1/18. Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.BACKGROUND: patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. methods: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/18. Motor control testing of upper limb function after botulinum toxin injection: a case study.OBJECTIVE: To evaluate changes in upper extremity function in a hemiparetic patient after treatment with botulinum toxin (BTX) using motor-control testing (MCT) techniques. DESIGN: Interventional with longitudinal study, open label. SETTING: A children's hospital and a motor-control laboratory at a major academic center. PARTICIPANTS: A 16-year-old male with right hemiparetic cerebral palsy and a healthy 12-year-old control subject. INTERVENTIONS: BTX injections to the elbow and wrist flexors. MAIN OUTCOME MEASURES: MCT was used to examine 4 upper extremity movements: forward reach, bilateral rhythmic movements (both muscle homologous and direction homologous), isometric pinch, and hand tapping. The patient was tested before treatment and at 2, 4, 6, 12, 18, and 24 weeks after treatment. In addition, range of motion (ROM), the Ashworth scale of spasticity, Functional Independence Measure, and the mobility and activities of daily living (ADL) sections of the Pediatric Evaluation of the Disability Inventory were performed. RESULTS: Forward reach demonstrated little change initially despite patient reports of "feeling looser." Improvement was noted after 18 weeks, but returned to baseline level at 24 weeks. Bilateral rhythmic movements also showed slight improvement at 18 weeks. Pinch force increased significantly after 2 weeks, but declined again at 6 weeks. Improvements occurred in ROM and the Ashworth rating of spasticity, but were not temporally associated with each other or with MCT results. Functional assessment data did not change during the study period. CONCLUSIONS: Improvements in more complex motor tasks were noted after significant delay from the time of treatment, while simpler tasks demonstrated a more rapid improvement, followed by a rapid return to baseline levels. This case suggests that MCT techniques can provide quantitative and qualitative data, which can add new information about upper extremity motor disability and the outcome of treatment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/18. Treatment of functional limitations at the knee in ambulatory children with cerebral palsy.The gait of ambulatory children with cerebral palsy frequently involves abnormal knee motion. Spasticity, muscle contracture formation, impairments of motor control, weakness, balance deficits, and extrapyramidal motions can all contribute to the functional limitations imposed at the knee. Careful clinical evaluation of the child and their gait must be performed in order to determine the best individual course of treatment. Often, three-dimensional motion analysis with assessment of muscle activity and force is necessary to completely assess the complexities of gait. Several typical gait patterns have been described involving the knee, including 'jump knee', 'crouch', 'true equinus', 'apparent equinus', 'recurvatum' and 'stiff knee' gait. Each of these gait patterns is defined here and discussed using case examples. These typical gait patterns are usually accompanied by involvement at the hip and ankle and may be combined with transverse plane rotational abnormalities. Treatment options such as rehabilitation (physiotherapy, casting, strengthening, and/or orthoses), spasticity management (intramuscular injections of phenol, alcohol, and botulinum toxin type A) and orthopaedic approaches are discussed for each entity.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
4/18. Radial head dislocation in children with cerebral palsy.Dislocation of the radial head in children with cerebral palsy (CP) is rarely reported, and the incidence of the condition is unknown. The authors present the treatment and outcome of 10 painful radial head dislocations in eight children with spastic quadriplegic-pattern CP treated over a 21-year period. Four patients were managed by open reduction of the radial head and reconstruction of the annular ligament, and four were managed by radial head excision followed by early motion. All of the patients who underwent reconstructive surgery suffered redislocation within 16 weeks of the procedure, with a return of pain and contracture of the elbow at subsequent follow-up. All four patients who underwent excision of the radial head remained pain-free, with improved elbow motion, at a follow-up of 4 years 4 months. The authors believe that once symptomatic radial head dislocation is established in CP patients, excision of the radial head gives a better final outcome than reconstructive procedures.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/18. A cerebral palsy assessment tool using anatomically based geometries and free-form deformation.A geometrical analysis tool for investigating muscle length change in cerebral palsy (CP) patients is presented. A subset of anatomically based geometries from the International Union of Physiological Sciences (IUPS) Physiome Project is used, which is derived from the visible human (VH) data set with muscle attachment information, and customised using volume-preserving free-form deformation (FFD), the 'host-mesh' technique. The model's intended use is to provide pre- and post-surgery assessment for muscle lengthening, a surgery performed to help slacken tight muscles and improve gait. The model is illustrated using healthy patient data from motion capture as a validation followed by three CP case studies to highlight its use. The methodology is presented in three stages, (1) a FFD of the complete lower limb, (2) a focused geometric study on the semimembranosus (SM) and gastrocnemius (GT) muscles, and (3) an improved hybrid mechanics-FFD approach as an improvement for future analysis, with differentiation between muscle and tendon lengthening, and contact detection between sliding muscles. Finally, the issues, limitations, in particular with the marker system, and model improvements are discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/18. A novel approach to prevent repeated catheter migration in a patient with a baclofen pump: a case report.We report a novel solution to a problem of repeated catheter migration that may aid others caring for patients with catheter migration problems. Catheter migration is a frequently reported complication of intrathecal drug delivery systems. We report on an ambulatory patient with a baclofen pump for control of spasticity due to cerebral palsy and dystonia; the patient suffered repeated episodes of catheter migration. The ultimate solution to the migrations was to place a pediatric pump in the lower thoracic, paraspinal region with the catheter entering the thoracic spine directly adjacent to the pump, thereby minimizing the differential motion between the pump and the spine, which was thought to be the cause of the repeated migration. This solution has not been previously described. Paraspinal pump placement may eliminate repeated catheter migration for patients with intrathecal drug pumps.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/18. Transient dystonic toe-walking: differentiation from cerebral palsy and a rare explanation for some unexplained cases of idiopathic toe-walking.We report on seven children (five males, two females) who presented with marked, often asymmetrical, toe-walking from onset of independent walking, associated with abnormal foot postures and increased tone at the ankles with characteristics of dystonia. Most of the children had presented with unusual pre-walking locomotion and a mild delay in independent walking. They did not fit into the usual categories of 'habitual' toe-walking or congenital short tendo calcaneus but nor did they have the clinical signs of spastic diplegia or of a peripheral neuromuscular disease. Normalization occurred progressively in the second to fourth years of life. The children were re-examined several years later (1 to 11y) and were normal. We believe that their persistent toe-walking corresponded to a variant of 'transient focal dystonia of infancy'. knowledge of its existence may justify a period of observation without special investigations, surgery, or casting.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/18. The effects of a short thumb opponens splint on hand function in cerebral palsy: a single-subject study.An AB single-subject research design was used to assess the effectiveness of a short thumb opponens splint on hand function in a 4-year-old girl with cerebral palsy. Baseline data for active range of motion, grip and pinch strength, grasp patterns, the Box and Block Test of manual dexterity (Mathiowetz, Voland, Kashman, & Weber, 1985), and 1-in. cube stacking were collected twice a week for 4 weeks. The child was fitted with a short thumb opponens splint, which was worn 6 hr during the day and all night for 4 weeks. The twice-weekly measures of the dependent variables continued during the treatment phase. Visual and statistical analysis of the data indicate that the child showed a clinically significant improvement in palmar and radial abduction, thumb opposition, grip strength, performance on the Box and Block Test scores, cube stacking, and lateral pinch. These results suggest that for this child with cerebral palsy, the use of a short thumb opponens splint improved underlying aspects of hand function as well as hand function itself. Replication of this study with a more complex single-subject design involving more subjects is recommended to confirm these results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/18. Bilateral spontaneous arthrodesis of the hip after combined shelf acetabular augmentation and femoral varus osteotomies.Spontaneous arthrodesis occurred after bilateral, extraarticular shelf augmentation and femoral varus osteotomies in a child with dislocated hips secondary to muscle imbalance from cerebral palsy. The proposed cause is heterotopic bone formation in the hip abductors in the face of insufficient range of motion exercise.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/18. The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy: a case study.ankle-foot orthoses are commonly used in the treatment of spastic cerebral palsy to hold the foot in a position conductive to a more functional gait. This study, utilizing quantitative biomechanical techniques, evaluates the effects of a rigid ankle-foot orthosis and a hinged ankle-foot orthosis on spastic cerebral palsy gait. The subject was a 4.5 year old female diagnosed as spastic diplegic cerebral palsied shortly after birth. Testing involved collection of kinematic coordinate data employing a WATSMART video system and ground reaction force data using a Kistler force plate. Jensen's (1978) photogrammetric method was used to estimate body segment inertial parameters. The hinged ankle-foot orthosis was found to be more effective than the rigid ankle-foot orthosis. The subject exhibited a more natural ankle motion during the stance phase of gait, greater symmetry of segmental lower extremity motion, and decreased knee moments during stance while wearing a hinged ankle-foot orthosis.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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