Common Gait Abnormalities of Each Joint in Children with Spastic Cerebral Palsy

OBJECTIVE: To investigate the prevalence of gait abnormalities of each joint of lower legs in children with spastic cerebral palsy (CP) and to find out the influences of subtype of CP, age, previous surgery and motor function on the gait abnormalities. METHOD: The gait analysis and foot scan from 320 children with CP were reviewed. Types of gait abnormalities were classified into 5 types for hip joint, 4 types for knee joint and 8 types for foot and ankle joint. The prevalence of gait abnormalities was assessed and the influence of subtype of CP, age, previous surgery and GMFCS (gross motor function classification system) level were also investigated. RESULTS: In foot and ankle joint, intoeing (63.8%) was the most common in all CP. In knee joint, jumping knee (32.8%) was the most common in diplegic and hemiplegic CP but crouch (47.6%) was the most common in quadriplegic CP. The likelihood of having planovalgus and crouch significantly increased with age and pes calcaneus increased after orthopaedic surgery. The children with lower functional level on GMFCS tended to show stiff and recurvatum knee pattern. CONCLUSION: Predominent gait abnormalities in each joint were assessed. Age, previous surgery, motor function and subtype of children with CP had a significant effect on the prevalence of gait abnormalities in each joint.

Is Electrical Stimulation Beneficial for Improving the Paralytic Effect of Botulinum Toxin Type A in Children with Spastic Diplegic Cerebral Palsy?

PURPOSE: The purpose of the present study was to investigate whether electrical stimulation (ES) improves the paralytic effect of botulinum toxin type A (BTX-A) and evaluate the differences between low frequency (LF) and high frequency (HF) ES in children with spastic diplegic cerebral palsy (CP). MATERIALS and METHODS: Twenty-three children with spastic diplegia CP who had BTX-A injections into both gastrocnemius muscles were assessed. Following the toxin injection, electrical stimulation was given to 1 side of the injected muscles and a sham-stimulation to the other side for 30 min a day for 7 consecutive days [HFES (25Hz) to 11 children, LFES (4Hz) to 12 children]. The compound motor action potentials (CMAP) from the gastrocnemius muscle were assessed before injection and at 5 time points (days 3, 7, 14, 21, and 30) after injection. The clinical assessments of spasticity were performed before and 30 days after injection. RESULTS: The CMAP area became significantly lower in both LFES and HFES sides from 3 days after injection compared to baseline values. In other words, the CMAP area of the sham-stimulated side showed a significant decrease at 7 or 14 days after injection. However, there were no significant differences in clinical assessment of spasticity between the stimulated and sham-stimulated sides. CONCLUSION: Short-term ES in both LF and HF to the spastic muscles injected with BTX-A might induce earlier denervating action of BTX-A. However, it does not necessarily lead to clinical and electrophysiological benefits in terms of reduction of spasticity.

Comparison of Postural Control Mechanisms during Quiet Standing between Healthy Children and Children with Spastic Diplegic Cerebral Palsy

OBJECTIVE: To identify the difference of postural control mechanisms between healthy children and children with spastic diplegic cerebral palsy (CP) METHOD: Nineteen children with spastic diplegic CP and 22 healthy children were enrolled. Pressure data were recorded while subjects stood on the dual force platform and net body coordinates of center-of-pressure (COP) were calculated. Outcome measurements included net body COP calculations for path length, medio-lateral and antero-posterior displacements, and correlation coefficients between parameters representing ankle, hip and transverse body rotation mechanisms. RESULTS: Children with CP showed more medio-lateral and antero-posterior displacements compared to healthy children. The coordinate of net body COP showed more correlation with transverse body rotation parameters for both medio-lateral and antero-posterior rections, and less correlation with ankle mechanism parameters for medio-lateral direction in children with CP. The visual information did not show a significant influence on keeping balance during quiet standing in children with CP. CONCLUSION: This study revealed that the ankle control mechanism for medio-lateral balance control during quiet standing was less used in children with CP. The transverse body rotation mechanisms contributed more significantly to postural control during quiet standing in children with CP.