Wondering how to correct crouch gait in cerebral palsy patients?
While it can be worrisome when your child starts to walk abnormally, there are some interventions you can seek to encourage normal walking.
This article will explain what causes crouch gait in children with cerebral palsy and what you can do to fix it.
What is Crouch Gait?
Crouch gait is an abnormal walking pattern that is common in children with spastic cerebral palsy.
It’s characterized by:
- the upward bending of the ankles (ankle dorsiflexion)
- bent knees (knee flexion)
- bent hips (hip flexion)
This positioning gives the appearance of being in somewhat of a crouching position while walking, resulting in the name crouch gait.
It’s caused by various muscle imbalances and if not properly taken care of, crouch gait can progressively worsen. This can result in an inability to walk, instability, and poor posture.
Other negative consequences of crouch gait are increased muscle stiffness, expending more energy to walk, and chronic pain.
While the brain damage that causes cerebral palsy does not get worse over time, spasticity can.
Spasticity is when muscles involuntarily stay contracted.
In cerebral palsy patients, the brain is unable to tell the affected muscles to relax, so they stay in a shortened, tight position.
When children with spasticity in their legs learn to walk, they may develop abnormal gait patterns like crouch gait.
Fatigue and Joint Pain
Walking with crouch gait requires more energy than unaffected walking patterns, which often causes fatigue and joint pain.
Your body has to work harder to stay balanced, and because your ankles, knees, and hips are continuously contracted, some muscles are constantly being strained, while others are underused.
This muscle imbalance increases joint pressure and can result in chronic pain.
Treating Crouch Gait in Cerebral Palsy Patients
When it comes to fixing crouch gait, you must 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 correct.
Children that habituate crouch gait will find it difficult to walk correctly, even after reducing spasticity.
Here are some ways to address spasticity resulting in crouch gait.
It’s essential to fix poor form and positioning, even if that means your child may walk more slowly or effortfully while learning to correct their gait.
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.
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. Although its effects do wear off over time, the positive results achieved may carry over.
3. 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 as 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.
4. Selective Dorsal Rhizotomy
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.
5. Single-Event Multi-Level Surgery (SEMLS)
SEMLS is the most invasive type of surgery for spasticity.
It involves surgery that starts at the hips and ends at the feet, individually addressing each muscle imbalance and bone deformity along the way.
SEMLs 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.
6. 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. Continuing with home exercises to carry over and solidify skills learned in therapy is also essential.
Crouch Gait In Children with Cerebral Palsy: Key Points
Abnormal walking patterns like crouch gait are common in children with cerebral palsy and if left poorly managed, can worsen over time.
By detecting the abnormal walking pattern as soon as it arises and seeking early management, individuals can prevent the progression of spasticity and the development of detrimental habits. Long term, this will help minimize pain and pressure on the joints while improving balance and posture.
Hopefully, this article helped you better understand why crouch gait in cerebral palsy patients occurs and how to go about treating it. Good luck!