Complications from Gait Treatment in Children with Cerebral Palsy

  • Freeman Miller
Living reference work entry


Gait abnormalities are one of the most common problems which occur in children with cerebral palsy (CP) who are able to walk. The primary classification for children with CP includes the Gross Motor Function Classification System (GMFCS) which is really based on the child’s ability to be mobile. For children at GMFCS levels I–III, the primary problem which most affects them is abnormalities in their gait. As the child develops improved skills and starts to ambulate often using an assistive device such as a posterior walker, the parents want to know what the child will be like walking when they are teenagers. Making these long-term predictions is very difficult especially when the child is only 2 or 3 years old. As the child ages and especially by middle childhood between 5 and 7 years of age, gait pattern becomes more clearly defined, and better long-term expectations can be defined. Because of the highly varied nature of the natural history of CP, a common mistake that is made especially by clinicians with limited experience is having too much confidence in the long-term prediction for an individual child. There are many real and potential complications in the treatment of gait problems in children with CP. Often, there is the presumption that nonoperative treatment has no complications; however, not addressing evolving deformities can lead to loss of ambulatory ability. This chapter addresses the common complications related to failure to treat, surgical decision-making, common surgical procedures, and postoperative rehabilitation.


Cerebral palsy Complications Gait analysis Surgery planning Rehabilitation 


  1. Bowen TR, Lennon N, Castagno P, Miller F, Richards J (1998) Variability of energy-consumption measures in children with cerebral palsy. J Pediatr Orthop 18:738–742PubMedGoogle Scholar
  2. Bowen TR, Miller F, Mackenzie W (1999) Comparison of oxygen consumption measurements in children with cerebral palsy to children with muscular dystrophy. J Pediatr Orthop 19:133–136PubMedGoogle Scholar
  3. Boyd R, Fatone S, Rodda J (1999) High-or low-technology measurements of energy expenditure in clinical gait analysis? Dev Med Child Neurol 41:676–682CrossRefPubMedGoogle Scholar
  4. Davids JR, Rowan F, Davis RB (2007) Indications for orthoses to improve gait in children with cerebral palsy. J Am Acad Orthop Surg 15:178–188CrossRefPubMedGoogle Scholar
  5. Gorter JW, Ketelaar M, Rosenbaum P, Helders PJ, Palisano R (2009) Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older. Dev Med Child Neurol 51:46–52CrossRefPubMedGoogle Scholar
  6. Karol LA, Chambers C, Popejoy D, Birch JG (2008) Nerve palsy after hamstring lengthening in patients with cerebral palsy. J Pediatr Orthop 28:773–776CrossRefPubMedGoogle Scholar
  7. Lebiedowska MK, Gaebler-Spira D, Burns RS, Fisk JR (2004) Biomechanic characteristics of patients with spastic and dystonic hypertonia in cerebral palsy. Arch Phys Med Rehabil 85:875–880CrossRefPubMedGoogle Scholar
  8. Liggio F, Kruse R (2001) Split tibialis posterior tendon transfer with concomitant distal tibial derotation osteotomy in children with cerebral palsy. J Pediatr Orthop 21:95–101CrossRefPubMedGoogle Scholar
  9. Nene AV, Evans GA, Patrick JH (1993) Simultaneous multiple operations for spastic diplegia, outcome and functional assessment of walking in 18 patients. J Bone Joint Surg Br 75:488–494PubMedGoogle Scholar
  10. 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 20:75–81PubMedGoogle Scholar
  11. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE (2000) Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 80:974–985PubMedGoogle Scholar
  12. 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 43:7–12PubMedGoogle Scholar
  13. Schutte LM, Narayanan U, Stout JL, Selber P, Gage JR, Schwartz MH (2000) An index for quantifying deviations from normal gait. Gait Posture 11:25–31CrossRefPubMedGoogle Scholar
  14. Schwartz MH, Rozumalski A (2008) The gait deviation index: a new comprehensive index of gait pathology. Gait Posture 28:351–357CrossRefPubMedGoogle Scholar
  15. Woratanarat P, Dabney KW, Miller F (2009) Knee capsulotomy for fixed knee flexion contracture. Acta Orthop Traumatol Turc 43:121–127CrossRefPubMedGoogle Scholar
  16. Wren TA, Otsuka NY, Bowen RE, Scaduto AA, Chan LS, Dennis SW, Rethlefsen SA, Healy BS, Hara R, Sheng M, Kay RM (2013) Outcomes of lower extremity orthopedic surgery in ambulatory children with cerebral palsy with and without gait analysis: results of a randomized controlled trial. Gait Posture 38:236–241CrossRefPubMedGoogle 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