Child Orthopedics

Frequently Asked Questions

What can be done to help children with cerebral palsy who walk crouched down? I have a fourth grade student in my class like this. I'd like to help but don't know what to suggest.

The first step may be to talk with the family. There may be an orthopedic surgeon already involved in this child's care. The school physical therapist is also an excellent resource.

Increased muscle tone called spasticity from this condition causes the crouch posture and gait (walking) pattern. As the child grows, the bones lengthen but the muscles still maintain their tight hold because of the spasticity. The result is the change in posture you see.

Without intervention, this pattern will likely get worse as the child grows. Physical therapy (PT) and surgery are the two main treatments for this problem. Just exactly what works best still hasn't been determined.

Numerous studies from both PTs and surgeons show varying results. Sometimes cutting the tight muscles helps stretch them out and restore motion. The therapist works with the child and family to help decrease disability and improve function.

The operation (or another, different procedure) may have to be done more than once as the child grows. For children with spastic diplegia cerebral palsy, just the legs are affected.

A recent study from Shriner's Hospital in Lexington, Kentucky showed that lengthening the hamstring muscle behind the knee helps improve knee extension and walking. Children who had this procedure were able to straighten up and walk better. They didn't walk normally, but they were much improved.

Your concerns are valid and should be brought up at the child's next individual educational planning (IEP) meeting (if not sooner).

Steven A. Lovejoy, MD, et al. The Effects of Hamstring Lengthening on Hip Rotation. In Journal of Pediatric Orthopaedics. March 2007. Vol. 27. No. 2. Pp. 142.

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