Propulsive function during gait in diplegic children: Evaluation after surgery for gait improvement

Seventeen patients with diplegic cerebral palsy were assessed hv clinical e xamination and three-dimensional gait analysis before and after surgery to improve gait. Selection of surgical procedures was according to a fixed set of selection criteria. The average postoperative follow-up was 3.8 years ( range, 2.6-5.7 years). Clinical examination revealed an improved range of m otion for the ankle and no reduction in the power grade at the hip, knee an d ankle after surgery. Kinematic parameters showed improved knee extension in stance and significant changes towards a normal ankle motion pattern pos toperatively. Kinetic evaluation demonstrated that most of the total power during walking was generated at the hip, with the ankle contributing a smal l part. After surgery, patients walked faster with an increased power gener ation at the hip during first double support and at the ankle during push o ff. Power generation at the hip in stance is pointed out to be an important mechanism for propulsion during walking.