Examination of a Child with Cerebral Palsy
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
Tone is resistance felt to a passive stretch in a relaxed state of muscle activity and is best demonstrated by passive movement about a joint. The child is assessed in a relaxed state and can be examined in the parent’s lap. It may be increased in the form of spasticity, dystonia, or rigidity. The criteria described by Sanger et al.6 to assess hypertonia can be followed: Palpate the muscle to be examined to assess whether there is muscle contracture at rest.Define the available passive range of motion by moving the limb gently.Now move the limb at different speeds through the available range to look for catch, i.e., sudden resistance offered to the passive range and further possible slow stretch.Now the patient is asked to move the same joint on the other side and look for an alteration in resistance to movement or involuntary movement on the side being examined, which may indicate the presence of dystonia.
The Kidney (KI)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Compartment syndrome of the medial foot may result in increased venous and capillary pressures due to venous outflow obstruction.8 Arterial blood has difficulty entering the fixed space, causing ischemia that compromises the integrity of capillary walls. As permeability of the walls increase, edema, hypoxia, and acidosis take hold. Complications such as nerve and muscle dysfunction ensue after three hours of ischemia. Damage to nerves may become irreversible after 12-24 hours, about the time that muscle contracture begins. While awaiting or considering urgent fasciotomy, treatment with laser therapy may aid tissue health. However, given the urgency required for surgical treatment, practitioner should not delay proper diagnosis or treatment of compartment syndrome in order to wait and see if physical medicine treatments help over the course of several days.
Neuromuscular disorders
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Muscle contracture (as distinct from contraction) is the adaptive change which occurs when a normally innervated muscle is held immobile in a shortened position for some length of time. If a joint is held flexed for a long time, it may subsequently be impossible to straighten it passively without injuring the muscle. Active exercise will eventually overcome the muscle contracture, unless the muscle has been permanently damaged.
The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study
Published in Acta Orthopaedica, 2019
Olof Lindén, Gunnar Hägglund, Elisabet Rodby-Bousquet, Philippe Wagner
A spastic muscle will not stretch to the same degree as a muscle with normal tone. Therefore, spasticity may inhibit growth in the length of the muscle, resulting in the development of muscle contracture, with a decreasing range of joint motion (Rang et al. 1986). Both spasticity and contracture of the gastrosoleus muscle may result in toe walking. However, spasticity and contracture may also compensate for weakness of the gastrosoleus muscle. The combination of reduced muscle tone and increased body weight with age might result in a change from toe walking to a calcaneal or crouch gait with increased dorsiflexion of the ankle joint during mid-stance. As an effect functional gait can be compromised and a continuous deterioration in walking function in the adult with CP has been reported (Opheim et al. 2009). The pros and cons of spasticity and the need for spasticity-reducing treatment may thus vary with age.
The efficacy of superior rectus recession with simultaneous inferior oblique disinsertion on superior oblique palsy with superior rectus contracture
Published in Strabismus, 2019
Seyhan B. Özkan, Ayse Ipek Akyuz Unsal, Derya Buran Kagnici
Jampolsky proposed that the SR contracture develops due to the manifestation of vertical deviation when fusion is disrupted during sleep or intermittently during casual seeing, whereas others considered that this is entirely a compensatory effort to overcome the excyclotorsion.1,26 Jampolsky suggested that treatment of patients with SR muscle contracture should include recession of the involved SR muscle, and controversially, Paris suggested that the appropriate treatment would be to focus on correction of excyclotropia rather than weakening the SR muscle.27 If SR contracture develops as a secondary problem in SOP, it needs to be treated targeting the main problem and then the secondary problem. In a case with SOP, SR recession as a single procedure will weaken the incyclotorsion action of SR muscle and will worsen the excyclotorsion related to the SOP. That is why, SR recession was used as an additional procedure in all of our patients in the study group.
Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy
Published in Disability and Rehabilitation, 2023
Merve Tunçdemir, Sefa Üneş, Jale Karakaya, Mintaze Kerem Günel
Cerebral palsy (CP) is the most common cause of physical disability and motor impairment in childhood [1]. Some children have only motor disorder, while others have many other problems accompanied with motor disorder. Many impairments of body structure and function are observed that cause limitations in activities and participation in children with CP [2]. These body structure and function impairments are neuromuscular and musculoskeletal problems included spasticity, hypertonia, muscle weakness, incoordination, poor balance, muscle contracture and reduced selective motor control [3–5]. Spasticity, muscle contractures and muscle weakness are more often observed problems compared to loss of selective motor control in children with spastic CP. Therefore, they are more focused problems on assessment or treatment-oriented research [2,6,7]. However, loss of selective motor control affects motor functions quite negatively than other impairments [6,7].
Related Knowledge Centers
- Autism Spectrum
- Hypertonia
- Muscle Atrophy
- Muscular Dystrophy
- Sarcomere
- Paralysis
- Connective Tissue
- Spasticity
- Toe Walking
- Polio