Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 09-13 | Jayanth Sampath, Taral Nagda

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.172

Submitted: 01/02/2024; Reviewed: 14/02/2024; Accepted: 18/03/2024; Published: 10/04/2024

Authors: Jayanth Sampath MS Ortho [1], Taral Nagda MS Ortho [2]

[1] Department of Paediatric Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.
[2] Department of Paediatric Orthopaedics, SRCC NH Children’s Hospital, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: jayanthdoc@gmail.com

Abstract

Levers in the human body play an important role in facilitating efficient movement. Muscle forces act around the axis of movement of adjacent joints. The normal moment of a joint (M) is the product of the muscle force (F) and the length of lever arm (d). The primary neurological insult in cerebral palsy (CP) causes shortening of muscles, joint contractures, and torsional abnormalities in bones. The resulting ineffective lever arm leads to a failure to produce an appropriate torque and subsequent gait abnormalities. Therefore, the effects of lever arm dysfunction should be considered when gait improvement surgery is being offered to children with CP. This review will explain the role of levers in normal human biomechanics and the significance of lever arm dysfunction in the management of CP.
Keywords: Biomechanics, Lever arm, Disorder, Cerebral palsy

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How to Cite this Article:  Sampath J, Nagda T | Understanding the Biomechanics of Lever Arm Disorders in Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 09-13 . https://doi.org/10.13107/ijpo.2024.v10i01.172

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Upper Limb in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 39-49 | Praveen Bhardwaj, Vigneswaran Varadharajan, Mukil Venthan S, S Raja Sabapathy 

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.177

Submitted: 28/01/2024; Reviewed: 16/02/2024; Accepted: 11/03/2022; Published: 10/04/2024

Authors: Praveen Bhardwaj MS Ortho [1], Vigneswaran Varadharajan MS Ortho [1], Mukil Venthan S MS Ortho [1], S Raja Sabapathy MS Ortho [2]

[1] Department of Hand & Reconstructive Microsurgery Ganga Hospital, Coimbatore, Tamil Nadu, India
[2] Department of Plastic, Hand & Reconstructive Microsurgery Ganga Hospital, Coimbatore, Tamil Nadu, India

Address of Correspondence

Dr. Praveen Bhardwaj,
Consultant- Hand & Reconstructive Microsurgery Ganga Hospital, 313- Mettupalayam Road Sai Baba Colony Coimbatore, Tamil Nadu, India
E-mail: drpb23@gmail.com

Abstract

Cerebral palsy (CP) is a complex neuromuscular disorder characterized by impaired movement and coordination, often resulting in significant gait abnormalities. The spectrum of motor function impairment varies greatly among individuals with CP, influenced by muscle control issues and specific types of cerebral palsy, including spasticity and ataxia. Gait analysis, comprising both observational and instrumented techniques, is essential for assessing gait patterns and identifying abnormalities. While observational gait analysis provides qualitative insights, instrumented gait analysis offers a detailed and objective assessment through motion capture technology, allowing for comprehensive evaluation of joint angles(Kinematics) and forces(Kinetics).
Understanding gait patterns is crucial for making informed clinical decisions regarding therapeutic interventions such as surgery and orthotic management. Literature has demonstrated that gait analysis significantly improves surgical recommendations and outcomes, highlighting the importance of incorporating detailed gait data into treatment planning. However, limitations such as variability in data accuracy, the complexity of methods, and hesitancy among some orthopaedic surgeons to adopt these techniques need to be addressed. The integration of gait analysis into clinical practice represents a paradigm shift in the management of cerebral palsy, transitioning treatment from an art to a science. It enables clinicians to tailor interventions based on individual biomechanical profiles, ultimately enhancing the functional ability and quality of life for patients. Continued research and standardized practices are essential to maximize the effectiveness of gait analysis in this population, ensuring that children withe cerebral palsy receive the most appropriate and effective care.
Keywords: Gait Analysis, Cerebral Palsy, Instrumented Gait Lab

References

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How to Cite this Article:  Bhardwaj P, Varadharajan V, Venthan SM, Sabapathy SR | Upper Limb in Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 39-49 . https://doi.org/10.13107/ijpo.2024.v10i01.177

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Role of Gait Analysis in Management of Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 34-38 | Chasanal Rathod

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.176

Submitted: 13/01/2024; Reviewed: 05/02/2024; Accepted: 21/03/2024; Published: 10/04/2024

Authors: Chasanal Rathod MS Ortho [1,2]

[1] Department of Paediatric Orthopaedic Surgery, SRCC Children’s Hospital, Mumbai, Maharashtra, India.
[2] Xavier’s Gait Lab, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Chasanal Rathod,
Paediatric Orthopaedic Surgeon, SRCC Children’s Hospital, Mumbai, Maharashtra, India. Xavier’s Gait Lab Mumbai, Maharashtra, India.
E-mail: chasanal@gmail.com

Abstract

Cerebral palsy (CP) is a complex neuromuscular disorder characterized by impaired movement and coordination, often resulting in significant gait abnormalities. The spectrum of motor function impairment varies greatly among individuals with CP, influenced by muscle control issues and specific types of cerebral palsy, including spasticity and ataxia. Gait analysis, comprising both observational and instrumented techniques, is essential for assessing gait patterns and identifying abnormalities. While observational gait analysis provides qualitative insights, instrumented gait analysis offers a detailed and objective assessment through motion capture technology, allowing for comprehensive evaluation of joint angles(Kinematics) and forces(Kinetics).
Understanding gait patterns is crucial for making informed clinical decisions regarding therapeutic interventions such as surgery and orthotic management. Literature has demonstrated that gait analysis significantly improves surgical recommendations and outcomes, highlighting the importance of incorporating detailed gait data into treatment planning. However, limitations such as variability in data accuracy, the complexity of methods, and hesitancy among some orthopaedic surgeons to adopt these techniques need to be addressed. The integration of gait analysis into clinical practice represents a paradigm shift in the management of cerebral palsy, transitioning treatment from an art to a science. It enables clinicians to tailor interventions based on individual biomechanical profiles, ultimately enhancing the functional ability and quality of life for patients. Continued research and standardized practices are essential to maximize the effectiveness of gait analysis in this population, ensuring that children withe cerebral palsy receive the most appropriate and effective care.
Keywords: Gait Analysis, Cerebral Palsy, Instrumented Gait Lab

References

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How to Cite this Article:  Rathod C | Role of Gait Analysis in Management of Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 34-38. https://doi.org/10.13107/ijpo.2024.v10i01.176

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Lever Arm Disorders of the Feet in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 26-33 | Atul Bhaskar

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.175

Submitted: 11/02/2024; Reviewed: 26/02/2024; Accepted: 13/03/2024; Published: 10/04/2024

Authors: Atul Bhaskar MS Ortho, FRCS Ortho, MCH, DNB [1,2,3]

[1] Department of Orthopaedics, Apollo Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, SRCC NH Hospital, Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Atul Bhaskar,
Paediatric Orthopaedic Surgeon, Department of Orthopaedics, Apollo Hospital, SRCC NH Hospital, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
E-mail: arb_25@yahoo.com

Abstract

The key for optimum management for progressive musculoskeletal deformities in cerebral palsy patients is understanding the causative mechanisms. The impact of muscle shortening and contracture on the long bones and joints leads to lever arm problems in the foot and ankle and the associated deformities.
Management of each deformity is considered separately although many of these can occur concurrently and the severity my vary in an individual.
Keywords: Lever, Cerebral palsy, Foot & Ankle

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How to Cite this Article:  Bhaskar A | Lever Arm Disorders of the Feet in Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 26-33.
https://doi.org/10.13107/ijpo.2024.v10i01.175

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Crouch Gait: Evaluation and Management

Volume 10 | Issue 1 | January-April 2024 | Page: 20-25 | Hitesh Shah, Dhiren Ganjwala

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.173

Submitted: 08/02/2024; Reviewed: 28/02/2024; Accepted: 17/03/2024; Published: 10/04/2024

Authors: Hitesh Shah MS Ortho [1], Dhiren Ganjwala MS Ortho [2]

[1] Department of Paediatric Orthopaedics, Kasturba Medical College, Manipal, Manipal academy of higher education, Manipal, Karnataka,
[2] Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Dhiren Ganjwala,
Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.
E-mail: ganjwala@gmail.com

Abstract

Crouch gait, a common gait abnormality in spastic diplegia, is characterized by increased knee flexion, ankle dorsiflexion, and reduced hip extension during the stance phase. It occurs due to impairments in anti-gravity muscles and is often aggravated during adolescence due to growth spurts. The condition can result from factors such as lever arm dysfunction, joint deformities, muscle elongation, and weakness. Crouch gait significantly affects mobility, causing early fatigue, patellar tendon elongation, and potential arthritis. Prevention involves strengthening anti-gravity muscles, maintaining proper weight, and using orthoses to correct deformities. Treatment options include surgical interventions like osteotomies, tendon lengthening, and patellar tendon advancement to address deformities and restore function. Non-surgical methods include muscle-strengthening exercises and the use of appropriate orthoses. A comprehensive assessment of modifiable and non-modifiable factors is crucial for tailored management, ultimately improving gait and reducing energy expenditure during walking.
Keywords: Crouch gait, Cerebral palsy, Patella alta, Planovalgus foot, Knee fixed flexion deformity

References

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How to Cite this Article:  Shah H, Ganjwala D | Crouch Gait: Evaluation and Management International |  Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 20-25 https://doi.org/10.13107/ijpo.2024.v10i01.174

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Lever Arm dysfunction of Hips in Cerebral Palsy

Volume 10 | Issue 1 | January-April 2024 | Page: 14-19 | Jitendra Kumar Jain

DOI- https://doi.org/10.13107/ijpo.2024.v10i01.173

Submitted: 14/01/2024; Reviewed: 10/02/2024; Accepted: 06/03/2024; Published: 10/04/2024

Authors: Jitendra Kumar Jain MS Ortho [1]

[1] Trishla Foundation, Tagore Town, Prayagraj, Uttar Pradesh, India.

Address of Correspondence

Dr. Jitendra Kumar Jain,
Chairman, Trishla Foundation, Tagore Town, Prayagraj, Uttar Pradesh, India.
E-mail: jjain999@gmail.com

Abstract

In cerebral palsy, hip dysfunction is the second most common problem after equines deformity. Abnormal skeletal development of the proximal femur due to abnormal forces in cerebral palsy leads to lever arm function by reducing the length of the lever arm contributing to one of very important causes of gait abnormality. High hip anteversion, high neck shaft angle, subluxation, and dislocation are the most common lever arm dysfunctions at the hip joint. This lever arm dysfunction increases progressively with age and correspondence to GMFCS level. If not identified at a very early stage then it may progress to completely deform the femoral head & hip joint. Early identification and preventive surgery help in preventing progression in GMFCS I to III but can progress despite of preventive surgery in non-walker children FMFCS IV & V. Recurrence of the problem is also very common in non-walker children. So we need detailed information about the lever arm problem in the hip and how to deal with this problem in cerebral palsy children. In this article, we have discussed etiology, and how to identify and management protocols for different lever arm dysfunctions of the hip in cerebral palsy.
Keywords: Cerebral palsy, Lever arm dysfunction of hip, Hip subluxation, Anteversion

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How to Cite this Article:  Jain J | Lever Arm dysfunction of Hips in Cerebral Palsy | International Journal of Paediatric Orthopaedics | January-April 2024; 10(1): 14-19 .  https://doi.org/10.13107/ijpo.2024.v10i01.173

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