Cerebral palsy
The aim of orthopaedic surgical treatment.
The ultimate goal: to improve the quality of patient survival.
It can be divided into three categories.
1, improve the patient’s motor function, mainly in the improvement of upper limb spatial mobility and hand grasping and pinching ability, improve lower limb walking ability, improve trunk stability, so as to enhance the patient’s independent living skills; especially for patients with better intellectual status, better muscle autonomic motor control potential, relatively simple condition, more good surgical results.
2. Prevention. The original purpose is to prevent potential secondary impairment rather than to improve the patient’s function in the near future after surgery, for example, early release of hip adductors to reduce the risk of hip dislocation and spinal deformity to prevent deterioration of cardiopulmonary function, which obviously may not bring “immediate” effect to the patient and his family, but is of realistic value for long-term prognosis.
3. Correct the patient’s morbid posture. This increases the ease of access to health care.
For example, the presence of severe intellectual deficits, poorer potential for voluntary muscle control and complex co-morbidities, deterioration of personal hygiene due to severe medical conditions, difficulty in receiving daily care, and patient self-compliance. In this case, the focus is on complete correction of the deformity rather than on functional improvement, but it is also important to take both into account as much as possible.
Cerebral palsy rehabilitation should be a “family-centered” rehabilitation that provides guidance and services throughout the life course.
Cerebral palsy (CP) is a movement and postural abnormality caused by damage to the immature central nervous system during gestation, at birth, and 4 weeks after birth, often accompanied by impairment of intelligence, movement, and sensation. The central nervous system lesions are resting, while secondary lesions of the skeletal-muscular system progressively worsen with growth and development until skeletal maturity (16 years of age and into adulthood).
Asphyxia at birth is no longer a common cause, problems before delivery are considered the main cause, 50% are preterm, another 50% have low birth weight, often less than l.5 Kg, and 5% postnatal factors. Hydrocephalus and twin rates are high.
The growth rate of spastic muscles in children with spasticity is only 55% of the growth rate of bones. Progressive progression of motor disability, which usually does not show significant orthopedic difficulties in the first 10 years of life, but can become increasingly evident thereafter.
The age for orthopedic surgery is 7 years or older for the upper extremity and 3 years or older for the lower extremity, with family members or with a desire and request for surgical treatment.
Contraindications to surgery.
1. Significant hand and foot tardive dyskinesia.
2. Severe coracoacromial deformity of the trunk
3. limb deformity due to torsional spasm. The above should be treated by a neurosurgeon.
The main goal of functional training: to enhance the strength of non-spastic muscles, improve balance, avoid or reduce joint contractures, and improve motor function.
The upper limbs mainly train forearm rotation and backward movement, that is, the elbow against the thoracic side of the palm to the sky to the ground, wrist dorsal extension, finger extension and flexion movement and thumb to palm movement, and gradually improve the flexibility of movement.
Lower limbs: crawling, kneeling, squatting, standing, paying attention to walking posture and running and jumping, certain game movements. Reasonable training before different surgical categories as prescribed by the doctor.
Orthotic treatment of children should emphasize the principles of early detection and prevention.