Managing crouch gait in cerebral palsy with a powered knee brace

For many children with cerebral palsy (CP), walking is possible, but not always easy.

Crouch gait, where the knees remain bent during walking, is one of the most common and challenging movement patterns seen in ambulant children with CP. It demands extra effort from the muscles, increases fatigue, and can lead to long-term joint problems if not managed carefully.

Traditional ankle foot orthoses (AFOs) have long been the cornerstone of crouch gait management. They provide excellent support, stability, and alignment. But for some children, that’s no longer enough. The problem isn’t always the fit of the brace. It’s that walking in the real world requires more dynamic assistance than a passive device can provide.

Understanding crouch gait

Crouch gait is characterised by excessive knee flexion during the stance phase of walking. Instead of standing tall with the knees straight at midstance, the child remains in a crouched position.

This posture can develop for several reasons:

• Weakness in the quadriceps or hip extensors
• Tight hamstrings or hip flexors
• Poor motor control or balance strategies
• Habitual movement patterns reinforced over time

Why crouch gait matters

While some degree of knee flexion is normal during walking, persistent crouch increases energy expenditure, places extra strain on the quadriceps, and reduces step length. Over time, it can lead to:

• Fatigue and reduced walking endurance
• Progressive muscle shortening (contractures)
• Joint pain and degeneration at the knee hips
• Difficulty maintaining independent waling into adolescence or adulthood

Crouch gait often worsens with growth, especially during puberty, when children gain height and weight faster than their muscle strength adapts. Early, proactive management is therefore essential.

Limits of traditional AFOs

AFOs remain a key part of managing crouch gait. They stabilise the ankle and foot, promote correct alignment, and can encourage a more efficient step. For many children, they are highly effective, particularly when combined with physiotherapy and strength training.

However, AFOs are passive devices. They can hold the foot and ankle in an optimal position, but they cannot provide power to help the child move through each phase of gait.

In practice, this means:

• The AFO helps keep the foot stable, but the knee still flexes excessively if the quadriceps are weak.
• The device may support a good gait pattern n the clinic, but once the child tires, crouch returns.
• Walking outside, on uneven surfaces, or over longer distances often reveals the limits of passive correction.
• Parents may notice rapid shoe wear, dragging feet, or increasing fatigue at the end of the day.

Despite optimal orthotic fitting, some children simply cannot maintain the improve walking pattern once they leave the controlled environment of therapy or gait lab sessions.

When AFOs aren’t enough

You might start to question whether AFOs alone are enough if you notice any of the following:

• Persistent crouch gait despite well-fitting braces and regular physiotherapy.
• Fatigue or reduced endurance, even over short distances.
• Rapid shoe wear caused by dragging toes or scuffing.
• Loss of progress between therapy sessions; a good pattern in clinic but a less efficient one at home or school.
• Increased knee or hip flexion during growth spurts.

In these situations, clinicians and families often look for more solutions – something that can help children use their strength more effectively, rather than simply holding the leg in place.

This is where smart powered orthoses, sometimes described as robotic orthoses, are beginning to change what’s possible.

Smart powered orthoses: the next step

A smart powered orthosis, such as the Agilik, adds intelligent, motor-driven assistance to the knee joint. It combines traditional orthotic support with robotic technology that senses movement and provides power when needed.

How it works

• Sensor on the leg and foot detect which part of the gait cycle the users is in.
• A microprocessor analyse that data in real time.
• A small motor applies gentle torque to assist either knee extension (standing up tall) or flexion (lifting the leg through).
• The device adapts to each step, helping the user walk more smoothly and efficiently.

Unlike exoskeletons, smart orthoses don’t take over. The user still initiates the movement; the orthosis simply supports it, offering “a power boost” at key moments. This combination of active user control with robotic assistance helps maintain natural movement patterns.

In the clinic, physiotherapists can often help a child achieve an excellent, upright gait pattern through hands-on cueing and repetition. But once the child leaves, those cues disappear.

A smart powered orthosis essentially acts as a continuous external gait coach, reinforcing the correct pattern step after step, throughout the day.

The result is:

• More consistent walking quality in real-life setting, not just therapy sessions.
• Reduced energy cost per step, meaning children can walk further and for longer.
• Maintenance of muscle length and joint range through regular full extension.
• Prevention of secondary problems like knee or hip flexion contractures.

Because the device provides active assistance, children can experience a real functional change: walking taller, more efficiently, and with less fatigue.

Although long-term data are still emerging, early clinical use of smart powered orthoses like the Agilik has shown encouraging results:

• improved knee and hip extension during stance
• more symmetrical and fluid walking patterns
• greater endurance and participation at school or int he community
• less fatigue at the end of the day
• potential for “carry-over” improvement,  where walking looks better even after removing the device

These gains go beyond what static orthoses can achieve alone, supporting not only mobility but also confidence and independence.

Integrating smart powered orthoses into therapy

Devices like the Agilik are most effective when integrated into a multidisciplinary rehabilitation programme, involving:

• Orthotists, who assess fit and adjust the power settings.
• Physiotherapists, who guide gait training and strengthening exercises.
• Medical or rehabilitation specialists, who monitor progress and long-term outcomes.
• Families and case managers, who support consistent daily use.

Together, this team ensures that the powered orthosis complements, rather than replaces, traditional therapy.

Crouch gait remains one of the most difficult patterns to manage in ambulant cerebral palsy. While AFOs, stretching, and strengthening remain essential, they cannot always deliver the active assistance needed to maintain efficient walking in everyday life.

Smart powered orthoses, such as the Agilik, represent an important evolution in treatment combining robotic intelligence with orthotic expertise to help children walk more naturally, conserve energy, and protect their joints for the future.

For many families, these devices offer something simple but powerful: the chance for their child to move more freely and confidently, every day.

If you think your child might benefit from a smart powered orthosis like the Agilik, our clinical team can guide you through the assessment process and arrange a trial fitting.

This allows you to see, in real time, how powered assistance could affect your child’s walking pattern, posture, and endurance.