Why is joint range of motion limited in patients with cerebral palsy?

2012 ◽  
Vol 38 (1) ◽  
pp. 8-13 ◽  
Author(s):  
M. de Bruin ◽  
M. J. C. Smeulders ◽  
M. Kreulen
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Muscle Tone ◽  
Surrounding Tissue ◽  
Spastic Cerebral Palsy ◽  
Joint Angles ◽  
Joint Range Of Motion ◽  
Joint Range ◽  
Selection Of Patients ◽  
Selection Of

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Understanding why these contractures develop in cerebral palsy will affect the selection of patients suitable for surgical treatment as well as the choice for specific surgical procedures. The generally accepted hypothesis in patients with spastic cerebral palsy is that the hyper-excitability of the stretch reflex combined with increased muscle tone result in extreme angles of the involved joints at rest. Ultimately, these extreme joint angles are thought to result in fixed joint postures. There is no consensus in the literature concerning the pathophysiology of this process. Several hypotheses associated with inactivity and overactivity have been tested by examining the secondary changes in spastic muscle and its surrounding tissue. All hypotheses implicate different secondary changes that consequently require different clinical approaches. In this review, the different hypotheses concerning the development of limited joint range of motion in cerebral palsy are discussed in relation to their secondary changes on the musculoskeletal system.

scholarly journals A Review of Perforator Flaps for Burn Scar Contractures of Joints

2018 ◽  
Vol 27 (1) ◽  
pp. 66-77 ◽  
Author(s):  
Ryan T. Lewinson ◽  
Lauren C. Capozzi ◽  
Kody Johnson ◽  
Alan Robertson Harrop ◽  
Frankie O. G. Fraulin ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Controlled Trial ◽  
Case Series ◽  
Surrounding Tissue ◽  
Anatomical Landmarks ◽  
Perforator Flaps ◽  
Burn Scar ◽  
Scar Contracture ◽  
Joint Range Of Motion ◽  
Joint Range

Objective: Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking. Methods: MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained ≥10 patients with burn scar contracture were considered. Results: Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n = 218) and knee (n = 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n = 26 patients) and venous congestion (n = 17 patients). Conclusions: Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches.

scholarly journals Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy

Neurosurgery ◽  
2016 ◽  
Vol 79 (3) ◽  
pp. 336-344 ◽  
Author(s):  
Walid A. Abdel Ghany ◽  
Mohamed Nada ◽  
Mahmoud A. Mahran ◽  
Ahmed Aboud ◽  
Moustafa G. Mahran ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Daily Living ◽  
Intraoperative Monitoring ◽  
Muscle Tone ◽  
Operative Techniques ◽  
Postoperative Assessment ◽  
Joint Range Of Motion ◽  
Children With Cerebral Palsy ◽  
A Prospective Study ◽  
Joint Range

Abstract BACKGROUND: Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities. OBJECTIVE: To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP. METHODS: Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs. RESULTS: Changes in muscle tone, joint range of motion, and dystonia were significant (P =.000) at postoperative assessment visits. CONCLUSION: This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia.

Functional outcomes following selective posterior rhizotomy in children with cerebral palsy

1991 ◽  
Vol 74 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Warwick J. Peacock ◽  
Loretta A. Staudt
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Muscle Tone ◽  
Functional Mobility ◽  
Spastic Cerebral Palsy ◽  
Range Of Movement ◽  
Content Type ◽  
Before And After ◽  
The Status ◽  
Selective Posterior Rhizotomy

✓ The recent increase in popularity of selective posterior rhizotomy demands objective documentation of surgical outcome. For this reason, the authors have analyzed the status of 25 children with spastic cerebral palsy before and after rhizotomy to determine the effects of this therapy on muscle tone, range of movement, and motor function. Postoperative tests showed a reduction in muscle tone compared with preoperative assessments. Range of motion in the lower extremities was significantly increased and improvements in functional gross motor skills were noted. An increase in range of motion in the knees and thighs during gait was detected in 18 ambulatory patients studied with computerized two-dimensional motion analysis. Preliminary findings indicate that selective posterior rhizotomy reduced spasticity, thereby increasing range of motion and contributing to improvements in active functional mobility.

scholarly journals The effects of kinesio taping of lower limbs on functional mobility, spasticity, and range of motion of children with spastic cerebral palsy

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mirjavad Tabatabaee ◽  
Moslem Cheraghifard ◽  
Alireza Shamsoddini
Keyword(s):  
Cerebral Palsy ◽  
Range Of Motion ◽  
Muscle Tone ◽  
Intervention Group ◽  
Treatment Method ◽  
Functional Mobility ◽  
Lower Limbs ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Kinesio Taping

Abstract Background Cerebral palsy (CP) is a non-progressive neurological disease in a growing brain. Objective The aim of this study was to explore the effects of kinesio taping (KT) of the lower limbs on functional mobility, spasticity, and range of motion (ROM) of children with cerebral palsy. Methods Thirty children with spastic cerebral palsy aged 3 to 10 years old were selected from pediatric rehabilitation clinics. Subjects were divided randomly into intervention and control groups. Each group contains 15 subjects. Both groups received kinesio taping along with occupational therapy for 2 weeks. In the intervention group, kinesio taping was applied in a treatment mode with suitable tension; however, taping was applied in the control group in a sham mode. Timed get up and go (TUG), Modified Modified Ashworth (MMA), and goniometer tests were used prior to the intervention and 2 days and 2 weeks after the intervention. Results Short-term application of kinesio taping in the intervention group did not lead to significant changes in ROM (P = 0.582), muscle tone (P = 0.317), and functional mobility (P = 0.320). However, long-term application of kinesio taping improved the range of motion, muscle tone, and functional mobility (P < 0.05). No significant change has been observed in the control group in different intervals. Conclusion The findings indicated that kinesio taping can increase ROM of the knee and reduce spasticity. It also can improve the functional mobility. Therefore, it seems that kinesio taping is efficient for rehabilitation of spastic CP as a reliable treatment method. Trial registration IRCT, IRCT2017082135822N1, Registered 19 September 2017, https://fa.irct.ir/IRCT2017082135822N1.

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