Article

While past investigations focused on describing pelvic motion patterns in the
frontal and transversal plane, the sagittal plane "double bump" pattern commonly
found in children with cerebral palsy was only rarely investigated, especially
concerning the underlying pathology. 375 ambulatory (GMFCS I-III) patients with
bilateral spastic cerebral palsy were included in this study. Gait and clinical
data (ROM, strength, spasticity) were classified in two different ways: (a) into
two groups of normal and enhanced mean anterior pelvic tilt and (b) into two
groups of moderate and excessive ROM in pelvic tilt. The results reveal that
increased mean pelvic tilt is mainly associated with gait features of reduced hip
extension and increased pelvic and trunk obliquity ROM but with increased knee
ROM. In the clinical exam this corresponds to a smaller passive knee extension
deficit and reduced knee flexor strength. It seems that flexors to extensors
strength imbalance at the knee is a major feature why mean pelvic position is
tilted anterior whereas maximum passive hip extension is of minor importance.
Contrarily, excessive sagittal pelvic ROM is associated with increased knee
flexion at initial contact and reduced knee ROM. Furthermore, Duncan-Ely- and
Tardieu-tests show both increased values in this group with excessive pelvic
range of motion indicating for spastic rectus femoris activation. The results of
our study indicate that the two gait variables are influenced by different
specific mechanisms which are now described for the first time. Since the pelvis
plays a central role during gait, these findings should be considered when
planning single event multilevel surgery in patients with cerebral palsy.
CI - Copyright (c) 2013. Published by Elsevier B.V.

Langue : ANGLAIS