Abstract
Introduction: Spastic cerebral palsy (CP) is the most prevalent motor disability in children, defined by chronic spasticity, muscle stiffness, and motor control impairment, resulting in gait disturbances, postural instability, and decreased walking speed. Orthopedic surgery, including tendon lengthening and muscle releases, is routinely employed to rectify musculoskeletal deformities and enhance motor function. The extent to which these surgeries affect gait kinematics, postural balance, and walking speed is uncertain. The purpose of the current study was to assess the influence of orthopedic surgery on gait kinematics, postural balance, and gait speed in children with spastic CP via a multi-dimensional approach.
Materials & Methods: A prospective observational cohort study was carried out in 30 children (5–12 years, GMFCS Levels I–III) who were scheduled for orthopedic surgery. Participants were evaluated preoperatively and 6 and 12 months after surgery. Outcomes were gait kinematics (stride length, cadence, joint angles), postural balance (Pediatric Balance Scale [PBS], Timed Up and Go [TUG] test), and gait speed (10-Meter Walk Test [10MWT]). Data were analyzed using repeated-measures ANOVA, and effect sizes (Cohen's d) were determined.
Results & Discussion: At 12 months after surgery, there were significant improvements in all outcome measures. Stride length improved by 12.5% (p < 0.01), and cadence by 8.3% (p < 0.05). Knee flexion angle and ankle dorsiflexion angle also improved significantly (p < 0.01). Postural balance was improved, with PBS scores rising from 42.3 to 48.7 (p < 0.01) and TUG test times falling from 12.5 to 9.8 seconds (p < 0.01). Walking speed was enhanced by 18.6% in comfortable speed and 15.2% in fast speed (p < 0.01). Subgroup analysis showed greater improvement in children with GMFCS Level I compared to Levels II and III (p < 0.05). No differences were noted between tendon lengthening and muscle releases (p > 0.05).
Conclusion: Orthopedic surgery significantly improves gait kinematics, postural balance, and gait velocity in children with spastic CP, with the effects being preserved 12 months post-surgery. The findings emphasize the contribution of surgical interventions and personalized rehabilitation protocols in improving functional mobility and quality of life in these patients.