Swing phase problems in cerebral palsy

Abstract

The normal human gait cycle is commonly divided in two phases: stance and swing. The objective of stance phase is to provide support, stability, and propulsion and contribute to the advancement of the limb in swing. Ground clearance and appropriate pre-positioning of the foot are prerequisites of normal gait during swing. Normal characteristics of stance and swing phases ensure adequate step length and energy conservation during walk. Swing phase problems in cerebral palsy tend to be related to spasticity, abnormal muscular control, poor opposite limb balance, and lack of power. From a clinical point of view, knee stiffness and ankle insufficient dorsiflexion constitute the two major abnormalities in the sagittal plane, whereas in the frontal and transverse planes, excessive hip adduction and foot deviations can cause problems with limb advancement. Rectus femoris (RF) abnormal activity has been proposed as the main cause of knee stiffness in patients with cerebral palsy. Spasticity and/or contractures of the hip adductors and tibialis posterior muscles can cause abnormal hip and ankle kinematics and can lead to foot deformities if left untreated. Indications for treatment should be based on patient's age and functional status. Different therapeutic approaches are described and commented in this chapter. A review of the literature based on the major articles in this field is provided.