This document discusses physiotherapy following reconstructive surgeries for conditions like cerebral palsy, polio, and leprosy. It focuses on cerebral palsy, explaining that orthopedic surgery can treat limitations in mobility and help prevent deformities. Common procedures discussed include muscle and tendon lengthening and transfers, tenotomies/myotomies, osteotomies, and arthrodesis. The goal is to improve range of motion, mobility, independence, and quality of life. Selective dorsal rhizotomy is also described as a way to reduce spasticity for some cerebral palsy patients.

1. Physiotherapy following
Re-constructive surgeries
Dr.Rachita Hada
MPT Ortho

2. 1. Cerebral Palsy
2. Poliomyelitis
3. Leprosy

3. Cerebral Palsy
• Surgery treats several conditions resulting from
cerebral palsy. Various orthopedic procedures
• for example, Easing spasticity with surgery
improves range of motion and fine motor
control, helping patients walk with or without
assistive devices, and grasp small items.

4. • In addition to improving mobility and
coordination, surgical intervention may also
correct or help prevent deformities and
other cerebral palsy complications.
• Orthopedic surgery is widely used to treat
movement limitations.

5. • As part of a comprehensive therapy plan, surgery
can help improve a cerebral palsy patient’s
independent mobility and support healthy
physical development.
• Orthopedic surgery on the legs, feet, ankles,
arms and wrists leads to better posture and
control for some patients, correcting alignment
and enhancing motor functioning.

6. • Physical therapy, medication, and other forms of
treatment have a positive impact, but surgical
procedures may provide additional benefits for select
cerebral palsy patients.
• CP surgery:
Improves – mobility, posture, physical alignment, range
of motion
Promotes – independence, healthy physical
development
Prevents – complications and deformity

7. Surgery addresses these and other
conditions:
• Spinal curvature (scoliosis)
• Muscle spasticity
• Tremors
• Hearing difficulty
• Gastrointestinal distress
• Pain
• Joint problems
• Spinal deformities
• Hip dislocation
• Contracture

8. Types of Surgery
• Effective cerebral palsy surgery improves quality
of life for the patient.
• Orthopedic procedures, for instance, are widely
used to enhance mobility and independence.
• Other types of CP surgery address co-occurring
conditions, like hearing, vision and digestive
difficulties.

9. ORTHOPEDIC SURGERY
• Orthopedic surgery is recommended when movement
is severely limited by cerebral palsy and/or pain is
present. Various orthopedic procedures ease
spasticity and increase range of motion, enhancing
mobility and comfort.
• Orthopedic surgery is also used to reduce
complications and limitations resulting from bone and
joint deformities. The following surgical procedures
may improve conditions related to cerebral palsy.

10. MUSCLE LENGTHENING
• When CP muscle contracture is severe, lengthening
procedures may improve the patient’s ability to walk and
move independently. The surgery may also remedy joint
problems caused by contracture, reducing the possibility of
deformity or dislocation.
• The hamstring is among the most common muscles
targeted for lengthening, as well as the heel cord. While
recovery time was once a major concern, modern
minimally invasive procedures enable patients to begin
rehabilitation within days.

11. TENDON LENGTHENING
• Like muscle lengthening, this procedure reduces
spasticity associated with cerebral palsy. Tendon
lengthening helps patients walk, but some
research indicates muscle and tendon
lengthening may have detrimental long-term
effects. As a result, surgeons have become more
selective when lengthening tendons and muscles.

12. TENDON TRANSFER
• Cerebral palsy commonly causes tendons to pull too
hard in one direction, leading to deformity. Turned-in
feet, for example, result when tibialis tendons exert
irregular pull.
• Surgeons correct the condition by transferring a
portion of the tendon to balance its pull on the ankle
joint. Another variation of the surgery transfers
tendons around the knee, correcting spasticity in the
thigh and making it easier for the patient to walk.

13. TENOTOMY/MYOTOMY
• Cutting tendons (tenotomy) or muscles
(myotomy) may be recommended when
contracture is severe and other remedies fall
short. Braces and casts are used following
surgery, to support alignment and growth. The
procedure is particularly beneficial for those at
risk of hip fracture or displacement.

14. OSTEOTOMY
• Osteotomies treat bone deformities in the lower
extremities. Bone problems can interfere with
gait and comfort – leading to dislocation, in some
cases. Osteotomy cuts and reshapes the surfaces
of bones in affected areas, realigning hips, knees
and ankles. To reduce hip complications,
osteotomy may be used to correct the angle and
“twist” of the femur.

15. ARTHRODESIS
• In cases of severe joint limitation, permanently fusing
bones may present the best surgical
alternative. Arthrodesis removes damaged cartilage,
before shaping bones and fusing the joint in a rigid
position. Although motion is lost in the affected joint,
arthrodesis addresses pain and may ultimately improve the
patient’s ability to walk.
• Orthopedic surgeons strive to maximize the abilities of
each patient. In order to have the greatest impact,
specialists set surgical goals, based upon patients’
movement capabilities.

16. SELECTIVE DORSAL RHIZOTOMY
• This permanent surgical procedure improves mobility
outcomes for select cerebral palsy patients, particularly
those suffering from spastic CP. Selective dorsal rhizotomy
(SDR) involves cutting sensory nerve fibers that extend
from muscles to the spinal cord.
• To perform SDR, surgeons examine and manipulate nerve
fibers responsible for muscle movement. By dividing the
dorsal roots and stimulating them electronically, it is
possible for neurosurgeons to identify particular nerve
fibers responsible for spasticity. Cutting the appropriate
nerves moderates the number of messages sent from
muscles to the brain, ultimately reducing spasticity.

17. Successful SDR surgery leads to improvements in these
areas:
• Sitting
• Walking
• Standing
• Self-care
• Lifestyle activities
• Balance
• Voluntary motor control

18. Leprosy