Release Date: 2024-01-19

Orthopedic Problems and Management in Cerebral Palsy

Musa Eymir (Author), Nilsah Yilmaz (Author)

Release Date: 2024-01-19

Orthopedic problems in cerebral palsy occur secondary to primary deficits. Primary deficits include impairment in position, abnormalities in muscle tone, imbalance and coordination disorders, decreased strength and loss of selective motor control. Secondary deficits include muscle contractures and bone deformities, leading to further motor dysfunction and the need for orthopedic surgery. Management of orthopaedic problems [...]

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Work TypeBook Chapter
Published inPhysiotherapy and Rehabilitation for Cerebral Palsy
First Page105
Last Page123
DOIhttps://doi.org/10.69860/nobel.9786053358794.6
ISBN978-605-335-879-4 (PDF)
LanguageENG
Page Count19
Copyright HolderNobel Tıp Kitabevleri
Licensehttps://nobelpub.com/publish-with-us/copyright-and-licensing

Orthopedic problems in cerebral palsy occur secondary to primary deficits. Primary deficits include impairment in position, abnormalities in muscle tone, imbalance and coordination disorders, decreased strength and loss of selective motor control. Secondary deficits include muscle contractures and bone deformities, leading to further motor dysfunction and the need for orthopedic surgery. Management of orthopaedic problems caused by contractures and deformities is achieved through conservative treatments, pharmacologic agents or surgery. Conservative treatment consists of occupational therapy and physical therapy. Pharmacologic treatment aims to provide benefit by affecting the neurological processes underlying orthopedic problems. Surgical methods are aimed at bone deformities and muscle contractures. All of these methods aim to improve motor function and aim to do so by reducing or eliminating the orthopedic problems that play a role in the impairment of function. Orthopedic problems can be found throughout the musculoskeletal system. The most common orthopedic deformities in the foot are equinus, pes planovalgus, clubfoot; knee flexion deformity in the knee, dysplasia in the hip and scoliosis in the spine. Management of equinus is often achieved with serial casts, botulinum toxin injection, and triceps surae muscle lengthening surgery. Pes planovalgus is treated with orthotic approaches and clubfoot is treated with serial casting and orthotics called ponseti method. In knee flexion deformity, ground reaction aphosis is considered to be a better treatment option than surgery. In hip dysplasia, the decision of conservative or surgical treatment is based on the migration percentage, which gives information about the amount of separation. The most current approach among conservative treatment options is hip abduction orthosis. Botulinum toxin injection accompanies the use of orthosis. Surgical options include open hip reduction, femoral varus derotation osteotomy, pelvic osteotomy or radical surgery. The treatment should be based on the clinical picture, the needs of the child with cerebral palsy and feedback from the family. Finally, scoliosis in cerebral palsy is mostly ’C’ shaped and in the thoracolumbar region. The use of a brace appropriate to the curvature is the first option. Surgery is preferred when vital functions are jeopardized and the most common surgical method is fusion surgery.

Musa Eymir (Author)
Asst. Prof. Dr., Erzurum Technical University
https://orcid.org/0000-0002-9671-9583
3The author received his undergraduate degree in Physical Therapy and Rehabilitation at Hacettepe University 2008, his master’s degree in Orthopedic Physiotherapy at Dokuz Eylül University in 2016, and his doctorate from the Department of Physical Therapy and Rehabilitation at Dokuz Eylül University in 2021. The author worked as a Physiotherapist at different Special Education and Rehabilitation centers from 2008 to 2014. He started to study in academia in 2014 and as a Research Assistant at the School of Physical Therapy and Rehabilitation at Dokuz Eylül University between 2014 and 2021. In June 2021, he started to study as a Research Assistant at the Department of Physical Therapy and Rehabilitation at Erzurum Technical University. By September 2021, he was promoted to Assistant Professor Doctor within the same university and department, where he continues his professional academic life.

Nilsah Yilmaz (Author)
M.Sc. PT, Tokat Gaziosmanpasa University
https://orcid.org/0000-0002-3044-3326
3The author worked as a Physiotherapist at different Special Education and Rehabilitation centers from 2014 to 2016. She started to study in academia in 2016 and as a Research Assistant at the School of Physical Therapy and Rehabilitation at Dokuz Eylül University between 2016 and 2020. In January 2020, she started to study as a Research Assistant at the Department of Physical Therapy and Rehabilitation at İzmir Kâtip Çelebi University. By July 2023, she was promoted to Assistant Professor Doctor within the same university and department, where she continues her professional academic life.

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