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The Spastic Hip – Hip Flexion in Spastic Cerebral Palsy
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
An 8-year-old boy with a history of spastic triplegia presented with progressive gait disturbance and loss of endurance. He had previously been treated with physical therapy, serial casting, and BOTOX injections. He used a hinged ankle-foot orthosis and required a posterior walker for support, and at night he wore dynamic knee extension orthoses. Despite all of this, he developed progressive knee flexion and walked on his toes. He had occasional anterior knee pain, and got tired very quickly. While he had functioned at the GMFCS 3 level previously, his function had deteriorated to GMFCS 4.
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The spastic deformities should be differentiated from muscle contractures. In a relaxed patient with spastic deformity, the passive range of movements are full and normal at the affected joint. Muscle or joint contracture has restricted passive movements in the affected joints. Spasticity is classically classified by the number of limbs involved: Monoplegia (one extremity), hemiplegia (one arm, one leg), diplegia (two legs), triplegia (two legs, one arm) and quadriplegia (all four extremities). Motor function is also classified as spastic, flaccid and athetoid. Many patients have a combination of movement patterns (Table 3.3).Hand fractures
Cerebral Palsy
Published in Merlin G. Butler, F. John Meaney, Genetics of Developmental Disabilities, 2019
The neurological manifestations of CP are divided into five different types and characterized by the degree of muscle tone and/or the movement disorder: spastic (increased tone), dyskinetic (an involuntary uncontrolled movement disorder), ataxic, mixed, and hypotonic (abnormally low tone and relatively uncommon). Cerebral palsy is further classified according to the muscle groups involved: quadriplegia (all four extremities are affected), triplegia (three extremities are affected), diplegia (two lower extremities are most affected), monoplegia (one extremity is affected), and hemiplegia (one side of the body is affected).
What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR)
Published in Disability and Rehabilitation, 2019
Israt Jahan, Mohammad Muhit, Tasneem Karim, Hayley Smithers-Sheedy, Iona Novak, Cheryl Jones, Nadia Badawi, Gulam Khandaker
In our study, we identified that 32 of our children had both severe acute malnutrition (SAM) and severe chronic malnutrition (Figure 1). Among them, nearly two-third of these children had a monthly income of 5000–9999 BDT (∼62–124 USD), MACS level IV–V and GMFCS level IV–V (68.8%, 63.6% and 68.8%, respectively). Moreover, 40.6% of these children had spastic triplegia/quadriplegia and 28.1% had moderate to severe intellectual impairments (Figure 1).
Nutritional status of children with cerebral palsy in remote Sumba Island of Indonesia: a community-based key informants study
Published in Disability and Rehabilitation, 2021
Israt Jahan, Mohammad Muhit, Denny Hardianto, Tasneem Karim, Mahmudul Hassan Al Imam, Manik Chandra Das, Hayley Smithers-Sheedy, Nadia Badawi, Gulam Khandaker
The majority of children in our study had triplegia/quadriplegia (53.8%) and their nutritional status was relatively poor compared to others in the cohort. Similar patterns were observed for children with dyskinesia. These findings are consistent with other studies previously conducted in Indonesia [11], and other LMICs [7–10].
Myelopathy in West Nile virus encephalitis: Report of a case and review of literature
Published in The Journal of Spinal Cord Medicine, 2020
Jayantee Kalita, Amar Vibhute, Mritunjai Kumar, Usha K. Misra
Spinal cord involvement manifesting with polio-like illness has been reported in WNV infection both as a part of encephalitis and isolated polio-like illness4–17 (Table 1). In a study, 3 out of 16 seropositive WNV encephalitis patients had flaccid weakness with rigidity, tremor and myoclonus.4 West Nile virus myelopathy is usually asymmetrical, flaccid, areflexic, associated with bladder dysfunction but without a sensory deficit. Spinal MRI reveals signal changes in the anterior spinal cord and enhancement of cauda equina and anterior roots. Electromyography reveals evidence of anterior horn cell involvement.1 Based on these findings, spinal cord manifestation in WNV infection is considered to be anterior horn cell damage. Al-Shekhlee and Kartirji reported paralytic polio-like illness in 5 patients due to WNV infection. Spinal MRI was done in one patient and revealed T2 hyper intensity of anterior gray mater. Electromyography in these patients was consistent with anterior horn cell involvement. One patient improved and the remaining 4 had a poor outcome.16 Saad et al. reported 56 patients with acute flaccid weakness due to WNV infection including their 3 patients. The extent of paralysis ranged from single extremity to severe quadriplegia with bulbar weakness; 57% had quadriplegia, 4% triplegia, 13% paraplegia and 26% had monoplegia. Twenty-six percent of patients had cranial nerve palsy mainly facial diplegia, and 54% needed mechanical ventilation. Cranial MRI was non diagnostic. Spinal MRI was done in 21 patients and was abnormal in 8; 6 had cauda equina enhancement including conus in 2, one had T2 hyper intensity extending from C1–C7 and another had T2 hyper intensity of anterior gray mater. Fifty-one patients were followed up; 11 died and 40 had persistent weakness.17 Polio-like illness has also been reported in other arbovirus infection such as Japanese encephalitis. In a study on 12 patients with JE, 7 had evidence of anterior horn cell involvement; focal reflex loss in 6, wasting in 7 and fibrillation and sharp waves in all the 7 patients. Lower motor neuron changes however were replaced by pyramidal or extrapyramidal signs at follow up.18