Cerebral Palsy Gait Pathology

Abstract

Cerebral palsy (CP) is a condition whose primary cause is related to an injury to the immature brain. This may involve primarily the area of the motor control system or maybe more generalized; however, it almost always has an impact on how a child walks. Because the primary insult to the central nervous system occurs before there is a full maturation of the nervous and musculoskeletal systems, there are many secondary consequences impacting on further development. Interactions between the forces of growth and development with the central nervous system deficit are major drivers for the abnormal gait patterns seen in individuals with CP. The central nervous system deficit also has impacts on how the control system is taken over by remaining healthy parts of the brain. Most children with cerebral palsy have some delay in the initiation of bipedal gait. They often start requiring assistance with the use of their upper extremities through the use of walkers. The musculoskeletal adaptations to abnormal control such as lack of torsional control or increased spasticity and increased joint stiffness have further secondary impacts on the musculoskeletal system and indirectly on gait. The secondary impacts include lack of correction of infantile torsion, decreased growth in muscles leading the muscle contractures, and limited joint range of motion. There are defined interactions between the balance system, motor control, energy production, and the musculoskeletal systems that maintain functional ambulatory ability. Deficiencies in one or two systems can often be accommodated with increased involvement from another system. Understanding the primary pathology as separate from the secondary adaptation is an important aspect in treatment planning. This chapter reviews the impact of balance, motor control, energy production, and musculoskeletal subsystems on the development and function of gait in a child with cerebral palsy.