Correction of Sagittal Plane Spinal Deformities with Unit Rod Instrumentation in Children with Cerebral Palsy

2004 ◽  
Vol 86 ◽  
pp. 156-168 ◽  
Author(s):  
Kirk W. Dabney ◽  
Freeman Miller ◽  
Glenn E. Lipton ◽  
Eric J. Letonoff ◽  
H. Catherine McCarthy
Keyword(s):  
Cerebral Palsy ◽  
Sagittal Plane ◽  
Spinal Deformities ◽  
Children With Cerebral Palsy

CORRECTION OF SAGITTAL PLANE SPINAL DEFORMITIES WITH UNIT ROD INSTRUMENTATION IN CHILDREN WITH CEREBRAL PALSY

2003 ◽  
Vol 85 (12) ◽  
pp. 2349-2357 ◽  
Author(s):  
GLENN E. LIPTON ◽  
ERIC J. LETONOFF ◽  
KIRK W. DABNEY ◽  
FREEMAN MILLER ◽  
H. CATHERINE MCCARTHY
Keyword(s):  
Cerebral Palsy ◽  
Sagittal Plane ◽  
Spinal Deformities ◽  
Children With Cerebral Palsy

scholarly journals Development and conservative treatment of spinal deformities in cerebral palsy

2020 ◽  
Vol 14 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Reinald Brunner
Keyword(s):  
Cerebral Palsy ◽  
Motor Control ◽  
Conservative Treatment ◽  
Sagittal Plane ◽  
System Level ◽  
Spinal Deformities ◽  
Brace Treatment ◽  
Trunk Control ◽  
Upper Extremity Function ◽  
Change Position

Incidence and cause Cerebral palsy (CP) is characterized by poor motor control. The more severe the affection is, the more patients are prone to deformities. Patients with Gross Motor Function Classification System level V run an up to 90% risk for spinal deformities. These are caused by poor trunk control under load. Although trunk tone is impossible to assess it seems to be low in the majority of patients, leading to collapse under gravity. The constant malposition results in growth asymmetry which leads to fixation and deterioration of the deformity. Brace treatment Brace treatment has a poor reputation in respect to the final outcome. Conventional braces as constructed for other spinal deformities are indeed difficult for patients with CP as they cannot change position in the brace and do not tolerate pressure on the belly for reflux problems. Respecting these points improves the tolerance of braces but still the time of use is far from the necessary when the trunk is upright. Nevertheless, they can help to postpone surgery for scoliosis, but they are very inefficient for sagittal plane deformities. Aim of treatment The lack of trunk control further leads to an impairment of head control and upper extremity function. Providing stability improves these problems. Braces are superior to seating shells for both treating deformity and providing stability as they remain close to the skin and follow movements. Supports on seating shells in contrast are too far away for controlling the deformity and provide stability only if the patient doesn’t move forward.

scholarly journals Spine deformities in patients with cerebral palsy; the role of the pelvis

2020 ◽  
Vol 14 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Carol Hasler ◽  
Reinald Brunner ◽  
Alon Grundshtein ◽  
Dror Ovadia
Keyword(s):  
Cerebral Palsy ◽  
Sagittal Plane ◽  
Pelvic Obliquity ◽  
Sagittal Profile ◽  
Spinal Deformities ◽  
Pelvic Fixation ◽  
Equilibrium Control ◽  
Increased Risk ◽  
Iliac Screws ◽  
Spine Deformities

Introduction Progressive neuromuscular spinal deformities with pelvic obliquity and loss of sitting balance are typical features of severely affected patients with cerebral palsy. The pelvis represents the key bone between the spine and the lower extremity when it comes to deciding whether and when to operate and if spine or hip surgery first is beneficial. The pelvis can be looked at as the lowest vertebra and as the rooftop of the lower extremities. Biomechanical considerations To allow for a normal spinal shape, the pelvis needs to be horizontal in the frontal plane and mildly anterior tilted in the sagittal plane, less for sitting and more for standing. Any abnormal pelvic position requires spinal compensation and challenges the equilibrium control of the individual. Both anatomical neighbourhoods – the spine and the hip joints — have to be considered when spinal deformities, hip instability and contractures evolve, in conservative therapy (bracing, physiotherapy, seating in the wheelchair) and when surgical interventions are weighed out against each other. Surgical considerations Multiple anatomical factors such as sagittal profile and pelvic orientiation, pelvic transverse plane asymmetries and lumbosacral malformations have to be considered in case the pelvis is instrumented with sacral and iliac screws. Rotational deformities and asymmetries of the pelvic bones make the safe insertion of long screws challenging. Advantages of primary pelvic fixation include correction of pelvic obliquity, especially considering the lever arm of the whole spinal construct. The risk of revision surgery due to progression of distal curves is also reduced. Disadvantages of pelvic fixation include the complexity of the additional intervention, which may result in longer operating times, increased risk of blood loss, infection and hardware malpositioning.

scholarly journals Effect of a Combined Stretching and Strength Training Program on Gait Function in Children with Cerebral Palsy, GMFCS Level I & II: A Randomized Controlled Trial

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 250
Author(s):  
Merete Aarsland Fosdahl ◽  
Reidun Jahnsen ◽  
Kristin Kvalheim ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Intervention Program ◽  
Comparison Group ◽  
Sagittal Plane ◽  
Controlled Trial ◽  
Intervention Group ◽  
Knee Extension ◽  
Maintenance Program ◽  
Children With Cerebral Palsy ◽  
Gait Function

Background and objectives: Ambulant children with cerebral palsy (CP) often develop impaired gait, and reduced active knee extension is often a part of the problem. This study aimed to evaluate the effect of a combined intervention program including stretching and progressive resistance exercise (PRE) targeting active knee extension on gait function, in children with spastic CP. Materials and methods: Thirty-seven children (21 boys, 16 girls, mean age 10.2 (±2.3) years), classified by Gross Motor Function Classification System I–III, were randomized to an intervention (n = 17) and a comparison group (n = 20). The intervention group received a 16-week combined exercise program (3 sessions per week) including stretching of hamstrings and PRE targeting the lower extremities, followed by a 16-week maintenance program (1 session per week). The comparison group received care as usual. Gait function was evaluated by three-dimensional gait analysis (3DGA); knee, hip and pelvic kinematics in the sagittal plane, step length and speed, Gait Deviation Index (GDI), and Six-Minute Walk test (6MWT) at 0, 16, and 32 weeks. Results: There were no statistically significant differences between the intervention group and the comparison group for any of the gait parameters measured at 16 and 32 weeks. There was a significant increase in gait distance measured by 6MWT within both groups; however, no differences between the groups were found. Conclusion: A 16-week combined stretching and PRE program followed by a 16-week maintenance program did not improve gait function in ambulant children with CP.

The Effects of Acute Intense Physical Exercise on Postural Stability in Children With Cerebral Palsy

2016 ◽  
Vol 33 (3) ◽  
pp. 271-282 ◽  
Author(s):  
Matthew J. Leineweber ◽  
Dominik Wyss ◽  
Sophie-Krystale Dufour ◽  
Claire Gane ◽  
Karl Zabjek ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Physical Exercise ◽  
Postural Stability ◽  
Sagittal Plane ◽  
Center Of Pressure ◽  
Force Plate ◽  
Frontal Plane ◽  
Increased Risk ◽  
Children With Cerebral Palsy ◽  
Risk Of Falls

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.

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