Cerebral palsy of brain which is debilitating for the patient

1. Cerebral palsy

2. definition
• A group of permanent disorders of development of movement and
posture,causing activity limitation,that are attributed to non
progressive disturbances that oiccured in the developing fetal and
infant brain.The motor disorders of cerewbral palsy are often
accompanied by disturbances of sensations,perceptoion,cognition
,communication,behaviour,epilepsy and secondary musculosc
• Keletal problems.

3. CLASSIFYING CEREBRAL PALSY
• 1.MOVEMET DISORDER
• 2.SPASTICITY
• 3.DYSTONIA
• 4.MIXED MOVEMENT DISORDER
• 5.ATAXIA
• 6.HYPOTONIA

4. CLASSIFICATION BY GROSS MOTOR FUNCTION
• 1.GMFCS LEVEL 1
• 2.GMFCS LEVEL 2
• 3.GMFCS LEVEL 3
• 4.GMFCS LEVEL 4
• 5.GMFCS LEVEL 5

5. DIAGNOSIS AND ASSESSMENT
• 1.History
• 2.physical examination
• 3.assessment of gmfcs
• 4.functional mobility scale
• 5.functional assessment questionnaire
• 6.longitudinal assessment with radiology .hip surveillance
• 7.instrumented gait analysis
• 8.video gait analysis

6. Physiotherapy and occupational therapy in cp
• 1.biomechanical approach
• 2.neurodevelopmental therapy.the Bobath approach
• 3.Cognitive Approach.
• 4.Constraint induced movement therapy

7. Botulinum neurotoxin A in cerebral palsy
• 1.spastic equinus
• 2.Spastic equinovarus and equinovalgus
• 3.Injection of the hamstrings and adductor muscles in cerebral palsy
• 4.multilevel injection of botulinum neurotoxin A in cerebral palsy
• 5.Botulinum neurotoxin A in upperlimb in cedrebral palsy

8. Saggital gait pattrerns ,spastic hemiplagia
• 1.type 1 hemiplegia
• 2.type 2 hemiplegia
• 3.type 3 hemiplegia
• 4.type 4 hemiplagia

9. Saggital gait patterns
• 1.true equinus
• 2.jump gait
• 3.apparent equinus
• 4.crouch gait

10. MANAGEMENT
Musculoskeletal management is based on gmfcs levels

11. Management in gmfcs 1
• Lower limb surgery
• -children with type1 hemiplegia ,no orthopaedic surgery
required.children with type 2 hemiplegia develop equinus
contractures and may benefit from lengthening of gastrocsoleus
The gastrocnemeius lengthening is done by1. The Strayer distal
gastrocnemius recession
2. Strayer distal Gatrocnemius recession combined with soleal fascial
lengthening.

12. Gmfcs type 1 management
• Upper limb –
• The green transfer isn the single most useful tendon transfer in
hemiplegic upper limb function

13. GMFCS TYPE 2
• Clinical presentation Suggested management
• Mild dynamic varus in younger child- Inject Gs and TP with BoNT+AFO
• Mild to moderate flexible varus:diplegia-IMT TP +GR+AFO+SEMLS
• Moderate,flexible varus:Hemiplegia-IMT TP or SPOTT+GSR+AFO
• Moderate to severe flexible varus hemiplegia-IMT
TP+SPLATT+GSR+AFO
Moderate fixed varus – soft tissue balancing + cal osteotomy/shorten
lateral column
Severe fixed varus - soft tissue balancing +triple arthrodesis

14. GMFCS 3
• HIP SURVEILLANCE AND PREVENTIVE HIP SURGERY
• ADDUCTOR AND ILLIOPSOAS RELEASE

15. GMFCS TYPE 4
• RECONSTRUCTIVE HIP SURGERY-3 MAIN COMPONENTS
• 1.ADDUCTOR RELEASE
• 2.FEMORAL OSTEOTOMY
• 3.PELVIC OSTEOTOMY

16. GMFCS TYPE 5
• PREVENTIVE AND RECONSTRUCTIVE HIP SURGERY-HIGH FAILURE Rate
• Salvage surgery-a)replacement arthroplasty
• b)Interposition Arthroplasty with a shoulder
prosthesis
• c)Subtrochanteric extension of proximal femur
• d)limited excision of proximal femur along with
intertrochanteric line combned with valgus osteotomy
• e)valgus osteotomy without resection of femoral head