Crouch gait and its brief Medical And Physiotherapy Management

what is crouch gait and its Physiotherapy rehabilitation
this type gait mostly seen in spastic diaplegic Cerebral palsy child least common in quadriplegic C P , and hemiplegic C P

1. Crouch Gait

2. Defination - (With or without stiff knee ) is defined as excessive ankle dorsiflexion, knee and hip flexion during the stance phase. -This gait disorder is common among patients with cerebral palsy. -Crouch gait is an abnormal walking pattern

3. - This pattern is part of the natural history of t he gait disorder in children with more severe diplegia and in the majority of children with spastic quadriplegia. -The commonest cause of crouch gait in children with spastic diplegiais isolated lengthening of the heel cord in the younger child.

4. Cause : - - Muscle weakness -spasticity, -joint contractures, -bony deformities, -motor control deficits in addition to changes in muscle extension capacities that result from a crouched posture

5. All Interacting factor may contribute to crouch gait - A combination of hip flexion - Knee flexion, - Excessive ankle dorsiflexion (the latter may be represented by flatfoot or calcaneus) -Common in diplegic CP

6. Summary in brief - Walking with crouch gait uses up more energy than normal walking, which causes fatigue and joint pain.Essentially, your body has to work harder to stay balanced, and because your ankles, knees, and hips are continuously bent, some muscles are constantly being strained, while others are underused -= This muscle imbalance increases joint pressure and can result in chronic pain -- Crouch gait is a common gait deviation, often seen among ambulatory diplegic and quadriplegic patients, once they reach the pubertal spurt, when weak muscles can no longer support a toe walking pattern because of rapidly increased weight

7. - This form of gait is highly ineffective and might compromise walking ability over time -The anterior knee is overloaded; pain, extensor mechanism failure, and arthritis might develop - Its progressive nature often requires surgical intervention. -The cause of crouch gait is multifactorial, and surgery should be tailored to meet the individual's specific anatomic and physiologic abnormalities.

8. Management:- When it comes to fixing crouch gait, you need to 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 fix. Children that habituate crouch gait will find it difficult to walk correctly, even after reducing spasticity

9. Braces I t’s essential to fix form over function. 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 ..Floor reaction ankle-foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait.

10. Botox 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

11. 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 than 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

12. 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.

13. Single Event Multilevel surgery -SEMLS is the most invasive type of surgery for spasticity. Essentially, it’s a series of surgeries start at the hips and end at the feet. Each muscle imbalance or bone deformity is addressed one by one. This 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

14. Physiotherapy :- 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.

15. Rehabilitation Stretching and Alignment of Bilateral Lower limb :- Bilateral lower limb Medial hamstring Hip flexor iliopsoas Plantar flexor Adductor Medial rotators

16. Stretching and alignment of bilateral upper limb ( if required) - Bilateral pronator Bilateral wrist and thumb flexor Shoulder flexor and Adductor Prone lying extension for spinal flexor stretchi ng

17. Strengthening Exercises Bilateral Quadriceps Bilateral hamstring Bilateral Gluteal hip extensors Spinal extensors Ankle plantar flexor Core muscle strengthening Bridging

18. Prone lying reach out Prone extension Prone lying single limb reach out Side to sit

19. Swiss ball / Gym ball Prone lying reach out Prone extension Prone lying single limb reach out Side to sit

20. High Sitting Over The ball Catch and throw heavy objects Reach out in different direction Rocking in high sitting

21. Standing Oriented Excercise Side to side Backward and forward Step standing over the balance board High sitting High sitting to standing( high - low floor) Cross leg high sitting over the bloaster Sit to stand from bloaster One Foot Standing Stride Standing

22. Positional Oriented Excercise Heel sitting TO KNEELING Static kneeling Reach out in kneeling Catch and throw Kneeling walk forward and backwa rd

23. Transition Quadruped Heel sitting Kneeling half kneeling standing walking

24. Activity which is help in Gait MODIFICATION Step standing activity oriented One foot standing activity’ oriented Figure of 8 walking Walking over foot mark

25. WALKING with or without mobility Aids Depends upon the child current physical endurance and and level of disability Walking with walker Rollator Walking wait Tripod and stick Walk independently

26. MISCELLANEOUS ACTIVITY Ramp Walking Stair Climbing Jumping over trumpulling Stepping over step ( with or without support ) Crossing obstacles Walk over aligner Walk over bridge aligner ( if possible )