Hemiplegic or Unilateral Cerebral Palsy Gait

Abstract

Hemiplegic pattern cerebral palsy (CP) means the motor lesion is primarily located on one side of the body usually involving both the arm and a leg. Another synonymous term is unilateral CP. There are many children who have primary involvement on one side of the body; however, they may have also some contralateral abnormalities. There are no clear definitions of when unilateral or hemiplegic pattern CP becomes bilateral or diplegia or quadriplegic pattern CP. Hemiplegic pattern CP makes up approximately one third of all children with the diagnosis. The vast majority of children with hemiplegic pattern CP tend to be high-functioning community ambulators with Gross Motor Function Classification System (GMFCS) I or II. Large majority of individuals with hemiplegic pattern CP become full and normal independent functioning members in the society. The functional ability of individuals with unilateral CP tends to be much more influenced by concurrent cognitive disability or epilepsy and then motor impairment. Many children with unilateral CP do develop musculoskeletal deformities impairing their gait pattern and upper extremity function, which are amendable to surgical correction. The Winter's classification divides hemiplegic gait into four patterns. Type 1 has ankle plantar flexion in swing phase with an inactive or very weak tibialis anterior, which is the cause of the plantar flexion. Type 2 has an equinus gait pattern but with spastic or contracted plantar flexors, which overpower an active dorsiflexor. Type 3 includes the ankle position of type 2, further adding abnormal function of the knee joint. Type 4 includes all problems of type 3 with the addition of abnormal function of the hip joint muscles. The separation of these types is usually easy through a combination of physical examination, EMG, kinematic evaluation, and kinetic data. As with all biological groups, however, there are intermediate patients. The goal of this chapter is to review the natural history and treatment plan for the individual with hemiplegic pattern CP.