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

Abstract

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.