Cerebral Palsy: Causes and Treatment Alternatives, Based On The Evidence Provided by Gait Analysis - Rupcich M, Bravo R
Cerebral Palsy: Causes and Treatment Alternatives, Based On The Evidence Provided by Gait Analysis - Rupcich M, Bravo R
Cerebral Palsy: Causes and Treatment Alternatives, Based On The Evidence Provided by Gait Analysis - Rupcich M, Bravo R
Cerebral palsy is a pathology whose origin is in the immature nervous system, its
Marcel Rupcich G,1 Ricardo J Bravo2,3
common denominator is the loss of selective motor control, accompanied by other 1
Pediatric Orthopaedic Service, Centro Médico Docente La
manifestations derived from the neurological injury, such as abnormal tone, balance
Trinidad,Venezuela
disorders, and proprioception, so which results in a central motor dysfunction, 2
Center for Assistive Technology, Universidad Simón Bolívar,
presenting alterations of muscles and skeleton during the development of the child. Venezuela
Current concepts on biomechanical mechanisms governing normal and pathological 3
Neurodevelopment Unit, Residencia Humana,Venezuela
gait, have been provided by a tool known as a gait lab, that allows us to obtain a series
of data and measurements objectively and accurately. The Gait analysis has allowed Correspondence: Marcel Rupcich G, Pediatrics Department,
us to understand how and why these alterations compromise the normal ambulation, Centro Médico Docente La Trinidad, Caracas,Venezuela, Tel
being able to present protocols of treatment much more effective and lasting +58-412-3327825, Email
As a result, without treatment, the gait of patients who have the Selective dorsal rhizotomy (SDR) is a procedure intended to
necessary motor skills to walk will deteriorate over time.4 For them, reduce spasticity,13,14 one type of high muscle tone. During an SDR,
walking may become more exhausting5 and/or painful, and they will sensory nerve rootlets at the lumbar and sacral levels of the spinal
require more assistance to remain mobile.4,6 cord are electrically stimulated to determine if they trigger a normal
or an abnormal response. Those producing an abnormal response are
Overview of treatments cut, thus reducing spasticity. An inpatient stay is required for this
For children who have cerebral palsy, treatments to improve or procedure. Primordial attention in the indication of the procedure is
maintain walking function typically include measures to reduce high the selection of the patient.
muscle tone and orthopedic surgery to correct bony deformities, Corrective orthopedic surgery of the lower extremities
balance muscles and improve joint function.7 Gait analysis helps
guide the specific types of intervention. One of the key benefits of Orthopedic surgery is often recommended to relieve contractures
gait and motion analysis is the ability to accurately and quantitatively and correct bone and joint misalignments.10 In children with cerebral
measure8 patients’ gait patterns.9–11 These data allow us to objectively palsy, tone management usually occurs first.
identify orthopedic and neuromuscular problems10 and then use
Single-event multilevel surgery (SEMLS) refers to multiple bone
clinical expertise and guidance from existing evidence to recommend
and soft-tissue orthopedic procedures performed at more than one
treatments.11 This assessment and review of results has enabled discard
level (hip, knee, ankle or foot) during one episode of anesthesia.
surgical procedures that were useless and even harmful; allowing to
The approach is based on the premise that for children who have
know much better the problem. Gait data are also useful as a tool for
cerebral palsy and other complex gait disorders, it is best to correct all
assessing outcomes.12 By measuring changes in the gait pattern after
deformities simultaneously to optimize and balance muscle and joint
treatment, we also can gauge the efficacy of treatments in an unbiased
function. SEMLS reduces the need for multiple isolated admissions
and precise manner.12
and repeated episodes of anesthesia. This type of procedure would not
be possible without tools such as gait analysis.10,11
Conclusion 6. Opheim A, Jahnsen R, Olsson E, et al. Walking function, pain, and fatigue
in adults with cerebral palsy: A 7 year follow up study. Dev Med Child
The gait analysis allows the application of the scientific method: Neurol. 2009;51(5):381–388.
Collect facts. Organize these facts into principles or laws, Postulate 7. Yack JH, Winter D. Economy of two joint muscles. Proceedings of the
hypothesis to explain the facts and laws and compare the hypothetical Fifth Biennial Conference of the Canadian Society for Biomechanics,
deduction with the experimental results. Definitely, the pathology is Ottawa, Canada, Aug. 27-25, 1988.
better understood as well as the principles that govern it, so we can
apply evidence-based methods for its treatment. 8. Ounpuu S, Gage R, Davis R. Three-dimensional lower extremity Kinetics
pediatric gait. J Pediat Orthop. 1991;11(3):341–349.
Acknowledgments 9. Dobson F, Morris M, Baker R, et al. Clinician agreement on gait pattern
ratings in children with spastic hemiplegia. Dev Med Child Neurol.
None. 2006;48(6):429–435.
Conflicts of interest 10. Winters T, Gage J, Hicks R. Gait patterns in spastic hemiplegia in children
and young adults. J Bone Joint Surg Am. 1987;69(3): 437–441.
Authors have no conflict of interest to declare.
11. Gage J R, Schwartz M, Koop S, et al. The Identification and Treatment
References of Gait Problems in Cerebral Palsy: 180-181 (Clinics in Developmental
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Citation: Marcel RG, Bravo RJ. Cerebral palsy: causes and treatment alternatives, based on the evidence provided by gait analysis. MOJ Orthop Rheumatol.
2019;11(3):141‒142. DOI: 10.15406/mojor.2019.11.00488