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Cerebral Palsy


- Discussion:
    - pattern of hip deformity in cerebral palsy depends on type and extent of neurologic impairment;
    - non progressive neuromuscular disorder w/ onset before 2 yr resulting from injury to the immature brain;
    - etiology includes:  perinatal infections (TORCH), prematurity (most common), anoxic injuries, head injuries, and meningitis;
    - commonly immobility leads to joint contractures that, if uncorrected, can progress to cartilage deformity and joint dysplasia;
    - associated disorders:
           - convulsive seizures occur in about 25% of patients, most often in those with hemiplegia;
           - strabismus and other visula field defects may be seen.
           - children with athetosis due to kernicterus commonly display nerve deafness and paralysis of upward gaze;
           - children with spastic hemiplegia or paraplegia frequently have normal intelligence and a good prognosis for social independence;
           - spastic quadriplegia and mixed forms often are associated w/ disabling mental retardation;
    - diff dx:
          - w/ a "progressive CP" consider another diagnosis such as the San Filippo's syndrome (see mucopolysaccharidoses); 
    - surgery is best reserved for children over 3 yr with spastic CP, good intelligence, and voluntary muscle control;
    - muscle imbalance yields later to bony changes, so goal is to perform soft tissue procedures early and, if necessary, bony procedures later; 

- Assessment:
    - classification:
    - sites of involvement:
          - spine:
          - hip joint in CP:
          - flexion deformity of the knee:
          - foot and ankle in CP:
          - hand in cerebral palsy 

- Evaluation:
    - patient locomotor profile is based on primative reflexes;
    - presence of 2 or more primitive reflexes usually means the child will be a non ambulator;
           - common tests are the Morrow and Parachute Reflexes, which normally dissapear at 4-5 months; 
    - parachute reflex:
             - hold the child prone and then lower the child rapidly toward the floor;
             - parachute reaction is normal or positive if the child reaches toward the floor 
             - references:
                    - Relationship between the parachute reactions and standing and walking in normal infants.
                    - The parachute reactions in normal and late walkers.

Current Concepts Review.  Management of the Hip in Cerebral Palsy.

Review Article: Current Concepts: Surgical Management of Spastic Diplegia in Cerebral Palsy.

Gait patterns in spastic hemiplegia in children and young adults.

Posterior transfer of the adductors in children who have cerebral palsy. A long-term study.

Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults. Adjunctive treatment of thumb-in-palm deformity in cerebral palsy.

Capsulodesis of the metacarpophalangeal joint of the thumb in children with cerebral palsy.

Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia.

Bone-mineral density in children and adolescents who have spastic cerebral palsy.

The use of the pathokinesiology laboratory to select muscles for tendon transfers in the cerebral palsy hand.

Determinants of muscle function in the spastic lower extremity.

The relationship between preoperative nutritional status and complications  after an operation for scoliosis in patients who have cerebral palsy.

Fragmentation of the distal pole of the patella in spastic cerebral palsy.    

Avulsion of the distal pole of the patella in cerebral palsy. A cause of deteriorating gait.  

Clinical and electromyographic study of seven spastic children with internal rotation gait.   

The development of mature gait.   

Cerebral Palsy: An Overview from the Orthopaedic Care Textbook

Surgical Management of Cerebral Palsy in the Upper Extremity from the Orthopaedic Care Textbook