orthopedics.cerebral palsy.(dr.baxtyar rasul)

Cerebral palsy

Group of disorders which result from

non-progressive brain damage during

early development

Incidence: 2/ 1000 lives

Causal factors:

1 -Prematurity

2 -Perinatal anoxia

3 -Kernicterus

4 -Post-natal brain infection

5 -Post-natal injury

Early Diagnosis

1 -perinatal difficulty

2 -Stiff Baby

3 -Dribbling at the mouth

2 -Difficulty in sucking and swallowing

5 -Developmental milestones delayed

( Normally holds head up at 3 months Sits up at 6 months Walking at 12 months

Later Diagnosis

3 typs:

Spastic Paresis(% 60)

SpasticityWeaknessBrisk reflexesBabiniski sign (+ve(Normal sensation

±Fits ±Impaired intelligence

Appear as (1( Hemiplegia( One side of body(

( 2 (Diplegia ( Both lower limbs(

( 3 (Total body paresis( Usually low IQ(

( 4 (Isolated asymmetrical paresis

Athetosis

Continous , involuntary writhing movements

Ataxia

Muscular incoordination during voluntary movements

Characteristic deformities

Elbow flexion

Wrist flxion

Fingers flexion

Hip adduction( scissor posture(

Knee flexion

Ankle equinus

Treatment

Medication: Fits and Hyperactivity

Physiotherapy: 1st year of life

Splintage:

) 1 (To counteract spastic deformitie

) 2 (Hold position after surgery

Botulinum A toxine:

to decrease muscle tone

Surgery:) 1 (Spastic postures which cannot be controlled by conservative

Measures.

) 2 (Fixed deformities

) 3 (Secondary complications ( Bone deformity, Hip dislocation , Joint instability(

Principles and Guidelines of Treatment

)1 (Hemiplegia = Good response to conservative or surgical treatment Will be able to walk unaided.

Diplegia = More difficult but will be able to walke

Total body involvement: Poor prognosis for walking

)2 (Surgery at 6 years age( Unless fixed deformity threatening)

)3 (Surgical options:

) a (Tight muscles are released OR Their tendons lengthened

(b (Nerve transaction when severe spasticity

) c (Correction of fixed deformities by: (1) Osteotomy

) 2 (Joint fusion

) 3 (Arthroplasty