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Definition, overview and assessment of cerebral palsy

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Definition

Cerebral palsy is defined by the presence of problems of movement (motor abnormalities) of the extremities due to an injury in the immature brain, before two years of age (Figure 1).
 

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Figure 1. Cerebral palsy with right spastic hemiparesis, showing difficulties in manual activities (motor) and finger deformities.

Cerebral palsy is often associated with disturbances of sensation (touch) and may have a low cognitive development in the most severe forms. Brain injury can occur before, during or after birth. The most frequent causes are birth asphyxia and prematurity.


Overview

"Frequency": Cerebral palsy is becoming more common in developed countries due to increased survival of preterm infants. Currently affects 2 of every 1000 babies.

 

Neurological types of cerebral palsy:

Spastic; Most common form. There are muscles with increased muscle tone ("stiff or tense"). In this article we will discuss presmidaente form.

Dystonic-athetoid; Presents involuntary movements of the limbs.


Anatomic types of spastic CP :

According to the affected limbs there are three types:

  • Hemiplegic, which affects the upper and lower extremity of the same side (Figure 2).
  • Quadriplegic, affecting all four limbs (Figure 3).
  • Diplegic, affecting the lower extremities.

     

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Figure 2. Spastic left hemiparesis with limited mobility in the upper extremity.


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Cerebral palsy with involvement of all four limbs. Most severe form.

Evaluation of patients with CP

The clinical course of patients is complex due to the heterogeneity of spasticity or weakness of the affected muscles. The patient should be assessed multiple times before making a decision. This is the way to get a good treatment outcome.

We assess the sensitivity of the hand (Figure 4), strength (Figure 5), range of motion of all joints and the situation of each muscle, tracking whether the muscle has spasticity or weakness.
 

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Figure 4. Measurement of tactile sensitivity.
 

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Figure 5. Measurement of thumb pinch strength with a dynamometer.
 

The limb function is assessed by a function test. We use the Sollerman test of grip patterns. Function tests are applied before and after surgery to quantify the improvement of use of the patient's hand.

It is fundamental to define what tasks or activities of daily living are considered most relevant by the child. Establish functional goals of treatment.

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Brachial Plexus Birth Palsy: Definition and Mechanisms of Injury:
Risk of brachial plexus birth palsy. Necessary diagnostic tests.
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Diagnosis and Treatment of Shoulder Dysplasia
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Clinical experience of Dr Soldado
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Short or absent thumb: thumb hypoplasia
Deviated wrist: radial and ulnar clubhand
Short fingers: Brachydactyly, symbrachydactyly, amniotic band syndrome
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Extra fingers or thumb: Polydactyly
Glued fingers or syndactyly
Cerebral Palsy
Definition, overview and assessment of cerebral palsy
Upper extremity problems in children with spastic hemiparesis
Nonsurgical treatment of spastic hemiparesis
The upper extremity in cerebral palsy with spastic tetraparesis
Surgical treatment of spastic hemiparesis
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Pediatric vascular microsurgery: overview
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Classification and treatment of physeal fractures
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Fractures of the forearm and wrist of the child
Hand fractures in children
Upper extremity injuries of the child
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