Abstract
A high number of children with cerebral palsy (CP) have spastic gait and consequently abnormalities in joint patterns. Several factors have been contributing to the lack of consensus on the spasticity effect in cerebral palsy gait and would be summarized and discussed in this chapter, e.g., spastic gait patterns are in constant evolution during the process of growth; there are still considerable limitations in the methodologies used to assess spasticity during gait; a wide range of rehabilitation strategies have been explored to control spasticity during gait. Spastic gait patterns are divided in hemiplegic (5 types) and diplegic (4 types) with the most prevalent joint abnormalities described in the sagittal plane. Ashworth, Tardieu, and DAROM scales and Pendulum Tests are widely used to assess spasticity but do not reliably explain the spasticity effects during gait. Orthotics, adequate exercise or handling techniques, botulinum injections, or surgical procedures have been used to manage spasticity effects.
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Abel MF, Damiano DL, Blanco JS, Conaway M, Miller F, Dabney K, Sutherland D, Chambers H, Dias L, Sarwark J, Killian J, Doyle S, Root L, LaPlaza J, Widmann R, Snyder B (2003) Relationships among musculoskeletal impairments and functional health status in ambulatory cerebral palsy. J Pediatr Orthop 23(4):535–541
Awaad Y, Rizk T (2012) Spasticity in children. J Taibah Univ Med Sci 7(2):53–60
Bar-On L, Molenaers G, Aertbelien E, Van Campenhout A, Feys H, Nuttin B, Desloovere K (2015) Spasticity and its contribution to hypertonia in cerebral palsy. BioMed Res Int 2015:1–10
Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D (2005) Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 47:571–576
Boyd R, Graham HK (1999) Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with CP. Eur J Neurol 6:23–35
Chang FM, Rhodes JT, Flynn KM, Carollo JJ (2010) The role of gait analysis in treating gait abnormalities in cerebral palsy. Orthop Clin N Am 41(4):489–506
Crenna P (1998) Spasticity and ‘Spastic’ gait in children with cerebral palsy. Neurosci Biobehav Rev 22(4):571–578
Damiano DL (2006) Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Phys Ther 86(11):1534–1540
Damiano DL, Quinlivan JM, Owen BF, Payne P, Nelson KC, Abel MF (2002) What does the Ashworth scale really measure and are instrumented measures more valid and precise? Dev Med Child Neurol 44(2):112–118
Damiano DL, Laws E, Carmines DV, Abel MF (2006) Relationship of spasticity to knee angular velocity and motion during gait in cerebral palsy. Gait Posture 23(1):1–8
Dana R, Cub DA (2013) Cerebral palsy gait, clinical importance. MAEDICA – J Clin Med 8(4):388–393
Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, Morrison LA, Shrader MW, Tilton A, Vargus-Adams J (2010) Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology and the practice committee of the child neurology society. Neurology 74(4):336–343
Diane L, Martellotta L, Sullivan J, Granata P, et al. (2000) Muscle force production and functional performance in spastic cerebral palsy: Relationship of cocontraction. Archives of Physical Medicine and Rehabilitation 81(7):895–900
Domagalska M, Szopa A, Syczewska M, Pietraszek S, Kidoń Z, Onik G (2013) The relationship between clinical measurements and gait analysis data in children with cerebral palsy. Gait Posture 38(4):1038–1043
Fheodoroff K, Jacinto J, Geurts A, Molteni F, Franco JH, Santiago T, Rosale R, Gracies J-M (2016) How can we improve current practice in spastic paresis? Eur Neurol Rev 11(2) (Epub ahead of print)
Filloux FM (1996) Neuropathophysiology of movement disorders in cerebral palsy. J Child Neurol 11(Suppl 1):S5–S12
Frisch D, Msall ME (2013) Health, functioning, and participation of adolescents and adults with cerebral palsy: a review of outcomes research. Dev Disabil Res Rev 18(1):84–94
Gage JR (2004) The treatment of gait problems in cerebral palsy. Mac Keith, London
Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR (2005) Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil 91(3):421–428
Grunt S, Fieggen AG, Vermeulen RJ, Becher JG, Langerak NG (2014) Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature. Dev Med Child Neurol 56(4):302–312
Gunduz A, Kumru H, Pascual-Leone A (2014) Outcomes in spasticity after repetitive transcranial magnetic and transcranial direct current stimulations. Neural Regen Res 9(7):712–718
Hobart JC, Riazi A, Thompson AJ (1994) Spasticity: a review. Neurology 44(11):S12–S20
Kembhavi G, Johanna D, Kelsey P, Devon P (2011) Adults with a diagnosis of cerebral palsy: a mapping review of long-term - Review Development medicine and child neurology 53(7):610–614
Lance JW (1980) Symposium synopsis. In: Feldman RG, Young RR, Koella WP (eds) Spasticity: disordered motor control. Chicago, Yearbook Medical Publishers
Lance JW, McLeod JG (1981) A physiological approach to clinical neurology. Butterworths, London
Love SC, Novak I, Kentish M, Desloovere K, Heinen F, Molenaers G, O’Flaherty S, Graham HK (2010) Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol 17:9–37
Martin L, Baker R, Harvey A (2010) A systematic review of common physiotherapy interventions in school-aged children with cerebral palsy. Phys Occup Ther Pediatr 30(4):294–312
Middleton A, Fritz SL, Lusardi M (2015) Walking speed: the functional vital sign. J Aging Phys Act 23(2):314–322
Miller F (2004) Cerebral palsy. Springer, New York
Monge Pereiraa E, Rueda FM, Diego IMA, de la Cuerda RC, de Mauroc A, Miangolarra JC (2014) Empleo de sistemas de realidad virtual como método de propiocepción en parálisis cerebral: guía de práctica clínica. Neurologia 29(9):550–559
de Morais Filho MC, Kawamura CM, Lopes JAF, Neves DL, Cardoso M d O, Caiafa JB (2014) Most frequent gait patterns in diplegic spastic cerebral palsy. Acta Ortop Bras 22:197–201
Novacheck TF, Stout JL, Tervo R (2000) Reliability and validity of the Gillette Functional Assessment Questionnaire as an outcome measure in children with walking disabilities. J Pediatr Orthop 20(1):75–81
O’Byrne JM, Jenkinson A, O’Brien TM (1998) Quantitative analysis and classification of gait patterns in cerebral palsy using a three-dimensional motion analyzer. J Child Neurol 13(3):101–108
Pandyan AD, Johnson GR, Price CIM, Curless RH, Barnes MP, Rodgers H (1999) A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil 13(5):373–383
Patrick E, Ada L (2006) The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil 20(2):173–182
Paul SM, Siegel KL, Malley J, Jaeger RJ (2007) Evaluating interventions to improve gait in cerebral palsy: a meta-analysis of spatiotemporal measures. Dev Med Child Neurol 49(7):542–549
Piccinini L, Cimolin V, Galli M, Berti M, Crivellini M, Turconi AC (2007) Quantification of energy expenditure during gait in children affected by cerebral palsy. Eura Medicophys 43(1):7–12
Rathinam C, Bateman A, Peirson J, Skinner J (2014) Observational gait assessment tools in paediatrics – a systematic review. Gait Posture 40(2):279–285
Roberts A, Stewart C, Freeman R (2015) Gait analysis to guide a selective dorsal rhizotomy program. Gait Posture 42(1):16–22
Rodda J, Graham HK (2001) Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol 8:98–108
Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R (2004) Sagittal gait patterns in spastic diplegia. J Bone Joint Surg Br 86(2):251–258
Ross SA, Engsberg JR (2007) Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehab 88(9): 1114–1120
Scholtes VAB, Becher JG, Beelen A, Lankhorst GJ (2006) Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments. Dev Med Child Neurol 48(1):64–73
Sossai R, Vavken P, Brunner R, Camathias C, Graham HK, Rutz E (2010) Patellar tendon shortening for flexed knee gait in spastic diplegia. Gait Posture 41(2):658–665
Thomason PJ, Selber P, Graham HK (2013) Single event multilevel surgery in children with spastic cerebral palsy: 5 year prospective cohort study. Gait and Posture 37(1):23–28
Trompetto C, Marinelli L, Mori L, Pelosin E, Currà A, Molfetta L, Abbruzzese G (2014) Pathophysiology of spasticity: implications for neurorehabilitation. BioMed Res Int 2014:1–8
Wilson NC, Chong J, Mackey AH, Stott NS (2014) Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review. Dev Med Child Neurol 56(9):808–814
Wren TA, Do KP, Hara R, Dorey FJ, Kay RM, Otsuka NY (2007) Gillette gait Index as a gait analysis summary measure: comparison with qualitative visual assessments of overall gait. J Pediatr Orthop 27(7):765–768
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Rosa, M.C.N., Roque, A.G.G. (2016). Spasticity Effect in Cerebral Palsy Gait. In: Müller, B., et al. Handbook of Human Motion. Springer, Cham. https://doi.org/10.1007/978-3-319-30808-1_55-1
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DOI: https://doi.org/10.1007/978-3-319-30808-1_55-1
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