Definition: -
(with or without stiff knee ) is defined as excessive ankle dorsiflexion, knee, and hip flexion during the stance phase.
-This gait disorder is common among patients with cerebral palsy.
-Crouch gait is an abnormal walking pattern
-This pattern is part of the natural history of
the gait disorder in children with more severe diplegia and in the majority of children with spastic quadriplegia.
-the commonest cause of crouch gait in children with spastic diplegia isolated lengthening of the heel cord in the younger child.
(Summary In brief )
-Walking with crouch gait uses up more energy than normal walking, which causes fatigue and joint pain. Essentially, your body has to work harder to stay balanced, and because your ankles, knees, and hips are continuously bent, some muscles are constantly being strained, while others are underused
-= This muscle imbalance increases joint pressure and can result in chronic pain
-- Crouch gait is a common gait deviation, often seen among ambulatory diplegic and quadriplegic patients, once they reach the pubertal spurt when weak muscles can no longer support a toe walking pattern because of rapidly increased weight
-This form of gait is highly ineffective and might compromise walking ability over time
-The anterior knee is overloaded; pain, extensor mechanism failure, and arthritis might develop
- Its progressive nature often requires surgical intervention.
-The cause of crouch gait is multifactorial, and surgery should be tailored to meet the individual's specific anatomic and physiologic abnormalities.
Cause :
-Muscle weakness
-spasticity,
-joint contractures,
-bony deformities,
-motor control deficits in addition to changes in muscle extension capacities that result from a crouched posture
All interacting factors that may contribute to crouch gait
-A combination of hip flexion
- Knee flexion,
- Excessive ankle dorsiflexion (the latter may be represented by flatfoot or calcaneus)
-Common in diplegic CP
Treating Crouch Gait in Cerebral Palsy Patient
When it comes to fixing crouch gait, you need to treat the underlying spasticity.
Failure to do so will harm your child’s stability, posture, and joint strength in the long run.
The earlier you catch your child’s abnormal gait pattern, the easier it will be to fix.
Children that habituate crouch gait will find it difficult to walk correctly, even after reducing spasticity
It’s essential to fix form over function.
Children with impaired motor control won’t magically fix their abnormal gait.
Orthotic devices like braces can help promote proper form.
They hold limbs in place to subtly stretch the muscle and prevent further contractions
..Floor reaction ankle-foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait.
Botox is a medication that physicians will inject into spastic muscles
It blocks the overactive nerve signals and temporarily relieves high muscle tone.
This provides a window of opportunity for your child to practice walking with proper form
Baclofen_Pump
The surgery to implant a baclofen pump under the skin of the abdomen allows a consistent supply of baclofen to flow into the spinal cord.
Baclofen is a muscle relaxant that, like Botox, relieves high muscle tone.
Because the drug is administered directly to the spinal cord, you don’t need as high of a dose than you would if you were to take it orally.
However, the pump does need regular refills, so baclofen pumps may not be the most ideal treatment for children.
A selective dorsal rhizotomy is a surgery that involves selectively cutting overactive sensory nerve fibers.
By limiting the communication between the muscles and the brain, spasticity is significantly reduced.
Single Event Multi-Level Surgery SEMLS)
-SEMLS is the most invasive type of surgery for spasticity.
Essentially, it’s a series of surgeries that start at the hips and end at the feet.
Each muscle imbalance or bone deformity is addressed one by one.
This can involve lengthening tendons, moving muscles, and altering bones.
Fixing the alignment of the musculoskeletal system is able to significantly reduce spasticity without directly intervening with the central nervous system
.
Physical Therapy
Lastly and most importantly, intensive physical therapy is essential for treating abnormal gait patterns like crouch gait.
Whether your child uses a brace, Botox, or gets surgery to treat spasticity, they must participate in intensive physical training to fix their gait.
The physical therapy must be challenging and frequent to activate neuroplasticity in the brain and replace the old walking pattern.
Physiotherapy management of crouch gait ...
Stretching of Tight Structure
Bilateral lower limb
Medial hamstring
Hip flexor iliopsoas
Planter flexor
Adductor
Medial rotators
Stretching and alignment of bilateral upper limb ( if required)
Bilateral pronator
Bilateral wrist and thumb flexor
Shoulder flexor and Adductor
Prone lying extension for spinal flexor stretching
Strengthening of a major group of muscle
Bilateral Quadriceps
Bilateral hamstring
Bilateral Gluteal hip extensors
Spinal extensors
Ankle plantar flexor
Core muscle strengthening
Bridging
Swiss_ball
Prone lying reach out
Prone extension
Prone lying single limb reaches out
Side to sit
High sitting over the ball
Catch and throw heavy objects
Reach out in a different direction
Rocking in high sitting
Standing oriented balance board
Side to side
Backward and forward
Step standing over the balance board
High sitting
High sitting to standing( high - low floor)
Cross leg high sitting over the bloaster
Sit to stand from bloaster
Up - and down
Heel sitting - kneeling vice versa
Static kneeling
Reach out in a kneeling
Catch and throw
Kneeling walk forward and backward
Reach out in half kneeling
Half kneeling to standing
Standing orientated exercises Static and dynamic posture
Step standing
One foot standing
Stride standing
Transitions
Quadruped __ Heel sitting __ kneeling __half kneeling __ standing __walking
Step standing activity oriented
One foot standing activity’ oriented
The figure of 8 walking
Walking over foot mark
Walking
with or without mobility Aids Depends upon the child current physical endurance and level of disability
Walking with Walker Rollator
Walking wait Tripod and stick
Walk independently
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