Classification of Spastic Hemiplegic Cerebral Palsy in Children

Riad, Jacques; Haglund-Åkerlind, Yvonne; Miller, Freeman

doi:10.1097/bpo.0b013e3181558a15

Cited by 40 publications

(43 citation statements)

References 14 publications

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“…One would think the more pronounced the involvement is, with a higher Winters classification type, the greater the need for compensatory mechanisms would be. As previously reported by Riad et al [23] and more recently by McDowell et al [14], in attempts to classify a population-based sample of children with hemiplegic CP, as many as 38 of 94 (42%) could not be classified according to Winters' original classification system [30]. Although the patients in our study had very mild involvement, we detected compensatory mechanisms; this finding implies a strong, more or less conscious drive toward normality and symmetry in movement pattern.…”

Section: Discussionsupporting

confidence: 80%

“…Participants (and their parents if subjects were younger than 18 years) gave informed consent before inclusion. We collected baseline data and patients were classified using a modification [23] of the classification of Winters et al [30] ( Table 1). The modification includes the least involved patients (Type 0), and in this study, 21 of the 46 patients had the mildest form.…”

Section: Patients and Materialsmentioning

confidence: 99%

“…The predictor variables were muscle volume ratio of the hemiplegic and noninvolved sides, age, previous calf muscle surgery, modified classification of Winters et al [23,30], walking speed, tibia length discrepancy, and femur length discrepancy. We performed an interaction test and checked for multicollinearity problems.…”

Section: Patients and Materialsmentioning

confidence: 99%

“…Those with mild hemiplegic CP most frequently show deviations in the sagittal plane in ankle movement when assessed with GA, although the deviations can be very subtle [4,14,23,30]. On the other hand, kinetic data from GA, including calculations of forces acting over the joints derived from force plates, can reveal decreased moments, mistimed pathologic moments in the gait cycle, and decreased muscle work.…”

Section: Introductionmentioning

confidence: 99%

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Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Riad

Modlesky

Gutierrez-Farewik

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Individuals with spastic hemiplegic cerebral palsy are typically high functioning and walk without assistive devices. The involved limb is usually smaller and shorter, although it is not clear whether the difference in muscle volume has an impact on walking capacity. Questions/purposes We determined the volume of muscles important for propulsion and related that volume to concentric muscle work during walking on the hemiplegic and noninvolved sides in patients with cerebral palsy. Patients and MethodsWe studied 46 patients (mean age, 17.6 years; range, 13-24 years) with spastic hemiplegic cerebral palsy. We assessed muscle volume using MRI and concentric muscle work in the sagittal plane from the hip, knee, and ankle using three-dimensional gait analysis. Patients were classified by Winters' criteria to assess the involvement of cerebral palsy and movement pattern during walking. Results On the hemiplegic side, muscles were smaller, except for the gracilis muscle, and concentric muscle work from the ankle plantar flexors, knee extensors, and hip flexors and extensors was lower compared to the noninvolved side. Hip extensor work was higher on the hemiplegic and the noninvolved sides compared to a control group of 14 subjects without cerebral palsy. Hemiplegic to noninvolved volume ratios correlated with work ratios (r = 0.40-0.66). The Winters classification and previous calf muscle surgery predicted work ratios. Conclusions Our observations of smaller muscles on the hemiplegic side and changes in muscle work on both sides can help us distinguish between primary deviations that may potentially be treatable and compensatory mechanisms that should not be treated.

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Section: Discussionsupporting

confidence: 80%

Section: Patients and Materialsmentioning

confidence: 99%

Section: Patients and Materialsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Riad

Modlesky

Gutierrez-Farewik

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Identification of gait patterns in CP has potential applications as, for example, to assist in the clinical decision-making and in the communication of healthcare professionals [24][25][26] . In this respect, many authors have been contributed to the study of gait analysis in children with spastic diplegia CP 2,4,10,28 .…”

Section: Discussionmentioning

confidence: 99%

Correlação entre a Visual Gait Assessment Scale, Edinburgh Visual Gait Scale e Escala Observacional da Marcha em crianças com paralisia cerebral diparética espástica

Bella¹,

Rodrigues²,

Valenciano³

et al. 2012

Rev. bras. fisioter.

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Bilateral symmetry in leg and joint stiffness in children with spastic hemiplegic cerebral palsy during gait

Huang

Kuo

et al. 2020

Journal Orthopaedic Research

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Deviations are often identified at individual joints in the gait analysis of patients with cerebral palsy. Previous gait studies on hemiplegic cerebral palsy (HCP) have focused mainly on deviations of the affected side. The current study aimed to quantify and compare the joint and leg stiffness, the contributions of skeletal and muscular components, and the associated joint angles and moments of the affected and nonaffected lower limbs during level walking in children with spastic HCP. A total of 12 children with spastic HCP and 12 healthy controls walked at a self‐selected speed in a gait laboratory while their kinematic and forceplate data were measured and analyzed during loading response, midstance, terminal stance, and preswing. The altered joint kinematics and kinetics in the nonaffected limb in the HCP group appeared to be mainly a compensatory strategy to minimize the bilateral asymmetry in leg stiffness during the double‐limb support phase and joint stiffness during the entire stance phase. The current results suggest that therapeutic planning and decision‐making for children with HCP should consider not only the mechanics of the affected side but also the control of the nonaffected side.

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Classification of Spastic Hemiplegic Cerebral Palsy in Children

Abstract: Diagnostic level 4. See instructions to authors for a complete description of levels of evidence.

Cited by 40 publications

References 14 publications

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Are Muscle Volume Differences Related to Concentric Muscle Work During Walking in Spastic Hemiplegic Cerebral Palsy?

Correlação entre a Visual Gait Assessment Scale, Edinburgh Visual Gait Scale e Escala Observacional da Marcha em crianças com paralisia cerebral diparética espástica

Bilateral symmetry in leg and joint stiffness in children with spastic hemiplegic cerebral palsy during gait

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