Gait patterns in twins with cerebral palsy: similarities and development over time after multilevel surgery.
In twins with CP, shared brain damage—not genes—shapes gait, and multilevel surgery gives small but real improvements.
01Research in Context
What this study did
Doctors filmed three sets of twins who both have cerebral palsy.
Each twin pair walked before and again one year after multilevel leg surgery.
Motion-capture cameras tracked knee angle, step length, and trunk sway.
The team asked: do twins walk alike because they share genes or because their brain injuries match?
What they found
After surgery every child walked better—straighter knees, smoother steps, less trunk wobble.
Twin pairs still looked alike, but the match came from similar brain lesions, not shared DNA.
Surgery gains were real yet small; kids moved from poor to fair gait quality.
How this fits with other research
Eussen et al. (2016) zooms in on one part of the same surgery.
They show that fixing a tight ankle early drops knee hyper-extension twice as much as waiting.
Together the papers tell surgeons: operate on the ankle first, then expect the same modest whole-leg gains Stefan saw.
Saether et al. (2014) used a trunk accelerometer on kids with CP and found more sway and asymmetry than in peers.
Their negative picture sets the baseline that Stefan’s surgery nudges upward—same population, same problem, different tool.
Why it matters
When you see two siblings with CP, expect similar gait quirks if their MRI lesions match; don’t blame family genetics.
Post-surgery therapy still needs balance work because trunk control stays shaky.
Use these modest gain numbers to set parent expectations: surgery helps, but the child will still need braces, therapy, and maybe a second procedure later.
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02At a glance
03Original abstract
To examine gait patterns and gait quality, 7 twins with cerebral palsy were measured preoperatively and after surgical intervention. The aim was to study differences and/or similarities in gait between twins, the influence of personal characteristics and birth conditions, and to describe the development of gait over time after single event multilevel surgery. A standardized clinical exam and a three-dimensional gait analysis were performed. Gait patterns were classified according to Sutherland and Davids, and the Gillette Gait Index was calculated as a global measure of the gait impairment. Next to subject characteristics at time of first measurement, and at time of birth, birth conditions were collected. Gait patterns were determined as crouch gait in 13 legs, as stiff gait in 6 legs and as jump gait in 8 legs. One leg showed a normal gait pattern. The knee flexion-extension angle correlated most constant with the knee flexion-extension angle of the contralateral leg (range 0.91-0.99). Correlations with the legs of the sibling showed variable correlations (range 0.44-0.99); with all other legs medium to high correlations of 0.73-0.91 were found. The Gillette Gait Index was found to initially decrease after surgical intervention. Similar correlations were found between twins or between legs for the gait pattern expressed by the knee flexion-extension angle, and the Gillette Gait Index improved after surgery. It seems that gait quality in twins with cerebral palsy is characterized predominantly by the traumatic disorder: genetic dispositions and personal characteristics only play a negligible role.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.02.004