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PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.

PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett‘s and Tukey‘s multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Currently, operative treatment is preferred in dislocated calcaneal fractures. Most frequently used is the extended lateral approach, the disadvantage of which is the risk of early complications. Therefore, less invasive operative techniques are sought that would reduce the risk of such complications. The presented study aimed to compare the two different surgical approaches with respect to the restoration of gait stereotype using the objective pedobarography. We assume that the limited operative approach in osteosynthesis of intra-articular calcaneal fractures results in comparable or earlier restoration of gait stereotype with regard to temporal and dynamic parameters compared to the extended lateral approach. MATERIAL AND METHODS The research study comprised a total of 22 patients who underwent the surgical treatment of intra-articular calcaneal fractures, divided into two groups by the applied operative approach. The first group consisted of 10 patients treated with less invasive sinus tarsi operative approach (ST). For osteosynthesis a calcaneal nail (C-nail, Medin, CR) was used. The second group consisted of 12 patients, to whom extended lateral approach (EXT) was applied. For osteosynthesis a calcaneal plate 3.5 mm (DePuy Synthes, Switzerland) was used. Pedobarographic measurement using a tensometric platform was performed in all the patients, always six months post-operatively. Temporal and dynamic variables of the gait cycle during the interaction of the foot with the ground were monitored. RESULTS In the EXT group, significant differences between the injured and healthy foot were found in walking 6 months after the surgery in most of temporal and dynamic variables. The ST group, however, showed no significant differences between the values for the injured and healthy foot in most of temporal and dynamic variables. DISCUSSION Six months after the surgery, the patients continue to carefully load the heel, regardless of the selected surgical approach, due to which the pressure at this place is significantly reduced and tends to be transferred to the midfoot or forefoot. This finding corresponds with previous studies. The patients undergoing a less invasive surgical approach load both the operated and healthy feet. Also, with regards to temporal parameters, as early as 6 months after the surgery correct gait stereotype is restored under the heel in these patients. We believe this is achieved thanks to less pain due to a limited extent of the surgical approach. On the very contrary, the extended lateral approach can cause deterioration of conditions for the restoration of gait stereotype due to the presence of extensive scarring on the heel side with a limited mobility of talocalcaneal joint or also an impaired mobility of peroneal tendons outside the ankle bone. CONCLUSIONS Six months after the surgical treatment of calcaneal fractures changes still persist in gait stereotype. The analysis of temporal and dynamic gait parameters in the followed-up group of patients reveals that the limited sinus tarsisurgical approach results in an earlier restoration of gait stereotype compared to the extended lateral approach. A higher number of patients in the respective groups is necessary in order to obtain more general results. Key words:sinus tarsi; extended lateral approach; plantar pressure; force; contact time.

Copyright of Pediatrie pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of the study is to investigate the influence of selected indexes and angle parameters of the foot on kinematic changes of the ankle, knee, hip and pelvis during the gait cycle. The research group consisted of 27 male with an average age of 24.1. Selected indexes and foot angular parameters were obtained by processing four imprints of the bare foot in each of the subject. The Vicon MX system was used for kinematic analysisof the gait. We have noted the influence of foot indexes on kinematic parameters in all joints of the lower extremity. Statistically significant differences were found in maximum flexion and extension of the hip in the sagittal plane during the gait cycle. We found that the foot angle and heel angle do not affect the kinematic parameters of the lower extremity and pelvis. Big toe angle affects the peak of ankle plantar flexion during loading response. [ABSTRACT FROM AUTHOR]

INTRODUCTION The anterior cruciate ligament (ACL) reconstruction is a tried and tested method in treating knee joint instability which brings valuable results in an acceptable time frame. In the long-term follow-up, however, a higher risk of knee osteoarthritis development is described. One of the possible reasons is considered to be the abnormal kinematics of the operated knee. The purpose of our study was to determine the degree to which the ACL reconstruction helps restore the correct gait cycle compared to the healthy limb. MATERIAL AND METHODS The study included patients after the ACL reconstruction performed in the period from 1 January 2016 to 31 March 2018. With the use of strict criteria, 11 patients were selected for kinematic analysis, who underwent examinations in a gait laboratory and were also evaluated using the Tegner and Lysholm rating systems and the IKDC (International Knee Documentation Committee) knee score, namely preoperatively and at 6 and 12 months postoperatively. The kinematic assessment of gait was carried out using the Vicon MX system with the placement of reflexive markers in line with the Plug-In Gait model. RESULTS The clinical outcomes (namely the score according to Tegner, Lysholm as well as the IKDC) during the first year postoperatively showed a major improvement in knee function and the achievement of the pre-injury activity level. The kinematic analysis revealed lower knee extension at the stance phase and lower overall range of motion of the limb with the injured ACL compared to the healthy limb. The follow-up evaluation at 6 and 12 months postoperatively showed a persisting between-limbs difference in knee extension, whereas the range of motion gradually improved during the year. CONCLUSIONS Although our study confirmed that the ACL reconstruction is an efficient method to treat knee joint instability, it also indicated that even at one year after the ACL reconstruction, the kinematics of the operated knee was not fully restored to the level of the heathy knee. The persisting limb-difference in gait kinematics could contribute to the gradual development of degenerative changes in the operated knee joint. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The study describes changes in gait parameters (temporal-spatial parameters, kinematic parameters represented by the global Gait Deviation Index) of individuals with Adolescent Idiopathic Scoliosis (AIS) compared to the healthy population. The hypothesis assumed a difference in the observed parameters between the two mentioned groups. MATERIAL AND METHODS In a retrospective study, the temporal-spatial parameters and Gait Deviation Index (GDI) of a cohort of 45 AIS patients (36 girls and 9 boys with the mean age of 15.2 years, the mean Cobb angle of the thoracic curve of 47.3° and the lumbar curve of 51.8°) were compared to a typically developing population of 12 healthy individuals with no musculoskeletal pathology. The difference of followed-up parameters in patients with AIS compared to normal values was assessed by one-sample Student’s T-test at the significance level of p = 0.05. RESULTS The gait analysis shows significant deviations in the gait stereotype of patients with AIS compared to the healthy population. Statistically significant differences within temporal-spatial parameters were confirmed for cadence, walking speed, step time, stride time for left leg, step length, stride length and step width. The mean GDI of the cohort reached the value of 91.07 that indicates a slight alteration of gait, however, even this change is statistically significant. DISCUSSION In our cohort of patients with AIS, we identified a significantly reduced walking speed (on average 15.4% compared to normal values. At the same time, a reduction in cadence (by an average of 7.5%) and an increase of the stride time (by an average of 12%) were recorded. Our mean GDI values were 91.07, which is consistent with the results reported in the literature for comparable groups of AIS patients. CONCLUSIONS Our study demonstrated that AIS significantly affects gait stereotype. The differences compared to the group of healthy individuals within temporal-spatial parameters were confirmed for cadence, walking speed, duration and length of step and stride, and step width. The kinematic analysis of gait using the global (GDI) index in patients with AIS demonstrated its slight alteration. A better understanding of the change in movement stereotypes and gait in patients with AIS can bring wider possibilities for individualizing conservative treatment and also can help prevent secondary changes in the locomotor system. [ABSTRACT FROM AUTHOR]

Copyright of Occupational Medicine / Pracovní Lékarství is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the last 15 years robotic assistive devices are coming to the fore of the neurorehabilitation field. According to existing results, these devices are a supportive frame in the rehabilitation process in patients with central motor impairment. After significant proof of concept in adults, therapy has been implemented in the pediatric neurorehabilitation field, especially in cerebral palsied children (CP). The aim of the article is to introduce and summarize neurobiomechanical aspects of robotic assistive gait training in current research results of CP children. Up to current research, positive effect of the robotic assistive gait therapy has been proved. Particularly, improvement in gross motor, balance, increase of range of motion, decrease of spasticity and active participation were observed. Although there is a lack of randomized clinical trials, robotic assistive gait therapy seems to be a convenient and promising method in modern approach of pediatric neurorehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Physical Culture / Tělesná Kultura is the property of Palacky University in Olomouc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Physical Culture / Tělesná Kultura is the property of Palacky University in Olomouc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Physical Culture / Tělesná Kultura is the property of Palacky University in Olomouc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Developmental coordination disorder (DCD), also known as developmental dyspraxia, is a chronic neurological disorder beginning in childhood, that can affect planning of movements and coordination. Balance dysfunction is one of the most common sensorimotor impairments observed among children with DCD, which may have influence on daily living activities, such as walking. Objective: The aim of this study was to compare spatio-temporal parameters of gait between typically development (TD) children and children at risk of DCD, who had also problems with balance and assess the impact of these problems on selected parameters and phases in a gait cycle. Methods: Children (n = 28, Mage = 8.6 ± 1.0 years) were part of this study. The results of MABC-2 were used to classify motor competence level in children and also for a determinantion of the balance level. Optojump-Next was used to collect spatio-temporal parameters related to the gait patterns. The IBM SPSS-21 software was used for statistical analysis. Results: The results showed that children at risk of DCD were different from TD children in the step length (p < .001), in the stride length (p < .001), in the stance phase (p = .007, resp. p = .017), in the double support phase (p = .011, resp. p = .032), in the single support phase (p < .001), in the contact phase (p = .021), in the loading phase (p = .047), in the pre-swing phase (p = .002), in the swing phase (p = .015, resp. p = .004) and in the step speed (p < .001). Conclusion: The majority of previous works, which are focused on walking in children at risk of DCD, are based only on results of the evaluation of the complex motor level of children and they ignore the results of the balance level. This can largely distort conclusions, because not all the children with DCD have balance problems. It is necessary to work with the result of single tests, which are closely connected with the task and not only with the total test score of test batteries, because they may have a big impact on the final result.

Background: Motor coordination problems of children with developmental coordination disorder (DCD) have been frequently associated with poor visuospatial processing. Objective: The aim this study has been to investigate a role of the vision in the motor control of walking between typical developing children (TD) and children at risk of DCD (DCDR). Methods: Participants included 16 TD (mean age 9.1, SD 1.0 years), and 16 DCDR, (mean age 8.7, SD 0.8 years) who walked along a 10 meter walkway using the Optojump instrument to assess the spatio-temporal variables of the gait pattern in full vision (FV) and non-vision (NV) conditions. Data was analyzed in a two-way mixed-effect ANOVA (2 groups - TD vs. DCDR, 2 visual conditions - FV vs. NV) with repeated measurement on the last factor (p ≤ .05). Results: The results demonstrated that DCDR children walked slower and with shorter steps than their TD peers. Also, withdrawing the vision affects some parameters of the gait cycle including the stance-phase, single-support, load-response and pre-swing regardless of the level of motor coordination of the children. Conclusions: A higher dependency on visual information or impaired utilization of proprioceptive inputs for execution of simple walk in the stable environment were not confirmed in the children with motor difficulties.

BACKGROUND: Developmental coordination disorder (DCD) is impairment in motor coordination which can be manifested also by poor balance. Some childrenwith DCD can be more dependent on visual feedback to control their movements. This fact can result in disruption of predictive control, recognition of movement errors and correcting them.OBJECTIVE: The aim of the study was to compare foot pressure distribution and basic temporal and spatial variables during gait in the children with a risk of developmental defi ciency in balance and without motor diffi culties.METHODS: According to the results of the Test MABC-2 (Movement Assessment Battery for Children) subjects were divided into two groups – with the risk of developmental defi ciency in balance (rBAL) (n = 4, age 4.0 ± 1.2 years, weight 18.3 ± 3.5 kg, height 102.9 ± 10.6 cm) and without motor diffi culties (KS) (n = 9, age 4.4 ± 1.2, weight 17.9 ± 2.9 kg, height 106.4 ± 7.9 cm). Distribution of plantar pressure was detected by the Footscansystem (RSscan International, Olen, Belgium). Basic time and pressure variables were assessed in these areas: lateral and medial heel, 1st–5th metatarsal, midfoot and big toe and other toes. The gait was performed at self-selected speed, barefoot, three trials per child. Diff erences between groups were assessed by eff ect size – Cohen’s d.RESULTS: The medium eff ect was reported for pressure impulse in lateral heel, pressure peak in medial heel, pressure peak, pressure impulse and contact duration of 1st metatarsal, contact duration in 4th metatarsal and pressurepeak in area of 2nd–5th toe. Except for the pressure peak in the fi rst metatarsals, all of the mentioned parameters were higher in the KS group. Generally, the foot pressure and foot contact in the rBAL group was smaller and shorter, so their steps were faster and diff erent from a normal gait performance. Large eff ect sizes were found for contact duration in the 1st metatarsal and pressure peak in the 2nd metatarsal. It means that the rBAL children had shorter fi rst metatarsal contact duration and produced higher pressure on 2nd metatarsal than the KS children. Also, the step length of the rBAL group was less symmetric than in the KS group. The period of stance and double support was found similar in both groups.CONCLUSIONS: The results may indicate that as early as preschool age there could be discernible diff erences in some parameters of gait cycle between the typically developed children and children with delayed motor development.

Copyright of Medicina Sportiva Bohemica et Slovaca is the property of Ceska spolecnost telovychovneho lekarstvi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rehabilitation & Physical Medicine / Rehabilitace a Fyzikální Lékařství is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION The anterior cruciate ligament (ACL) reconstruction is a tried and tested method in treating knee joint instability which brings valuable results in an acceptable time frame. In the long-term follow-up, however, a higher risk of knee osteoarthritis development is described. One of the possible reasons is considered to be the abnormal kinematics of the operated knee. The purpose of our study was to determine the degree to which the ACL reconstruction helps restore the correct gait cycle compared to the healthy limb. MATERIAL AND METHODS The study included patients after the ACL reconstruction performed in the period from 1 January 2016 to 31 March 2018. With the use of strict criteria, 11 patients were selected for kinematic analysis, who underwent examinations in a gait laboratory and were also evaluated using the Tegner and Lysholm rating systems and the IKDC (International Knee Documentation Committee) knee score, namely preoperatively and at 6 and 12 months postoperatively. The kinematic assessment of gait was carried out using the Vicon MX system with the placement of reflexive markers in line with the Plug-In Gait model. RESULTS The clinical outcomes (namely the score according to Tegner, Lysholm as well as the IKDC) during the first year postoperatively showed a major improvement in knee function and the achievement of the pre-injury activity level. The kinematic analysis revealed lower knee extension at the stance phase and lower overall range of motion of the limb with the injured ACL compared to the healthy limb. The follow-up evaluation at 6 and 12 months postoperatively showed a persisting between-limbs difference in knee extension, whereas the range of motion gradually improved during the year. CONCLUSIONS Although our study confirmed that the ACL reconstruction is an efficient method to treat knee joint instability, it also indicated that even at one year after the ACL reconstruction, the kinematics of the operated knee was not fully restored to the level of the heathy knee. The persisting limb-difference in gait kinematics could contribute to the gradual development of degenerative changes in the operated knee joint. Key words: anterior cruciate ligament deficiency, anterior cruciate ligament reconstruction, knee kinematics during gait, knee osteoarthritis.

Purpose of the Study: Cerebral palsy is a serious world-wide problem; its incidence ranges from one to five per thousand of live-born children and is much influenced by gestation age and birth weight. In orthopaedic treatment of lower extremity motor disorders, one of the options for contracture or deformity elimination and for stiff leg gait improvement is rectus femoris tendon transfer. The aim of this study was to evaluate the results of this surgical technique., Material and Methods: In the period from 1993 to 2003, 15 patients of both sexes, aged 5 to 13 years, were treated by the Gage method (22 operations) in our department. The indication for surgery was excessive spasticity of the femoral quadriceps muscle at the beginning of the swing phase of the gait cycle. The spastic syndromes included quadruparesis in seven patients, diparesis in seven patients and hemiparesis in one patient. After surgery, a circular plaster cast was applied for 4 weeks. Following immobilization, all patients received a short-term inpatient and long-term outpatient physical therapy. They were followed- up for 1 to 10 years and gait improvement was analyzed on the basis of three criteria in the swing phase: quality of the initial swing, frequency of tripping over the toe and the degree of knee flexion. The results were evaluated on a 1-to-4 scale (best to worst), categorizing the patients into four groups., Results: The first, second and third categories included eight, five and two patients, respectively. None of the patients was placed in the fourth category. Surgery did not increase the initial range of inner hip rotation. Patients with milder forms of cerebral palsy (diparesis and hemiparesis) achieved better results., Conclusions: Our results showed that distal rectus femoris tendon transfer significantly improved knee flexion during the swing phase of the gait cycle. The prerequisite for a good outcome of surgery is a pre-operative potential for passive knee extension and stable function of the other lower extremity joints. Key words: cerebral palsy, surgical treatment, quadriceps tendon transfer.