Study: Females with cerebral palsy require more cautious hamstring lengthening

CLEARWATER BEACH, Fla. – Both male and female patients with cerebral palsy can benefit from medial and lateral hamstring lengthening, but more careful use in females is warranted, according to a presenter at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting, here. 

Hank White, PT, PhD, physical therapist at Shriners Hospital for Children in Lexington, Ky., performed a retrospective review of 121 children with spastic diplegia who underwent a motion analysis study before and after lengthening. The mean age at surgery was 12 years for both genders and the mean time from surgery to the postoperative gait study was 1.4 years.

Hank White 

Outcome measures included gross motor function measure score (GMFM), walking velocity, cadence, stride lengths and walking kinematic data of the trunk, pelvis, hips, knees and ankles. Analysis of variance was performed to assess mean changes in all patients over time, and independent t-tests were used to assess preoperative variables.
“Preoperatively, there was no significant difference in age, height or time between evaluations,” White said. “[There was] no significant difference in the number of prior surgeries or the [total] number of surgeries performed. There was no difference in GMFM classification or scores, kinematic data during stance and no difference in temporal spatial data. So, we had a very similar [presentation] among the patients.”

Findings showed that males who had postoperative knee hyperextension also showed a decrease in GMFM scores, however, males without hyperextension demonstrated an increase. Females had a decrease regardless of knee hyperextension.

Researchers also found non-significant increases in walking speed and stride length, and decreases in cadence for both genders. Both genders had significantly less anterior pelvic tilt and decrease in hip flexion during stance and stance knee flexion.

“We noticed the females had a larger magnitude of decrease in knee flexion throughout the gait cycle, which resulted in a higher incidence of hypertension post-hamstring lengthening,” White said. “Because of these findings, we believe more judicious use of medial and lateral hamstring lengthening should be performed for females.” – by Shawn M. Carter


White. Paper #10. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; May. 13-16, 2015; Clearwater Beach, Fla.

Disclosure: White reports no relevant financial disclosures.


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