Musculoskeletal Physiology Impacting Cerebral Palsy Gait

Abstract

Many children with cerebral palsy (CP) have problems with their gait. For some children, this is their primary physical disability, and for others it really makes an impact on their day-to-day care. The primary pathology of CP resides in a static lesion of the brain. This static brain lesion impacts the development of the spinal cord function, the peripheral nervous system maturation, and the development of bones and muscles. It is not clear if all of the secondary changes are compensatory to make up for poor control from the central program generator in the brain or if the secondary changes are also a primary aspect of the pathology. The secondary changes include a decrease in selective motor control through the reduction of motor units in muscles, the shortening of muscle fibers which decreases joint range of motion, increased tendon lengths, and the reduce complexity of motor control. These multiple complex secondary changes have a strong impact on the individual child’s function and are a challenge to plan proper treatment program to improve their motor function. The goal of this chapter is to define the elements of the musculoskeletal physiology which impact gait and to explain common changes which occur as a consequence of childhood CP.