Cerebral palsy is a group of disorders that affect a person’s ability to move and maintain balance and posture. It is the most common motor disability in childhood, caused by abnormal brain development or damage to the developing brain. A person’s specific pattern of walking is known as their gait. Because cerebral palsy impacts muscle control, coordination, and tone, it frequently leads to distinct walking patterns.
Common Gait Patterns in Cerebral Palsy
The specific appearance of a person’s gait is determined by which muscles are affected. One of the most recognizable patterns is a scissoring gait, where a person’s knees and thighs press together or cross over each other while walking. This pattern creates an abnormally narrow base of support and can make walking inefficient.
Another frequent pattern is toe walking, which is defined by the absence of a normal heel-strike when the foot meets the ground. Individuals with this gait walk on the balls of their feet, a pattern known as equinus. While some children with cerebral palsy can stand with their feet flat, the toe-walking pattern emerges during movement.
A crouch gait is characterized by excessive bending at the ankles, knees, and hips, making it appear as though the person is in a constant state of crouching. This pattern can sometimes be an unintended consequence of surgical procedures. The body compensates for weakness and instability by maintaining this flexed posture.
Finally, gait patterns are also described by the limbs they affect. A hemiplegic gait involves impairments on one side of the body. The arm on the affected side is held in a flexed position, while the leg is stiff and swings outward in a semicircular motion called circumduction. A diplegic gait primarily affects both legs, often resulting in either a scissoring or crouch pattern.
Neuromuscular Factors Influencing Gait
The distinct walking patterns in cerebral palsy are caused by how the brain injury affects communication between the nervous system and muscles. These neuromuscular factors include issues with muscle tone, involuntary movements, and coordination.
The most common factor is spasticity, which refers to abnormally high muscle tone that leads to stiffness and jerky movements. Spasticity is velocity-dependent, meaning the resistance to movement increases with the speed of the stretch. This stiffness is directly responsible for patterns like the scissoring gait, caused by spastic hip adductors, and toe walking from spastic calf muscles.
Some individuals experience dystonia, which involves involuntary muscle contractions that cause twisting, repetitive movements, or sustained abnormal postures. These uncontrollable movements can affect different parts of the body, adding unpredictability to a person’s gait and disrupting coordinated walking.
A less common factor is ataxia, which results from damage to the cerebellum. Ataxia is characterized by a lack of voluntary control over muscle movements, leading to an unsteady, clumsy, and wide-based gait.
Muscle weakness is also a significant contributing factor. Alongside stiff or overactive muscles, there is often an underlying weakness that impairs function. For instance, in a crouch gait, weakness in the core and extensor muscles contributes to the flexed posture.
Gait Assessment and Diagnosis
To understand and properly treat an individual’s walking pattern, clinicians use a combination of assessment methods. The initial step is often an observational gait analysis, where a trained healthcare professional watches the person walk. The observer looks for characteristics such as asymmetry, problems with balance, and the specific patterns of movement at the hip, knee, and ankle.
To enhance the analysis, video recording is frequently used. Filming the person walking allows clinicians to review the gait cycle in slow motion and pause at specific moments. This offers a more detailed perspective on joint angles and the timing of movements, which might be missed in real-time observation.
A physical examination is also performed to assess factors that influence gait. This includes testing muscle tone to identify spasticity, measuring muscle strength to detect weakness, and evaluating the range of motion in the joints. These physical findings help explain why the person walks the way they do.
In specialized clinics, a 3D computerized gait analysis may be conducted. This involves placing small, reflective markers on the person’s body, which are tracked by infrared cameras as they walk across force plates. This technology provides precise, quantitative data on joint motion, forces, and muscle activity.
Management and Therapeutic Interventions
Managing gait issues in cerebral palsy involves a multidisciplinary approach aimed at improving mobility, preventing deformities, and enhancing overall function. Treatment plans are highly individualized based on the specific gait pattern and underlying neuromuscular factors.
Physical therapy is a foundational component of gait management. Therapists use exercises designed to stretch tight, spastic muscles and strengthen weaker ones. Gait training is also a focus, where individuals practice walking patterns to improve balance, coordination, and endurance.
Orthotics, such as braces or splints, are frequently prescribed to support and align the body correctly during movement. Ankle-Foot Orthoses (AFOs) are among the most common types used. These devices are worn inside the shoe to help control ankle position, prevent toe walking, and provide a stable base for walking.
Medications can be used to manage spasticity. For individuals with widespread stiffness, oral medications may be prescribed to relax muscles throughout the body. When spasticity is concentrated in a few specific muscles, such as the calf muscles in toe walking, targeted injections of botulinum toxin (Botox) can be effective. This treatment temporarily weakens the overactive muscle, reducing stiffness.
In cases where conservative treatments are not sufficient to address severe contractures or deformities, surgery may be considered. Procedures like tendon lengthening can release a tight Achilles tendon, while selective dorsal rhizotomy involves cutting specific nerve fibers to permanently reduce spasticity.