Tendon release reduced joint stiffness with unaltered leg stiffness during gait in spastic diplegic cerebral palsy

Biomechanical deviations at individual joints are often identified by gait analysis of patients with cerebral palsy (CP). Analysis of the control of joint and leg stiffness of the locomotor system during gait in children with spastic diplegic CP has been used to reveal their control strategy, but the differences between before and after surgery remain unknown. The current study aimed to bridge the gap by comparing the leg stiffness—both skeletal and muscular components—and associated joint stiffness during gait in 12 healthy controls and 12 children with spastic diplegic CP before and after tendon release surgery (TRS). Each subject walked at a self-selected pace on a 10-meter walkway while their kinematic and forceplate data were measured to calculate the stiffness-related variables during loading response, mid-stance, terminal stance, and pre-swing. The CP group altered the stiffness of the lower limb joints and decreased the demand on the muscular components while maintaining an unaltered leg stiffness during stance phase after the TRS. The TRS surgery improved the joint and leg stiffness control during gait, although residual deficits and associated deviations still remained. It is suggested that the stiffness-related variables be included in future clinical gait analysis for a more complete assessment of gait in children with CP.

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Gait Analysis before and after Gastrocnemius Fascia Lengthening for Spastic Equinus Foot Deformity in a 10-Year-Old Diplegic Child

Case Reports in Medicine ◽

10.1155/2010/417806 ◽

2010 ◽

Vol 2010 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Manuela Galli ◽

Veronica Cimolin ◽

Giorgio Cesare Santambrogio ◽

Marcello Crivellini ◽

Giorgio Albertini

Keyword(s):

Decision Making ◽

Cerebral Palsy ◽

Gait Analysis ◽

Lower Limb ◽

Foot Deformity ◽

Cerebral Palsy Child ◽

Before And After ◽

Kinetic Effects ◽

Kinematics And Kinetics

Purpose. This case study quantified kinematic and kinetic effects of gastrocnemius lengthening on gait in a Cerebral Palsy child with equinus foot.Methods. A 10-year-old diplegic child with Cerebral Palsy was evaluated with Gait Analysis (GA) before and after gastrocnemius fascia lengthening, investigating the lower limb joints kinematics and kinetics.Results. Kinematics improved at the level of distal joints, which are directly associated to gastrocnemius, and also at the proximal joint (like hip); improvements were found in ankle kinetics, too.Conclusions. This case study highlighted that GA was effective not only to quantify the results of the treatment but also to help preoperative decision making in dealing with CP child.

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Gait Analysis of Children with Cerebral Palsy Before and After Selective Lengthening of Lower Limb Muscles

Biomechanisms ◽

10.3951/biomechanisms.19.173 ◽

2008 ◽

Vol 19 (0) ◽

pp. 173-182

Keyword(s):

Cerebral Palsy ◽

Gait Analysis ◽

Lower Limb ◽

Lower Limb Muscles ◽

Children With Cerebral Palsy ◽

Limb Muscles ◽

Before And After

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Effects of Tendon Release Surgery on Inter-Limb Leg Stiffness Control in Children with Spastic Diplegic Cerebral Palsy during Gait

Applied Sciences ◽

10.3390/app11104562 ◽

2021 ◽

Vol 11 (10) ◽

pp. 4562

Author(s):

Chien-Chung Kuo ◽

Hsing-Po Huang ◽

Hsuan-Yu Lu ◽

Tsan-Yang Chen ◽

Ting-Ming Wang ◽

...

Keyword(s):

Cerebral Palsy ◽

Stance Phase ◽

Reaction Force ◽

Bilateral Symmetry ◽

Healthy Controls ◽

Leg Stiffness ◽

Characteristic Features ◽

Total Leg ◽

Analysis System ◽

Single Limb Support

Impaired motor control and musculotendon tightness in the lower extremities are characteristic features of patients with diplegic cerebral palsy (CP). Tendon release surgery (TRS) helps improve joint and leg stiffness, but the effects of TRS on inter-limb coordination in terms of the total leg stiffness, and the bilateral symmetry in leg stiffness during gait, remain unknown. Ten children with spastic diplegic CP scheduled for TRS and ten healthy controls participated in this study. The inter-limb sharing of total leg stiffness during double-limb support phase and bilateral leg stiffness symmetry during stance phase of gait were calculated using the kinematic and ground reaction force data measured by a motion analysis system. Before TRS, the patients with diplegic CP walked with a decreased share of total leg stiffness during weight-acceptance (p < 0.05) and with increased bilateral leg stiffness asymmetry during single-limb support and weight-transfer during gait (p < 0.05) when compared to healthy controls. After TRS, the bilateral leg stiffness asymmetry was significantly reduced in the CP group, especially in the terminal stance phase, with inter-limb sharing of total leg stiffness becoming similar to that in controls (p > 0.05). The surgery seemed to improve the lower limb control and increased the bilateral limb symmetry during gait.

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Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy

Prosthetics and Orthotics International ◽

10.1177/0309364618791615 ◽

2018 ◽

Vol 43 (1) ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Ingrid Skaaret ◽

Harald Steen ◽

Terje Terjesen ◽

Inger Holm

Keyword(s):

Cerebral Palsy ◽

Gait Analysis ◽

Lower Limb ◽

Three Dimensional ◽

Foot Orthoses ◽

Important Improvement ◽

Gait Dysfunction ◽

Ankle Foot Orthoses ◽

Profile Score ◽

Lower Limb Surgery

Background: Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year postoperatively, many children are recommended continued use of ankle-foot orthoses. Objectives: Our aims were to quantify the impact of ankle-foot orthoses on gait 1 year postoperatively and evaluate predictors for clinically important improvement. Study design: Prospective cohort study. Methods: A total of 34 ambulating children with bilateral cerebral palsy, with mean age 11 years (range 6–17), comprising 12 girls and 22 boys, were measured with three-dimensional gait analysis preoperatively (barefoot) and 1 year postoperatively (barefoot and with ankle-foot orthoses). Outcome was evaluated using gait profile score, key kinematic, kinetic and temporal–spatial variables in paired sample comparisons. Logistic regression was used to evaluate predictors for clinically important improvement with orthoses (⩾1.6° change in gait profile score). Results: Walking barefoot 1 year postoperatively, major improvements were seen in gait profile score and key variables. With ankle-foot orthoses, there were significantly improved step length and velocity, additional moderate reduction/improvement in gait profile score and knee moments and decreased stance ankle dorsiflexion compared to barefoot. Children using ground reaction ankle-foot orthoses ( n = 14) decreased stance knee flexion from 13.9° walking barefoot to 8.2° with orthoses. High gait profile score and more gait dysfunction preoperatively were significant predictors of clinically important improvement walking with orthoses. Conclusion: The results indicate improved gait function walking with ankle-foot orthoses versus barefoot 1 year after lower limb surgery. Stronger impact of ankle-foot orthoses was found in children with more pronounced gait dysfunction preoperatively. Clinical relevance The 1-year postoperative three-dimensional gait analysis is a useful method to assess treatment outcome after lower limb surgery in children with bilateral cerebral palsy and could also guide clinicians whether further treatment with ankle-foot orthoses is indicated, using clinically important differences as thresholds to evaluate their impact on gait.

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