Researcher(s)
- Tanmayee Joshi, Biomedical Engineering, University of Delaware
Faculty Mentor(s)
- Chris Church, Orthopedics, Nemours Hospital
- Jason Howard, Orthopedics, Nemours Hospital
Abstract
Cerebral Palsy (CP) is the most common cause of childhood physical disability.1 Crouched gait, characterized by sustained knee flexion, is most common motor impairment seen in children with diplegic CP.2 Anterior pelvic tilt (APT), which may be linked to lumbar lordosis and back pain,3,4 is commonly seen in children with CP. The causes of APT are unknown, however, hamstring lengthening (HL) is hypothesized to have an impact.5,6 This study aims to identify what factors influence change in APT in ambulatory children with CP.
In this IRB approved retrospective study, data was collected from hospital records and Nemours gait lab database from 2002-2022. Pairs of gait analyses were evaluated to determine change in APT and knee flexion at initial contact during gait. Children with CP met inclusion criteria if they were bilaterally involved, diagnosed with GMFCS I-III, and had two gait analyses were included in the study.
A stepwise regression analysis was conducted and found that medial HL (p<0.0001), medial and lateral HL (p<0.001), psoas lengthening (p<0.01), low burden surgeries (p<0.001), Achilles tendon lengthening (p<0.001), rectus femoris resection (p<0.01), rhizotomy (p<0.001), knee flexion (p<0.0001), GMFM-D (p<0.05), age (p<0.01), pelvic tilt (p<0.0001), hip extension PROM (p<0.05), and hip flexion (p<0.0001) significantly impacted APT. A multivariate analysis was conducted and found that medial HL (p<0.0001), medial and lateral HL (p<0.0001), psoas lengthening (p<0.0001), DFEO (p<0.0001), gastrocnemius lengthening (p<0.05), rectus femoris surgery (p<0.0001), knee flexion (p<0.0001), and pelvic tilt (p<0.0001) significantly impacted knew flexion at initial contact.
Many of the factors influencing APT also showed to improve knee flexion at initial contact. When treating crouched gait, it is important to minimize iatrogenic effects of increasing APT. The change in APT is multifactorial, affected by other procedures rather than just HL’s. It is essential to consider all factors to help anticipate or prevent worsening APT.