3. In Bone and joint changes cerebral palsy
result from muscle spasticity and contracture.
The spine and the joints of the lower
extremity are most commonly affected.
Scoliosis may progress rapidly and may
continue after skeletal maturity.
Increased thoracic hypnosis and lumbar
lordosis, spondylolisthesis, spondylolysis, and
pelvic obliquity may accompany the scoliosis.
Progressive hip flexion and adduction lead to
windswept deformity, increased femoral
anteversion, apparent coxa valga,
subluxation, deformity of the femoral head,
hip dislocation, and formation of a
pseudoacetabulum.
4. In the knee, flexion contracture,, and
patellar fragmentation are the most
commonly seen abnormalities.
Recurvatum deformity can also
develop in the knee secondary to
contracture of the rectus femoris
muscle.
Progressive equinovalgus and
equinovarus of the foot and ankle are
associated with rocker-bottom
deformity and subluxation of the
talonavicular joint.
6. Spasticity
Spasticity is increase in tonic reflexes
Exaggerated tendon jerks
Spasticity is one part of the upper motor neuron
syndrome, but it is a widespread problem in
cerebral palsy; it is debilitating, affects function
and can lead to musculoskeletal complications.
Significant advances have occurred in
antispasticity management (and related
musculoskeletal problems) in children with
cerebral palsy during the past 5-10 years the
potential for combination treatment with other
modalities.
There is a role of biomechanical assessment and
providing mobility aids/casting/orthoses and
motor training/stretching exercises
7.
8. Thoracolumbar spine
The prevalence of scoliosis in patients with spastic
cerebral palsy ranges from 15% to 61% .Males are
more commonly affected .This is in contrast to
idiopathic scoliosis, which has an 8:1 female
predominance. Curves are typically less than 40° but
can range from 10° to 146°.
The incidence of scoliosis increases with age and
decreased ambulation. Most scoliotic curves progress
from postural to fixed deformities . Body braces
showed benefit in a randomised controlled trial.
The Milwaukee brace is one particular body brace that
is often used. Modern CAD / CAM braces are used in
Europe
9.
10. Treatment
Treatment is primarily aimed at improving sitting
balance and halting curve progression. Severe
deformities may be prevented by external
bracing if scoliosis is detected early .
The patients' wheelchair needs to be assessed
and modified in order to accommodate for their
corrected spinal posture and seating balance
after surgery.
A reclining wheelchair can be used initially to
provide better sitting comfort during the
immediate postoperative period and while a
patient who has been fused distally to the
sacrum and the pelvis has difficulties to sit to
90°.
11.
12.
13. hip
Hip subluxation and dislocation are the second most
common deformities in patients with spastic cerebral palsy,
with a reported prevalence of up to 28%.
The spastic adductors and iliopsoas muscles overpower
the weaker hip abductors and extensors . This may result
in scissor gait (bilateral adduction hip contracture) or
windswept deformity.
Windswept deformity (adduction contracture of one hip and
abduction contracture of the other hip) occurs in up to 23%
of patients . Impaired ambulation and sitting balance,
greater trochanteric decubiti, and pain may also be present
14. treatment
Treatment is aimed at preventing adduction and
flexion deformity and progression to subluxation
or dislocation . Nonsurgical management
involves stretching the spastic agonist muscles
and strengthening the weaker antagonist
muscles. Abduction splinting may also be used .
Hkfo is recommended in case of hip deformity
Since 1992 following orthosis has been used for
thousands of CP children in many countries
15.
16. knee
Knee flexion deformity (crouch knee) is the most
common knee abnormality in spastic cerebral
palsy .
This deformity is associated with hip and ankle
flexion contractures and is due to spasticity of
the hamstrings .
As flexion progresses, more force is placed on
the quadriceps muscles, leading to
overstretching of the quadriceps muscle fibers
and the infrapatellar tendon, causing patella alta,
patellar fragmentation, chondromalacia, joint
instability, muscle weakness, and pain.
17.
18. treatment
Treatment of knee flexion deformity is aimed at
progression
ground reaction ankle foot orthosis (GRAFO) is
use .
GRAFO locks ankle and resist ankle dorsi flexion
Help to correct crouch from plantar flexion
KAFO is used to correct the deformity
19.
20. Foot
Equinus deformity (plantar-flexed calcaneus)
is the most common musculoskeletal
abnormality in patients with spastic cerebral
palsy . A fixed or spastic contracture of the
gastrocnemius and soleus causes the
characteristic tiptoe or toe-heel gait with an
inability to keep the heel in the shoe. Equinus
is commonly associated with knee flexion and
valgus or varus deformity of the hind foot
and forefoot.
21.
22. treatment
The goal of treatment is to prevent and
correct deformities to increase function.
braces attempt to stretch shortened
muscles
Floor reaction orthosis
Ankle foot orthosis is given in case of foot
deformity
25. Gait disorders
Stiff knee gait
characterized by limited knee flexion in swing
phase due to rectus femoris firing out of phase
Crouch gait
hamstring contracture - most common cause(results in a
combination of hip flexion, knee flexion, and ankle
equinus)
Toe-walking gait
common in hemiplegics
• Treatment:
Ankle foot orthosis
26. Upper extremity deformities
Most pts w/ hemiplegic cerebral palsy have
functionless hand marked by:
- flexion of the elbow with pronation of the
forearm
- flexion of the wrist and fingers: spasticity,
weakness, flexion deformity of the wrist &
fingers
- thumb in palm deformity
- loss of sensation and proprioception.
27. Deformities in upper extrimty
Shoulder internal rotational contracture
Fore arm pronation
Wrist flexion deformity
Thumb in palm deformity
Finger flexion deformity
28.
29. Conclusion
Cerebral palsy is a central nervous system
disorder characterized by muscle
spasticity and contracture. Scoliosis and
flexion deformities of the hips, knees, and
feet occur. Early recognition of
progressive deformity allows timely
treatment and prevention of irreversible
change.
