Gait Analysis Interpretation in Cerebral Palsy Gait: Developing a Treatment Plan

  • Freeman Miller
Living reference work entry


Ambulatory children with CP require treatment of the whole motor system, not consideration of a problem in only one segment or subsystem of the gait pattern. The goal is to understand all the primary and secondary problems as much as possible and then address all these problems in one operative event. With tools for gait evaluation, few children should need to have approximately two surgical experiences during their childhood years to treat problems related to gait. The surgery can be arranged for children and families, so it occurs when the families can best manage the time commitment and children are least impacted with respect to school. As the pathologies for each joint, movement segment, and motor subsystem are combined into the whole functioning musculoskeletal system, patterns of involvement have to be defined. The treatment planning requires a full assessment of the child’s gait pathology. The current standard of care for the evaluation and treatment of complex gait disorders in children with CP requires a detailed and diligent investigation to understand the pathology. This investigation is ideally carried out in an accredited clinical diagnostic gait laboratory. This investigation should obtain a detailed history relative to the child’s diagnostic etiology, developmental history, past treatment, and recent functional changes. It is also important to get an accurate assessment of the family and the child’s primary concerns and complaints. A detailed physical examination should include measured joint ranges of motion, muscle strength, motor control, and muscle tone evaluation. A clearly defined protocol including a structured video recording should be made in two planes of the child walking with sufficiently undressed to be able to see the whole lower extremities without any clothing covering them. Full-body 3-D kinematic evaluation will assess the motion of the major joints. The utilization of a kinetic assessment will allow an understanding of some of the related forces driving the pathology. The goal of this chapter is to synthesize for the clinician all of the data which is available to develop a specific treatment plan for a pathologic gait in a child with CP.


Cerebral palsy Gait analysis Gait interpretation Gait treatment Diplegia Hemiplegia 


  1. Arnold AS, Liu MQ, Schwartz MH, Ounpuu S, Dias LS, Delp SL (2006) Do the hamstrings operate at increased muscle-tendon lengths and velocities after surgical lengthening? J Biomech 39:1498–1506CrossRefPubMedGoogle Scholar
  2. Baddar A, Granata K, Damiano DL, Carmines DV, Blanco JS, Abel MF (2002) Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthening. J Bone Joint Surg Am 84-A:736–744CrossRefPubMedGoogle Scholar
  3. Carney BT, Oeffinger D, Meo AM (2006) Sagittal knee kinematics following hamstring lengthening. Iowa Orthop J 26:41–44PubMedPubMedCentralGoogle Scholar
  4. Ferrari A, Brunner R, Faccioli S, Reverberi S, Benedetti MG (2015) Gait analysis contribution to problems identification and surgical planning in CP patients: an agreement study. Eur J Phys Rehabil Med 51:39–48PubMedGoogle Scholar
  5. Filho MC, Yoshida R, Carvalho Wda S, Stein HE, Novo NF (2008) Are the recommendations from three-dimensional gait analysis associated with better postoperative outcomes in patients with cerebral palsy? Gait Posture 28:316–322CrossRefPubMedGoogle Scholar
  6. Gough M, Shortland AP (2008) Can clinical gait analysis guide the management of ambulant children with bilateral spastic cerebral palsy? J Pediatr Orthop 28:879–883CrossRefPubMedGoogle Scholar
  7. Gough M, Schneider P, Shortland AP (2008) The outcome of surgical intervention for early deformity in young ambulant children with bilateral spastic cerebral palsy. J Bone Joint Surg (Br) 90:946–951CrossRefGoogle Scholar
  8. Kadhim M, Miller F (2014) Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait Posture 39:793–798CrossRefPubMedGoogle Scholar
  9. Laracca E, Stewart C, Postans N, Roberts A (2014) The effects of surgical lengthening of hamstring muscles in children with cerebral palsy–the consequences of pre-operative muscle length measurement. Gait Posture 39:847–851CrossRefPubMedGoogle Scholar
  10. Lofterod B, Terjesen T (2008) Results of treatment when orthopaedic surgeons follow gait-analysis recommendations in children with CP. Dev Med Child Neurol 50:503–509CrossRefPubMedGoogle Scholar
  11. Niklasch M, Doderlein L, Klotz MC, Braatz F, Wolf SI, Dreher T (2015) Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: uni- or bilateral femoral derotation osteotomy? Gait Posture 41:670–675CrossRefPubMedGoogle Scholar
  12. Park MS, Chung CY, Lee SH, Choi IH, Cho TJ, Yoo WJ, Park BS, Lee KM (2009) Effects of distal hamstring lengthening on sagittal motion in patients with diplegia: hamstring length and its clinical use. Gait Posture 30:487–491CrossRefPubMedGoogle Scholar
  13. Perry J, Burnfield JM (2010) Gait analysis: normal and pathological function. SLACK, ThorofareGoogle Scholar
  14. Perry J, Thorofare NJ (1992) Gait analysis: normal and pathologic function. Slack, ThorofareGoogle Scholar
  15. Rasmussen HM, Pedersen NW, Overgaard S, Hansen LK, Dunkhase-Heinl U, Petkov Y, Engell V, Baker R, Holsgaard-Larsen A (2015) The use of instrumented gait analysis for individually tailored interdisciplinary interventions in children with cerebral palsy: a randomised controlled trial protocol. BMC Pediatr 15:202CrossRefPubMedPubMedCentralGoogle Scholar
  16. Rha DW, Cahill-Rowley K, Young J, Torburn L, Stephenson K, Rose J (2015) Biomechanical and clinical correlates of swing-phase knee flexion in individuals with spastic cerebral palsy who walk with flexed-knee gait. Arch Phys Med Rehabil 96:511–517CrossRefPubMedGoogle Scholar
  17. Rha DW, Cahill-Rowley K, Young J, Torburn L, Stephenson K, Rose J (2016) Biomechanical and clinical correlates of stance-phase knee flexion in persons with spastic cerebral palsy. PM R 8:11–18. quiz 18CrossRefPubMedGoogle Scholar
  18. Rodda JM, Graham HK, Carson L, Galea MP, Wolfe R (2004) Sagittal gait patterns in spastic diplegia. J Bone Joint Surg (Br) 86:251–258CrossRefGoogle Scholar
  19. Salazar-Torres JJ, McDowell BC, Kerr C, Cosgrove AP (2011) Pelvic kinematics and their relationship to gait type in hemiplegic cerebral palsy. Gait Posture 33:620–624CrossRefPubMedGoogle Scholar
  20. 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

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