CASE REPORT 0The present case is presented to show the effect of physical therapy on severely affected child using GMFCS as measurement scale pre- and post-therapy. The patient was a 9-year-old boy with spastic diplegia functioning at GMFCS Level V. [ijcpjournal.org]

In the past three years he has made presentations on the application of HBOT to autism and chronic neurological conditions to the U.S. [hbot.com]

[…] been associated with genetic abnormalities; congenital brain malformations; maternal infections or fevers; and/or injury before, during or shortly after birth. [1] [3] [4] There is no cure, and treatment options vary depending on the signs and symptoms present [rarediseases.info.nih.gov]

The feet and ankles present more problems than the knees due to a short tight Achilles tendon, which can lead to toe walking. There is risk that the hips may become dislocated and for this reason, the child’s hips must be closely monitored. [originsofcerebralpalsy.com]

Certain medical conditions and factors may increase the risk of a child having cerebral palsy and spastic diplegia: Maternal infection or high fever during pregnancy; Complicated labor and delivery; Breech presentation; Rh (blood type) incompatibility [birthinjurysafety.org]

• Failure to Thrive

  The initial presentation is commonly in the first year of life, with failure to thrive and hepatosplenomegaly. [adc.bmj.com]

  […] to Thrive Respiratory Problems Incontinence Intellectual Impairment This image gives a nice pictorial overview of the problems experienced by children with Cerebral Palsy. [physio-pedia.com]

• Muscle Spasticity

  Cerebral palsy surgery is also a suggested option for muscle spasticity control Advanced technologies help individually for their mobility for example wheelchair. [trishlafoundation.com]

  Bohannon RW, Smith MB (1987) Inter-rater reliability of a Modified Ashworth Scale of muscle spasticity. PhysTher 2: 206-208. [omicsonline.org]

  The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. [fpnotebook.com]

  Spasticity in the muscles of one or both legs may affect a person’s ability to Stand upright Sit upright Transfer from one position to another Move and reposition in bed Walk and run Effect on speech Spasticity can also be present in smaller muscles [cerebralpalsy.org.au]

  Spasticity Long-term outlook for the child with cerebral palsy Since CP is a lifelong condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capabilities at home and in the community [stanfordchildrens.org]

• Scissoring Gait

  Other signs and symptoms may include delayed motor or movement milestones (i.e. rolling over, sitting, standing); walking on toes; and a "scissored" gait (style of walking). [1] [2] As with other types of cerebral palsy, spastic diplegia is usually caused [rarediseases.info.nih.gov]

  People with spastic diplegia often walk with a “scissor gait” caused by tight muscles in the hips and legs. The muscles become so tight the legs want to turn inward and sometimes cross over each other at the knees. [cerebral-palsy-information.com]

  They may walk on their toes, or walk with a scissored gait. Fortunately, although symptoms may change as the child grows older, spastic diplegia does not worsen over time. [birthinjurysafety.org]

  Standing chair can be used.For scissors gait, You should use physio ball to reduce that position. 29-07-2008 11:49 AM #6 Forum Member Array Re: Cerebral Palsy - spastic diplegia...help!!! [physiobob.com]

  There are a host of ways that specialists use to correct the “scissor gait” of patients diagnosed with Spastic Diplegia. [medicalook.com]

• Chest Deformity

  His body was completely stiff with marked asymmetrical spasticity in lower limbs, truncal dystonia, and chest deformity with cardio respiratory complications. [ijcpjournal.org]

• Acute Low Back Pain

  [2003]-Conducted a study on effects of MET in patients with acute low back pain. The results showed that MET was effective in decreasing disability and improving function in patients with acute low back pain. [ukessays.com]

• Long Legs

  Long leg braces and knee braces are almost never needed for children with diplegia. Surgery is not usually recommended for children of this age. [disabled-world.com]

• Clonus

  During testing we observed clonus only in gastrocnemius and soleus muscles. [omicsonline.org]

  Ankle clonus. Bilateral Babinski sign. Scissoring posture of legs when held in the air supported by the axillae due to spasticity in the hip adductor muscles. Tiptoe walking. Atrophy and impaired growth of legs in severe cases. [pathophys.org]

  However, children aged 2 years and over with evolving CP will also have clonus and exaggerated deep tendon reflexes (DTRs) in the lower limbs. [adc.bmj.com]

  Further evidence of brain movement involvement on the hemiplegic side includes hyperreflexia of the deep tendon reflexes, ankle clonus, and extensor toe signs. [childneurologyfoundation.org]

  Clonus and muscle spasms are not uncommon. Clonus is a series of involuntary rhythmic muscular contractions and relaxations. These are caused by the pain and/or stress of muscle tightness, indicating especially hard-working and/or exhausted muscles. [abclawcenters.com]

• Hyperreflexia

  Classification Physiologic Classification Spastic (most common) Velocity-dependent increased muscle tone and hyperreflexia with slow, restricted movement due to simultaneous contraction of agonist and antagonist muscles. [orthobullets.com]

  It is part of the upper motor neuron syndrome characterized by hyperreflexia, clonus, extensor plantar responses and primitive reflexes. Spastic Cerebral Palsy is the most common form of Cerebral Palsy. [physio-pedia.com]

  Hyperreflexia – Abnormal increase in deep tendon reflexes. Deep tendon reflexes are elicited by the striking of the muscle tendon with a reflex hammer. Hypertonia – Increased muscle tone from expected (See muscle tone). [childneurologyfoundation.org]

• Abnormal Gait

  Common patterns can be seen in people with Cerebral Palsy and movement-limiting symptoms can include: Contractures, or joints will not extend fully Movements can be exaggerated Abnormal reflexes Abnormal gait Crossed knees Walking on tiptoes Quick links [cerebralpalsy.org.uk]

  The abnormal gait is often quite bizarre and may initially be interpreted as psychogenic in origin or “hysterical”. The gait disturbance usually shows a dramatic and sustained response to small doses of levodopa. [adc.bmj.com]

• Bilateral Ankle Clonus

  hyperactive deep tendon reflexes, bilateral ankle clonus, extensor toe signs)[see above]. [childneurologyfoundation.org]

Options for Cerebral Palsy Treatment Spastic diplegia cerebral palsy does not have any complete cure but the management in the condition of spastic CP is possible after some common treatments in patients. [trishlafoundation.com]

Experienced treatment teams for individuals with spastic diplegia CP can help determine the treatments which are best suited for them. [cerebralpalsylawdoctor.com]

Two approaches used for the treatment of children with physical disabilities are advanced physiotherapy treatment called Neuro developmental therapy (NDT) and muscle energy technique (MET). [ukessays.com]

[…] et al, NDT was compared to the Adeli Suit Treatment (AST) in twenty-four children with CP for four weeks, five days per week for two-hour sessions. [pediastaff.com]

Group A: Myofascial release and conventional PT treatment. Group B: conventional PT treatment. Both the groups received training for 4 weeks. [omicsonline.org]

With early intervention and proper treatment, the prognosis for children with spastic diplegia is favorable. [cerebralpalsyguidance.com]

Homeopathy Prognosis These children should be diagnosed early and treated as babies on neurological lines. The result of early treatment can be surprising. [icddelhi.org]

Diplegic Cerebral Palsy Prognosis Per the U.S. National Library of Medicine (NCBI), prognosis is favorable for children with diplegic CP. As previously mentioned, diplegic CP is the least invasive type of CP, affecting mainly the legs. [birthinjuryguide.org]

Guide to Physical Therapist Practice in Neuromuscular practice pattern 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-Congenital Origin or Acquired in Infancy or Childhood. 16 Prognosis [pediastaff.com]

Prognosis CP is not a progressive but the symptomscan become more severe over time Prognosis depends on intensity oftherapy during early childhood Tend to develop arthritis at a youngerage than normal because of pressureplaced on joints by excessively [slideshare.net]

Etiology Clin Obstet Gynecol. 2008 Dec;51(4):775-86. Pediatr Neurol. 2009 Mar;40(3):168-74. [pathophys.org]

Traditionally prenatal etiology, prematurity, total growth retardation, perinatal asphyxia and other perinatal causes like trauma have all been implicated as risk factors for cerebral palsy. (National collaborative perinatal project NCPP data). [ukessays.com]

Several other classification systems exist based on the pathophysiology, etiology, and distribution of motor deficits [ 5 ]. [omicsonline.org]

Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51. [Medline]. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. [emedicine.staging.medscape.com]

Cerebral palsy: classification and epidemiology. Physical Medicine and Rehabilitation Clinics of North America, 20(3), 425-452. doi: 10.1016/j.pmr.2009.06.001 See abstract Paneth, N. (2008). Establishing the diagnosis of cerebral palsy. [cerebralpalsy.org.au]

The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 28(4): 183-91. Review. Pandyan AD, Gregoric M, et al. 2005. Spasticity: clinical perceptions, neurological realities and meaningful measurement. [theratogs.com]

Epidemiology Unfortunately, it is difficult to access and clarify the prevalence and incidence rate of disabilities in poor-resource settings (Gladstone, 2010). [physio-pedia.com]

Epidemiology The incidence of CP is about 2 per 1000 livebirths The incidence is higher in males than infemales Other associated problems include Mental disadvantage (IQ 50): 31% Active seizures: 21% Mental disadvantage (IQ 50) and not walking:20% [slideshare.net]

Pathophysiology Arch Dis Child Fetal Neonatal Ed. 2008 Mar;93(2):F153-61. [pathophys.org]

Several other classification systems exist based on the pathophysiology, etiology, and distribution of motor deficits [ 5 ]. [omicsonline.org]

Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology. Washington, DC: American College of Obstetricians and Gynecologists; 2003. [Full Text]. Capute AJ, Accardo PJ, eds. [emedicine.staging.medscape.com]

The CP prevention research was unveiled at the prestigious American Academy of Cerebral Palsy and Developmental Medicine Conference held in Orlando, Florida. [cpaustralia.com.au]

Minimizing the numbers of surgeries a child experiences is essential because it might prevent them from seeing themselves as being, 'sick.' [disabled-world.com]

The increased extensor spasm prevents the child from rolling over and the absence of body-righting reflexes prevents him from developing a reciprocal flexion and extension of the hips and knees to rollover smoothly. [icddelhi.org]

and joint receptors. [11] Severe consequences in a cerebral palsy child can be prevented with early diagnosis and comprehensive physiotherapy intervention. [ijcpjournal.org]

B about fall prevention strategies and functional training, as well as environmental modifications. Note: The above-referenced clinical review is freely accessible to all readers of the EBSCO Health Rehabilitation Reference Center Newsletter. [health.ebsco.com]