Cerebral Palsy - Concepts and Current Views

Cerebral Palsy - Concepts and Current Views - Cerebral...

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Cerebral Palsy concepts and current views Mamoun Kremli Associate Professor Consultant Pediatric Orthopedics College of Medicine & King Khalid University Hospital
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cerebral palsy Definition None progressive disease of the CNS secondary to a perinatal insult, resulting in varying degrees of motor milestone delay and dysfunction Incidence 2 – 5 % of live births 2 per thousand children at school age
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Cerebral palsy Classification Pattern of involvement : Diplegia Hemiplegia Triplegia Quadriplegia (total body) Type of motor dysfunction : Spastic / Ataxic / Mixed / Athetoid / hypotonic 65% 5% 12% 10% 1%
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Cerebral palsy Spastic Diplegia The most common type Speech / intellect: normal – slightly impaired UL : gross motor OK minor incoordination of fine motor skills LL : spastic : hip: flexion, adduction, int. rotation knee: flexor / extensor spasticity /or equal ankle: equinus foot: pes valgus Most walk independently by 4 years
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Cerebral palsy Spastic Hemiplegia 30 % of all CP One side affection upper > lower extremity 50 % mentally retarded 33 % seizures
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Cerebral palsy Spastic Quadriplegia All four limbs involved – and trunk Often mentally retarded With seizures Most ( 80 % ) non walkers
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Cerebral palsy Clinical Assessment Goals of Physical Examination Determine grades of muscle strength and selective control. Evaluate muscle tone and determine type. Evaluate degree of deformity / contracture at each joint. Assess linear, angular and torsional deformities of spine, long bones, hands and feet. Appraise balance, equilibrium and standing / walking posture.
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Cerebral palsy Clinical Assessment Hip Flexors Thomas test easy & simple, well known problem : depends on how much is the other hip flexed
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Cerebral palsy Clinical Assessment Hip Flexors With fixed knee flexion, Thomas test should be performed with knee outside at table edge to prevent false positive results
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Cerebral palsy Clinical Assessment Hip Flexors Staheli Test More accurate Prone position Pelvis over table edge
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Cerebral palsy Clinical Assessment Hip Flexors Ely / Rectus Femoris Test Well known Significance ?
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Cerebral palsy Clinical Assessment Hip Adductors Hip abduction / knees extended Hip abduction / knees flexed The Gracilis
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Cerebral palsy Clinical Assessment Knee Flexion The Hamstring Test Hip flexed 90 Popliteal angle
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Cerebral palsy Clinical Assessment Ankle Silfverskiold – 1923 Gastroc. Vs T. Achilles ( Soleus )
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Cerebral palsy Clinical Assessment Rotational Profile Foot propagation angle Femoral rotation int. / extr. Rotation Tibial rotation Foot – Thigh Angle
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