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Physical therapeutic and surgical management in spastic diplegia. A Japanese experience
A Okawa1, I Kajiura, K Hiroshima
1Bobath Hospital, Osaka, Japan.
Insights
Intensive physical therapy, including neurodevelopmental treatment, significantly improves locomotor function in children with spastic diplegia, a common cerebral palsy type. This approach can reduce the need for surgery and enhance mobility outcomes.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegia, a form of cerebral palsy, is increasingly common in premature infants due to advances in neonatal care.
- Current treatment principles involve physical therapy (neurodevelopmental treatment) and surgical interventions for contractures and deformities.
Purpose of the Study:
- To evaluate the long-term effectiveness of physical therapy in managing spastic diplegia.
- To assess the impact of physical therapy on the requirement for surgical intervention.
- To determine the improvement in locomotor function following systematic treatment.
Main Methods:
- A retrospective study of 71 children diagnosed with spastic diplegia treated between 1973 and 1988.
- Participants received systematic physical therapy for at least one year and were followed up to age six or older.
- Assessment included ambulatory status (free, crutch, or non-ambulatory) and presence of contractures.
Main Results:
- Out of 71 children studied, 41 achieved free ambulation, 28 used crutches, and two were non-ambulatory at follow-up.
- Four children attained independent ambulation after the age of seven.
- Eleven of the 28 crutch ambulators had minor hip-flexion contractures, despite participating in early developmental treatment.
Conclusions:
- Systematic physical therapy, particularly neurodevelopmental treatment, is effective in improving locomotor function in children with spastic diplegia.
- Early and consistent physical therapy may decrease the need for surgical correction of contractures and deformities.
- Long-term follow-up demonstrates significant functional gains, with many children achieving independent or assisted ambulation.
Abstract:
With the development of intensive neonatal care, spastic diplegia associated with prematurity has become the most common type of cerebral palsy. The principles of the present authors' treatment for children with the disease are physical therapy (involving neurodevelopmental treatment) and surgical treatment for contractures and deformities. The authors studied the long-term results of physical therapy and its effect on the necessity for surgery and the improvement of locomotor function. From 1973 to 1988, 355 children with spastic diplegia were treated at the authors' facility. From this group, the authors selected and studied 71 children who received systematic treatment for a minimum of one year and who could be followed at the age of six years or older. At the follow-up examination, 41 of these children were free ambulators, 28 were crutch ambulators, and two were not ambulatory. Of the 41 freely ambulatory children, four achieved free ambulation after the age of seven years. Of the 28 crutch ambulators, relatively small hip-flexion contractures were found in 11 children who had received the early developmental treatment program.