1. What is cerebral palsy and how is it caused?
Cerebral palsy is a non-progressive brain injury that can be caused by prenatal, childbirth, or some other cause in early infancy, and is mainly characterized by motor and postural abnormalities, along with other manifestations. Although the clinical symptoms may vary with age and brain development, the brain lesion does not usually continue to worsen.
2.How can I tell if my child has cerebral palsy?
The symptoms of cerebral palsy are complex and varied, and the performance varies depending on the location of the damage, even in different stages of the disease in the same patient. You can visit the pediatrics and neurology departments of local regular hospitals to determine the diagnosis.
Common manifestations.
Motor development is backward, active movement is reduced; muscle tension, difficulty in moving; abnormal posture in prone position, supine position, and from supine to sitting position, such as standing with legs crossed like scissors, walking with toes on the ground, foot inversion, foot valgus, lumbar scoliosis, etc.
Cerebral palsy can also be combined with epilepsy, mental retardation, abnormal behavior, strabismus, language disorder, sensory disorder, etc.
3.What are the principles of cerebral palsy treatment and what are the main treatment methods at present?
Treatment is mainly based on functional training and physical therapy, combined with drugs, surgery and application of orthopedic devices to reduce symptoms and symptomatic treatment.
We need to pay attention to early detection and early treatment in regular hospitals; pay attention to the comprehensive treatment of movement disorders and comorbidities; combine family training and doctor’s guidance; follow the law of children’s movement development, and promote children to produce correct movement step by step.
Early intellectual and language training, motor function training and prevention of deformities are crucial. Only normal or near-normal intellectual conditions can make it possible for the child to actively cooperate with effective functional training.
Functional training can be done in the rehabilitation department of a regular hospital, where a specific program can be developed through an assessment of the patient’s condition and adjusted in a timely manner according to the recovery situation, mainly consisting of somatic training, skill training, and language training.
Medication, including Antan, baclofen, botulinum toxin, and neurotrophic drugs, can only partially improve the condition.
Orthotics promote the physiological alignment of the bones and reduce the tension of the muscles around the joints.
About 1/3 of children with spastic cerebral palsy require surgical treatment. Surgical treatment consists of neurological surgery, tendon and soft tissue surgery, and bone surgery. The former is for spasticity and the latter is for orthopedics. Neurological surgery includes selective posterior spinal nerve rhizotomy (abbreviated as SPR) and selective peripheral neurotomy (abbreviated as SPN), the former being the most commonly used. In principle, neurological surgery is performed first, followed by orthopedic surgery. After the spasticity is relieved by neurological surgery, orthopedic surgery is feasible for those who still have residual deformity.
4. Which cerebral palsy patients are suitable for surgical treatment?
After systematic and regular non-surgical treatment with poor results, patients can be considered for SPR surgery if they meet the conditions for surgery after examination by specialists: simple muscle spasticity; no obvious fixed deformity; certain motor ability of spinal limbs; intelligence close to normal and can cooperate with post-surgical rehabilitation training; serious muscle spasticity that affects daily life, care and rehabilitation.
Patients are not suitable for surgery if they have the following conditions: low intelligence, unable to cooperate with rehabilitation training; weak muscle strength, low muscle tone; ataxia; severe fixed deformity of the limbs; severe deformity of the spine.
5.What are the methods and effects of surgery?
Surgical treatment can supplement non-surgical treatment or create favorable conditions for non-surgical treatment.
Selective posterior spinal nerve rhizotomy (SPR) surgery is usually performed in the lumbar segment of the back or the neck, which can successfully preserve the sense of touch while relieving spasticity more completely, so that the patient can have significant functional improvement. The efficiency of SPR in the lumbosacral segment to release lower extremity spasticity is 90%. Some patients also showed partial improvement in upper extremity spasticity, salivation and abnormal pronation after the procedure. The effectiveness of SPR in the cervical segment for upper extremity spasticity was 64-83%.
At the current level of testing, surgery can only provide relative relief of overall muscle group spasm, but it cannot yet target a particular muscle spasm for localized release.
6.Possible phenomena after surgery?
After surgery, there may be dullness, numbness, muscle weakness, unsatisfactory spasm relief, urinary and bowel dysfunction, and spinal instability.
7.How much does the surgery cost?
After the initial examination by the doctor in the outpatient clinic, the patient can be admitted to the ward for detailed pre-surgical examination and laboratory tests if the condition allows and there are no other diseases that obviously affect the surgery, and those who are qualified for surgery will be scheduled for surgery after careful preparation. The preoperative preparation is about 1 week and the postoperative period is about 2-3 weeks. The examination fee, anesthesia and surgery fee, and medication fee for hospitalization will cost about 20,000 Yuan.
8.What are the precautions after discharge from the hospital?
Standardized and long-term rehabilitation training should be emphasized after surgery, which can prevent recurrence and relapse of the disease, and home rehabilitation training is effective and economical. Parents should pay attention to face the reality, adhere to the treatment, be patient and loving to the child, not overprotective, not intimidating, not comparing with other normal children, and encourage to participate in games and activities within their ability.