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Muscle hypoextensibility in children with cerebral palsy: II. Therapeutic implications
Insights
Treatments for cerebral palsy with triceps surae hypoextensibility vary based on muscle trophic regulation. Surgery improved function in defective groups, while casting was effective in normal groups, though braces were needed to prevent recurrence.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy often involves triceps surae hypoextensibility, impacting gait.
- Muscle trophic regulation may influence treatment outcomes in these children.
Purpose of the Study:
- To evaluate the effectiveness of muscle lengthening treatments for triceps surae hypoextensibility in children with cerebral palsy.
- To compare outcomes between defective and normal muscle trophic regulation groups.
Main Methods:
- Twenty-nine children with cerebral palsy were divided into two groups based on muscle trophic regulation.
- Treatments included successive plaster casting or surgical elongation of the tendon/aponeurosis.
- Torque values were measured against tibiocalcanean angles before and after interventions.
Main Results:
- Surgery improved passive dorsiflexion and clinical function in the defective trophic regulation group without altering passive muscle stretch range.
- Plaster casting was effective in the normal trophic regulation group but required post-treatment bracing to prevent recurrence.
- Both interventions increased passive muscle stretch and caused an unavoidable displacement of passive and active curves, affecting tiptoe walking.
Conclusions:
- Treatment success for triceps surae hypoextensibility in cerebral palsy depends on muscle trophic regulation.
- Surgical intervention offers functional improvement for defective muscle groups, while conservative methods may suffice for normal groups.
- Long-term management, including bracing, is crucial to maintain gains and prevent recurrence of hypoextensibility.
Abstract:
Twenty-nine children with cerebral palsy and triceps surae hypoextensibility were divided into 2 groups. In group I trophic regulation of the muscle was defective and in group II it was normal. Torque values were plotted against tibiocalcanean angles before and after treatment, which consisted of muscle lengthening by successive plaster casting or of surgical elongation of the tendon or the aponeurosis. In group I, casting had no effect, but surgery increased passive dorsiflexion and gave definite clinical improvement without modifying the range of passive muscle stretch. In group II, with normal muscle adaptation, plaster casts were successful when tolerated. Children in this group required braces after surgery to prevent rapid recurrence of hypoextensibility. Both casting and surgery increased the passive muscle stretch. There was a displacement of the starting point of the passive and active curves in both groups. This is an unavoidable side-effect which makes walking on tiptoes impossible after casting or surgery.