnd if it aﬀects the function of legs and balance of children with spastic hemiplegia. Research aim was to establish if the use of virtual reality and visual feedback with traditional physiotherapy improve the function of legs and balance of children with cerebral palsy. Methods. Nine children with cerebral palsy participated in the research. Participants were randomly divided into two groups – virtual reality group (n = 6) and control (n = 3). Virtual reality group practised exergaming and stretching exercises for 10 weeks, twice a week. Control group practiced conventional physiotherapy and stretching exercises for 6 weeks, twice a week. We measured the range of motion of the lower limb, spasticity of the lower limb using Modifed Ashworth’o Scale, static, dynamic balance, trunk coordination using Trunk Impairment Scale at the start and the end of the research, and balance using Pediatric Balance Scale. Results. Virtual reality and visual feedback reduced the spasticity of the lower limb, improved balance and postural control for children with cerebral palsy, but it did not improve the range of motion of the lower limb of children with cerebral palsy. Conclusions. Virtual reality and visual feedback did not improve the range of motion of the lower limb of children with cerebral palsy. Virtual reality and visual feedback reduced spasticity of the lower limb, improved balance and postural control for children with cerebral palsy.Keywords. Cerebral palsy, virtual reality, visual feedback, postural control, muscle architecture.

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A DYNAMIC SEATING SYSTEM FOR CHILDREN WITH CEREBRAL PALSY

Journal of Musculoskeletal Research ◽

10.1142/s0218957709002158 ◽

2009 ◽

Vol 12 (01) ◽

pp. 21-30 ◽

Cited By ~ 3

Author(s):

Michael E. Hahn ◽

Sheri L. Simkins ◽

Jacob K. Gardner ◽

Gaurav Kaushik

Keyword(s):

Cerebral Palsy ◽

Range Of Motion ◽

Motor Function ◽

Control Group ◽

Significant Group ◽

Gross Motor ◽

Gross Motor Function ◽

Muscle Spasticity ◽

Children With Cerebral Palsy ◽

Dynamic Seating

The study's aim was to determine the initial effects of a dynamic seating system as a therapeutic intervention in children with cerebral palsy. A two-factor, repeated-measures design was used. Twelve children with neuromuscular dysfunction (mean age 6.0, SD 2.7 years) were included in the study, randomly assigned to an experimental or a control group. At study initiation the experimental group received a wheelchair with dynamic seating components that allows limited range of motion in the hip and knee, and the control group received a static setting wheelchair. Participants were evaluated for range of motion, muscle spasticity (Modified Ashworth Scale), motor function (Gross Motor Function Measure), and level of disability (Pediatric Evaluation of Disability Inventory) at study initiation, 3-months, and 6-months post intervention. Both groups improved in motor function over time, particularly in the categories of Sitting and Crawl/Kneel. Measures of disability improved in both groups for the categories of self-care, mobility, and social function. A larger, more homogeneous sample would likely show significant group differences in measures of muscle spasticity, gross motor function and disability.

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