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1. AMBULATORY POTENTIAL
IN
• DIPLEGIA
• HEMIPLEGIA
• QUADRIPLEGIA

2. AUGMENTATION OF
WALKING ABILITY
 ACTUALISATION OF AMBULATORY
POTENTIAL
 SAFETY IN AMBULATION
  ENERGY CONSUMPTION
 NORMALISATION OF WALKING
PATTERN

3. TYPES OF DEFORMITIES
 DYNAMIC SHORTENING
 MYOSTATIC DEFORMITY
 OSTEOARTICULAR DEFORMITIES

6. CLINICAL EVALUATION
AND INVESTIGATIONS
 GAIT ASSESSMENT
 QUANTITATIVE GAIT ANALYSIS
 X’RAY
 DYNAMIC ELECTRO-MYOGRAPHY
 PEDOBAROGRAPHY ENERGETICS
(OXYGEN CONSUMTION)

7. PHYSICAL EXAMINATION
 ASHWORTH SCALE
 PASSIVE RANGE MOTION
 ACTIVE RANGE MOTION
 VOLUNTARY CONTROL
 EQUILIBRIUM TEST

8. GAIT DEFICITS
PRIMARY
 DUE TO DISORDER
OF CNS
 SPASTICITY
 IMPAIRED BALANCE
 IMPAIRED MOTOR
CONTROL

9. SECONDARY AND
TERTIARY DEFICIENCY
 DUE TO GROWTH AND
DEVELOPMENT OF
MUSCULOSKELETAL SYSTEM.

10. COMMON PATTERN
OF GAIT
 JUMP GAIT
 CROUCH GAIT
 STIFF GAIT
 RECURVATUM GAIT
 SCISSORING GAIT
 INTOEING AND OUT-TOEING

11. FOCUS OF ORTHOPAEDIC
INTERVENTIONS
• TO REDUCE SPASTICITY
• TO CORRECTION OF DEFORMITIES
• TO UPGRADE FUNCTIONAL LEVELS
 TO IMPROVE GAIT PARAMETERS
 STABILITY OF LIMB IN STANCE
 CLEARANCE IN SWING
 EFFECTIVE SHIFTING
 SEQUENCING
 PREVENTION OF SECONDARY AND TERTIARY
DEFICIENCIES
 COSMETIC
 NON-AMBULATORS PROVIDING WIDE BASE
FOR PROPER SITTING AND POSITIONING

12. IMPORTANCE OF MULTI
JOINT PARAMETERS
 SEVERITY OF THE SPASTICITY AND
DEFORMITY MORE IN MJM
 EFFECT ON PROXIMAL AND DISTAL
JOINT
 UNMASKING OF SPASTICITY EFFECT ON
ARTICULAR PERIARTICULAR
STRUCTURES

13. TYPICAL PATTERN OF CP
DIPLEGIA

15. SINGLE JOINT PARAMETERS
• HIP JOINT
A) HIP ADDUCTION DEFORMITY
• MUSCLES AFFECTED----
• AL, AB, GRACILIS
• ADDUCTOR MAGNUS

16. EXAMINATION

18. PATHOMECHANICS
• NARROW BASE
• INSTABILITY
• KNOCK KNEE
• SHORT STRIDE LENGTH
• APPARENT SHORTENING

19. SURGICAL INDICATIONS
• RESTRICTION OF ABDUCTION TO
• LESS THAN 20 DEGREES

20. SURGICAL OPTIONS
• ADDUCTOR TENOTOMY
• OBTURATORY NEURECTOMY
• A.L., A.B., & G.R. TENOTOMY
• ONLY A.L. TENOTOMY
• ADDUCTOR ORIGIN TRANSFER

23. B) HIP FLEXION
DEFORMITIES
• MUSCLES---------
• ILIO-PSOAS
• RECTUS,SARTORIUS,ADDUCTORS
TFL
• PATHOMECHANICS

28. INCLINATION OF PELVIS
• H.S SPASTICITY – POSTERIOR
INCLINATION
• WITHOUT H.S SPASTICITY – ANTRIOR
INCLINATION
• X’RAY – LATERAL VIEW
• SACRO-FEMORAL ANKLE---50O-60O

29. MANAGEMENT OPTION
• ILIO-PSOAS TENOTOMY

34. C) HIP INTERNAL ROTATION
DEFORMITY
• MUSCLES ----------
• ANTERIOR FIBRES OF GLEUTEUS
MEDIUS, TFL ,SEMI TENDINOSIS,
• EXCESSIVE FEMORAL ANTIVERSION

36. TESTING TOCHANTERIER
PROMINENECE ANKLE TEST
(RUWE)

44. SURGICAL OPTIONS
• STAHELI PROPOSES FDO
IF AV > 50O
• INTERNAL HIP ROTATION OF
> 85O
• EXTERNAL HIP ROTATION OF
< 10O

45. DISLOCATION OF HIP IN CHILDREN
WITH CEREBRAL PALSY
•  RISK OF LATERAL DISPLACEMENT
- 7% IN AMBULATORY
- 60% IN NON-AMBULATORY
• CAUSE : PAIN
CONTRACTURES
PROBLEMS WITH SITTING,
STANDING AND WALKS
FRACTURES
SKIN ULCERATIONS
• ACETABULARY INDEX < 30%
• MIGRATION PERCENTAGE < 33%

46. HIP DISLOCATION

47. KNEE FLEXION DEFORMITY
MUSCLES
• HAMSTRINGS
• PATHTOMECHANICS
- EXCESSIVE LOAD ON THE KNEE
- PSEUDO-EQUINUS
PATELLA ALTA
- ELONGATION OF LIGAMENTUM
PATELLA
- HIP FLEXION DEFORMITY
- POSTERIOR INCLINATION OF PELVIS

49. CO-SPASTICITY OF
QUADRICEPS

52. SURGICAL OPTION
- HS TENOTOMY
- HS TRANSFER
- HS FRACTIONAL LENGTHENING
A) ONLY MEDIAL
B) BOTH MEDIAL AND LATERAL

57. STIFF KNEE GAIT
• SPASTICITY OF RECTUS FEMORIS
• DUNCAN -ELYS TEST
• TRANSFER OF RECTUS TO SEMI-
TENDINOSIS OR SARTORIUS

63. ANKLE FOOT EQUINUS
DEFORMITY
• MUSCLE
• GASTROSOLEUS
• PES VALGUS
• PES VARUS
2 PHOTO

70. SURGICAL OPTIONS
• MUSCLE RELEASE
• FRACTIONAL PERONEI
LENGTHENING
• PERONEI TO TIB-POSTERIAL
• GRICE’EXTRAARTICULAR
ARTHRODESIS OF SUBTALAR JOINTS
• TRIPLE ARTHRODESIS

71. • TIBIAL TORSION
• DEROTATION OSTEOTOMY
• HALLUX VALGUS
• FUSION OF MP JOINTS

74. CLASSIFICATION OF HEMIPLEGIC GAIT
(WINTER, GAGE, HIKES)
GROUP I – DROP FOOT DURING SWING PHASE
OF GAIT
GROUP II – EQUINUS IN BOTH STANCE AND SWING
PHASE OF GAIT BECAUSE OF FIXED
EQUINUS CONTRACTURE
GROUP III - INVOLVEMENT AT THE KEE WITH A
LEXED STIFF KNEE GAIT
GROUP IV – INVOLVE HIP WITH INCREASED
FLEXION AND REDUCED AT BOTH HIP,
KEE AND EQUINUS AT ANKLE
DRAW BACKS:- BASED ON DATA RELEVANT TO SAGITTAL
PLANE ONLY WHEREAS SIGNIFICANT
ABNORMALIITIES OCCUR IN CORONAL PHASE AND
TRANSVERSE PLANE