Lower Limb In Cerebral Palsy Research Articles

Motor Recovery of Lower Limbs in Cerebral Palsy with Botulinum Toxin and Physioteraphy

The gait is a central function in the neuropsychological development of the normal child and in neuromotor diseases such as PCI. Spasticity is a major problem that prevents the development of motor functions remaining in these patients, thus producing a limited participation in recreational and sports activities and social activities. The synergistic action of the FET and the BTX-A can be a valuable aid, as the transient inhibition of muscle spasticity, can allow the subject to learn to reorganize through the rehabilitation intervention movement in a different way, in order to reduce the functional limitations in the lower limbs allowing a greater motor skills and thus a better quality of life.

Treatment of spasticity of lower limbs in cerebral palsy with the selective lumbosacral posterior rhizotomy: an accompanying long-term efficacy

Objective To investigate the treatment of spasticity of lower limbs in cerebral palsy with the selective lumbosacral posterior rhizotomy (SPR). Methods The clinical data of 1 455 patients with spastic cerebral palsy with lower limbs pasticity treated by SPR were analyzed retrospectively. In addition to relieving the lower limb spasticity after procedure, the long-term follow-up of other accompanying effects were performed. Results All 1 455 patients were followed up for 21.8 (mean, 12-44) months. While adding up the efficacy of relieving lower limb spasticity with operation (the total spasm remission rate was 94.8% and the gait function improvement rate was 85.6%) during the follow-up period, the improvement of other concomitant symptoms of patients was observed: the improvement rates of salivation, oral dyskinesia and dysarthria, spasticity of upper limbs, and strabismus were 64.5% (300/465), 39.1% (135/345), 33.3% (240/720), and 33.3% (225/675), respectively. Conclusions While in the treatment of spasticity of lower limbs in cerebral palsy, SPR improves the concomitant symptoms, such as salivation, oral dyskinesia and dysarthria, spasticity of upper limbs, and strabismus in different degrees in 33.3-64.5% patients. Its specific mechanism needs to be further studied. Key words: Spastic cerebral palsy; Selective lumbosacral posterior rhizotomy; Efficacy

Toxine botulinique type A chez l’enfant : évaluation des indications à partir d’une revue de la littérature

Introduction. – The aim of this study is to review the literature to indications of botulinum toxin type A in children. Method. – We review the international literature from 1990 to 2002 by querying the Pubmed database with the keywords “children” and “botulinum toxin”. Results. – Two hundred and forty-eight articles are retrieved. We selected the most relevant 64 articles among them. Several questions remain pending: which optimal dose, which periodicity for injections, which optimal age to prolong efficiency? The main criteria to estimate efficiency is functional ability improvement. No significant side effects are noted. The main use of botulinum toxin is the management of the spastic lower limb in cerebral palsy. Discussion. – This review of the literature makes it possible to specify the interests and the operational limits of botulinum toxin in the child. Its effectiveness with the upper limb is not proven. The other indications remain to be studied in a more precise way. Conclusion. – This review shows many studies give the indications of botulinum toxin in children. The main indication is the lower limb spaticity in cerebral palsy. New prospective and double-blind studies should be performed with larger samples.

Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy,

Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy,

Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy

We evaluated gross motor function following botulinum toxin A (BTX‐A) injections in the lower limbs of children with spastic cerebral palsy in a randomized clinical trial, using a cross‐over design. Forty‐nine children (24 males, 25 females, age range 22 to 80 months) were randomly allocated to two groups: group 1 received BTX‐A and physiotherapy, and group 2 received physiotherapy alone for 6 months. At the end of this period, group 2 received BTX‐A and physiotherapy and group 1 continued with physiotherapy alone. Assessment measures were the Gross Motor Function Measure (GMFM), the Vulpe Assessment Battery (VAB), joint range of movement, the Modified Ashworth Scale, and a parental questionnaire. Sustained gains in gross motor function were found in both groups of children but the only additional benefit found in group 1 was a significant increase in fine motor rating on the VAB. By contrast, parents rated the benefit of treatment highly. It is likely that assessment at 3 and 6 months post injection was too late to demonstrate peak gross motor function response and that changes in GMFM are not sustained over 6 months with a single dose. Further studies should investigate changes over shorter time periods and consider covariables such as BTX‐A dosage, number of injection sites, and the role of repeated injections combined with other interventions such as casting.

Current evidence for the use of botulinum toxin type A in the management of children with cerebral palsy: a systematic review.

Management of children with cerebral palsy (CP) is the focus of considerable resources in many countries, so that evaluation of the efficacy for new and established treatments is imperative. Botulinum toxin type A (BTX-A) is a relatively new method of spasticity management in children with cerebral palsy. It has been the focus of extensive research since its application to cerebral palsy 10 years ago. In a systematic review relating to the management of the lower limb in cerebral palsy 156 papers were identified. These were categorized according to Sackett and the World Health Organisation International Classification of Impairments, Disabilities and Handicaps model. We identified 10 randomized trials evaluating the use of BTX-A in the lower limb in children with cerebral palsy in a systematic review. A meta-analysis showed the pooled risk difference between BTX-A and placebo in three trials was 0.25 (95% CI 0.13, 0.37) and 0.23 (95% CI -0.06, 0.53) for two trials of BTX-A and casting using the physicians rating scale. These represent moderate treatment effects that are dosage-dependent. Outcomes were also compared for function in five studies. The type of evidence for BTX-A was graded by each treatment indication and directions for future research were then drawn from the available evidence.

Incoming President's Address

I thank you for the confidence that you have shown in electing me your President. It is a great honour to be following in the footsteps of Knud Jansen, our Founding President, and the other Presidents who came after him, all whom have made a significant contribution to the Society. I have had the good fortune to have worked for ISPO in one capacity or another under all the Presidents. I hope that some of their dedication, wisdom and good humour has passed on to me to allow me to carry out this task in a positive and productive manner. The Society has achieved a great deal since its foundation in 1970. It has created a truly international and multidisciplinary forum of all those professionals working in the fields of prosthetics, orthotics and rehabilitation engineering through its Congresses, conferences, and regional and national meetings. It has run workshops and seminars on such topics as the deformed foot, CAD CAM in prosthetics and orthotics and trans-femoral sockets. It has organised consensus conferences on amputation surgery, the orthotic treatment of the lower limb in cerebral palsy, appropriate prosthetic technology for low-income countries and, most recently, the treatment of poliomyelitis. It has disseminated information worldwide through its publications, Prosthetics and Orthotics International and the reports of its workshops and consensus conferences, and also by offering courses in different regions of the world. As a result of a series of meetings the Society has laid down standards for education and training of prosthetics and orthotics personnel in low-income countries. These standards have now been accepted by all the major international and national agencies working in this important area. This work has culminated in the publication of a package for education and training of the Category I1 professional that provides detailed information to those who wish to establish a course in low-income countries. We could continue to look back at other activities and congratulate ourselves for all that the Society has achieved. However the truth of the matter is that we have only just scratched the surface and much remains to be done. The World Health Organisation has estimated that there is a need for 20,000 trained prosthetics and orthotics personnel to meet the needs in low-income countries. Altogether there are only about 2,000, a shortfall of 18,000. The overall needs in low-income countries are immense. They have few resources and many problems. It is our duty to ensure that all efforts that are made are part of a strategy to ensure the establishment of long-term prosthetics and orthotics and other rehabilitation services in these countries. It is necessary to examine the components and technologies used in these countries with regard to function and costs as well as the sustainability and effectiveness of the services established. Many low-income countries require aid as a direct result of present or past conflict. The Society must support, as far as it can, those National and International agencies that are providing prosthetics and orthotics services in these situations. In the industrial world the standards of education and training of prosthetists and orthotists are extremely varied, from university level in some countries to little or none in others. The challenge in this regard is to produce adequate numbers of well-educated prosthetics and orthotics personnel to an acceptable standard and it is the Society’s intention to pursue the implementation of its information package for the education and training of Category I professionals. There continues to be a great proliferation of components and techniques, many of which have reached the market place without any proper independent evaluation of their effectiveness, function or outcome. Much work needs to be done in this direction.

Quantitative analysis and classification of gait patterns in cerebral palsy using a three-dimensional motion analyzer.

Gait disorders in cerebral palsy can be accurately analyzed using the CODA-3 system presenting quantitative data representing movement of the hip, knee, and ankle in the sagittal plane. We describe a technique that classifies abnormal gait automatically on the basis of sagittal kinematic data. Fifty-five hemiplegic and 91 diplegic patients were analyzed using an opto-electronic scanner (CODA-3). The sagittal kinematics of the affected limb in hemiplegics correlated with those of both affected limbs in diplegics. We introduce the concept of the "plegic limb." Sagittal kinematics of 237 affected limbs were studied using cluster statistical analysis. Eight clear groups emerged. The predominant clinical features, typical of each group, were identified and described (eg, stiff leg gait, genu recurvatum, or crouch gait). We propose this classification system as a new technique to use gait analysis data to automatically classify abnormal movements of the lower limb in cerebral palsy.

Surgical treatment of the lower limbs in cerebral palsy: a review.

Surgical treatment of the lower limbs in cerebral palsy: a review.

Early protective approach for the dislocation of the hip joint with cerebral palsied children

The most serious deformity that can develop in the lower limb in cerebral palsy is dislocation of the hip.In the early stages of development of subluxation, in our 25 hips, both iliopsoas and adductor release are sufficient to prevent the progress of subluxation towards dislocation. In older children of them, over the age of five years, we have found no further deterioration, but in 5 of 14 hips no cnange of view radiologically after release of iliopsoas and adductor.On the other hand, in 7 of 38 hips, we could not prevent the progress of subluxation, when released the adductor only.

Surgery in lower limbs in cerebral palsy.

SUMMARYNinety‐three cerebral‐palsied patients aged between 3 and 18 years underwent a total of 230 corrective operative procedures of the lower limbs at the Children's Orthopaedic Hospital, Bombay. Pre‐operatively, 49 of the patients were unable to walk and the other 44 had defective gait, or deformities affecting gait, and needed some form of support in walking. Post‐operatively, 84 patients showed some improvement in their ability to walk, ranging from very good to fair; there was no improvement in the other 9 patients. The results show that it is possible to get satisfactory results after surgery, even in mentally defective children, provided that adequate pre‐ and post‐operative training is given and that the parents take a continued interest in the child's progress.RÉSUMÉChirurgie des membres inférieurs dans l'infirmité motrice cérébrale93 enfants imc, de 3 à 18 ans, ont bénéficié de 230 opérations correctives des membres inférieurs au Children's Orthpédique Hospital, de Bombay. Avant intervention, 49 des enfants étaient incapables de marcher, les 44 autres avaient des troubles de la démarche ou présentaient des déformations affectant la démarche et avaient besoin de quelque aide de marche. Après l'intervention, 84 enfants Ctaient améliorés, les résultats allant de très bons à moyens pour l'aptitude à la marche; seuls 9 sur les 93 enfants n'ont pas été ameliorés. Les résultats montrent qu'il est possible d'obtenir des améliorations par la chirurgie, même chez les enfants mentalement déficients, à condition qu'un entrainement adéquat pré‐ et post‐opératoire soit donné et que les parents continuent à s'intdresser aux progrès de l'enfant.ZUSAMMENFASSUNGChirurgische Eingriffe an den unteren Extremitäten bei cerebraler KinderlähmungIm Krankenhaus für Kinderorthopädie in Bombay wurden 93 Patienten mit Kinder‐ähmung in Alter von 3 bis 18 Jahren insgesamt 230 korrektiven operativen Eingriffen unterzogen. Präoperativ konnten 49 der Patienten nicht gehen, die anderen 44 waren gehbehindert oder hatten den Gang beeintrachtigende Mißbildungen und benötigten irgendeine Gehhilfe. Postoperativ zeigten 84 Patienten sehr gute bis maßig gute Besserung ihrer Gehfähigkeit; nur 9 der 93 Patienten zeigten keine Besserung. Die Ergebnisse demonstrieren, daß durch chirurgische Eingriffe zufriedenstellende Resultate erzielt werden können, sogar bei geistig retardierten Kindern, vorausgesetzt daß ein angemessenes prä‐und post‐operatives Training gewährleistet ist und daß die Eitern weiterhin an dem Fortschritt ihrer Kinder interessiert sind.RESUMENCirugía de extremidades inferiores en la parálisis cerebralNoventa y tres pacientes con parálisis cerebral de 3 a 18 años de edad, sufrieron un total de 230 intervenciones correctivas a nivel de extremidad inferior en el Hospital Ortopédico Infantil de Bombay. Antes de la intervención 49 de los pacientes eran incapaces de andar y los otros 44 presentaban una marcha defectuosa o deformidades afectando la marcha y necesitaban algün tipo de soporte para andar. Después de intervenidos, 84 pacientes mostraron una mejoría en su habilidad para la marcha, que osciló entre muy buena y bastante buena; sól 0 9 de los 93 pacientes no mejoraron. Los resultados demuestran que es posible conseguir resultados satisfactorios con la cirugía, incluso en niños con retraso mental, siempre que se de un entrenamiento adecuado antes y despéts de la intervención y los padres mantengan un interés continuo en el progreso del niño.