New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Abstract

SynopsisCerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life.

Estimation of botulinum toxin type A efficacy on spasticity and functional outcome in children with spastic cerebral palsy

“…The main role in the formation of normal patterns of motoric function rests on physical treatment, while the BTA treatment makes to some degree easier implementation of such treatment. Thus physical therapy is a necessary part of treatment in children with CP after BTA, as has been supported by several studies 2,26,27 . After 6 months from the beginning of the BTA, physical therapy and orthoses, there was no significant difference in functional improvement, but there was a greater distribution of participants with I and II functional levels on the GMFCS scale.…”

“…Thus, it can be concluded that for children with CP, with mild to moderate levels of motoric functional disturbances classification, improvement after BTA, physical therapy and orthoses is expected. The advantage of GMFCS beside categorization of child's functional mobility is that it can be used for estimating whether a child should be referred for hip dysplasia radiographic screening 26 . We demonstrated that there was significant increase in GMFM scores after 8 and 16 weeks from the application of BTA in both groups of patients.…”

The results of single-event multilevel orthopedic surgeries and the early rehabilitation used in complex with botulinum toxin treatment in patients with spastic forms of cerebral palsy

“…Допускается, что оперативное вмешательство может быть выполнено по-следовательно на двух конечностях (особенно когда вы-полняются реконструктивные вмешательства в области крупных суставов), с перерывом в 3-6 нед, но во время одной госпитализации. Таким образом, реабилитацион-ный период остается единым для обоих оперативных вме-шательств [2,9,10]. В нашем исследовании оба эти под-хода имели место: при двусторонних формах поражения -в 36 случаях, при последовательном -в 19 случаях с пере-рывом не более 5 нед.…”

“…Детский церебральный паралич (ДЦП) является наи-более частой причиной тяжелой физической инвалидиза-ции в детстве [1][2][3][4]. Несмотря на многообразие консерва-тивных методов лечения этого заболевания, значимым является формирование контрактур, деформаций конеч-ностей и скелета, что неизбежно приводит к необходимо-сти ортопедической хирургической коррекции данных осложнений [5][6][7][8].…”

Can robotic-based top-down rehabilitation therapies improve motor control in children with cerebral palsy? A perspective on the CPWalker project

“…robotic platforms) has been proposed to improve current rehabilitation strategies [14]. According to a bi-center survey [15], no severe side effects have emerged from these strategies and the vast majority of children were highly motivated to participate with motivation being sustained throughout the training period.…”