Principles of Cerebral Palsy

Principles of Cerebral Palsy - Principles of Cerebral Palsy...

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Unformatted text preview: Principles of Cerebral Palsy Mamoun Kremli Associate Professor Consultant Pediatric Orthopedics College of Medicine & King Khalid University Hospital 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 Cerebral palsy Classification According to Type of motor dysfunction Spastic 65 % Athetoid 10 % Ataxic 5 % Mixed 12 % Hypo tonic 1 % Cerebral palsy Classification According to Pattern of involvement Monoplegia : one limb / rare Diplegia : both LL >> UL / good intelligence / prematurity Hemiplegia : unilateral usually UL > LL / 33 % seizures 50 % mentally retarded Triplegia : rare / usually both LL + one UL Quadriplegia : total body / often mentally retarded / with seizures / severe hypoxia Double hemiplegia : bilateral UL > LL 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 Cerebral palsy Spastic Hemiplegia 30 % of all CP One side affection upper > lower extremity 50 % mentally retarded 33 % seizures Cerebral palsy Spastic Quadriplegia All four limbs involved and trunk Often mentally retarded With seizures Most ( 80 % ) non walkers 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. Cerebral palsy Clinical Assessment Hip Flexors Ilio-psoas ( the main and most powerful ) Sartorius Tensor fascia lata Rectus femoris Adductors Cerebral palsy Clinical Assessment Hip Flexors Thomas test easy & simple, well known problem : depends on how much is the other hip flexed 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 Cerebral palsy Clinical Assessment Hip Flexors Staheli Test Prone position Pelvis over table edge More accurate Cerebral palsy Clinical Assessment Hip Flexors Ely / Rectus Femoris Test Well known Significance ? Cerebral palsy Hip Adductors Superficial layer-Pectineus-Adductor longus-gracilis Cerebral palsy Hip Adductors Intermediate layer- adductor brevis Cerebral palsy Hip Adductors Deep layer- adductor Magnus Cerebral palsy Clinical Assessment Hip Adductors Hip abduction / knees extended Hip abduction / knees flexed The Gracilis Cerebral palsy...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Principles of Cerebral Palsy - Principles of Cerebral Palsy...

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