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Arm posturing during walking in children with spastic hemiplegic cerebral palsy
Jacques Riad1, Scott Coleman, Freeman Miller
1Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Insights
Elbow flexion in children with hemiplegic cerebral palsy naturally decreases with age. Surgical intervention for elbow flexor lengthening did not improve arm positioning or walking patterns.
Area of Science:
- Neurology
- Orthopedics
- Pediatrics
Background:
- Elbow flexion in hemiplegic cerebral palsy presents functional and cosmetic challenges.
- Understanding the natural progression of arm positioning is crucial for managing this condition.
Purpose of the Study:
- To investigate the natural history of elbow positioning during walking in children with hemiplegic cerebral palsy.
- To evaluate the impact of surgical intervention on arm positioning and gait patterns.
Main Methods:
- Utilized 3-dimensional gait analysis to assess 175 children with hemiplegic cerebral palsy.
- Compared a surgical subgroup (n=10) with a nonoperative group (n=59).
Main Results:
- Significant spontaneous decrease in elbow flexion and increase in elbow extension observed on the hemiplegic side with age.
- Elbow range of motion did not significantly improve on the hemiplegic side.
- Surgical lengthening of elbow flexors did not enhance arm positioning or normalize gait.
Conclusions:
- Spontaneous improvements in elbow extension occur with age in hemiplegic cerebral palsy.
- The effectiveness and optimal timing of surgical interventions for improving arm posture require further investigation.
Abstract:
Elbow flexion in hemiplegic cerebral palsy causes not only a functional impairment but is also a cosmetic concern. We report on the natural history of arm positioning during walking at different ages. One hundred seventy-five children (mean age +/- SD, 9.2 +/- 4.1 years) were assessed by using 3-dimensional gait analysis. The results showed a significant spontaneous decrease of elbow flexion on the hemiplegic side with increasing age (P=0.001) and no change on the non involved side. The elbow extension significantly increased on the hemiplegic side (P=0.017) and on the non involved side (P=0.012). The range of motion did not improve significantly on the hemiplegic side, but did on the non involved side (P=0.003). Inasmuch as the hemiplegic side starts out with more flexion at a young age compared with the non involved side, the improvement in extension is not as great as on the non involved side, and there is no marked gain in range of motion.A decreased variability was noted, measured as SDs of the mean elbow flexion, although it was only significant on the non involved side (P=0.008). Comparing a subgroup of 10 patients who had surgical treatment involving the lengthening of the elbow flexors with a nonoperative group of 59 patients, we found that surgery did not contribute to a better positioning of the arm nor did it normalize the movement pattern while walking. Surgical treatment has been proposed to improve the function and the appearance of the posturing arm in hemiplegic cerebral palsy; however, improvement might be expected spontaneously, and the indication and timing of surgical intervention is not clear.
