My Orthopaedic Surgeon

Notes on orthopaedic examination of Cerebral Palsy cases

PDF publications on Cerbral Palsy from Global-HELP Health Education using Low-cost Publications

Definition - Non-progessive syndrome of brain damage causing altered posture and movement and occasional sensory and intellectual dysfunction.

Objectives
1. Define cerebral palsy, tone, reflex
2. Discuss classification of cerebral palsy
3. Discuss etiology and prevalence of cerebral palsy
4. Describe the assessment and recording of examination of a patient with cerebral palsy
5. Discuss natural history of cerebral palsy
6. Discuss the effect of contracture of the gastrosoleus, hamstrings, and hip flexors
7. Describe methods of mobility and communication for children with spastic quadriparesis
8. Discuss current modalities used for control of tone
9. Discuss problems of parents of children with cerebral palsy

Separate pages on -
* CP Mx Diplegics
* CP Mx Hemiplegia
* Cerebral Palsy

Objectives
1. Describe early symptomatology and signs of Friedreich ataxia.
2. Discuss genetic transmission of Friedreich ataxia
3. Describe the orthopaedic problems associated with Friedreich ataxia

Friedreich ataxia (FA) is the prototype of all forms of progressive ataxia and accounts for approximately one half of all cases of hereditary ataxia. FA is an autosomal recessive spinocerebellar disorder, which has a slow but relentlessly degenerative course.
Synonyms and related keywords: FA, progressive ataxia, hereditary spinal ataxia, heredotaxia
Natalya V Bulaeva, MD 2005

Definition - Hereditary Spinal Cerebellar Ataxia
- Inherited Spinal Cerebellar Degen
- Onset by age 10

Objectives
1. Define hereditary motor sensory neuropathy and list several types
2. Describe presenting symptoms and signs of type 1 Charcot-Marie-Tooth disease
3. Discuss orthopaedic problems associated with HMSN, and an approach to management

Upper extremity involvement in cerebral palsy interferes with optimal use of the hands. Contractures of the elbows, for example, may interfere with the ability to position the hands in space. Mild to moderate wrist contractures may interfere with grasp and release and limit use of the affected hand as an assisting hand. Severe wrist contractures may interfere with dressing as a stiff flexed wrist is hard to get through a shirt or coat sleeve.

In the developed world paralytic poliomyelitis is almost extinct. This is clearly not the case elsewhere While immunization has markedly decreased the incidence it has no effect on those who already have had the disease. These children are now mostly adults. This has a number of important orthopedic implications: 1) Adults do not heal as readily; 2) Postoperative regimens need to be extended; 3) Postoperative rehabilitation facilities will be in more demand; 3) Adults will have a more difficult time accommodating alterations in the mechanics that follows some operations. Well-intended surgery may not have the results expected; 4) What will be the worldwide impact of “Post-Polio syndrome (new functional loss that may occur many decades after the disease first occurred in childhood). By some estimates 40% of polio victims will suffer from Post-Polio syndrome as they reach their 50s and 60s. The decisions in the surgical treatment of polio are more difficult than the procedures themselves. Hurried decisions are frequently bad—if in doubt, proceed cautiously and in stages.
Hugh G. Watts, M.D. Techniques in Orthopaedics® 20(2):179 –189 © 2005

Definition - Acute viral infection that is localised to
Anterior Horn Cells
Brainstem Motor Nuclei
Hallmark is weakness with normal sensation

Objectives
1. Describe the pathophysiology of poliomyelitis
2. Discuss the role of vaccination on the present geographic distribution of poliomyelitis
3. Describe orthopaedic problems associated with poliomyelitis
4. Discuss a treatment approach for orthopaedic problems secondary to poliomyelitis
5. Discuss post-polio syndrome