Cerebral palsy

NewsBot · Sep 17, 2020

Crouch gait or flexed-knee gait in cerebral palsy: Is there a difference? A systematic review
R.O’SullivanA.MarronK.Brady
Gait & Posture ;Volume 82, October 2020, Pages 153-160

Highlights
•Crouch gait and flexed knee gait are essentially synonymous terms.
•Definitions of both predominantly focused on knee position.
•27 % of papers provided no definition of the gait pattern.
•Definitions should specify objective knee position, rationale and period in the gait cycle.
•Gait analysis societies may have a role in defining common gait patterns in CP.
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Background
Crouch or flexed-knee gait is one of the most common pathological gait patterns in cerebral palsy (CP). Differences exist in definitions used; the degree of knee flexion, inclusion of hip or ankle position, and timing in the gait cycle. This ambiguity may be responsible for variations in prevalence rates and difficulty comparing data across studies.

Research question
What are the kinematic parameters used to define crouch or flexed-knee gait in CP gait? A secondary aim was to examine the quality of data reporting, focusing on the sample characteristics, inclusion/exclusion criteria and the choice of limb included for analysis.

Methods
Articles included in this review reported on a specified cohort of adults or children with crouch or flexed-knee gait assessed with 3-dimensional gait analysis. A customised data extraction and quality assessment table was designed specific to the research question.

Results
The majority (75 %) of included studies used the term crouch gait. Where the pattern was defined, 80 % of crouch papers and 94 % of flexed-knee gait papers based this solely on knee position. Kinematic parameters were clearly defined when they provided objective values of knee flexion, supported this with rationale and provided a reference point in the gait cycle. Only 22 % of crouch papers and 19 % of flexed-knee gait papers provided this information. The majority of studies (67 % crouch; 90 % flexed-knee) specified which limb(s) were included for analysis with the majority including both limbs. Objective values of knee flexion ranged from 8 o to 30 o.

Significance
This review highlights that crouch and flexed knee are synonymous and ambiguity exists in the kinematic definition making it difficult to make compare data amongst study cohorts. Future research should provide detailed definitions including the threshold value of knee flexion, how it was derived, the timing in the gait cycle and the limb(s) included in analysis.
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NewsBot · Apr 28, 2021

Foot and ankle somatosensory deficits in children with cerebral palsy: A pilot study
Anastasia Zarkou et al
J Pediatr Rehabil Med. 2021 Apr 23

Purpose: To investigate foot and ankle somatosensory function in children with cerebral palsy (CP).

Methods: Ten children with spastic diplegia (age 15 ± 5 y; GMFCS I-III) and 11 typically developing (TD) peers (age 15 ± 10 y) participated in the study. Light touch pressure and two-point discrimination were assessed on the plantar side of the foot by using a monofilament kit and an aesthesiometer, respectively. The duration of vibration sensation at the first metatarsal head and medial malleolus was tested by a 128 Hz tuning fork. Joint position sense and kinesthesia in the ankle joint were also assessed.

Results: Children with CP demonstrated significantly higher light touch pressure and two-point discrimination thresholds compared to their TD peers. Individuals with CP perceived the vibration stimulus for a longer period compared to the TD participants. Finally, the CP group demonstrated significant impairments in joint position sense but not in kinesthesia of the ankle joints.

Conclusions: These findings suggest that children with CP have foot and ankle tactile and proprioceptive deficits. Assessment of lower extremity somatosensory function should be included in clinical practice as it can guide clinicians in designing more effective treatment protocols to improve functional performance in CP.
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NewsBot · Oct 16, 2021

Is the Prevalence of Equinus Foot in Cerebral Palsy Overestimated? Results from a Meta-Analysis of 4814 Feet
Axel Horsch et al
J Clin Med. 2021 Sep 13;10(18):4128

Background: Equinus is a common foot deformity in patients with cerebral palsy (CP). However, its prevalence is scarcely reported in the literature. Therefore, we conducted this review to estimate the prevalence of equinus foot in CP.

Methods: Eight databases were searched. Our primary outcome was the prevalence of equinus foot in CP patients. Subgroup analysis was conducted based on study design, the laterality of CP, and whether equinus foot was defined or not.

Results: The prevalence of equinus foot in CP was 93% (95% CI: 71-99). The prevalence was 99% (95% CI: 55-100), 96% (95% CI: 57-100), and 65% (95% CI: 37-86) in unilateral, both, and bilateral CP, respectively. Based on study design, equinus foot prevalence was 92% (95% CI: 34-100) in case series and 62% (95% CI: 47-74) in cohort studies. Four studies reported definition criteria for equinus foot, with a pooled prevalence rate of equinus foot of 99% (95% CI: 36-100) compared to a rate of 89% (95% CI: 59-98) among studies that lacked a definition criterion.

Conclusions: This is the first meta-analysis to address the prevalence of equinus foot in CP patients. Although its prevalence is very high, our findings should be interpreted with caution due to the presence of multiple limitations, such as the lack of standardized definition criteria for equinus foot, the inappropriate study design, the wide confidence interval of equinus foot rate, and the small number of studies investigating it as a primary outcome.
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NewsBot · Feb 8, 2022

Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy
Ana Ramírez-Barragán, María Galán-Olleros, Raquel Maroto, Rosa M Egea-Gámez, Ignacio Martínez-Caballero
J Pediatr Orthop. 2022 Feb 8

Background: Planovalgus foot (PVF) in cerebral palsy (CP) tends toward progression and rigidity in adolescence, especially in patients with greater functional impairment. Deformity at the talonavicular joint justifies the use of talonavicular arthrodesis as a corrective surgical technique. This study aims to assess patient or caregiver functional satisfaction and radiographic outcomes of talonavicular arthrodesis for PVF in CP patients with assisted ambulation in the long-term.

Methods: Retrospective comparative study of level III and level IV pediatric CP patients who underwent talonavicular arthrodesis for PVF between 1999 and 2010 as part of multilevel surgery and with a minimum follow-up of 10 years. Radiologic correction at 10 years was compared with preintervention values, and functional impact at 10 years was measured by the foot function index (FFI); correlation between radiologic measurements and FFI were obtained, and complications were recorded.

Results: Forty-nine PVFs in 25 patients with CP (72% level III and 28% level IV) were included; 52% were male. The patients had a median age of 12 years at the time of surgery (range: 11 to 15) and 23 years at the time of the study (21 to 26). Significant (P<0.01) pre-post radiologic improvements were obtained in Meary angle (37.86±10.7/8.37±5.5 degrees), calcaneal pitch (3.20±8.1/13.22±5.6 degrees), lateral talocalcaneus angle (42.18±12.1/25.29±2.9 degrees), Moreau-Costa-Bartani angle (167.04±8/146.12±7.1 degrees), talus-first metatarsal angle (27.92±13.9/9.69±4.4 degrees), anteroposterior talocalcaneal angle (37.61±7.4/22.61±2.4 degrees), and talus coverage angle (37.04±11.11/2.45±2.5 degrees). At 10 years postoperatively, functional outcome measured with the FFI was satisfactory (33.9±15.2%) and the mean maximum pain was 3.04; 56% of cases had mild pain. All patients were able to wear an ankle-foot orthosis and 8 no longer needed the device. A significant correlation was found between the talofirst metatarsal angle and the FFI (P=0.024). There were 8% of cases with screw protrusion and 14% presented pseudarthrosis, most of them asymptomatic.

Conclusions: The adequate functional outcome, as well as the persistence of long-term radiologic correction and acceptable number of complications, enables us to recommend talonavicular arthrodesis as an alternative treatment to consider in level III and level IV CP patients with PVF.
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NewsBot · Mar 28, 2022

Ankle Dorsiflexor Function after Gastrocsoleus Lengthening in Children with Cerebral Palsy: A Literature Review
Nicholas Sclavos et al
Medicina (Kaunas). 2022 Mar 2;58(3):375

Background and Objectives: Ambulant children with cerebral palsy can demonstrate persistent "foot drop" after successful gastrocsoleus lengthening (GSL) surgery for equinus deformity. This may be due to inadequate strength and/or selective motor control of the ankle dorsiflexor muscles. A procedure has been developed to reduce foot drop-Tibialis Anterior Tendon Shortening (TATS), to be performed in conjunction with GSL. However, it is currently unclear how ankle dorsiflexor function changes after surgery and which children could benefit from TATS. This review summarises changes in ankle dorsiflexor function after GSL for equinus, as reported in the literature. Methods: A search was performed of the Medline, Embase and PubMed databases from 1980 to 5 March 2021. Keywords included "cerebral palsy", "equinus deformity", "orthopedic procedures" and "gait analysis". The search identified 1974 studies. Thirty-three cohort studies met the inclusion criteria for this review. Results: Twenty-two studies reported improvement in swing phase ankle dorsiflexion kinematics, after GSL. There was also evidence that clinical measures of ankle dorsiflexor strength improved after surgery. Four studies reported changes in selective motor control, with mixed results across the studies. Conclusions: There is good evidence that swing phase ankle dorsiflexion improves after GSL surgery. Although, there is limited evidence that this correlates with reduced foot drop or diminished need for an ankle-foot orthosis. Future research should be prospective, randomised, include a large sample size, and should focus on identifying the optimal candidates for TATS.
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NewsBot · Apr 27, 2022

Topical Review: Approach to Diagnosis and Management of the Pediatric Foot and Ankle in Cerebral Palsy Patients

NewsBot · Jul 29, 2022

Gait Analysis in Children with Cerebral Palsy: Are Plantar Pressure Insoles a Reliable Tool?
Maria Raquel Raposo et al
Sensors (Basel). 2022 Jul 13;22(14):5234

Cerebral palsy (CP) is a common cause of motor disability, and pedobarography is a useful, non-invasive, portable, and accessible tool; is easy to use in a clinical setting; and can provide plenty of information about foot-soil interaction and gait deviations. The reliability of this method in children with CP is lacking. The aim of this study is to investigate test-retest reliability and minimal detectable change (MDC) of plantar pressure insole variables in children with CP. Eight children performed two trials 8 ± 2.5 days apart, using foot insoles to collect plantar pressure data. Whole and segmented foot measurements were analyzed using intraclass correlation coefficients (ICC). The variability of the data was measured by calculating the standard error of measurement (SEM) and the MDC/ICC values demonstrated high test-retest reliability for most variables, ranging from good to excellent (ICC ≥ 0.60). The SEM and the MDC values were considered low for the different variables. The variability observed between sessions may be attributed to the heterogeneous sub-diagnosis of CP.
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NewsBot · Jul 30, 2022

Defining Equinus Foot in Cerebral Palsy
Axel Horsch et al
Children (Basel). 2022 Jun 25;9(7):956

Background: Equinus foot is the deformity most frequently observed in patients with cerebral palsy (CP). While there is widespread agreement on the treatment of equinus foot, a clear clinical definition has been lacking. Therefore, we conducted this study to evaluate functional changes in gait analysis in relation to maximum possible dorsiflexion (0°, 5°, 10° and 15°) and in two subgroups of CP patients (unilateral and bilateral).

Methods: In this retrospective study, CP patients with different degrees of clinically measured maximum dorsiflexion were included. We further subdivided patients into unilaterally and bilaterally affected individuals and also included a healthy control group. All participants underwent a 3D gait analysis. Our goal was to determine the degree of maximum clinical dorsiflexion where the functional changes in range of motion (ROM) and ankle moment and power during gait were most evident. Then, a subgroup analysis was performed according to the affected side.

Results: In all, 71 and 84 limbs were analyzed in unilaterally and bilaterally affected subgroups. The clinically 0° dorsiflexion group barely reached a plantigrade position in the 3D gait analysis. Differences in ROM were observed between subgroups. Ankle moment was quite similar between different subgroups but to a lower extent in the unilateral group. All CP patients had reduced ankle power compared to controls.

Conclusions: A cutoff value of clinical ≤ 5° dorsiflexion is the recommended value for defining a functionally relevant equinus foot in CP patients.
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NewsBot · Aug 29, 2022

Long-term outcome of extraarticular subtalar arthrodesis in children with cerebral palsy using modified Grice technique
Jiri Jochymek, Tereza Peterkova
Acta Orthop Belg. 2022 Jun;88(2):223-230

The purpose of the study is to describe and analyse long-term results of the modified Grice procedure with specially prepared pre-shaped autograft from iliac crest. 54 patients (101 feet) who underwent modified Grice procedure, were retrospectively analysed. Before and after the surgery, talocalcaneal (TC) angle and calcaneal inclination (CI) angle were measured and compared with post-operative values. Furthermore, AOFAS score was assess pre-and postoperatively as well as the subjective evaluation of the patients or their parents. Detailed analysis was performed separately for patients with different forms of CP. Postoperatively, TC angle and subjective assessment decreased, and CI angle and AOFAS score increased significantly compared to pre-operative values. The significant difference was observed among different CP groups in all observed parameters. Severe complications were not observed. The modified Grice procedure with specially prepared pre-shaped autograft showed promising long-term results.
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NewsBot · Nov 14, 2022

Analysis of Running Gait in Children with Cerebral Palsy: Barefoot vs. a New Ankle Foot Orthosis
Federica Camuncoli et al
Int J Environ Res Public Health. 2022 Oct 30;19(21):14203

Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0-3% GC (p < 0.017) and during the entire swing phase 31-100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to differ significantly both in absorption and generation 5-10%GC (p < 0.001); 21-27%GC (p < 0.001) with a reduction in both cases when the AFO was worn. No statistical differences were recorded in the GRF components, in the affected ankle torque and hip and knee kinematics and kinetics.
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NewsBot · May 19, 2023

Assessment of Five-Foot Plantar Morphological Pressure Points of Children with Cerebral Palsy Using or Not Dynamic Ankle Foot Orthosis
Senem Guner et al
Children (Basel). 2023 Apr 13;10(4):722

People with spastic cerebral palsy (CP) often experience a decline in gait function and flexion. The children's posture and hip strategy, which leads to knee flexion, predisposes these children to increased contact area in the medial foot region. This study investigated the use of DAFO (dynamic ankle-foot orthosis) prescribed to patients with cerebral palsy (CP) to determine the plantar pressure distribution with orthosis use. Eight children with spastic CP (age 4-12 years) were classified as Gross Motor Function Classification System (GMFCS) levels I-II with a maximum spasticity level of 3 in their ankle muscles according to the Modified Ashworth Scale. We assessed the plantar distribution by using eight WalkinSense sensors in each trial and exported data from the proprietary software (WalkinSense version 0.96, Tomorrow Options Microelectronics, S.A.). The plantar pressure distribution was conducted under two conditions: only shoes and DAFO with shoes. The activation percentages for sensor number 1 under the 1st metatarsal and sensor number 4 under the lateral edge of the heel were significantly different under the DAFO condition. The 1-point sensor activation percentage significantly decreased, while the 4-point sensor activation percentage increased during DAFO walking. According to our study findings, there was an increase in pressure distribution in the lateral part of the foot during the stance phase in DAFO. DAFO improved the gait cycle and influenced the plantar foot pressure in children with mild cerebral palsy.
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NewsBot · Jun 5, 2023

Parent experience with ankle-foot orthoses for their young children with cerebral palsy: a qualitative study
Pegah Firouzeh et al
Disabil Rehabil. 2023 Jun 3;1-8

Purpose: This study explored the experiences of parents of young children with cerebral palsy who used Ankle-Foot Orthoses (AFOs).

Materials and methods: Parents of children with cerebral palsy (n = 11; age range 2-6 years) who used solid or hinged AFOs participated. Interpretive Description, a qualitative methodological approach focused on the application of findings to clinical practice, was used. Semi-structured interviews were conducted, and themes were developed using thematic analysis.

Results: Four themes described parent experience with their children's AFOs: 1) "Hear what I am saying": Collaborative decision-making with families, 2) "Is my child going to be excluded because of AFOs?": Parent and child adjustment was a journey, 3) AFOs created financial and practical challenges, 4) The perceived benefits of AFO use.

Conclusions: Adjusting to AFOs was a challenging and time-consuming process for parents and children, which may have resulted in lower frequency and duration of use than anticipated by clinicians. Clinicians must be aware of the physical and psychosocial adjustment process as children and families adapt over time and work with families to ensure AFO use is optimized and individualized.
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NewsBot · Jun 5, 2023

Ankle-foot orthoses among children with cerebral palsy: a cross-sectional population-based register study of 8,928 children living in Northern Europe
Jessica Stockman et al
BMC Musculoskelet Disord. 2023 Jun 2;24(1):443

Background: Cerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age.

Method: Aggregated data on 8,928 participants in the national follow-up programs for CP for the respective countries were used. Finland does not have a national follow-up program for individuals with CP and therefore a study cohort was used instead. Use of AFOs were presented as percentages. Logistic regression models were used to compare the use of AFOs among countries adjusted for age, CP subtype, GMFCS level, and sex.

Results: The proportion of AFO use was highest in Scotland (57%; CI 54-59%) and lowest in Denmark (35%; CI 33-38%). After adjusting for GMFCS level, children in Denmark, Finland, and Iceland had statistically significantly lower odds of using AFOs whereas children in Norway and Scotland reported statistically significantly higher usage than Sweden.

Conclusion: In this study, the use of AFOs in children with CP in countries with relatively similar healthcare systems, differed between countries, age, GMFCS level, and CP subtype. This indicates a lack of consensus as to which individuals benefit from using AFOs. Our findings present an important baseline for the future research and development of practical guidelines in terms of who stands to benefit from using AFOs.
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NewsBot · Apr 15, 2024 at 3:12 AM

Changes in foot posture evaluated with dynamic pedobarography over the course of childhood in ambulatory youth with cerebral palsy
Chris Church, Nancy Lennon, Madison Lennon, John D Henley, Thomas Shields, Tim Niiler, Daveda A Taylor, M Wade Shrader, and Freeman Miller
Journal of Children’s Orthopaedics 2024, Vol. 18(1) 3 –12

Purpose: Foot deformities are prevalent in children with cerebral palsy, but there is limited research on the progression of foot posture during growth. Our study aimed to evaluate the change in dynamic foot posture in children with cerebral palsy. Methods: Children with cerebral palsy, aged 17–40 months, were recruited to participate in this Institutional Review Board–approved prospective longitudinal study by having serial foot posture evaluations. The coronal plane index and foot segmental impulses were measured with dynamic pedobarography. Data were compared between children stratified by Gross Motor Function Classification System level and typically developing children using serial Welch’s t-tests across time with Holm correction for multiple comparisons. Results: In total, 33 children (54 limbs) were included in the analysis (21 bilateral and 12 unilateral; Gross Motor Function Classification System: I-13, II-14, III-4, IV-2. Children completed 16.9 (± 4.4) evaluations (initial age 2.9 (± 0.7) and final age 18.6 (± 1.7) years)). Early valgus foot posture normalizes in children at Gross Motor Function Classification System levels I/II and persists in children at levels III/IV who do not have foot surgery. For most young children, foot posture development is variable. Conclusion: Foot posture in young children with cerebral palsy begins in valgus and tends to normalize in youth who walk without an assistive device. Conservative management of foot deformity is recommended in early childhood.
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Cerebral palsy

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Supination resistance and RCSP in cerebral palsy

Hallux valgus in cerebral palsy

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Cerebral palsy

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Supination resistance and RCSP in cerebral palsy

Hallux valgus in cerebral palsy

Steptember Cerebral Palsy Alliance

Midfoot break in cerebral palsy

Paediatric Cerebral palsy orthoses

Shockwave therapy for spasticity in cerebral palsy

Cerebral Palsey and Bad Bunions!!!

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