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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ten children with cerebral palsy are presented on whom stereotaxic operations on the central nervous system were performed with the aim of ameliorating athetosis and spasticity. Tere were seven alert and co-operative children with spastic hemiplegia or diplegia, of whom six received benefit from thalamotomy or dentatotomy. The seventh, a child with diplegia, had improvement of his left lower limb, but the right became worse. One child with spastic diplegia, in whom a thoracic meningocoele had been closed at birth, was not improved by bilateral dentatotomy. Two severely quadriplegic children each had bilateral dentatotomy; one was a child with dystonic and spastic quadriplegia. In both cases the resulting reduction in tone and extensor spasm rendered the nursing of these patients much easier. The place of stereotaxic surgery in the central nervous system in the management of children with cerebral palsy is discussed. We suggest that in selected cases the stereotaxic operation should be performed early in order to gain the greatest benefit. Stereotaxic surgery should be regarded as an integral part of the management which involves close co-operation of paediatrician, physiotherapist, neurosurgeon and orthopaedic surgeon.
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PMID:Stereotaxic neurosurgery in the management of cerebral palsy. 110 96

Twenty-three ambulatory children with spastic diplegic cerebral palsy were evaluated clinically and by electromyography before and after hip-muscle surgery. The stretch tests originally designed to distinguish specific muscle tightness and spasticity were found to be non-specific when tested by electromyography. Ambulatory electromyograms using needle electrodes and telemetry generally showed decreased activity in the released muscles and, on occasion, changes in activity in muscles not operated on. These unanticipated changes after release may explain some of the unpredictability of results of such procedures in cerebral palsy.
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PMID:Electromyography before and after surgery for hip deformity in children with cerebral palsy. A comparison of clinical and electromyographic findings. 125 25

Our study concerns a patient with cerebral palsy, submitted to conventional occupational therapy and functional electrical stimulation. The results as to manual ability, spasticity, sensibility and synkinesis were satisfactory.
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PMID:[Functional electric stimulation (FES) in cerebral palsy]. 130 99

Fifty consecutive children are described with spastic cerebral palsy treated with selective functional lumbar and sacral rhizotomy and followed for a minimum of 6 months. In all patients, spasticity improved postoperatively, but this was not necessarily accompanied by a functional improvement. Eighteen children who could not walk preoperatively were able to do so after rhizotomy. All 17 children who could walk preoperatively could do so following surgery, and in 15, gait was improved. Complications included transient urinary dysfunction in 4 children and sensory loss in 1. The operative procedure evolved with time: the technique of replacement laminotomy was refined; the electrophysiologic basis for selection of nerve rootlets changed after studies of nonspastic controls; smaller percentages of the L3 and L4 roots were sectioned in an attempt to prevent postoperative weakness of quadriceps, and there was a trend in the most recent patients to cut a smaller portion of all the posterior roots.
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PMID:Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases. 141 40

The pathophysiology of spasticity and the history of posterior rhizotomies are reviewed. The rationale for selective posterior rhizotomies is that electrical stimulation identifies afferent posterior rootlets that terminate on relatively uninhibited alpha motoneurons; if these uninhibited rootlets are divided, spasticity can be alleviated without loss of other posterior root functions. Indications, technique, and results of selective posterior rhizotomies are presented. The use of continuous intrathecal baclofen (CITB) is summarized. CITB at doses of approximately 300 micrograms/day consistently reduces lower extremity spasticity and diminishes or alleviates muscle spasms in adults with spasticity of spinal origin. Single doses of intrathecal baclofen significantly decrease lower extremity muscle tone in children with cerebral palsy, and the effects can be maintained in these patients by CITB infusions which diminish muscle tone not only in the lower extremities, but in the upper extremities as well. CITB is best accomplished via an externally programmable pump that allows titration of the daily dose to attain the desired reduction in spasticity. Factors influencing the decision for rhizotomy or CITB are presented.
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PMID:Neurosurgical treatment of spasticity: selective posterior rhizotomy and intrathecal baclofen. 143 44

Selective functional posterior rhizotomy (SFPR) is a popular operation for the treatment of spasticity in children with cerebral palsy, but the physiologic basis of the procedure is poorly understood. As part of SFPR operations in 60 consecutive children, the responses to electrical stimulation of posterior lumbosacral roots and rootlets, and the corresponding anterior roots were studied. In addition, similar electrical stimulation of posterior roots was performed in four nonspastic "control" children. Sustained responses to 50 Hz stimulation, one of the criteria used to signify abnormality in the spastic children, was found frequently in the "control" children. Contralateral spread to the lower limb muscles and suprasegmental spread to the upper limbs, face, and neck were determined to be the most valid criteria which differentiated abnormal from normal responses. Stimulation of anterior nerve roots at 50 Hz caused sustained responses and ipsilateral lower limb spread, at a low threshold compared to that of corresponding posterior roots. The results of this study bring into question the validity of some of the criteria that are used to select abnormal posterior rootlets in the SFPR procedure, and suggest criteria that may be more valid based on findings in nonspastic children.
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PMID:Observations on electrical stimulation of lumbosacral nerve roots in children with and without lower limb spasticity. 145 94

The Slump Test is an inexpensive, easily administered assessment tool that can help record qualitative changes in sitting in an objective manner. Objective data are useful to document treatment efficacy over time. Over the past 2 years, the Slump Test has been administered at our clinic to a varied population with respect to age, neuromuscular condition, and functional abilities. At the time of this writing, more than 200 children have had the Slump Test administered as part of their assessment protocol. Most of these children have been between the ages of 3 and 8 years; have cerebral palsy, decreased trunk control, and limb spasticity; and are dependent on a wheelchair or aide for ambulation. In conclusion, the picture representation and objective data obtained from the Slump Test along with a qualitative description of sitting have provided us with a useful means of assessing change over time.
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PMID:The slump test. 155 50

Spasticity in children with cerebral palsy may inhibit function and reduce progress in therapy. Selective posterior rhizotomy, a neurosurgical procedure, has been found to effectively reduce spasticity in selected cases. The literature suggests that positive changes in upper extremity function results from this surgery. At the Alberta Children's Hospital in Calgary, Alberta, Canada, all candidates for this surgery are screened by the neuromotor clinic team, which includes an occupational therapist, a speech therapist, and a physical therapist. This paper outlines the specific changes seen in the upper extremity functions of 7 children over a 12-month period following their surgeries. The data collected suggest the children had improved function in activities of daily living, play skills, balance, and endurance. This paper focuses on the changes in activities of daily living and recommends future direction for research in this area.
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PMID:Upper extremity functional changes following selective posterior rhizotomy in children with cerebral palsy. 160 94

The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the selection of abnormal circuits within the central nervous system of children with spasticity due to cerebral palsy is described. The decision to transect dorsal rootlets is made on the basis of electrophysiological, behavioral and medical criteria. In 100 cases the average number of rootlets transected was 64%. Of the total stimulated, 23.3% exhibited normal electrophysiological and behavioral responses. Decision making regarding the preservation or transection of the remaining 12.7% of the segments is described. This information is presented in an effort to increase understanding of this particular portion of the procedure and to encourage standardization of the procedure between centers in the future.
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PMID:Intraoperative monitoring in selective dorsal rhizotomy. 166 63

The purpose of this article is to discuss physical therapy for children with cerebral palsy who undergo orthopedic surgery. Children with spasticity (increased tone) often undergo surgical procedures to increase the length of the hip, knee, and ankle musculature in an attempt to improve musculoskeletal alignment and functional abilities. Presurgical assessment of posture and movement to determine potential for change in function and postsurgical management are discussed. Intervention immediately following soft tissue surgery at the hips and knees and intervention at the time of cast removal for those children immobilized in a hip spica cast are reviewed. Specific postsurgical management protocols related to immobilization in splints/casts, positioning, and treatment activities are presented.
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PMID:Lower-extremity surgery for children with cerebral palsy: physical therapy management. 172 44


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