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Cerebral palsy
K W Dabney1, G E Lipton, F Miller
1Alfred l. duPont Institute, Wilmington, DE 19899, USA.
Insights
Cerebral palsy results from early brain damage affecting motor control. Management focuses on posture, hip health, spinal deformity, and maximizing function through interventions like gait analysis and spasticity control.
Area of Science:
- Neurology
- Pediatrics
- Orthopedics
Background:
- Cerebral palsy (CP) originates from static lesions in the cerebral motor cortex before, during, or shortly after birth.
- Causes include cerebral anoxia, hemorrhage, infection, and genetic syndromes.
- CP is classified by movement type (spastic, athetoid) or body part involvement (hemiplegia, diplegia, quadriplegia).
Purpose of the Study:
- To outline the comprehensive management of cerebral palsy.
- To detail orthopedic concerns for both nonambulatory and ambulatory patients.
- To review current orthopedic interventions and spasticity management techniques.
Main Methods:
- Multidisciplinary team approach involving pediatricians and orthopedists.
- Focus on posture, hip dislocation prevention (spastic hip disease), and spinal deformity correction.
- Utilizing computerized gait analysis for ambulatory patients to guide orthotic or surgical treatment.
Main Results:
- For nonambulatory patients, priorities include posture, preventing hip dislocation, and custodial care.
- For ambulatory patients, maximizing function is key, aided by gait analysis.
- Orthopedic interventions for upper extremity involvement and spasticity control methods are reviewed.
Conclusions:
- Effective cerebral palsy care requires a coordinated team approach.
- Addressing orthopedic issues like spastic hip disease and scoliosis is crucial.
- Advanced treatments like selective dorsal rhizotomy and botulinum toxin offer improved spasticity management.
Abstract:
Cerebral palsy is caused by a static lesion to the cerebral motor cortex that is acquired before, at, or within 5 years of birth. Multiple causes for the condition exist and include cerebral anoxia, cerebral hemorrhage, infection, and genetic syndromes. Cerebral palsy is commonly classified according to the type of movement problem that is present (spastic or athetoid) or according to the body parts involved (hemiplegia, diplegia, or quadriplegia). To care for children with cerebral palsy, a team approach is most effective; the team should include the pediatrician and orthopedist, among others. In the nonambulatory patient, good sitting posture, the prevention of hip dislocation (spastic hip disease), and the maintenance of proper custodial care are prime concerns. Careful monitoring and treatment of spastic hip disease and the correction of scoliotic spinal deformity are also important. In the ambulatory patient, the main goal is to maximize function. Computerized gait analysis in patients with complex gait patterns helps to show whether orthotic or surgical treatment is indicated. In this paper, we also review both the proper indications for orthopedic intervention in patients with upper extremity involvement and recent methods to control spasticity, such as selective dorsal rhizotomy and administration of botulinum toxin or intrathecal baclofen.