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Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment
Joanne Zhou1, Erin E Butler2, Jessica Rose1
1Department of Orthopaedic Surgery, Stanford UniversityStanford, CA, USA; Motion and Gait Analysis Lab, Lucile Packard Children's HospitalPalo Alto, CA, USA.
Insights
Cerebral palsy (CP) is a common childhood movement disorder. This review details brain injury, neuromuscular deficits, and gait abnormalities in CP, linking them to improve targeted treatments.
Area of Science:
- Neurology
- Pediatrics
- Biomedical Engineering
Background:
- Cerebral palsy (CP) is the most prevalent pediatric movement disorder.
- Diagnosis often relies on motor delays, abnormal muscle tone, or gait issues.
- Neural underpinnings of CP-related gait abnormalities are not fully understood.
Purpose of the Study:
- To review brain injury patterns in CP.
- To outline neuromuscular deficits associated with CP, particularly spastic CP.
- To examine the influence of these deficits on gait abnormalities and identify treatment targets.
Main Methods:
- Review of existing literature on CP brain injury, neuromuscular deficits, and gait.
- Analysis of the relationship between brain injury location/extent and CP characteristics.
- Integration of information on neural correlates of gait abnormalities.
Main Results:
- CP involves diverse brain injury mechanisms, patterns, and timing (prenatal, perinatal, postnatal).
- Neuromuscular deficits in spastic CP include weakness, shortened muscles, spasticity, and impaired motor control.
- Gait abnormalities are directly influenced by these neuromuscular deficits.
Conclusions:
- Understanding the link between brain injury, neuromuscular deficits, and gait is crucial for effective CP treatment.
- Identifying neural correlates of gait abnormalities can guide strategic interventions.
- Further research can reduce the long-term impact of CP on children's functional outcomes.
Abstract:
Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.