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.

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 series of case studies on the effect of a midfoot control ankle foot orthosis in the prevention of unresolved pressure areas in children with cerebral palsy

2001 ◽  
Vol 25 (3) ◽  
pp. 246-250 ◽  
Author(s):  
M. Bill ◽  
R. McIntosh ◽  
P. Myers
Keyword(s):  
Cerebral Palsy ◽  
Case Studies ◽  
Muscle Tone ◽  
Evidence Base ◽  
Triceps Surae ◽  
Orthotic Devices ◽  
Ankle Foot Orthosis ◽  
Children With Cerebral Palsy ◽  
Foot Position ◽  
Foot Orthosis

This paper reports on a series of case studies where improvements were sought in muscle tone and gait in children with cerebral palsy. A Midfoot Control Ankle Foot Orthosis (AFO) was developed to control foot position in a cohort of patients with cerebral palsy (CP). The concept of controlling midfoot and hindfoot with an encapsulated internal Supra-Malleolar AFO that fitted into an external AFO was shown to be effective in ambulant children with CP. Some initial problems of compliance were noted and postulated to be due to difficulties associated with previous orthotic devices. Evidence from the case studies suggest that the developed Supra-Malleolar AFO orthoses enables children with CP to maintain mobility without skin tissue damage, delays the need for surgery and at the same time maintains the length of the Triceps Surae (Gastrocnemius and Soleus) complex. Plans for further research are discussed which will contribute to the evidence base for this particular orthotic device.

The use of botulinum toxin therapy for lower-extremity spasticity in children with cerebral palsy

2006 ◽  
Vol 21 (2) ◽  
pp. E1 ◽  
Author(s):  
Susan R. Criswell ◽  
Beth E. Crowner ◽  
Brad A. Racette
Keyword(s):  
Cerebral Palsy ◽  
Botulinum Toxin ◽  
Lower Extremity ◽  
Muscle Tone ◽  
Botulinum Toxin A ◽  
Multidisciplinary Treatment ◽  
Safety Margin ◽  
Technical Information ◽  
Botulinum Toxin Therapy ◽  
Children With Cerebral Palsy

✓ Hypertonicity is a leading cause of disability for children with cerebral palsy (CP). Botulinum toxin A (BTA) chemically denervates muscle tissue and is commonly used in the management of lower-extremity hypertonicity in children with CP because of its focal effects and wide safety margin. Randomized controlled trials have demonstrated that BTA injections in the ankle flexors, hamstrings, and adductors reduce spasticity and result in improved passive and active range of motion. In other studies, improvements in gait and measurements of functional outcome were found in appropriately selected children who had been injected with BTA. A multidisciplinary treatment approach that includes physical therapists, occupational therapists, orthotists, neurologists, physicians with expertise in performing botulinum toxin injections, orthopedic surgeons, and neurosurgeons is critical to optimize care in children with lower-extremity tone due to CP. In this paper, the authors propose treatment algorithms based on clinical presentation, detailed dosing, and technical information to optimize the treatment of these children. With a multidisciplinary approach, children with lower-extremity hypertonicity due to CP can experience improvements in muscle tone and function.

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