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Academic Subject
Developmental Rounds
Equinus Gait & Crouch Posture in a 4yo Child with Spastic Diplegia (GMFCS Level II)
Topic Summary & Background: 4-year-old girl with spastic diplegic cerebral palsy ambulates independently with bilateral toe-walking and 15° knee flexion during midstance. Modified Ashworth Scale (MAS) is 2 for gastrocnemius-soleus bilaterally.
Key Discussion Questions:
- Solid AFO vs Hinged AFO vs Ground Reaction AFO (GRAFO) selection for crouch control.
- Role of serial casting protocol combined with Botulinum Toxin-A (Botox) injections.
- Facilitating hip extensor (gluteus maximus) and quadriceps power during play-based functional training.
Standard Clinical Consensus: Standard Clinical Consensus: In GMFCS Level II crouch gait, Ground Reaction AFOs (GRAFO) create an extension moment at the knee during midstance by blocking ankle dorsiflexion, preventing further quad fatigue.
DA
Dr. Aarti Tiwari, MPT (Pediatrics)
Pediatric Specialist • Just now
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