Crouch gait—reducing it, correcting it—is one of our primary goals at Bionic Power. The Agilik, our smart orthotic device, has been designed to curtail and correct crouch gait, a common disorder among people with cerebral palsy (CP), spina bifida, and other knee-extension-deficiency disorders. Crouch gait is clinically described as excessive ankle dorsiflexion and excessive knee and hip flexion during the stance phase. It is an inefficient walking gait that makes walking more tiring.
Crouch gait has various causes: growth spurts (when muscles cannot keep up with rapidly increasing weight), physical deformities, weight gain, muscle weakness, poor motor control, and contractures. It is a vicious circle in that having crouch gait tends to lead to worse crouching, and it can also lead to all sorts of other issues.
The Effects of Crouch Gait on Children—with Cerebral Palsy
For children with CP, one of the most challenging effects of crouch gait is hypertonia—also known as high muscle tone and often referred to as spasticity. This is a condition that causes tight muscles and stiff, jerking movements and sometimes joint dislocation and pain—caused by the involuntary contractions of the child’s muscles. This makes it extremely difficult to relax and hard to sit, stand, and walk.
As many as 80 percent of all children with CP experience spasticity. Spasticity arises because the cerebral palsy damaged a child’s brain in such a way that the brain cannot tell the affected muscles to relax and, in an effort to create stability, overstimulates muscles. This miscommunication leads to involuntary muscle contractions, or spasticity, which worsens as the child gets older. This spasticity can interfere with the development of a normal gait pattern and often leads to crouch gait.
High muscle tone can also pull a child’s body into itself as their body matures, leading to deformities. And low muscle tone (hypotonia), which often affects the abdominal muscles in children with CP, can lead to instabilities in their trunk and torso, difficulties with balance, and poor posture. Spasticity, if unchecked, puts undue pressure on a child’s musculoskeletal system—their muscles, bones, and joints.
Flexion and Range of Motion
Crouch gait derives its name from how a person looks when they’re walking. It’s as if they are crouching over while moving forward. The crouch comes from their knees and hips excessively bending (in flexion), while their ankles bend. It’s especially common in pediatric cerebral palsy and in children with spastic CP.
Flexion is crucial to walking, sitting, and standing—or getting up from a seated position. Flexion also has to do with Range of Motion (RoM). A person’s knee RoM is a combination of how far they can extend and flex their knee. Extension being the ability to straighten the leg, and flexion being the ability to bend it. In most children, 1.6-5º extension is a completely straightened leg, and 142-152º is a fully flexed leg. The inability to extend fully, or seemingly being stuck in flexion, can cause many other problems.
The Wear and Tear of Crouch Gait
A significant impact of excessive knee flexion is crouch gait, one of the most common pathological walking patterns among children with CP. Again, people struggling with crouch gait cannot fully extend their knees when walking. Their inability to fully straighten their legs puts extreme stress on their quadriceps muscles (the muscles of the front and side of the thigh) and their knee joints. That’s because they’re always in use.
This constant flexion wears kids out more quickly, which then limits how long and how far they can walk. They get tired. Their knees hurt. Not to mention the toll it takes on their self-confidence. And, as pointed out by Flint Rehab, “Because of the additional strain on the muscles, joints, and bones, the body must work harder to maintain balance. Additionally,” they added, “the continuous contraction of the ankles, knees, and hips results in constant pressure on some muscles while others remain underused. This muscle imbalance increases joint pressure and often results in chronic pain.”
Crouch gait can also lead to joint pain, degenerative arthritis, and bony deformities. It’s no wonder that so many children with crouch gait tend to regress to assistive walking aids or wheelchairs.
Treat It Early—and Often
However, as also pointed out in the 2020 edition of Cerebral Palsy: “Children who start to walk independently by age 3 are usually more mild and at lower risk for late severe deformities which impair their gait.”
Which is why it’s often critical that children with CP tackle crouch gait early on. Treating it in childhood seems to be the best way to maintain mobility into adulthood—and preventing other afflictions that can emerge if left untreated.
Crouch Gait Treatments—and the Agilik
Currently, the most effective treatments for crouch gait include invasive surgery, physical therapy and strengthening, botulinum toxin injections (essentially, Botox—the same bacterium used to smoothen away wrinkles), and, of course, orthotics such as the Agilik.
Although the long-term benefits of these interventions have not yet proven to definitively alleviate crouch gait for most children, use of orthotics such as the Agilik looks promising, and may prove to be the most effective corrective for crouch gait. It can also be combined with surgery as a post-surgical therapy.
Crouch Gait Vs. The Agilik
The Agilik provides a boost, giving the wearer the support they need to stand tall and walk strong. This mobility not only leads to proper bodily alignment and posture, it also helps wearers develop better form and reduces the overall stress on their bodies. As well, it often lessens if not minimizes spastic movements—loosening muscles that might otherwise seize up.
The Agilik also helps stretch out and lengthen the muscles that have tightened up—even when the child is stationary. The pain that can so disrupt a child or adolescent’s sleep, mood, and growth goes down. And because the Agilik functions by assisting or resisting knee extension and flexion throughout the wearer’s gait cycle, when they’re using this orthotic in resistance mode, the Agilik works the wearer’s muscles in such a way that it improves their strength.
The Agilik, then, helps correct a child’s crouch gait. It improves their posture, helps manage their spasticity, curtails whatever deformities might have been developing, and best of all, we hope its effects will continue even after the child has taken off the device.
Learn more about clinical trials with the Agilik here. And sign up for our mailing list here.