Treatment of Cerebral Palsy: Surgery
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy
Cerebral Palsy

Surgical Intervention

Surgery is recommended for a number of different conditions associated with Cerebral Palsy. Any surgery is likely to involve pre- and post-operative care. In many cases the application of casts or splints will be involved. The co-operation of the individual and the parents is fundamental. The surgeon and his or her team must take into account the frustrations andd pain that are involved in the procedures. In planning for corrective surgery all parties should be totally aware of the purpose and likely outcome of the procedure. This is especially true for school age children whose education will be disrupted by the time spent in the hospital and convalescing.

Cerebral Palsy

Cerebral Palsy

A common reason for a recommendation of surgery is contractures and other conditions which are causing: spinal deformities, pelvic deformities, hip deformities, knee deformities, hand and wrist deformities, and foot and ankle deformities.

Surgery to improve patterns of walking, standing and balancing is not generally recommended until a child’s lower limb potential has been fully assessed. Upper limb surgery is not usually advised before the age of six or more so that selective control and sensation can be assessed first.

Surgery is often recommended when the patient is suffering from extreme contractures that are unresponsive to other forms of cerebral palsy therapy. Severe contractures will inhibit movement, balance, and coordination. Many surgeons would prefer to see contractures avoided and gait and upper limb mobility improved through good physical therapy. There are still numerous instances, however, where surgery is advised. Doctors can fix contractures which are severely affecting a patient’s ability to function by surgically lengthening, shortening or cutting tendons and muscles which are causing bones to distort. Doctor’s can also improve bone deformity using instrumentation, which involves inserting a rod next to the deformed bone in order to straighten it.

Pre-operative analysis is the key to a successful surgery. Because movements like walking require more than 30 different muscles working in unison, it is important that the proper tendons and ligaments be adjusted.

A new tool that enables doctors to spot gait abnormalities, pinpoint problem muscles, and separate real problems from compensation is called gait analysis. Gait analysis combines cameras that record the patient while walking, computers that analyze each portion of the patient's gait, force plates that detect when feet touch the ground, and a special recording technique that detects muscle activity (electromyography). Using these specialized computers, doctors and specialists can analyze a patient's gait when walking, which can help the specialist to pinpoint muscles that need help. In addition to using specialized computers, they key to a successful surgery is a sensitive and appropriate appraisal of the effect any procedure may have on the rest of the body. For instance many incorrect postures are a result of the patient compensating for a causative, or fundamental, deformity elsewhere. “Surgery on a secondary deformity runs the risk of further disabling the patient by removing compensation she may need in order to function.” Total gait and posture analysis is therefore advised before any surgical procedure is even contemplated. In addition to whether or not the pre-surgical analysis is thorough and sensitive and finds that the procedure is quite likely to aide the patient, many doctors feel it imperative for the child to believe that he or she will benefit from the surgery and have an intelligence level that will enable him or her to understand the procedure he or she will be undergoing.

Because lengthening a muscle makes it weaker, surgery for contractures is usually followed by months of recovery. For this reason, doctors try to fix all of the affected muscles at once when it is possible or, if more than one surgical procedure is unavoidable, they may try to schedule operations close together.

A second surgical technique, known as selective dorsal root rhizotomy, aims to reduce spasticity in the legs by reducing the amount of stimulation that reaches leg muscles via nerves. In the procedure, doctors try to locate and selectively sever overactivated nerves controlling leg muscles. Although there is scientific controversy over how selective this technique actually is, recent research results suggest it can reduce spasticity in some patients, particularly those who have spastic diplegia. This procedure usually is done when a child is between 2 and 7 years of age. According to UCP, this procedure is usually recommended only for children with severe leg spacticity who have not responded well to other treatments.

Experimental surgical techniques include chronic cerebellar stimulation and stereotaxic thalamotomy. In chronic cerebellar stimulation, electrodes are implanted on the surface of the cerebellum -- the part of the brain responsible for co-ordinating movement -- and are used to stimulate certain cerebellar nerves. While it was hoped that this technique would decrease spasticity and improve motor function, results of this invasive procedure have been mixed. Some studies have reported improvements in spasticity and function, others have not.

Stereotaxic thalamotomy involves precise cutting of parts of the thalamus, which serves as the brain's relay station for messages from the muscles and sensory organs. This has been shown effective only for reducing hemiparetic tremors

 Surgery aimed at improving deformities caused by Cerebral Palsy is still being researched. Because the human body’s muscular and skeletal structures are so complex, the slightest alteration of a muscle or tendon may have huge, unforeseen effects. For instance, “weak muscles may have hidden strengths which could be removed by surgery… [and] in the first three to four years of life it may not be possible to establish where the main problems will occur.” Walking is also thought to be difficult to achieve through surgery after the age of eight. It is for this reason that surgery is most often a last resort. Research is currently underway to find new, more effective ways to use surgical measures in treating cerebral palsy."

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Treatment of Cerebral Palsy: Counseling, Music Therapy, Occupational Therapy,
Physical Therapy, Pharmeceuticals, Play Therapy, Speech Therapy and Surgery.