Subject: Cerebral Palsy and Other Motor Disorders

Series: Clinics in Developmental Medicine

Publication date: 02/12/2020

ISBN: 9781911612414

Edition: 1st

Pages: 163

Improving Quality of Life for Individuals with Cerebral Palsy through Treatment of Gait Impairment

International Cerebral Palsy Function and Mobility Symposium

Tom Novacheck, Michael Schwartz (Editors)

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Paperback edition (complete book)


Improving Quality of Life for Individuals with Cerebral Palsy through Treatment of Gait Impairment (free ebook!) Ebook edition (complete book)


How can the quality of life of those with cerebral palsy and associated gait impairment be improved? What needs to be done to ensure real progress in research? How can evidence for interventions be improved?

The Symposium brought together world-reknowned experts with a range of viewpoints to challenge each other and answer these questions, and prevent stagnation of outcomes. This publication unites these discussions to establish a framework to guide research efforts for the future and ensure meaningful progress. Authors consider how patient goals can be given more attention and ask how we can learn more details of the underlying neurological impairments.

  • Challenges long-held assumptions to explore the current state of research, testing, and treatment.
  • Topics are unified by common formats including bulleted key points and objectives, and specific research goals to make the results more rapidly accessible.


A useful resource for orthopaedic surgeons, physiatrists, physical therapists, kinesiologists, gait analysis experts, and other members of the interdisciplinary team involved in the identification and treatment of mobility impairments in children and young adults diagnosed with cerebral palsy.

Clinics in Developmental Medicine

Tom F Novacheck
Tom Novacheck

Orthopedic Surgeon and Associate Medical Director, Gillette Children’s Specialty Healthcare, Director of Clinical Research, Center for Gait and Motion Analysis; Professor, Dept of Orthopedics, Univ of Minnesota

Dr. Novacheck is a pediatric orthopaedic surgeon who specializes in treating cerebral palsy and other complex pediatric orthopaedic conditions.  He has been at Gillette Children’s Specialty Healthcare in St. Paul, MN, USA since 1991 after completing his pediatric orthopaedic fellowship at Newington Children’s Hospital in Connecticut. At Gillette Children’s, he is an Associate Medical Director, Director of Clinical Research in the Center for Gait and Motion Analysis, and immediate past Chief of Staff.  He is a Professor in the Department of Orthopedics at the University of Minnesota.  Dr. Novacheck’s research has focused primarily on outcomes studies of management of gait disorders in individuals with cerebral palsy and the improvement and development of motion analysis testing methods.  Educational activities for residents, fellows, and health care professionals are focused primarily on normal walking and running gait, as well as pathological gait, particularly cerebral palsy.  He has been a member of the teaching faculty of the annual international gait interpretation course since 1991. He is currently serving as the 1st Vice President of the American Academy for Cerebral Palsy and Developmental Medicine.

Michael H Schwartz
Michael Schwartz

Director of Bioengineering Research, Center for Gait and Motion Analysis Professor, Dept of Orthopedics, Univ of Minnesota.

Dr. Schwartz is a research scientist who specializes in understanding human movement, its impairments, and treatments. He specializes in the gait of children with cerebral palsy.  He has been at Gillette Children’s Specialty Healthcare in St. Paul, MN, USA since 1997 after completing a Ph.D. in Mechanics and an NIH post-doctoral fellowship at the University of Minnesota. At Gillette Children’s, he is Director of Bioengineering Research.  He is a Professor in the Department of Orthopedics at the University of Minnesota. Dr. Schwartz has over 100 peer-reviewed publications and an h-index of 49.

Author Appointments
1. Lever Arm Dysfunction: Improving Care Requires Greater Knowledge of Early Development and Long-term Consequences
Andrew G Georgiadis and Katherine M Steele
2. Accuracy in the Operating Room: Dialogue Between a Biomedical Engineer and an Orthopaedic Surgeon
Moran Sangeux and Thomas Dreher
3. Outcome Measurement in Ambulatory Cerebral Palsy
Benjamin Shore, Kaat Desloovere, and Unni G Narayanan
4. Definitions and Measurements of Spasticity and Dystonia: Pathways to Solve a Babylonian Confusion
Kaat Desloovere and Warren A Marks
5. Spasticity and Dystonia: Consequences, Management and Future Perspectives
Kristina Tedroff and Marjolein van der Krogt
6. Motor Control: Missing Links Between Neurologic Injury and Movement that Limit Care and Function
Warren A Marks and Katherine M Steele
7. The Muscle-Tendon Unit in Children With Cerebral Palsy
Rick Lieber and Tim Theologis
8. Pathomorphology of Skeletal Muscle in Cerebral Palsy: Current State and New Directions
Jason J Howard, H Kerr Graham, and Adam P Shortland
9. Treatment of Muscle Tendon Unit Dysfunction in Children with Cerebral Palsy: Historical Overview, Current Practices and Impact of Physics-based Modeling
Jon R Davids, Anahid Ebrahimi and Darryl G Thelen

This new offering from Mac Keith Press’ Clinics in Developmental Medicine series is a fascinating look at the current state of affairs in the treatment of cerebral palsy (CP). The genesis of the book was a conference held in Banff, Alberta, Canada in December 2019, which was attended by many of the world's experts in the field. These leaders and practitioners met to discuss the breadth of movement disorders, muscle physiology, orthopedics, outcome measures, etc. and to determine how present-day treatments are affecting patients under their care.

Individual chapters present the state of the art in the literature, the authors' interpretations of the literature, and personal opinions on aspects of their particular expertise. Each chapter also provides a 5-year plan: what questions needed to be asked and a roadmap for obtaining answers. This is a unique use of material generated by a symposium and should be applauded.

The technology discussed in the second chapter is interesting, but sometimes reads like an advertisement for a system that is not on the market yet. The question and answer format is certainly thought-provoking, but can become repetitive and ultimately detracts somewhat from the chapter.

Chapter 3 gives a plethora of information on outcome measures. It would have been nice to have an outline of which outcome measures should be used for each of the dimensions of the International Classification of Functioning, Disability and Health. Most of the questions were related to ambulatory patients and the outcomes of intervention.

The term ‘Babylonian Confusion’ should be defined in Chapter 4. I agree that there is much confusion in the field and it often feels like we are speaking different languages describing the same problem. Video links to examples of what the authors (and other professionals) would define as spasticity, dystonia, etc., with scales and various tests that assess these problems, may have been helpful adjuncts to this chapter.

There is an excellent chapter on treatment of spasticity and dystonia. I was surprised that there was no mention of the botulinum toxin type B and/or the other, newer toxins on the horizon, especially in the 5-year plan. It was equally surprising that intrathecal baclofen was not mentioned more often in the treatment of dystonia (vs the use of deep brain stimulation).

While there was some overlap in the two chapters on muscle physiology, there is excellent data with the potential for improvements in treatment of spasticity and contractures, utilizing basic science and potential translational research advances. Since this is a textbook, the personal opinions of the contributors are included in the text. But this subjectivity is tempered by the fact that all the authors felt further study was necessary in order to test their hypotheses.

I especially enjoyed the chapter on musculoskeletal tendon unit dysfunction. It is obvious that the authors have spent their entire careers thinking about and grappling with these problems. It is also instructive to know that while we are still relying on surgery to lengthen muscles, there might be new ways to treat these problems just around the corner.

I highly recommend Improving Quality of Life for Individuals with Cerebral Palsy through Treatment of Gait Impairment for all of us who care for children and adults with CP. As mentioned, there is a very good review of the literature but most importantly, the gaps in our knowledge are addressed—and could be filled in—by the 5-year plans offered. The editors and authors should be congratulated for taking this complex condition on in such a systematic manner and making it accessible for all.

Hank Chambers
Clinical Orthopedic Surgery, University of California, San Diego, CA, USA.