Hemiplegic or Unilateral Cerebral Palsy Gait

  • Freeman Miller
Living reference work entry


Hemiplegic pattern cerebral palsy (CP) means the motor lesion is primarily located on one side of the body usually involving both the arm and a leg. Another synonymous term is unilateral CP. There are many children who have primary involvement on one side of the body; however, they may have also some contralateral abnormalities. There are no clear definitions of when unilateral or hemiplegic pattern CP becomes bilateral or diplegia or quadriplegic pattern CP. Hemiplegic pattern CP makes up approximately one third of all children with the diagnosis. The vast majority of children with hemiplegic pattern CP tend to be high-functioning community ambulators with Gross Motor Function Classification System (GMFCS) I or II. Large majority of individuals with hemiplegic pattern CP become full and normal independent functioning members in the society. The functional ability of individuals with unilateral CP tends to be much more influenced by concurrent cognitive disability or epilepsy and then motor impairment. Many children with unilateral CP do develop musculoskeletal deformities impairing their gait pattern and upper extremity function, which are amendable to surgical correction. The Winter’s classification divides hemiplegic gait into four patterns. Type 1 has ankle plantar flexion in swing phase with an inactive or very weak tibialis anterior, which is the cause of the plantar flexion. Type 2 has an equinus gait pattern but with spastic or contracted plantar flexors, which overpower an active dorsiflexor. Type 3 includes the ankle position of type 2, further adding abnormal function of the knee joint. Type 4 includes all problems of type 3 with the addition of abnormal function of the hip joint muscles. The separation of these types is usually easy through a combination of physical examination, EMG, kinematic evaluation, and kinetic data. As with all biological groups, however, there are intermediate patients. The goal of this chapter is to review the natural history and treatment plan for the individual with hemiplegic pattern CP.


Cerebral palsy Hemiplegia Unilateral Winter’s classification 


  1. Abousamra O, Er MS, Rogers KJ, Nishnianidze T, Dabney KW, Miller F (2016) Hip reconstruction in children with unilateral cerebral palsy and hip dysplasia. J Pediatr Orthop 36:834–840CrossRefPubMedGoogle Scholar
  2. Andersen GL, Irgens LM, Haagaas I, Skranes JS, Meberg AE, Vik T (2008) Cerebral palsy in Norway: prevalence, subtypes and severity. Eur J Paediatr Neurol 12:4–13CrossRefPubMedGoogle Scholar
  3. Beckung E, Hagberg G, Uldall P, Cans C, Europe Surveillance of Cerebral Palsy in (2008) Probability of walking in children with cerebral palsy in Europe. Pediatrics 121:e187–e192CrossRefPubMedGoogle Scholar
  4. Darmency-Stamboul V, Chantegret C, Ferdynus C, Mejean N, Durand C, Sagot P, Giroud M, Bejot Y, Gouyon JB (2012) Antenatal factors associated with perinatal arterial ischemic stroke. Stroke 43:2307–2312CrossRefPubMedGoogle Scholar
  5. Hullin MG, Robb JE, Loudon IR (1996) Gait patterns in children with hemiplegic spastic cerebral palsy. J Pediatr Orthop B 5:247–251.Google Scholar
  6. Joo SY, Knowtharapu DN, Rogers KJ, Holmes L Jr, Miller F (2011) Recurrence after surgery for equinus foot deformity in children with cerebral palsy: assessment of predisposing factors for recurrence in a long-term follow-up study. J Child Orthop 5:289–296CrossRefPubMedPubMedCentralGoogle Scholar
  7. Lee JH, Sung IY, Yoo JY (2008) Therapeutic effects of strengthening exercise on gait function of cerebral palsy. Disabil Rehabil 30:1439–1444CrossRefPubMedGoogle Scholar
  8. Macwilliams BA, Harjinder B, Stevens PM (2011) Guided growth for correction of knee flexion deformity: a series of four cases. Strategies Trauma Limb Reconstr 6:83–90CrossRefPubMedPubMedCentralGoogle Scholar
  9. Renders A, Detrembleur C, Rossillon R, Lejeune T, Rombouts JJ (1997) Contribution of electromyographic analysis of the walking habits of children with spastic foot in cerebral palsy: a preliminary study. Rev Chir Orthop Reparatrice Appar Mot 83:259–264. SRC – GoogleScholarPubMedGoogle Scholar
  10. Riad J, Coleman S, Lundh D, Brostrom E (2011) Arm posture score and arm movement during walking: a comprehensive assessment in spastic hemiplegic cerebral palsy. Gait Posture 33:48–53CrossRefPubMedGoogle Scholar
  11. Riad J, Coleman S, Miller F (2007a) Arm posturing during walking in children with spastic hemiplegic cerebral palsy. J Pediatr Orthop 27:137–141CrossRefPubMedGoogle Scholar
  12. Riad J, Haglund-Akerlind Y, Miller F (2007b) Classification of spastic hemiplegic cerebral palsy in children. J Pediatr Orthop 27:758–764CrossRefPubMedGoogle Scholar
  13. Riad J, Haglund-Akerlind Y, Miller F (2008) Power generation in children with spastic hemiplegic cerebral palsy. Gait Posture 27:641–647CrossRefPubMedGoogle Scholar
  14. Rutz E, Baker R, Tirosh O, Romkes J, Haase C, Brunner R (2011) Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait Posture 33:152–157CrossRefPubMedGoogle Scholar
  15. Rutz E, Passmore E, Baker R, Graham HK (2012) Multilevel surgery improves gait in spastic hemiplegia but does not resolve hip dysplasia. Clin Orthop Relat Res 470:1294–1302CrossRefPubMedGoogle Scholar
  16. Schranz C, Kruse A, Kraus T, Steinwender G, Svehlik M (2016) Does unilateral single-event multilevel surgery improve gait in children with spastic hemiplegia? A retrospective analysis of a long-term follow-up. Gait Posture 52:135–139CrossRefPubMedGoogle Scholar
  17. Stout JL, Gage JR, Schwartz MH, Novacheck TF (2008) Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. J Bone Joint Surg Am 90:2470–2484CrossRefPubMedGoogle Scholar
  18. Taylor D, Connor J, Church C, Lennon N, Henley J, Niiler T, Miller F (2016) The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B 25:543–550CrossRefPubMedGoogle Scholar
  19. Tsang ST, McMorran D, Robinson L, Herman J, Robb JE, Gaston MS (2016) A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture 50:23–27CrossRefPubMedGoogle Scholar
  20. Turedi Yildirim A, Sutcu R, Koroglu M, Delibas N, Kisioglu N, Akar N, Ergurhan Ilha I (2015) The role of prothrombotic factors in children with hemiplegic cerebral palsy. Minerva Pediatr 67:279–284PubMedGoogle Scholar
  21. Winters TF Jr, Gage JR, Hicks R (1987) Gait patterns in spastic hemiplegia in children and young adults. J Bone Joint Surg Am 69:437–441CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations