Egyptian Rheumatology and Rehabilitation (Jan 2019)

Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy

  • John F.H Amen,
  • Dalia M.E El-Mikkawy,
  • Ahmed H Yosry,
  • Mohamed A El-Gebely,
  • Mostafa H.A El-Sherbini

DOI
https://doi.org/10.4103/err.err_3_19
Journal volume & issue
Vol. 46, no. 2
pp. 78 – 84

Abstract

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Background Crouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries. Objective To evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP. Patients and methods A total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively. Results Highly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500 m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance. Conclusion The rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery.

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