scholarly journals Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy

1998 ◽  
Vol 4 (1) ◽  
pp. E7 ◽  
Author(s):  
Peter C. Gerszten ◽  
A. Leland Albright ◽  
Graham F. Johnstone
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Intrathecal Baclofen ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Spastic Diplegia ◽  
Spastic Quadriplegia ◽  
Orthopedic Operation ◽  
The Mean

Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP). The authors retrospectively reviewed the need for orthopedic surgery of the lower extremities in 48 patients with spastic CP who were treated with IBI. Forty pumps were placed in patients suffering from spastic quadriplegia (84%) and eight (16%) in patients with spastic diplegia. The patients' ages ranged from 5 to 43 years (mean 15 years). The mean follow-up period was 53 months (range 22-94 months). The mean baclofen dosage was 306 μg/day (range 25-1350 μg/day). At the time of pump placement, subsequent orthopedic surgery was planned in 28 patients (58%); however, only 10 (21%) underwent orthopedic surgery after IBI therapy. In all 10 cases, the surgical procedure was planned at the time of initial evaluation for IBI therapy. In the remaining 18 patients, who did not subsequently undergo their planned orthopedic operation, it was believed that their lower-extremity spasticity had improved to the degree that orthopedic intervention was no longer indicated. In addition, although six patients had undergone multiple orthopedic operations before their spasticity was treated, no patient required more than one orthopedic operation after IBI treatment for their spasticity. The authors conclude that IBI for treatment of spastic CP reduces the need for subsequent orthopedic surgery for the effects of lower-extremity spasticity. In patients with spastic CP and lower-extremity contractures, spasticity should be treated before orthopedic procedures are performed.

Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy

1998 ◽  
Vol 88 (6) ◽  
pp. 1009-1013 ◽  
Author(s):  
Peter C. Gerszten ◽  
A. Leland Albright ◽  
Graham F. Johnstone
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Intrathecal Baclofen ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Content Type ◽  
Spastic Quadriplegia ◽  
The Mean ◽  
Fine Print

Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP). Object. To assess the need for orthopedic surgery of the lower extremities in such cases, the authors retrospectively reviewed the outcome in 48 patients with spastic CP who were treated with IBI. Methods. Pumps were placed in 40 patients (84%) suffering from spastic quadriplegia and eight patients (16%) with spastic diplegia. The patients' ages ranged from 5 to 43 years (mean 15 years). The mean follow-up period was 53 months (range 24–94 months). The mean baclofen dosage was 306 µg/day (range 25–1350 µg/day). At the time of pump placement, subsequent orthopedic surgery was planned in 28 patients (58%); however, only 10 (21%) underwent surgery after IBI therapy. In all 10 cases, the surgical procedure was planned at the time of initial evaluation for IBI therapy. In the remaining 18 patients, who did not subsequently undergo their planned orthopedic operation, it was believed that their lower-extremity spasticity had improved to the degree that intervention was no longer indicated. In addition, although six patients had undergone multiple orthopedic operations before their spasticity was treated, no patient required more than one operation after IBI treatment for spasticity. Conclusions. The authors conclude that IBI for treatment of spastic CP reduces the need for subsequent orthopedic surgery for the effects of lower-extremity spasticity. In patients with spastic CP and lower-extremity contractures, spasticity should be treated before orthopedic procedures are performed.

scholarly journals Effect of Passive Range of Motion Exercises on Lower-Extremity Goniometric Measurements of Adults With Cerebral Palsy: A Single-Subject Design

2002 ◽  
Vol 82 (7) ◽  
pp. 658-669 ◽  
Author(s):  
Sherri L Cadenhead ◽  
Irene R McEwen ◽  
David M Thompson
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Visual Analysis ◽  
Spastic Cerebral Palsy ◽  
Single Subject ◽  
Single Subject Design ◽  
Subject Design ◽  
Spastic Quadriplegia ◽  
Goniometric Measurements

Abstract Background and Purpose. People with spastic cerebral palsy often receive passive stretching that is intended to maintain or increase joint passive range of motion (PROM) even though the effectiveness of these exercises has not been definitively demonstrated. The purpose of this study was to determine the effect of PROM exercises on 6 adults with spastic quadriplegia and contractures. Participants. Four men and 2 women (X̄=31 years of age, range=20–44 years) who lived in an institution for people with mental retardation participated in the study. Methods. The authors used 2 multiple baseline designs. Three participants (group 1) received lower-extremity PROM exercises during phase A; PROM exercises were discontinued during phase B. Three participants (group 2) did not receive PROM exercises during phase A; PROM exercises were initiated during phase B. Data were analyzed using visual analysis and the C statistic. Results. Results varied with the method of analysis; however, phase A and phase B measurements, overall, did not differ for either group. Discussion and Conclusion. This study demonstrated use of a single-subject design to measure the effect of PROM exercises on adults with cerebral palsy. The authors concluded that the PROM exercise protocol did not have an effect on the lower-extremity goniometric measurements of the participants.

scholarly journals Selection of treatment modalities in children with spastic cerebral palsy

2006 ◽  
Vol 21 (2) ◽  
pp. E4 ◽  
Author(s):  
Paul Steinbok
Keyword(s):  
Cerebral Palsy ◽  
Treatment Options ◽  
Intrathecal Baclofen ◽  
Treatment Modalities ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Neurosurgical Procedures ◽  
Dorsal Rhizotomy ◽  
The Individual ◽  
The Impact

✓ The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.

Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy

1997 ◽  
Vol 86 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Michael R. Chicoine ◽  
T. S. Park ◽  
Bruce A. Kaufman
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Spastic Cerebral Palsy ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Group I ◽  
Group Ii ◽  
Surgery Rates

✓ If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective dorsal rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective dorsal rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective dorsal rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan—Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and “other” operations (p = 0.013). The data indicate that early rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.

scholarly journals Ocular defect in children with cerebral palsy and its correlation with the types of cerebral palsy

2021 ◽  
Vol 8 (4) ◽  
pp. 609
Author(s):  
Wasim Abed Aumi ◽  
Farhana Afroz ◽  
Shams Ibne Maksud ◽  
Mohammad Mahbubul Alam
Keyword(s):  
Cerebral Palsy ◽  
Refractive Error ◽  
Pathological Finding ◽  
Spastic Cerebral Palsy ◽  
Spastic Diplegia ◽  
Ophthalmological Examination ◽  
Musculoskeletal Problem ◽  
Spastic Quadriplegia ◽  
Ocular Defect ◽  
Children With Cerebral Palsy

Background: Cerebral palsy (CP) describes a group of permanent disorder of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbance that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy, and secondary musculoskeletal problem. However, no known study has been found on this aspect. Objective of this study was to evaluate the ocular defect in children with cerebral palsy and to correlate with the types of CP.Methods: Study was done in the Paediatric Neurology unit of BSMMU from January 2012 to July 2012. One hundred thirty children with cerebral palsy were studied. The patients were randomly selected who full filled the inclusion criteria and ophthalmological examination was done.Results: Sixty four (64%) of CP patients had pathological finding and 36% percent had normal finding. Most of the abnormalities were squint (strabismus) (40%) and refractive error (36.9%). Most of the ocular defects were found in spastic cerebral palsy, mainly in spastic quadriplegia (34.6%) and spastic diplegia (29.2%).Conclusions: Ocular defect like squint and refractive error common associations of cerebral palsy. Spastic quadriplegic and diplegic children had more ocular defects.

Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy

2016 ◽  
Vol 26 (6) ◽  
pp. 1652-1657 ◽  
Author(s):  
Paul R. P. Rushton ◽  
Luigi A. Nasto ◽  
Ranjit K. Aujla ◽  
Amr Ammar ◽  
Michael P. Grevitt ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Spastic Cerebral Palsy

scholarly journals Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

2015 ◽  
Vol 30 (4) ◽  
pp. 489 ◽  
Author(s):  
Seung Yeol Lee ◽  
Hye-Min Sohn ◽  
Chin Youb Chung ◽  
Sang-Hwan Do ◽  
Kyoung Min Lee ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Perioperative Complications

Normalizing Lower Extremity Strength Data for Children, Adolescents, and Young Adults with Cerebral Palsy

2009 ◽  
Vol 25 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Tishya A. L. Wren ◽  
Jack R. Engsberg
Keyword(s):  
Young Adults ◽  
Cerebral Palsy ◽  
Lower Extremity ◽  
Body Mass ◽  
Allometric Scaling ◽  
Plantar Flexion ◽  
Adolescents And Young Adults ◽  
Spastic Diplegia ◽  
Strength Data ◽  
Lower Extremity Strength

The traditional method for normalizing quantitative strength data is to divide force or torque by body mass. We have previously shown that this method is not appropriate for able-bodied children and young adults and that normalization using allometric scaling is more effective. The purpose of the current study was to evaluate the effectiveness of applying existing normalization equations for lower extremity strength to children, adolescents, and young adults with cerebral palsy (CP) and, if appropriate, to develop CP-specific normalization equations using allometric scaling. We measured the maximum torque generated during hip abduction/adduction, knee extension/flexion, and ankle dorsiflexion/plantar flexion in 96 subjects with spastic diplegia CP ages 4–23 years. Traditional mass normalization (Torque/Mass1.0) and allometric scaling equations from children without disability (Torque/Mass1.6for hip and knee; Torque/Mass1.4for ankle) were not effective in eliminating the influence of body mass. Normalization using CP-specific allometric scaling equations was effective using both muscle-specific and common (Torque/Mass0.8for ankle plantar flexors; Torque/Mass1.4for all others) scaling relationships. For the first time, normalization equations have been presented with demonstrated effectiveness in adjusting strength measures for body size in a group of children, adolescents, and young adults with CP.

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