LELAND STANFORD JUNIOR UNIVERSITY, THE
Grant: $390,557 - National Institutes of Health - Sep. 14, 2009
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Award Description: The goal of this work is to establish a scientific basis for treating crouch gait, one of the most common movement abnormalities among children with cerebral palsy. Crouch gait is characterized by persistent flexion of the knee. It is an inefficient means of locomotion; if not corrected it often leads to bone deformities and serious, life-long physical limitations. Surgeries are frequently performed in an effort to improve knee extension. However, it is extremely difficult to predict which patients will benefit from these procedures, in part, because the biomechanical factors that cause excessive knee flexion are not known. If these factors were identified, and if methods were developed to determine which of these factors contribute to an individual's abnormal gait, then treatments for crouch gait could be designed more effectively. Aims 1-2 will rigorously examine several hypothesized causes of crouch gait, including excessive forces generated by hamstrings and gastrocnemius muscles, weakness of the hip, knee, and ankle extensors, and torsional deformities of the tibia. Forward dynamic simulations will be created that reproduce experimentally measured movement dynamics of 45 subjects with crouch gait. A series of simulations of varying complexity will be analyzed to determine which of the hypothesized causes of crouch gait contribute to each subject's persistent knee flexion. Aims 3-4 will test the utility of our dynamic analyses for guiding treatment decisions by determining the accuracy with which biomechanical variables predict improvement in patients' stance phase knee flexion after surgical treatment for crouch gait. This work will provide improved guidelines for deciding which patients should undergo surgical lengthening of the hamstrings muscles to correct crouch gait, and which patients are more likely to benefit from other treatments, such as strengthening of the extensors or bracing. The success of this project will result in rigorously tested methods to aid treatment planning for crouch gait, and will hopefully produce better, more predictable treatment outcomes. Although multi-joint movement abnormalities such as crouch gait are exceptionally complex, the development and validation of dynamic simulations and statistical models that elucidate the causes of patients' movement abnormalities is an important and necessary step toward designing more effective treatments. PUBLIC HEALTH RELEVANCE: Crouch gait is one of the most common movement abnormalities among children with cerebral palsy. Surgeries are frequently performed in an effort to improve crouch gait, but it is difficult to predict which patients will benefit from these procedures because the biomechanical factors that cause crouch gait are unknown. This project will result in simulations and statistical models to aid treatment planning for crouch gait, which will hopefully lead to better, more predictable treatment outcomes.
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