CP is the most common motor disability in childhood. Cerebral means having to do with the brain.
Hence, most of the research on gait classification has focused on children who present predominantly with spasticity. They identified four homogenous groups of gait patterns that are observed in the sagittal plane and also described the major muscle groups affected. They identified four subgroups of bilateral lower limb spasticity observed in the sagittal plane.
Again details of the major muscle groups affected were provided and an AFO prescription to manage each of the clinical presentations was proposed. However, there are limitations to their clinical relevance and also to using them as a base for orthotic prescription.
Both gait classification systems rely solely on the identification of sagittal plane gait disturbances and do not fully address the range and magnitude of gait deviations in children with Cerebral Palsy.
Efficient walking relies upon the appropriate alignment of the lower limbs in all three of the sagittal, coronal and transverse planes. In both classification systems described by Rodda and Graham  they identified the muscles affected by weakness or spasticity for each group, including those that act in the coronal and transverse planes.
Muscle weakness and spasticity introduce abnormal rotational deformities in the lower limbs and these are observed in the coronal and transverse planes. Truly effective orthotic intervention must provide tri-planar control of the foot and ankle while providing tri-planar support for weaker muscles.
If tri-planar control and support is not provided, the function of the orthosis may be compromised and ultimately limit the benefits to the child. Therefore, these gait classification systems and proposed orthotic prescriptions have limited orthotic clinical applications.
Gait Patterns There are a couple of different common gait patterns found in people with cerebral palsy which will be covered in a little more detail below.
This page will focus on: The classification has direct relevance to understanding the gait pattern and management. There is no calf contracture and therefore during stance phase, ankle dorsiflexion is relatively normal. In the experience of the original author of this article, this gait pattern is rare, unless there has already been a calf lengthening procedure.
The only management maybe needed is a leaf spring or hinged ankle foot orthosis AFO. Spasticity management and contracture surgery are clearly not required. Management Orthotic management may include a leaf spring or hinged AFO.
There are two sub-catagories to type 2 hemiplegic gait patterns, which are: A pattern of true equinus can be seen, with the ankle in the plantar flexion range through most of the stance phase.
Management If there is a mild contracture, supplemental casting can be very effective. Once a significant fixed contracture develops, lengthening of the gastrocnemius and soleus may be indicated. Type 2 hemiplegia with a fixed contracture of the gastroc-soleus constitutes the only indication for isolated lengthening of the tendon achilles.
If the knee is fully extended or in recurvatum, then a hinged AFO with an appropriate plantar flexion stop is the most appropriate choice of orthosis.
A plantarflexion stop or posterior stop in an AFO is designed to substitute for inadequate strength of the ankle dorsiflexors during swing phase of gait. This stop is effective by limiting the plantarflexion range of motion of the talocrural joint. Older children with progressive valgus deformities are likely to become brace intolerant and require bony surgery.
At a later stage, management may consist of muscle tendon lengthening for gastroc-soleus contracture. Type 4 Hemiplegia In Type 4 hemiplegia there is much more marked proximal involvement and the pattern is similar to that seen in spastic diplegia. However, because involvement is unilateral, there will be marked asymmetry, including pelvic retraction.
In the coronal plane, there is hip adduction and in the transverse plane, internal rotation.
Management Management is similar to Type 2 and Type 3 hemiplegia, in respect to the distal problems. However, there is a high incidence of hip subluxation and careful radiographic examination of the hip is important.
The adducted and internally rotated hip will usually require lengthening of the adductors and an external rotation osteotomy of the femur.
Failure to address the hip adduction and hip internal rotation will usually mean that any distally focused intervention will fail and the overall outcome will be poor. The most common bony problems are medial femoral torsion, lateral tibial torsion, mid foot breaching, with foot valgus and abduction.
Rotational osteotomies and foot stabilization surgery are often required, in association with the spasticity and contracture management.A.
A1C A form of hemoglobin used to test blood sugars over a period of time. ABCs of Behavior An easy method for remembering the order of behavioral components: Antecedent, Behavior, Consequence. Cerebral palsy (CP) is an umbrella term for a group of disorders affecting body movement, balance, and posture.
Loosely translated, cerebral palsy means "brain paralysis." Cerebral palsy is caused by abnormal development or damage in one or more parts of the brain that control muscle tone and motor. Guidance, advice and information services for health, public health and social care professionals.
Spastic Cerebral Palsy. Spastic cerebral palsy is the most common type of CP, making up 70 to 80 percent of cases. People with spastic cerebral palsy often experience exaggerated or jerky movements (hypertonia). Spastic CP is caused by damage to the brain’s motor cortex, which controls voluntary movement.
This session gives you a sneak peek at some of the top-scoring posters across a variety of topics through rapid-fire presentations. The featured abstracts were chosen by the Program Committee and are marked by a microphone in the online program.
What is cerebral palsy? Cerebral palsy (CP) is a group of non-progressive motor conditions that cause physical disability. CP is caused by damage to the motor control centers of the developing brain, which can occur before a baby is born, during childbirth, or after birth up to age five (2).