Limited Selective Posterior Rhizotomy for the Treatment of Spasticity Secondary to Infantile Cerebral Palsy: A Preliminary Report

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 535-538 ◽  
Author(s):  
Jorge A. Lazareff ◽  
Ana Maria Mata-Acosta ◽  
Martha Alejandra Garcia-Mendez
Keyword(s):  
Cerebral Palsy ◽  
Plantar Flexion ◽  
Muscular Contraction ◽  
Lower Limbs ◽  
Functional Improvement ◽  
Infantile Cerebral Palsy ◽  
Motor Abilities ◽  
Hip Flexion ◽  
Abnormal Motor ◽  
Selective Posterior Rhizotomy

Abstract A limited selective posterior rhizotomy was performed on 30 children suffering from spasticity secondary to infantile cerebral palsy. As opposed to standard techniques that stimulate and divide the dorsal rootlets from L2 to S1, we dissected L4, L5, and S1 dorsal roots through an L5 to S1 laminectomy. Eight to 12 rootlets from each root were electrically stimulated with two unipolar electrodes (pulse width, 50 µsec: 10–50 V). The muscle responses were observed visually and registered by electromyography. Those rootlets associated with an abnormal motor response as evidenced by sustained muscular contraction or by prolonged electromyographic response were divided. Spasticity was scored from 0 to ++++. The muscular groups assessed were those involved in the flexion of the shoulder, elbow and wrist in the upper limbs, and those involved in flexion and adduction of the hip, flexion of the leg, and plantar flexion in the lower limbs. The patients were assessed 1 week before and 6 months after the operation. Reduction of spasticity was observed in all the muscular groups, and all the patients presented functional improvement of motor abilities. These preliminary results indicate that a limited procedure that reduces the extension of the laminectomy and the length of the operation could be effective for treating spasticity secondary to infantile cerebral palsy.

339 Outcome of Tibial Selective Motor Fasiculotomy in the Management of Equinovarus Deformity Due to Cerebral Palsy (A Prospective Cohort Study in 14 Children)

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Pavankumar Pelluru ◽  
Aneelkumar Pulugopu ◽  
Aniruddhkumar Purohit ◽  
Naveenkumar Balane
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lower Limbs ◽  
Safe Procedure ◽  
Plantar Flexors ◽  
Motor Abilities ◽  
Modified Ashworth Scale

Abstract INTRODUCTION Tibial Selective Motor fasiculotomy involves ablation of hyperexcitable tibial nerve fasicles, which help in reduction of spasticity in ankle plantr flexors METHODS This prospective cohort study included 14 children with cerebral palsy, age ranging from 5–18 (mean 10.21) years and M: F ratio is 5:1 having spasticity in the lower limbs. All the children were assessed pre and post operatively by Modified Ashworth Scale (MAS), Selective Voluntary Control (SVC) grade and locomotor Abilities (kneel walking, squat to stand, standing and walking). Tibial SMF was performed (n = 23) for relief of spasticity in ankle plantar flexors in 14 children and were followed for a mean of 30 (6-60) months. All the children were given physical therapy pre and post operatively. RESULTS >During a mean follow up (30 months) there was statistically significant reduction in spasticity (MAS, P < 0.005) from1.92 to 0.31 in ankle plantar flexors. Pre and post operative SVC grade also improved from 2.65 to 3.35 in ankle plantar flexors (p > 0.005). There were no complications and spasticity did not recur during follow up. 9 children required Z plasty simultaneously to relieve the contracture. CONCLUSION The Tibial SMF of tibial nerves significantly relieves spasticity in the ankle plantar flexors and thereby improves SVC equinous deformity and motor abilities in children having cerebral palsy. It is quite a safe procedure and the spasticity does not recur during a mean follow up of 30 months.

scholarly journals VIOLATIONS OF VISUAL-SPATIAL REPRESENTATIONS IN CHILDREN WITH INFANTILE CEREBRAL PALSY, APPROACHES TO CORRECTIVE THERAPY

2020 ◽  
Vol 26 (3) ◽  
pp. 26-27
Author(s):  
S. M. Komardina ◽  
S. V. Vlasenko
Keyword(s):  
Cerebral Palsy ◽  
Research Method ◽  
Brain Structures ◽  
Rehabilitation Program ◽  
Difficult Problem ◽  
Spatial Representations ◽  
Infantile Cerebral Palsy ◽  
Motor Abilities ◽  
Visual Spatial ◽  
Correction Program

The article notes that the issues of rehabilitation of patients with infantile cerebral palsy are an urgent and extremely difficult problem. In conditions of deficiency of cerebral supply due to organic lesions, functional pathological foci are formed in various brain structures in patients of this group. In such cases, the neuropsychological research method makes it possible to more accurately diagnose and lateralize the primary disorders of mental processes, to highlight the structure of the defect. The purpose of this report is to analyze the correctional work in violation of visual-gnostic functions in patients with various forms of cerebral palsy. A correction program was developed individually for each child, purposefully stimulating the parieto-occipital parts of the cerebral cortex. The increase in the child's motor abilities in combination with the improvement of visual-spatial representations made it possible to significantly increase the effectiveness of the entire rehabilitation program

scholarly journals Assessment of Functional End Ranges of Lower Limb Joints in Positions Commonly Used for ADLs in India

2021 ◽  
pp. 64-71
Author(s):  
Niketa Patel ◽  
Lavina Rajesh Khatri ◽  
Lata Parmar
Keyword(s):  
External Rotation ◽  
Plantar Flexion ◽  
Cultural Practice ◽  
Lower Limbs ◽  
Rural And Urban ◽  
Ankle Joints ◽  
Hip Abduction ◽  
Hip Flexion ◽  
Age Range ◽  
Ankle Plantar Flexion

Background: In many countries of Asian continent, floor sitting is preferred instead of chair supported sitting. Indian population differs noticeably in its cultural practice and daily tasks which involves squatting and cross-legged sitting on the ground. Aim: The purpose of the study was to assess the functional end-ranges of the hip, knee and ankle joints in healthy Indian subjects in positions commonly used for ADLs in India which includes squatting and cross-legged sitting. Methods: 66 healthy subjects were recruited from rural and urban populations with age range 30-50 years. Joint ROM of the lower extremities was measured using Universal Goniometer. All the subjects were asked to acquire squat and cross legged positions which were graded. Results: Our results finding showed that the subjects in cross leg sitting grade 2 (independent CLS) had hip flexion ranges ≥1150, hip abduction ≥ 410, hip external rotation ≥ 420, ankle plantar flexion ≥ 460, p<0.005.  For squatting, grade 2 (independent squat) had hip flexion ranges ≥ 1130,p>0.005, Knee flexion ≥1200, p>0.005 and ankle dorsiflexion ≥150, p<0.005. Conclusion: From the results, it is suggested that squatting and cross-leg sitting multiple times a day can prevent the early closer of end ranges of the lower limbs.

scholarly journals Distribution and motor ability of children with cerebral palsy in Scotland: a registry analysis

2018 ◽  
Vol 64 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Kate E Bugler ◽  
Mark S Gaston ◽  
James E Robb
Keyword(s):  
Cerebral Palsy ◽  
Functional Mobility ◽  
Lower Limbs ◽  
Health Board ◽  
Motor Ability ◽  
Time Data ◽  
Motor Abilities ◽  
Children With Cerebral Palsy ◽  
Integrated Pathway ◽  
First Time

Background and aims Cerebral palsy is the commonest long-term physical disability in children with a prevalence of between 1.77 and 2.11/1000 live births. In 2013, the Cerebral Palsy Integrated Pathway Scotland (CPIPS) surveillance programme was introduced in all 14 Health Boards in Scotland and provides a standardised musculoskeletal examination of the spine and lower limbs. The purpose of this study was to report the prevalence, subtypes, motor classification and motor ability of children with cerebral palsy in Scotland. Methods and results The family/carer’s postal address, the child’s neurological classification, motor subtypes, Gross Motor Functional Classification (GMFCS) Level and Functional Mobility Scale of 1972 children at first registration in CPIPS 2013–2018 were analysed. Their mean age at first assessment was 7.6 years. There was an overall prevalence of cerebral palsy in Scotland of 2.02/1000. GMFCS levels and Functional Mobility Scale data and prevalence were reported by Health Board and were comparable to that reported elsewhere. Conclusion For the first time, data are available on the motor abilities of the total population of children with cerebral palsy in Scotland. This information will be highly relevant to resource management of current and future motor needs of these children.

scholarly journals TORSIONAL DEFORMITIES OF LOWER LIMBS IN PATIENTS WITH INFANTILE CEREBRAL PALSY (LITERATURE REVIEW)

2014 ◽  
Vol 2 (1) ◽  
pp. 63-69
Author(s):  
Nikita Olegovich Husainov
Keyword(s):  
Cerebral Palsy ◽  
Literature Review ◽  
Lower Limbs ◽  
Long Term Results ◽  
Infantile Cerebral Palsy ◽  
Surgical Interventions ◽  
Biomechanical Features

The article highlights the literature devoted to the problem of torsional deformities of the lower limbs in patients with infantile cerebral palsy. It also describes biomechanical features peculiar to the patients with infantile cerebral palsy, as well as long-term results of performed surgical interventions.

scholarly journals Does Gait with an Ankle Foot Orthosis Improve or Compromise Minimum Foot Clearance?

Sensors ◽  
2021 ◽  
Vol 21 (23) ◽  
pp. 8089
Author(s):  
Pedro Fonseca ◽  
Leandro Machado ◽  
Manoela Vieira Sousa ◽  
Ricardo Sebastião ◽  
Filipa Sousa ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Lower Limbs ◽  
Passive Mode ◽  
Compensatory Mechanisms ◽  
Ankle Foot Orthosis ◽  
Foot Clearance ◽  
All Speeds ◽  
Hip Flexion ◽  
Ankle Plantar Flexion ◽  
Foot Orthosis

The purpose of this study was to investigate if the use of an ankle foot orthosis in passive mode (without actuation) could modify minimum foot clearance, and if there are any compensatory mechanisms to enable these changes during treadmill gait at a constant speed. Eight participants walked on an instrumented treadmill without and with an ankle foot orthosis on the dominant limb at speeds of 0.8, 1.2, and 1.6 km/h. For each gait cycle, the minimum foot clearance and some gait linear kinematic parameters were calculated by an inertial motion capture system. Additionally, maximum hip and knee flexion and maximum ankle plantar flexion were calculated. There were no significant differences in the minimum foot clearance between gait conditions and lower limbs. However, differences were found in the swing, stance and step times between gait conditions, as well as between limbs during gait with orthosis (p < 0.05). An increase in hip flexion during gait with orthosis was observed for all speeds, and different ankle ranges of motion were observed according to speed (p < 0.05). Thus, the use of an ankle foot orthosis in passive mode does not significantly hinder minimum foot clearance, but can change gait linear and angular parameters in non-pathological individuals.

scholarly journals Reducing severe spasticity in cerebral palsy following meningoencephalitis by botulinum toxin

2017 ◽  
Vol 26 (1) ◽  
pp. 76-80
Author(s):  
Prastiya I. Gunawan ◽  
Darto Saharso
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Motor Function ◽  
Side Effect ◽  
Botulinum Toxin Injection ◽  
Plantar Flexion ◽  
Severe Spasticity ◽  
Hip Flexion ◽  
Limb Flexion

A 3-year-old boy diagnosed with diplegic cerebral palsy had received Botulinum toxin injection to reduce severe spasticity. There was an improvement of muscles tone and motor function including better ability of limb flexion of the knees and hip, adduction of the hip, flexion of the toes, and plantar flexion of the foot. No side effect was observed after the procedure.

scholarly journals Treatment of the Spasticity in Children with Cerebral Palsy

2008 ◽  
Vol 7 (4) ◽  
pp. 363-367 ◽  
Author(s):  
Ajša Meholjić-Fetahović
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Lower Limbs ◽  
Functional Improvement ◽  
Good Effect ◽  
Physical Treatment ◽  
Neuromuscular Synapses ◽  
Children With Cerebral Palsy ◽  
Muscular Spasm ◽  
Significant Functional Improvement

Botulinum toxin is a natural purified protein and one of the strongest biological poisons - neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine.As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy - spasticity Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles.It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects.This work shows a case of a boy with spastic form of cerebral palsy. After being habilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs’ muscles and kinezitherapy intensified. After the administration of botulinum toxin significant functional improvement is noted.

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