Tag Archive for: Gait Analysis

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

1. Makki D, Duodu J, Nixon M. Prevalence and pattern of upper limb involvement in cerebral palsy. J Child Orthop. 2014 May;8(3):215-9. doi: 10.1007/s11832-014-0593-0. Epub 2014 May 14. PMID: 24824566; PMCID: PMC4142879.
2. Bhardwaj P, Sabapathy SR. Assessment of the hand in cerebral palsy. Indian J Plast Surg. 2011 May;44(2):348-56. doi: 10.4103/0970-0358.85356. PMID: 22022045; PMCID: PMC3193647.
3. Van Heest AE, Bagley A, Molitor F, James MA. Tendon transfer surgery in upper-extremity cerebral palsy is more effective than botulinum toxin injections or regular, ongoing therapy. J Bone Joint Surg Am. 2015 Apr 1;97(7):529-36. doi: 10.2106/JBJS.M.01577. PMID: 25834076.
4. Libberecht K, Sabapathy SR, Bhardwaj P. The relation of patient satisfaction and functional and cosmetic outcome after correction of the wrist flexion deformity in cerebral palsy. J Hand Surg Eur Vol. 2011 Feb;36(2):141-6. doi: 10.1177/1753193410384691. Epub 2010 Oct 8. PMID: 20935023.
5. Chaudhry S, Bhardwaj P, Venkatramani H, Sabapathy SR. The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making. J Am Acad Orthop Surg. 2021 May 1;29(9):e416-e426. doi: 10.5435/JAAOS-D-20-00719. PMID: 33883454.
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9. De Lepeleere B, Fitoussi F. Elbow Flexor Release Combined With Selective Neurectomy of Musculocutaneous Nerve for Spastic Elbow Flexion Deformity in Children and Adolescents. J Pediatr Orthop. 2024 Sep 1;44(8):e738-e743. doi: 10.1097/BPO.0000000000002729. Epub 2024 May 21. PMID: 38770666.
10. Cambon-Binder A, Leclercq C. Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity. Surg Radiol Anat. 2015 May;37(4):341-8. doi: 10.1007/s00276-014-1371-x. Epub 2014 Sep 6. PMID: 25193328.
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14. Schibli S, Fridén J. Rebalancing the Spastic Wrist by Transposition of Antagonistic Muscle-Tendon Complex. Tech Hand Up Extrem Surg. 2022 Jun 1;26(2):127-130. doi: 10.1097/BTH.0000000000000371. PMID: 34711790.
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16. Manske PR. Redirection of extensor pollicis longus in the treatment of spastic thumb-in-palm deformity. J Hand Surg Am. 1985 Jul;10(4):553-60. doi: 10.1016/s0363-5023(85)80082-4. PMID: 4020069.
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18. House JH, Gwathmey FW, Fidler MO. A dynamic approach to the thumb-in palm deformity in cerebral palsy. J Bone Joint Surg Am. 1981 Feb;63(2):216-25. PMID: 7462278.
19. Carlson MG. Green’s operative hand surgery. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors. Cerebral palsy. Philadelphia: Churchill Livingstone; 2005. pp. 1197–234.
20. Carlson EJ, Carlson MG. Treatment of swan neck deformity in cerebral palsy. J Hand Surg Am. 2014 Apr;39(4):768-72. doi: 10.1016/j.jhsa.2014.01.039. Epub 2014 Mar 6. PMID: 24613587.
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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

1. Bell KJ, Ounpuu S, DeLuca PA, et al. Natural progression of gait in children with cerebral palsy. J Pediatr Orthop. 2002;22:677–682
2. Gage JR, The neurological control system for normal gait. Gait Analysis in Cerebral Palsy. 1991 London MacKeith Press:37–60
3. Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop. 2003 May-Jun;23(3):296-301. PMID: 12724590
4. Harris GF, Wertsch JJ. Procedures for gait analysis. Arch Phys Med Rehabil. 1994 Feb;75(2):216-25. PMID: 8311681.
5. Gage JR. Gait analysis. An essential tool in the treatment of cerebral palsy. Clin Orthop Relat Res. 1993 Mar;(288):126-34. PMID: 8458125.
6. Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001 Nov;8 Suppl 5:98-108. doi: 10.1046/j.1468-1331.2001.00042.x. PMID: 11851738.
7. DeLuca, Peter; Davis, Roy; Õunpuu, Sylvia; Rose, Sally; Sirkin, Robert. Alterations in Surgical Decision Making in Patients with Cerebral Palsy Based on Three-Dimensional Gait Analysis. Journal of Pediatric Orthopaedics 17(5):p 608-614, September 1997.
8. Lofterød B, Terjesen T. Results of treatment when orthopaedic surgeons follow gait-analysis recommendations in children with CP. Dev Med Child Neurol. 2008 Jul;50(7):503-9. doi: 10.1111/j.1469-8749.2008.03018.x. PMID: 18611199.
9. Rutz E, Gaston MS, Tirosh O, Brunner R. Hip flexion deformity improves without psoas-lengthening after surgical correction of fixed knee flexion deformity in spastic diplegia. Hip Int. 2012 Jul-Aug;22(4):379-86. doi: 10.5301/HIP.2012.9453. PMID: 22878968.
10. Mallet C, Simon AL, Ilharreborde B, Presedo A, Mazda K, Penneçot GF. Intramuscular psoas lengthening during single-event multi-level surgery fails to improve hip dynamics in children with spastic diplegia. Clinical and kinematic outcomes in the short- and medium-terms. Orthop Traumatol Surg Res. 2016 Jun;102(4):501-6. doi: 10.1016/j.otsr.2016.01.022. Epub 2016 Mar 31. PMID: 27050557.
11. Dreher T, Wolf SI, Maier M, Hagmann S, Vegvari D, Gantz S, Heitzmann D, Wenz W, Braatz F. Long-term results after distal rectus femoris transfer as a part of multilevel surgery for the correction of stiff-knee gait in spastic diplegic cerebral palsy. J Bone Joint Surg Am. 2012 Oct 3;94(19):e142(1-10). doi: 10.2106/JBJS.K.01300. PMID: 23032593.
12. Végvári D, Wolf SI, Heitzmann D, Klotz MC, Dreher T. Does proximal rectus femoris release influence kinematics in patients with cerebral palsy and stiff knee gait? Clin Orthop Relat Res. 2013 Oct;471(10):3293-300. doi: 10.1007/s11999-013-3086-4. Epub 2013 Jun 5. PMID: 23737262; PMCID: PMC3773150.
13. Molenaers G, Desloovere K, Fabry G, De Cock P. The effects of quantitative gait assessment and botulinum toxin a on musculoskeletal surgery in children with cerebral palsy. J Bone Joint Surg Am. 2006 Jan;88(1):161-70.
14. Cook R, Schneider I, Hazlewood E, et al. Gait analysis alters decision making in cerebral palsy. J Pediatr Orthop 2003; 23:292–295.
15. Kay R, Dennis S, Rethlefsen S, et al. The effect of preoperative gait analysis on orthopaedic decision making. Clin Orthop Relat Res 2000; 372:217–222.
16. Chang FM, Seidl AJ, Muthusamy M, et al. Effectiveness of instrumented gait analysis in children with cerebral palsy: comparison of outcomes. J Pediatr Orthop 2006; 26:612–616.
17. Kay RM, Dennis S, Rethlefsen S, Skaggs DL, Tolo VT. Impact of postoperative gait analysis on orthopaedic care. Clin Orthop Relat Res. 2000 May;(374):259-64. doi: 10.1097/00003086-200005000-00023. PMID: 10818985
18. Schutte LM, Narayanan U, Stout JL, Selber P, Gage JR, Schwartz MH et al (2000) An index for quantifying deviations from normal gait. Gait Posture 11:25–31
19. Schwartz MH, Rozumalski A (2008) The Gait Deviation Index: a new comprehensive index of gait pathology. Gait Posture 28:351–357
20. Baker R, McGinley JL, Schwartz MH et al (2009) The gait profile score and movement analysis profile. Gait Posture 30:265–269
21. Noonan K, Halliday S, Browne B, et al. Interobserver variability of gait analysis in patients with cerebral palsy. J Pediatr Orthop 2003; 23:279 – 287.
22. States RA, Krzak JJ, Salem Y, Godwin EM, Bodkin AW, McMulkin ML. Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review. Gait Posture. 2021 Oct;90:1-8. doi: 10.1016/j.gaitpost.2021.07.009. Epub 2021 Aug 3. PMID: 34358847.
23. Wren TA, Gorton GE 3rd, Ounpuu S, Tucker CA. Efficacy of clinical gait analysis: A systematic review. Gait Posture. 2011 Jun;34(2):149-53. doi: 10.1016/j.gaitpost.2011.03.027. Epub 2011 Jun 8. PMID: 21646022.
24. Narayanan UG. The role of gait analysis in the orthopaedic management of ambulatory cerebral palsy. Curr Opin Pediatr. 2007 Feb;19(1):38-43. doi: 10.1097/MOP.0b013e3280118a6d. PMID: 17224660.

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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