The document discusses musculoskeletal deformities that are commonly seen in children with cerebral palsy, including scoliosis, hip dysplasia, knee flexion contractures, and foot/ankle equinus. It describes how these deformities develop from muscle spasticity and contractures over time. The management of these deformities involves physical therapy, stretching and strengthening exercises, orthotics, electrotherapy, chemodenervation, and orthopedic surgery as needed. Positioning, handling techniques, and postural aids are also important for treatment and prevention of deformities.

1. Dr. Mansoor Alam
Child Development Specialist
Institute for Child Development
New Delhi

2.  Dynamic deformities are related to joint
position, muscle function, and lever arm
length.
 Left untreated, dynamic deformities can be-
come static, because of either secondary
deformities in the bone or fixed joint
contractures.
 One example of a dynamic deformity is
functional equinus.

3.  Changes in bone and Joint results from muscle
spasticity and contracture in cerebral palsy.
 Spine: Scoliosis
 Hip: Flexed / Adducted
 Knee: Flexed / Recurvatum
 Foot: Equinovarus
 Hand: Wrist flexion / Pronated forearm

4.  The Spine and the joints of the lower extremity
are commonly affected.
 Scoliosis may progress rapidly and may
continue after the skeletal maturity.
 Increased thoracic kyphosis and lumbar
Lordosis, spondylolisthosis, spondylolysis, and
pelvic obliquity may accompany the scoliosis

5.  Scoliosis is a frontal deformity in which the
spine, when viewed straight on, curves to the
left or the right

6.  The prevalence of scoliosis in patients with
spastic cerebral palsy ranges from 15% to 61%.
Curves are typically less than 40% but can
range from 10 degree to 146 degree.
 The incidence of scoliosis increases with age
and decreases with ambulation.
 Most scoliotic curves progress from postural to
fixed deformity

7.  Kyphosis involves the upper back curving
forward. The condition can create the form of a
hump.

8.  Lordosis is also known as swayback. This is a
deformity of the lower back, in which it curves
inward instead of outward.

9.  Progressive hip flexion and adductor lead to
windswept deformity, increased femoral
anteversion, apparent coxa valga, subluxation,
deformity of the femoral head, hip dislocation
and formation of a pseudo acetabulum.

10.  Hip subluxation and dislocation are the most
common deformities in patients with spastic CP
with a reported prevalence up to 28%
 The spastic adductors and illopsoas muscles
overpower the weaker hip abductor and extensors.
This may result in scissor gait( Bilateral hip
adductor contracture) or windswept deformity
 Windswept deformity (Adduction contracture of
one hip and abductor contracture of the other hip)
occurs up to 23% in patients with spastic CP

12.  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

13.  Knee flexion deformity (Crouch Knee) is the
most common knee abnormality in spastic CP.
The deformity is associated with hip and ankle
flexion contracture and is due to spasticity of
the hamstrings.
 As flexion progresses, more force is placed on
the quadriceps muscle leads to overstretching
of the quadriceps muscle, and the infrapatellar
tendon causing patella alta, patellar
fragmentation, chondromalacia, joint
instability, muscle weakness and pain

15.  Progressive equinovalgus and equinovarus of
the foot and ankle are associated with rocker
bottom deformity and subluxation of the
talonavicular joint

16.  Equinovarus deformity is the most common
musculoskeletal abnormality in patients wrth
spastic cp.
 A fixed or spastic contracture of the
gastrocnemious and soleus produces tip toe
gait with an inability to keep the heel in the
shoes.
 Equinus is commonly associated with knee
flexion and valgus or varus deformity of the
hind or forefoot

18.  Mostly associated with Hemiplegia and
Quadriplegia
 flexion of the elbow
 Pronation of the forearm / Midarm
 Flexion of the wrist and fingers
 Thumb in palm
 Internally rotated shhoulder

20. Physical Therapy
 Postural Correction
 Stretching and Strengthening Program
 Functional Therapy
 Orthotic Aids
 Electrotherapy
Chemodenervation
Orthopedic Surgery

21.  Positioning
 Handling, Carrying and Transfer Technique
 Postural Aids / Equipment

22. Positioning
 Neuro Enhancing Positioning (NEP)
 Tone Reducing Positioning (TRP)
Positional Devices
 Side Lying Board
 Prone Wedge
 Customized Chair
 Aligner
 Stretching Frame

27. Children who do not have head control
 Side Lying Board
 Prone Wedge
 Supine Incliner
Children who do not have Sitting Ability
Corner Chair with Tray Cut Out
Arm Chair with Tray Cut Out

28. Children who do not have Standing Ability
 Supine Stander
 Prone Stander
 Australian Standing Frame
 Box Standing Frame
Children who have severe hip adductor spasticity
and prone to hip dislocation, a pommel is fitted in
All postural aids

29. Stretching Program
Sustained Stretching is always better than ROM
exercises
Fast ROM exercises are always harmful in
Spasticity Management
Sustained stretching with stretching devices for
4-6 hours can maintain the ROM
Sustained stretching with stretching devices for
6-8 hours can increase the ROM by 10%-25%

30. Strengthening Program
 Strengthening in children with cerebral palsy
and other neuromuscular disorders can be
beneficial for long-term functional gains,
improved movement patterns, and optimal
posture.
 Strength training is a type of physical
Exercises specializing in the use of resistance to
induce muscular contraction which builds
the strength, anaerobic endurance and size of
skeletal muscles.

31.  Functional physical therapy emphasizes the
learning of motor abilities that are meaningful
in the child’s environment and perceived as
problematic by either the child or parents.
 Children practice these motor abilities in
functional situations with the child having an
active role in finding solutions for motor
problems rather than having the physical
therapist’s handling result in a solution.

32.  An orthosis by definition, is "an externally
applied device used to modify the structural
and functional characteristics of the
neuromuscular and skeletal system.

33. Electrotherapy or electrical stimulation is the
therapeutic application of electric current.
Modern electrotherapy is primarily used to
improve functions and activities. This is called
functional electrical stimulation.
Electrotherapy can thus be used for rehabilitation
in order to:
 learn or re-learn movements
 prevent loss of muscle mass (‘atrophy’)
 support regeneration of the nervous system

34. Available Electrotherapy Avenues
 EMS
 NEMS
 FES
 TES
 EMG Biofeedback