SCISSOR GAIT
The manner in which a child with cerebral palsy walks is often that of a Scissor Gait. The walking is characteristic of how a marionette walks. Or Cerebral Palsy Doctors work with patients with a Scissor Gait.
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Scissor Gait
The effects of cerebral palsy (CP) can often be seen in how children learn to walk, as gait can be significantly altered or impaired as a result of this disorder.
The development of the scissor gait identifies one of the movement problems that may occur from cerebral palsy. Mobility may become difficult, painful, and uncharacteristically sluggish when walking in this manner. The scissor gait is a type of abnormal gait that frequently occurs in children with spastic cerebral palsy.
The cause of the gait disorder occurs when an upper motor neuron lesion is linked to the disorder. This walking style can remind parents of a puppet walking or moving. In addition, hypertonia causes the legs, hips, and pelvis to flex to varying degrees, giving the appearance of a crouched posture.
Tight adductor muscles cause irregular walking, which causes the knees and thighs to cross in a scissors-like motion, while the opposing muscles, the abductors, become weak from lack of use. This peculiar walking pattern is known as a scissoring gait, and it arises due to high muscle tone, or spasticity, in the hip adductors.
Common Features of Scissor Gait
- Rigidity and excessive adduction: The legs swing inward excessively, sometimes causing the knees and thighs to strike or cross each other with each step.
- Flexed posture: The hips, knees, and ankles often remain bent, creating a crouched appearance.
- Plantar flexion: Children may be forced to walk on their tiptoes if the muscles in the lower leg are tight, which is especially pronounced unless a surgical intervention relaxes these muscles.
- Internal hip rotation: The hips may rotate inward, further contributing to the crossing motion of the legs.
- Weakness in opposing muscles: Abductor muscles, which are responsible for moving the legs apart, become weaker over time due to underuse.
- Upper limb involvement: Sometimes, the upper limbs are used in complex, compensatory movements to help maintain balance and propel the body forward.
These features can present to varying degrees, regardless of how mild or severe the child’s cerebral palsy is, but they all contribute to the distinct, challenging pattern of the scissor gait.
Understanding the Mechanics of Scissor Gait
- Hip Adductors’ Role: These muscles are tasked with pulling the thighs together. When they are overly tight, they keep the legs in a closed position.
- Internal Hip Rotation: As a result of constant contraction, the hips rotate inward, preventing the upper legs from separating during movement.
QUESTIONS AND ANSWERS
What constitutes scissor gait, and why does my child walk with this pattern?
Scissor gait refers to a walking pattern where a child’s legs cross over each other as they walk. The gait usually indicates underlying conditions, including cerebral palsy, muscle weakness, or spasticity. The doctor will perform a thorough examination and may order tests to determine the cause of the scissor gait. Understanding the underlying condition becomes crucial for developing an appropriate treatment plan.
What are the treatment options for scissor gait, and can it be corrected?
Treatment for scissor gait depends on the underlying cause. It may involve physical therapy to improve muscle strength, flexibility, and coordination. In some cases, orthopedic interventions, braces, or assistive devices may be recommended to help correct the gait pattern. The specific treatment plan will be tailored to the child’s individual needs and the underlying condition contributing to the scissor gait.
What is the long-term outlook for my child's walking pattern, and will they be able to walk normally as they grow?
The long-term outlook for a child with scissor gait depends on the underlying cause and the effectiveness of the chosen interventions. In some cases, with appropriate treatment and rehabilitation, children can significantly improve their gait and function more normally. Regular follow-up with healthcare professionals, including orthopedic specialists and physical therapists, is essential to monitor progress and make adjustments to the treatment plan as needed. Early intervention and consistent management often contribute to better outcomes.
Parents should seek guidance from healthcare professionals who can conduct a comprehensive evaluation of the child’s gait pattern and provide personalized recommendations based on the specific underlying condition.
Walking differently can be a medical indication that something is wrong. Make an appointment with one of our pediatric orthopedists to ensure everything is fine
Importance of Early Intervention
Early intervention is essential because spasticity can worsen over time. Effective management of scissoring gait will focus on minimizing spasticity and promoting correct form. By addressing these issues early, it can be possible to improve balance and prevent negative impacts on growth.
Common Association
This type of gait is frequently observed in individuals with spastic diplegia, a form of cerebral palsy where motor impairments predominantly affect the legs. By understanding this, one can better appreciate the underlying challenges faced by those with this condition.
Unless the plantar flexor muscles become freed via an orthopedic surgical treatment, the child will continue to walk on tiptoes. No matter how mild or severe the spastic CP condition appears, these symptoms always occur in some way or to some extent.
Scissor Gait Symptoms
- Excessive swinging leg adduction and stiffness.
- The ankle bends in a plantar fashion.
- Flexed knees.
- Internal hip rotation and adduction.
- Constricted assisting motions of the upper limbs during walking due to increasing contractures of all spastic muscles.
Ineffective management of the scissor gait may provide the following risks:
- Growth restrictions or developmental defects as a result of unequal muscular pull
- Poor balance and occasional falling.
- Pressure sores develop as a result of the frequent rubbing of the knees.
- Restricted motion because of stiff joints.
- Discomfort brought by persistent muscular tension and joint stress.
- Loss of mobility when walking
Treatments for Scissor Gait
Our doctors believe that early intervention will significantly improve walking and prevent the development of a scissor gait in cerebral palsy children. A two-step program will fix a scissor gate. The first priority will get the muscles to easily contract and relax — spasticity must first be reduced. The second step will get the child to regularly work on improving their walking form through home exercises and physical therapy. Some treatments may work better than others for your child’s spasticity, depending on the severity. Determine the most efficient and advantageous course of treatment by speaking with your child’s physician or physical therapist.
Medications for Scissor Gait
For short spasticity alleviation, muscle relaxants like baclofen can help decrease muscular hyperactivity. Typically, muscle relaxants administered orally, taken several times daily, only temporarily relieve spasticity. Muscle relaxants can influence the entire body and might make your child feel drowsy, worn out, or weak. For people who simply have spasticity in their legs, this might not be the best option. Another option is an intrathecal pump that becomes surgically installed and can also be used to give medicine to reduce the problem. The danger of adverse effects is decreased since the muscle relaxant in the pump may be administered in lesser dosages because it is directly delivered to the spinal cord.
Orthotic Devices Aid in Managing Scissoring Gait in Children with Cerebral Palsy
Orthotic devices play a crucial role in addressing the scissoring gait often observed in children with cerebral palsy. By providing targeted support, these devices help maintain proper body alignment and muscular function.
Supporting Musculoskeletal Alignment
Orthotic devices, such as braces and splints, offer vital support to the body’s structure. They work to ensure normal musculoskeletal alignment, which is essential for effective movement. This alignment helps balance muscle tension and minimizes the impact of spasticity, a common challenge for children with cerebral palsy.
Promoting Balanced Growth
Children with cerebral palsy are at risk of experiencing disproportional growth due to unmanaged spasticity. Using orthotic devices can help counteract the effects of muscle tightness, thereby promoting balanced growth. By mitigating progressive tightening, these devices allow muscles to grow more symmetrically, preventing further complications.
Enhancing Leg Positioning
Specialized orthotic solutions, like de-rotation straps or hip orthoses, are designed to maintain leg alignment. These devices assist in keeping the legs parallel, reducing the tendency to cross as seen in scissoring gait. By improving positioning, they facilitate more natural walking patterns, enhancing independence and mobility for the child.
In summary, orthotic devices are indispensable tools in managing the challenges of scissoring gait in children with cerebral palsy. They support alignment, encourage proportionate growth, and improve leg positioning, all of which contribute to better walking function and overall quality of life.
Walkers help Individuals with Scissoring Gait Due to Cerebral Palsy
For individuals with cerebral palsy who experience a scissoring gait, maintaining mobility and improving balance are crucial. Walkers play a significant role in achieving these goals by providing necessary support.
Enhancing Balance and Mobility
Walkers help stabilize those with spasticity in the legs, allowing them to move more confidently and securely. By offering a structural support system, walkers minimize the fear of falling, thus encouraging more independent movement. This increased independence is vital for daily activities and participation in social settings.
Promoting Physical Health
Using a walker encourages individuals to bear weight on their legs as they move. This weight-bearing activity is beneficial for circulation, which can enhance overall cardiovascular health. Furthermore, it contributes to strengthening bones and muscles, essential for maintaining long-term mobility.
Addressing the Scissoring Gait
A scissoring gait, where legs tend to cross over each other, poses additional mobility challenges. Some walkers are specifically designed with features like straps or strategic cushioning. These modifications help keep the legs separated, which can prevent the scissoring motion and facilitate a more natural gait pattern.
In summary, walkers are more than just a tool for getting from point A to B. They are pivotal in enhancing balance, promoting physical health, and addressing the unique challenges of a scissoring gait in individuals with cerebral palsy.
How Botox Injections Alleviate Spasticity in Children with Cerebral Palsy
Botox injections offer a way to temporarily ease spasticity in children with cerebral palsy by interfering with nerve signals. Here’s a closer look at how they work:
- Mechanism of Action: Botox effectively blocks the nerve signals responsible for muscle contractions. By inhibiting these signals, the muscles are unable to tighten excessively, resulting in reduced stiffness.
- Duration of Relief: Typically, the effects last between three to six months. However, the exact duration can vary depending on factors such as the dosage administered and the severity of the child’s condition.
- Temporary Solution: It’s crucial to note that Botox is designed for short-term relief and is not a permanent solution for spasticity management. Adjustments or repeat treatments may be necessary over time.
- Complementary Rehabilitation: During the period when spasticity is reduced, it’s beneficial for children to engage in intensive gait training programs. This helps maximize the benefits by improving mobility and muscle coordination.
In summary, Botox injections provide a temporary but effective intervention for managing muscle stiffness, allowing for opportunities to focus on physical rehabilitation. Keep in mind that Botox offers a temporary fix rather than a permanent solution. Therefore, it is essential to integrate these injections into a broader, comprehensive treatment plan that focuses on long-term mobility and overall well-being for the child. Through careful planning and collaboration with healthcare professionals, Botox injections can significantly impact the management of scissoring gait, enhancing the quality of life for children with cerebral palsy.
Surgery for Scissor Gait
Kids with cerebral palsy who have various operations may experience less spasticity. Surgery in our practice becomes the last option after all other strategies fail or there is no alternative. For example, adductor lengthening surgery may be advised for children who walk with a scissoring gait as there is no alternative. The muscles in the inner thighs need to be lengthened. A selected dorsal rhizotomy procedure can lessen spasticity. By severing the hyperactive nerve fibers, a surgeon can stop and prevent muscle contractions. The muscles won’t be spastic once the nerve fibers are severed since they can’t grow again.
Physical Therapy
Children who always walked with a scissoring gait may do so even after their stiffness has been greatly decreased. Although, Surgery, nerve blockers, and muscle relaxants may reduce stiffness, they won’t teach your child how to walk correctly. Therefore, it will seem strange for your child to walk normally if they have walked for an extended period with a scissoring gait. So, children must undergo physical therapy and adopt new walking techniques in order to correct their form. In conclusion, a physical therapist will evaluate your child’s mobility and develop a special exercise program for them to work on their gait. The more children walk with a proper form, the more their brain circuits may get stronger and the movement pattern will feel more natural.
Choosing Medical City Children’s Orthopedics and Spine Specialists
Always consult with your doctor if your child begins to walk differently. If you come to one of our Medical City Children’s Orthopedics & Spine Specialists offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX our pediatric orthopedic doctors will examine your child and recommend the best treatment option to repair the problem and get your child back playing.
As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists, will examine your child and understand the reasons for an unusual gait. At that point, the doctor will prepare an individualized treatment plan for your child if he finds the cause of the unusual gait. After correcting the problem, your child will resume his or her favorite activities. For athletes, it may take up to a year before they may resume their sport.
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Footnote:
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