Complications from Gait Treatment in Children with Cerebral Palsy

Abstract

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.