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Swing Phase Adduction in Cerebral Palsy Diplegia: Correlation with Physical Exam Curtis Gale-Dyer, DO, Hank White, PT, PhD, Henry Iwinski, MD Shriners Children Hospital in Lexington, Kentucky Department of Physical Medicine and Rehabilitation, University of Kentucky.

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Swing Phase Adduction in Cerebral Palsy Diplegia: Correlation with Physical ExamCurtis Gale-Dyer, DO, Hank White, PT, PhD, Henry Iwinski, MDShriners Children Hospital in Lexington, KentuckyDepartment of Physical Medicine and Rehabilitation, University of Kentucky

  • Results: Out of 494 patients, 157 (31.8%) had hip adduction > 1 standard deviation normal motions. 27 of them were GMFCS level 1 (18% out of all Level 1), 37 were GMFCS level 2 (24% out of all Level 2), and 93 were GMFCS level 3 (48% out of all Level 3). For all participants, the correlation between the dynamic hip adduction when walking with:
  • PROM abduction with the knee flexed -0.239(P < .0001)
  • PROM abduction with the knee extended -0.233 (P < .0001)
  • PROM popliteal angle 0.204
  • (P < .0001).
  • Conclusions: The prevalence of excessive hip adduction when walking increased with increase in GMFM level. We did not find a significant correlation between dynamic gait pattern and passive range of motions. Therefore, for ambulatory children with CP a PROM limitation does not necessarily indicate a dynamic problem will be present when walking. This is why three-dimensional motion analysis evaluations are an important part of clinical care for children diagnosed with CP.
  • Keywords: Cerebral palsy; Clinical exam; Gait analysis

Objective: To determine: 1) the amount of adduction in the beginning phase of the swing cycle in cerebral palsy diplegia using dynamic gait study data and 2) if there is a correlation with dynamic gait study data; specifically hip adduction in the beginning phase of the swing cycle and passive range of motion (PROM) testing of hip adductors and hamstrings.

Design: Retrospective study

Setting: Motion analysis laboratory

Participants: 494 patients who were diagnosed with cerebral palsy diplegia and had a gross motor function classification system (GMFCS) of 1-3 and who underwent a three-dimensional motion analysis study as part of their routine clinical care retrieved from the motion analysis lab’s database. Subjects also had no previous history of surgery to their hip adductors or hamstrings.

Interventions: Not applicable

Main outcome measures: Hip adduction at 60% of the gait cycle (determined from gait analysis data), PROM abduction of the hip with the hip and knee flexed, PROM abduction with the hip and knee extend, PROM popliteal angle, GMFCS, and age.