الفهرس | Only 14 pages are availabe for public view |
Abstract Although there’s no cure for cerebral palsy, many of its symptoms can be treated and managed in ways that will improve children’s functional abilities. Treatment needs vary widely, depending on the nature and extent of brain damage. Therefore, treating cerebral palsy requires coordinated care from an interdisciplinary team of health‐care professionals. The anatomical and physiological consideration, clinical presentation and pathological mechanisms should be well known. The different assessment modalities including the electrophysiological techniques, the physical methods, spasticity rating scales and measures for disability are also crucial for those who work in this field. A prospective study was done at Ain Shams University Hospitals and Dar El‐Shefa Hospital on 30 children with spasc cerebral palsy, 19 of them with diplegia, 8 with quadriplegia, two with hemiplegia and one with triplegia, the mean age was 7.9 years and the mean follow up duraon was 9.9 months. All children were subjected to an arsenal of routine investigations, instrumented and manual physical evaluation, electrophysiological evaluation and orthopedic evaluation for concomitant joint deformities. 131 All children were selected according to standard inclusion criteria for each modality of treatment used in this work. Children were grouped into two groups according to the modality used. Intra‐operative electrophysiological monitoring was used in all surgical cases, either neurostimulation for selective neurotomies or EMG monitoring in selective dorsal rhizotomy and somatosensory evoked potentials in microsurgical DREZotomy. Selective peripheral neurotomy is applied to (15) children; statistically significant physical and functional improvement was shown in those children. There was only one case of reported clinical recurrence of reflex activity during the follow‐up period for those underwent neurotomy. The sciatic nerve is the most commonly operated; 24 neurotomies, the bial is the second; 22 neurotomies, the obturator; four neurotomies, and the median nerve; two neurotomies. Selective dorsal rhizotomy was performed in thirteen spastic children due to cerebral palsy with diffuse spasticity in both lower limbs. Spasticity control is achieved in all children immediately post operatively. 132 Intensive physical rehabilitation program (in the form of gradual stretching, casting, splinting, standing and gait training for lower limbs, occupational therapy for upper limb) was done starting from the second post‐operative day and continued as an outpatient program for at least four to six months. Follow‐up measurements are documented in follow‐up charts for each patient. Statistical analysis for results and interrelations were found to be more or less around international figures. The best results regarding function was found in those underwent neurotomies, perhaps due to the returning regain motor balance between agonist and antagonist immediately post operative. Functional outcome assessment is done for both groups, and comparison between the results of different procedures was made, which had close net results regarding tone reduction, joint range of motion and functional improvement. Cost/benefit evaluation in terms of low cost – high benefit is best presented with group (A): selective peripheral neurotomy in comparison to the centrally directed procedures. |