Understanding in Children with Cerebral Palsy: Orthopedic Problems

Book excerpt: Cerebral palsy presents stable encephalopathy that systemically influences on the child's and adult's organism. Orthopedic complications of cerebral palsy possess on the contrary progressive features and those complications cause gradual failure of motor ability of a person: impaired walking, loss of postural ability, reduced self-care and inclusion, finally quality of life becoming much worse. That is why orthopedic aspects are of great importance in children with cerebral palsy. This volume presents a collection of chapters covering a wide range of problems, from a system of universal classification of dysfunctions in Cerebral Palsy and practical issues of prevention of orthopedic complications orthopedic to surgery (diagnostics and quantitative interpretation of gait disorders in such patients, optimal methods of surgical intervention, hip surgery, spinal surgery) and aspects of nutritive status of this specific category of patients, associated comorbidities and their influence and connection with orthopedic problems. Furthermore, three chapters are dedicated to the anesthetic aspects of orthopedic surgery. The substantiation is given to the methods of combined anesthesia and sedation during surgery, as well as in the immediate postoperative period, taking into account concomitant epilepsy, increased intracranial pressure and spasticity in such children.Single-event multilevel orthopedic surgery is a recognized gold standard in ambulatory patients, though it varies according to gait patterns and associated orthopedic problems causing motor disorders. The book contains explanations and methodology of surgeries for conventional gait patterns, as well as in iatrogenic disorders caused by previous unreasonable interventions. The chapter on the correction of deformities and dysfunctions of the upper limb shows the first applied transfer of m.flexor cubitus ulnaris to the radius, which gave extremely positive results both in terms of function and aesthetics.Unfortunately, in Russia the number of CP patients with iatrogenic orthopedic disorders is high. Extremely negative consequences in the form of weakness of the triceps muscles after percutaneous fibromyotomies (so-called "Ulzibat method") or lengthening of the Achilles tendon in diplegia performed before the age of five years and before the development of muscle retraction lead to the development of crouch gait even in patients with high motor potential (GMFCS I, II). This complication of unreasonable surgical interventions develops in 5-7 years after primary surgery and in the opinion of doctors and parents is not related to previous procedures. This book, based on 3D-instrumented gait analysis, shows the features of iatrogenic crouch gait, as well as methods of surgical correction of this difficult situation.The data presented in this book are based, on the one hand, on the personal practical and scientific experience of each author, and on the other hand, the entire team of authors works in collaboration with each other, coordinating their decisions and interventions with colleagues, thus ensuring continuity in treatment of children and adults suffering from cerebral palsy.