[Multi-level surgery of a limb improves walking ability of a CP child]. / Alaraajojen monitasokirurgia parantaa CP-vammaisen lapsen kävelykykyä.

UNLABELLED: BACKGROUND. Correction of the deformities of the lower limbs in CP children is currently attempted in one go by using multi-level surgery in one operation involving multiple procedures. MATERIAL AND METHODS. We examined from patient records the surgical outcomes and operative harms of 40 CP children operated in the HUS Department of Gynecology and Pediatrics in 2000 to 2010. Clinical examination and analysis of gait were the most important methods of assessment. RESULTS AND CONCLUSION: Most CP children benefited from the operation, with a considerable improvement in their walking posture.

A test of the effort equalization hypothesis in children with cerebral palsy who have an asymmetric gait.

Healthy people can walk nearly effortlessly thanks to their instinctively adaptive gait patterns that tend to minimize metabolic energy consumption. However, the economy of gait is severely impaired in many neurological disorders such as stroke or cerebral palsy (CP). Moreover, self-selected asymmetry of impaired gait does not seem to unequivocally coincide with the minimal energy cost, suggesting the presence of other adaptive origins. Here, we used hemiparetic CP gait as a model to test the hypothesis that pathological asymmetric gait patterns are chosen to equalize the relative muscle efforts between the affected and unaffected limbs. We determined the relative muscle efforts for the ankle and knee extensors by relating extensor joint moments during gait to maximum moments obtained from all-out hopping reference test. During asymmetric CP gait, the unaffected limb generated greater ankle (1.36±0.15 vs 1.17±0.16 Nm/kg, p = 0.002) and knee (0.74±0.33 vs 0.44±0.19 Nm/kg, p = 0.007) extensor moments compared with the affected limb. Similarly, the maximum moment generation capacity was greater in the unaffected limb versus the affected limb (ankle extensors: 1.81±0.39 Nm/kg vs 1.51±0.34 Nm/kg, p = 0.033; knee extensors: 1.83±0.37 Nm/kg vs 1.34±0.38 Nm/kg, p = 0.021) in our force reference test. As a consequence, no differences were found in the relative efforts between unaffected and affected limb ankle extensors (77±12% vs 80±16%, p = 0.69) and knee extensors (41±17% vs 38±23%, p = 0.54). In conclusion, asymmetric CP gait resulted in similar relative muscle efforts between affected and unaffected limbs. The tendency for effort equalization may thus be an important driver of self-selected gait asymmetry patterns, and consequently advantageous for preventing fatigue of the weaker affected side musculature.