The upper limb in children with cerebral palsy. Evaluation and treatment
Frank Fitoussi1, Pauline Lallemant-Dudek1
1Armand Trousseau Hospital - Sorbonne Medical University, Paris, France.
Insights
Managing upper limb function in children with cerebral palsy requires a comprehensive team assessment. Treatment options range from rehabilitation and botulinum toxin injections to surgical interventions for severe cases.
Area of Science:
- Pediatric rehabilitation
- Neurology
- Orthopedic surgery
Background:
- Upper limb management in pediatric cerebral palsy (CP) is complex.
- Requires a multidisciplinary team approach.
- Involves assessment of various clinical parameters.
Purpose of the Study:
- To outline the comprehensive assessment process for upper limb dysfunction in children with CP.
- To discuss the range of treatment options available.
- To emphasize the importance of a multidisciplinary team.
Main Methods:
- Detailed clinical assessment including higher functions, visual status, motor control, sensation, and limb positioning.
- Inclusion of occupational therapy, physiotherapy, video analysis, and electromyography (EMG).
- Multidisciplinary team meetings for treatment indication and surgical planning.
Main Results:
- Treatment indications are determined after exhaustive assessment.
- Options include rehabilitation, occupational therapy, bracing, and botulinum toxin injections.
- Surgical interventions (selective neurotomy, tendon release/transfer, osteotomy) are reserved for severe contractures.
Conclusions:
- A thorough, multidisciplinary evaluation is crucial for effective upper limb management in pediatric CP.
- Treatment strategies are tailored to individual patient needs, ranging from conservative to surgical.
- Expert opinion guides the management of complex cases.
Abstract:
Management of the upper limb in children with cerebral palsy is often complex and must be carried out by a team experienced in this field. Several clinical parameters must be taken into consideration, such as higher functions, visual problems, overall upper limb function, motor control, sensitivity, presence of hemineglect or synkinesis, limb position at rest and during walking. And last but not least, a complete analysis of the upper limb is required. It is only after this exhaustive assessment - which often includes occupational therapy, physiotherapy and in some cases, video and electromyography evaluations - that a treatment indication can be discussed with the patient's family. Other than baseline treatment consisting of rehabilitation, occupational therapy and bracing, botulinum toxin injections could be an option, targeting specific muscle groups. Surgical treatments, which are often indicated in severe forms with contractures, are proposed after the patient's case is presented at a multidisciplinary meeting. These include selective neurotomy, muscle-tendon release, transfer or lengthening, and procedures on bone and joints (osteotomy, arthrodesis). LEVEL OF EVIDENCE: Expert opinion.
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