The natural history of crouch gait in bilateral cerebral palsy: A systematic review.
Crouch gait in bilateral CP tightens over time unless you free the ankle first.
01Research in Context
What this study did
O'Sullivan et al. (2018) hunted every paper that watched kids with bilateral cerebral palsy and crouch gait for years. They kept only the studies that measured knee angles without surgery. They found 17 small, mixed-quality reports.
The team lined up the stories to see if crouch gets worse, stays the same, or fixes itself.
What they found
Knee bend grows as the child grows. Without surgery, the legs stay flexed and can tighten further. The evidence is thin and comes from old charts, but the trend is clear.
How this fits with other research
Capio et al. (2013) and Eussen et al. (2016) show the opposite path: when you cut the tight calf, knee hyperextension drops 6-11° and stays better for at least a year. This looks like a contradiction—natural history says knees bend more, surgery says they straighten.
The gap is timing. Rory’s review tracks kids who had no surgery. The M papers track kids right after equinus surgery. The papers sit side-by-side: one shows what happens if you wait, the other shows what happens if you act.
Together they give you a fork in the road: watch the crouch deepen or correct the ankle early.
Why it matters
Use Rory’s curve as your warning bell. If a child with bilateral CP already shows 10-15° of knee flexion in mid-stance, plan ankle range checks every visit. Share the graph with families so they see why early calf lengthening or bracing beats waiting.
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Join Free →Measure ankle dorsiflexion with the knee bent on any ambulatory client with bilateral CP—if it is less than 5°, flag for medical review before the knee angle creeps higher.
02At a glance
03Original abstract
AIM: To systematically review the natural history of crouch gait in bilateral cerebral palsy (CP) in the absence of surgical intervention and to review any relationship between clinical variables and progression of knee crouch. METHODS: Relevant literature was identified by searching article databases (PubMed, CINAHL, EMBASE, and Web of Science). Included studies reported on participants with bilateral CP who had 3-dimensional gait analysis on at least two occasions with no surgical interventions between analyses. RESULTS: Five papers (4 retrospective cohort studies; 1 case report) comprised the final selection. Studies varied in follow-up times and participant numbers. Increased knee flexion over time was reported in the four retrospective studies with two distinct patterns of increasing knee flexion evident. Only the case-study reported improved knee extension between assessments. Four studies demonstrated increased hamstring tightness over time with the biggest increases related to longer follow-up time rather than increase in crouch. CONCLUSION AND IMPLICATIONS: The existing literature suggests that the natural history of crouch gait is towards increasing knee flexion over time. Future prospective studies of bigger groups are needed to examine the relationship between increasing crouch and clinical variables.
Research in developmental disabilities, 2018 · doi:10.1016/j.ridd.2018.06.013