Musculoskeletal Evaluation of Children with Cerebral Palsy

Cerebral Palsy (CP) is the most common chronic disability of childhood. The problems involved are complex; not only do these children have problems of mobility, but a plethora of associated problems [1]. A recent definition of CP includes secondary musculoskeletal problems [2]. The inclusion of this in the definition recognises the significance of musculoskeletal problems and the impact these problems have on the lives of children with CP and their families. Orthopedic management of the child with CP aims to reduce the impact of these musculoskeletal problems to help the child with CP to reach his maximum potential [3]. To accurately assess children and prepare management plans, a combination of medical history, physical examination, functional assessment, medical imaging, observational and instrumented gait analysis, and assessment of patient and family goals must be interpreted [4]. A detailed annual orthopedic assessment for all children with CP is recommended [5]. For an ambulant child, more frequent assessments are required during periods of rapid growth, observed deterioration in physical examination measures, and after interventions, including gait correction surgery. For a non-ambulant child, more frequent assessments are indicated according to hip surveillance guidelines [6, 7], during periods of observed deterioration, and following interventions such as hip or spine surgery. A systematic and practiced routine is conducive to efficiency and accuracy [5]. This paper discusses the Physical Examination Protocol used by the Hugh Williamson Gait Analysis Laboratory, in Melbourne, Australia.