Management of the lower extremities in children who have cerebral palsy.

Although the number of children who are born with cerebral palsy appears to have remained constant in the past ten years, the type of motor disorder that is seen has changed. At our clinic, approximately 65 per cent of the children have either spastic diplegia or hemiplegia, and the relative number who have involvement of the entire body has diminished. The most noticeable decrease has been in athetosis, particularly that due to erythroblastosis fetalis. This decrease is the result of the intensive preventive measures of Rh immunization and neonatal exchange transfusions. The present review highlights some of the more important changes that have developed in the management of spastic paralysis and subsequent deformities of the lower extremities. In some instances, experienced surgeons might discern a resurrection of older operative treatments. The nature of the muscle contracture in spastic paralysis has been recognized as shortening of the muscle-tendon unit due to its failure to keep pace with the growth of the bones. Ziv et al. conducted a unique experiment with genetically spastic mice and produced convincing evidence that muscle adds sarcomeres, most probably at the musculotendinous junction, in response to constant stretch. In children who do not have cerebral palsy, walking and movement provide all the stretch that is needed for the growth of muscles. However, when the muscles are spastic, this mechanism cannot occur. The work of Ziv et al. complements that of Tardieu et al. , who measured the differences between the ranges of dorsiflexion of the ankle that were obtained when the ankle was slowly dorsifiexed with minimum and maximum resistance in two groups of patients who had different degrees of sustained stretch over twenty-four hours. In one group the stretch was sustained for six hours and in the other, for an average of about two hours. The authors defined stretch of the soleus muscle as a length that was equal to or exceeded the threshold length. From the data, they determined the probability of a contracture and concluded that a sustained stretch of six hours a day prevented the contracture. Six hours was considered to be the same amount of time that

[1]  G. Fulford,et al.  Subtalar arthrodesis by cancellous grafts and metallic internal fixation. , 1976, The Journal of bone and joint surgery. British volume.

[2]  D. Cooperman,et al.  Hip Dislocation in Spastic Cerebral Palsy: Long‐Term Consequences , 1987, Journal of pediatric orthopedics.

[3]  T. Matsuo,et al.  Insufficiency of the Hip Adductor After Anterior Obturator Neurectomy in 42 Children with Cerebral Palsy , 1986, Journal of pediatric orthopedics.

[4]  S. Scott,et al.  Grice subtalar arthrodesis followed to skeletal maturity. , 1988, Journal of pediatric orthopedics.

[5]  M. Hoffer,et al.  Chiari Osteotomy in Cerebral Palsy , 1988, Journal of pediatric orthopedics.

[6]  A. Browne,et al.  One‐Session Surgery for Bilateral Correction of Lower Limb Deformities in Spastic Diplegia , 1987, Journal of pediatric orthopedics.

[7]  F. B. Palmer,et al.  The Effects of Physical Therapy on Cerebral Palsy: A Controlled Trial in Infants with Spastic Diplegia , 1988, The New England journal of medicine.

[8]  J. Reimers,et al.  Adductor Transfer Versus Tenotomy for Stability of the Hip in Spastic Cerebral Palsy , 1984, Journal of pediatric orthopedics.

[9]  R. Shiavi,et al.  Split posterior tibial-tendon transfer in spastic cerebral palsy. , 1983, The Journal of bone and joint surgery. American volume.

[10]  M. Hoffer,et al.  Supracondylar derotational osteotomy of the femur for internal rotation of the thigh in the cerebral palsied child. , 1981, The Journal of bone and joint surgery. American volume.

[11]  J. Gage,et al.  RECTUS FEMORIS TRANSFER TO IMPROVE KNEE FUNCTION OF CHILDREN WITH CEREBRAL PALSY , 1987, Developmental medicine and child neurology.

[12]  E. Bleck,et al.  PREVENTION OF SPASTIC PARALYTIC DISLOCATION OF THE HIP , 1985, Developmental medicine and child neurology.

[13]  H. Graham,et al.  Lengthening of the calcaneal tendon in spastic hemiplegia by the White slide technique. A long-term review. , 1988, The Journal of bone and joint surgery. British volume.

[14]  Gluteus medius and minimus insertion advancement for correction of internal rotation gait in spastic cerebral palsy. , 1980, The Journal of bone and joint surgery. American volume.