Stance Phase Problems in Cerebral Palsy (Strength)

Abstract

Normal human gait results from a combination of several complex coordinated activities. The variable loss of control that is associated with cerebral palsy (CP) lesions can cause multiple interruptions in the gait cycle. To understand and properly evaluate pathologic gait patterns and to provide proper medical remedies for gait impairments due to CP, the clinician must understand the normal gait cycle. Instrumented gait analysis is a tool that provides detailed information and quantitative measurements throughout the gait cycle to evaluate individual gait patterns that help surgeons plan appropriate interventions. There are several prevailing abnormal gait patterns associated with spastic CP. These patterns are categorized into those affecting stance vs swing phases of gait. The patterns at the knee most often responsible for impeding the gait cycle by causing stance phase instability are crouch gait and back-kneeing in sagittal plane kinematic. Patterns such as back-kneeing cause knee hyperextension which is especially bad for delaying push-off and propelling forward; crouch knee gait causes dropping down into hip and knee flexion. These two types of gait patterns require different types of intervention due to differing muscle responses. Identification of the correct gait pattern in cerebral palsy is required to create the correct management algorithm.