Adults with Cerebral Palsy

                      Dear all
                      Happy New Year!
                      I am currently in my final year of a BSc sports and exercise science degree at South Bank University
                      in London. For a piece of biomechanics coursework we are required to discuss gait deviations in adult
                      cerebral palsy from that of a normal population and also to discuss possible biomechanical
                      intervention strategies aimed at improving functional gait. I am having trouble finding data on cerebral
                      palsy in an adult population. I have read through James Gage's book 'Gait Analysis in Cerebral Palsy',
                      and have read quite a few journal articles on cerebral palsy in children, yet I am not sure whether this
                      source data is suitable for a discussion of cerebral palsy in adults.
                      Another option I have followed has been to look into gait deviation with hemiplegia/paresis after
                      accidents such as cerebrovascular trauma/stroke but I am not sure whether I would be able to use this
                      data either, as the
                      patients had a functional pyramidal system prior to the accidents/stroke and so had already developed
                      walking patterns that could be transferred to the extrapyramidal system.
                      Dr Chris Kirtley kindly suggested posting my query and so here I am. Any advice/direction about this
                      topic would be much appreciated.

                      Best regards
                    Liz Evans

I am not sure that I am on track with the meaning you have in mind in terms of data, but here are some resources that may help you.

The Adult With Cerebral Palsy
Clyde E. Rapp, Jr, MD; Margarita M. Torres, MD
Archives of Family Medicine
Vol. 9 No. 5, May 2000

>From the abstract:

A MEDLINE search of all English-language publications related to cerebral
palsy from 1985 to 1999 was conducted. Other older references also were
obtained from articles published during this period. Our personal
experiences in caring for a group of approximately 300 adults with
cerebral palsy and other developmental disabilities in specialized centers
for nearly a decade are used frequently throughout this review. Emphasis
is given to studies of adults. Studies of children are included because
there is a lack of data on adults.


Physical Therapy Volume 82  Number 7  July 2002
Research Report
Effect of Passive Range of Motion Exercises on Lower-Extremity Goniometric
Measurements of Adults With Cerebral Palsy: A Single-Subject Design
Sherri L Cadenhead, Irene R McEwen, and David M Thompson


Life expectancy in persons with severe developmental disability
by Edward HOFFMAN


Representation of Temporal Spatial Gait Parameters Using Means In Adults
WithoutImpairmentMarcus P. Besser, PhD, Keith Kmieczak, MS PT, Lauren
Schwartz, MS PT, MollySnyderman, MS PT, Jeremy Wasko, MS PT, Lisa
Selby-Silverstein, PhD PT NCSDepartment of Physical Therapy, Thomas
Jefferson University, Philadelphia, PA, 19107


GAIT STUDIES in Cerebral Palsy Adults


I hope that these citations will be helpful to your research.

David Dillard
Temple University
(215) 204 - 4584

Hello, and Happy New Year to all,
   In response to Ms. Evans' questions I have only some clinical
reminiscences, but over a period of 30 years of orthopedic practice, 25
of which were primarily with children, I have seen probably fewer than
10 adults with CP, all of whom were sent to me "because the adult
orthopedists said they didn't know much about CP".  I can't recall that any
of their gait problems were the same as the others--that is, they all
seemed individualistic problems, and often secondary to their ADL
.[activities of daily living]  circumstances.  E.g. a woman in her 50s,
walking all her life, moved from California to Pennsylvania to live with a
family member,and had pain in both feet--which eventually turned out to
be stress fractures from the increased stress of climbing stairs daily
[which she didn't do in Calif.].  Rest [in casts]x about 1 month and custom
modified shoes significantly improved her gait to "how it was before".
      I'll be very interested in what you can find, but it may take a large
survey to identify types of problems.

Mary Clark

I would second the other answer to this query.  the most recent experience i
have had with adult cp's was a lady in her fifties who required dorsiflexion
assist below knee metal afo's (klensac's) to prevent foot-drop.
it is an interesting point though, the lack of cp patients seen in their
adult life compared to their younger years.  where do they all go?

Doug Fyfe

My experience has been that they fall into one of two primary classes:
  1. They have been convinced that all that can be done has been done
  2. Insurance companies refuse to continue covering their expenses, and they simply can't afford the cost of care especially, that of orthotic management.
Stella Herrick

Dear Elizabeth,
no particular suggestion, but just my support that you're on the right way,
Please remember that the principles of biomechanical intervention strategies
quite independent of the pathological origin of the impairments/disablities
. So a mixture of what
is known from adult hemiplegia or cerebral palsied ch. in general will give
you enough material.
In the growing child biomechanical based interventions like muscle
elongations are applied with reluctance,
since the child is growing, which might interfere. Such considerations are
absent in the adult,
so biomechanical based interventions are much more relevant.
Please look also at orthosis as a basis for interventiuon, not only surgical
interventions, which are
more frequently avalable in literature,
kind regards and succes ,

Jaap Harlaar


An interesting question. In addition to the lack of data on CP in adults
there is a lack of therapy. The two might be related. Many children I know
of get therapy once a week up to the age of 16 or similar when they become
"adults" and then get no therapy after that.
You are right, I think, to be cautious about extrapolating from adults with
strokes etc. The acquisition of walking is not just dependent upon the
pyramidal system but also upon many other descending pathways, and spinal
circuits. One feature that is often neglected is the control of balance
which patients with stroke and CP are likely to have had very different
experiences of.
A further problem is that many, but not all, patients with stroke are
elderly and therefore are likely to have acquired supplementary movement
problems, possibly due to arthritis etc.
Not a lot of help I guess. Bear in mind that although the injury in CP is
non-progressive, its effects tend to be as the body becomes larger and the
issue of motor control more complex.
Best wishes,

Jonathan Norton,
MRC Human Movement Group
Sobell Department of Motor Neuroscience and Movement
Institute of Neurology, UCL
8-11 Queen Square
London WC1N 3BG
Tel. 020 7829 8725 ext 4120.                    email;
& Implanted Devices Group
Dept. of Medical Physics and Bioengineering
University College London

Hi Liz,
Adults with cerebral palsy really constitute a different set of problems
than the kids.  In the first place, they can not tolerate the "single stage
correction" type of approach that we use in children.  If they do have
surgery it has to be much more limited and then the rehabilitation is much
more intense and lasts longer as well.  They have a host of
social-psychological problems (including clinical depression in a
significant number of them).  Finally, they have degenerative conditions
such as arthritis of the hip or spine superimposed on the underlying
cerebral palsy.
With warm regards,
Jim Gage
I am presently writing a grant to study mobility
and activity and developement of secondary conditions in adults
with CP. I am a pediatric PT by trade but I find my population
with CP facing aging  issues. There is very little literature out there
on adults with CP.

Damiano and Abel did a gait study with adults with
CP (1999 or 2000?) that might provide you with some info. Margaret
Turk and colleagues at SUNY are doing research into issues of aging in
CP.Not much else out there and especially with gait. By the time
children with CP who were ambulatory get to be adults, a majority of them
chose to move to a w/c secondary to pain, deformities and energy
requirements, so really not much data on adult with CP who ambulate. Please
add me to your list. A colleague of mine forwarded the list messages to
me knowing that I would be interested.

                     Debbie Thorpe

Dear Liz,

I have seen many adults with cerebral palsy over the course of my career as a physical therapist who were referred for complaints of pain, increase in history of falls, complaints of joint pain and overuse syndomes, especially of the lower extremities. All of them had different postural organization and gait characteristics. Many of them had tendon lengthening procedures or osteotomies of the lower extremities to try to "correct their gaits".

As you noted, there is very little documented on adults with Cerebral Palsy. The following articles may be useful to you:
Murphy, K. P. 1995 Flynn J. M., Miller F 2002 Currie, DM 1993 and Root L, 1987

You may want to put in searches that cross reference cerebral palsy with older adults and with overuse injuries, pain, lower back pain, foot problems, crouch gait, scissoring gait....

Terri Miller, MS, PT 

Dear Debbie:
You might try The American Academy for Cerebral Palsy and Developmental Medicine. They can be reached at: Their monthly journal (Developmental Medicine & Child Neurology) is quite extensive.
Best of luck,

J.Andre Bonneville,MD