Cerebral Palsy

Foreword
Preface
Acknowledgments
Acknowledgments from the First Edition
Contents
About the Editors
Contributors
Part I: Diagnosis and Pathology
1 The Child, the Parent, and the Goal in Treating Cerebral Palsy
Introduction
How Different Is the Child with CP?
Family Impacts of the Child with CP
Care-Providing Community
Cerebral Palsy Clinic
Family Care Provider and Professional Care Provider Relationship
Family Response Patterns
Dealing with Blame
Giving and Dealing with Prognosis
Giving the Diagnosis
Medical Therapeutic Relationship to Child and Family
The Physical Therapist Relationship
When the Doctor-Family Relationship Is Not Working
When the Family Chooses Medical Treatment Against the Physician´s Advice
Recommending Surgery
A Plan for Managing Complications
When Complications Occur
The Final Goal
Cases
References
Part II: Etiology of Cerebral Palsy
2 Cerebral Palsy and the Relationship to Prematurity
Introduction
Natural History
Prevalence of Cerebral Palsy in Premature Infant
Etiologies of Cerebral Palsy Related to Prematurity
Intraventricular Hemorrhage (IVH)
Periventricular Leukomalacia (PVL)
Chorioamnionitis
Postnatal Glucocorticoid Therapy
Bronchopulmonary Dysplasia
Apnea of Prematurity
Neonatal Sepsis
Patent Ductus Arteriosus
Hypoxic-Ischemic Encephalopathy
Necrotizing Enterocolitis
Hypocarbia
Hyperbilirubinemia
Treatment
Perinatal and Postnatal Interventions to Reduce the Risk of Cerebral Palsy in Preterm Infants
Antenatal Glucocorticoids
Magnesium for Neuroprotection
Caffeine for Apnea of Prematurity
Delayed Cord Clamping
Follow-Up of the Premature Infant
Conclusion
References
3 Genetic Abnormalities and Congenital Malformations as a Cause of Cerebral Palsy
Introduction
Evolving Evidence in the Genetics of Cerebral Palsy
Natural History
Congenital Anomalies and Coexisting Conditions
Other Contributing Causes of Cerebral Palsy
Intrauterine Growth Restriction
Multiple Pregnancy
Intrauterine Infection
Thrombophilia
Hypoxia-Ischemia
Prematurity
Single-Gene Causes of Cerebral Palsy
Copy Number Variants
Recommendation for Treatment/Assessments
Cross-References
References
4 Infectious Etiologies of Cerebral Palsy
Introduction
Natural History
Epidemiology and Pathophysiology
Etiologies
Cytomegalovirus (CMV)
Testing, Treatment, and Outcomes
Herpes Simplex Virus (HSV) and Other Human Herpes Viruses
Testing, Treatment, and Outcomes
Enteroviruses and Parechoviruses
Testing, Treatment, and Outcomes
Emerging Viruses: Chikungunya Virus and Zika Virus
Testing, Treatment, and Outcomes
Neonatal Bacterial Pathogens
Testing, Treatment, and Outcomes
Other Pathogens to Consider
Testing, Treatment, and Outcomes
References
5 Perinatal Stroke as an Etiology of Cerebral Palsy
Introduction
Natural History
Epidemiology
Risk Factors
Pathophysiology
Diagnosis
Treatment
Acute Treatment
Chronic Treatment
Prevention
Complications of Stroke and Treatment
Conclusions
Cross-References
References
6 Problems During Delivery as an Etiology of Cerebral Palsy in Full-Term Infants
Introduction
Natural History
Problems During Birth as an Etiology of CP
Prematurity
Hypoxic-Ischemic Injury
Low Apgar Scores
Abnormal FHR Tracing
Meconium-Stained Amniotic Fluid
Intracranial Hemorrhage
Perinatal Stroke
Abnormal Labor
Umbilical Cord Complications
Placental Complications
Placental Abruption
Placental Infarction
Uterine Rupture
Instrumentation at Delivery
Fetal Presentation
Multiple Births
Chorioamnionitis
Treatment
Perinatal and Postnatal Interventions to Reduce the Risk of Cerebral Palsy
Complications
Cross-References
References
7 Postnatal Causes of Cerebral Palsy
Introduction
Natural History
Infectious Causes
Neonatal Sepsis
Viral Infections
Trauma
Congenital Heart Defects
Stroke
Neoplasms
Summary
Cross-References
References
Further Reading
8 Animal Models of Cerebral Palsy: What Can We Learn About Cerebral Palsy in Humans
Introduction
Studies in Mice
Infection/Inflammation model
Hypoxic/Ischemic Model
Studies in Rats
Hypoxic/Ischemic Model
Infection/Inflammation Model
Studies on the Effectiveness of Treatment Methods
Studies in Rabbits
Hypoxic/Ischemic Model
Infection/Inflammation Model
Studies in Sheep
Hypoxic/Ischemic Model
Infection/Inflammation Model
Studies on the Effectiveness of Treatment Methods
Studies in Nonhuman Primates
Hypoxic/Ischemic Model
Infection/Inflammation Model
Studies on the Effectiveness of Treatment Methods
Studies in Other Animals
Conclusion
Cross-References
References
9 The Effects of Umbilical Cord Blood and Cord Tissue Cell Therapies in Animal and Human Models of Cerebral Palsy
Introduction
Natural History
Treatment
Animal Studies of Cell Therapy in Brain Injuries
Animal Studies in Stroke
Animal Studies in Hypoxic/Ischemic Brain Injury
Animal Studies in Intraventricular Hemorrhage (IVH) and Periventricular Leukomalacia (PVL)
Summary of Animal Studies
Human Studies of Cell Therapy in Brain Injuries
Clinical Trials of Autologous Umbilical Cord Blood in CP
Clinical Trials of Allogeneic Umbilical Cord Blood in CP
Clinical Trials of MSCs in CP
Clinical Trials of CB in Babies with Hypoxic/Ischemic Encephalopathy (HIE)
Complications
Summary
Cross-References
References
10 Risk Factors for Developing Cerebral Palsy
Introduction
Gestational Age and Birth Weight
Prematurity as a Risk Factor for Cerebral Palsy
Prevention of CP in Preterm Infants
Birth Weight as Related to Gestational Age
Prevention of CP in Infants with Deviations from Optimal Intrauterine Growth
Twin or Multiple Birth
Assisted Reproductive Technology and the Risk for CP
Prevention of CP in Twins or Multiple Births
Maternal Risk Factors
Prevention of CP Related to Maternal Factors
Congenital Infections
Prevention of CP Related to Congenital Infections
Congenital Malformations
Prevention of CP Related to Congenital Malformations
Coagulopathies
Prevention of CP Related to Coagulopathies
Genetic Variants and CP
Prevention of CP Related to Genetic Causes
Perinatal Risk Factors
Prevention of CP Related to Perinatal Causes
Neonatal Risk Factors
Prevention of CP Related to Neonatal Causes
Post-neonatally Acquired CP
Prevention of CP Related to Postnatal Causes
Epilogue
Cross-References
References
Part III: Epidemiology
11 Epidemiology of Cerebral Palsy
Introduction
Definition and Classification of CP
Frequency and Patterns of Occurrence
Birth Prevalence: Overall Trends
Trends by Birth Weight and Gestational Age
Trends in Motor Severity and CP Subtypes
Accompanying Impairments
Survival in CP
Major Risk Factors
Multiple Birth
Congenital Anomalies
Congenital Cytomegalovirus
Prevention of CP
References
12 Health and Healthcare Disparities in Children with Cerebral Palsy
Introduction
The Disabled Population as a Population with Health and Healthcare Disparities
Health and Healthcare Disparities in Children with Special Healthcare Needs
Health and Healthcare Disparities in Children with Special Healthcare Needs With and Without Disability and/or Medical Complex...
Health and Healthcare Disparities in Children with Cerebral Palsy
Racial Variance Within Cerebral Palsy Prevalence
Socioeconomic Impact on Cerebral Palsy Prevalence
Identifying Vulnerability Causing Health and Healthcare Disparities in the Cerebral Palsy Population
The Measurement of Healthcare Disparities in Cerebral Palsy
Strategies to Resolve Healthcare Disparities in the Cerebral Palsy Population
Predisposing and Enabling Factor Disparity Interventions
Need Factor Interventions Within the CP Population
The Medical Home and Care Coordination
Disparities in the Transition into Adult Healthcare
Transition of Orthopedic Services in the CP Population
Quality, Cost, and Value: Their Impact and Importance on Disparities in Children with Disabilities
Value for CSHCN, CMC, and Children with CP: The Patient and Family Perspective
Value of CSHCN, CMC, and Children with CP: The Provider and Payor Perspectives
Value and Healthcare Delivery Models in CSHCN, CMC, and Children with CP
Value and Alternative Payment Models in CSHCN, CMC, and Children with Cerebral Palsy
A High-Value Musculoskeletal Model of Care Delivery for the CP Child
Health Policy to Prevent Health and Healthcare Disparities in CSHCN
Cases
Case 1 (Pre-care Coordination) (Fig. 7)
Case 2 (Fig. 8)
References
Part IV: Pathology
13 Neuroimaging Pathology in Cerebral Palsy
Introduction
Fetal Neuroimaging Techniques
Hypoxic-Ischemic Brain Injury
Preterm
White Matter Injury of Prematurity or Periventricular Leukomalacia (Mild to Moderate Hypoperfusion)
Profound Hypotension in Preterm Infants
Germinal Matrix and Intraventricular Hemorrhage
Porencephalic Cyst
Term Infants
Watershed Predominant Pattern of Injury
Basal Ganglia/Thalamus Pattern
Perinatal Stroke
Congenital Infections of the Central Nervous System
Cytomegalovirus
Toxoplasmosis
Lymphocytic Choriomeningitis Virus
Congenital Malformations
Lissencephaly (The Agyria-Pachygyria Complex)
Microcephaly with Simplified Gyral Pattern (MSG)
Schizencephaly
Megalencephaly-Postaxial Polydactyly-Polymicrogyria-Hydrocephalus Syndrome (MPPH)
Septo-Optic Dysplasia
18q-Syndrome
Syntelencephaly
Joubert Syndrome and Related Disorders (Molar Tooth Malformations)
Rhombencephalosynapsis
Aicardi Syndrome
Hydranencephaly
Miscellaneous
Kernicterus
Conclusion
Cross-References
References
14 Current Imaging: PET Scan Use in Cerebral Palsy
Introduction
Cranial Ultrasonogram
Magnetic Resonance Imaging
Positron Emission Tomography
Diffusion Tensor Imaging
Conclusion
Cross-References
References
15 Neuromuscular Junction Changes in Spastic Cerebral Palsy
Introduction
Structure and Action of the NMJ
NMJ Formation during Development
Postsynaptic Maturation
Presynaptic Maturation
NMJ Microanatomic Organization in CP
NMJ Ultrastructure in CP
NMJ Gene Expression in CP
Medications That Target NMJs
Conclusion
Cross-References
References
16 Muscle Changes at the Cellular-Fiber Level in Cerebral Palsy
Introduction
Muscle Growth
Longitudinal Growth and Sarcomere Addition
Postnatal Development
Sarcomere Adaptation
Sarcomeres in Children with CP
Extracellular Matrix
Changes in ECM Content
Passive Mechanical Properties of Muscle Fibers and Bundles
Muscle Stem Cells, Postnatal Development, and Contractures
Satellite Cells (Muscle Stem Cells)
Function of Satellite Cells
Satellite Cells in Children with Cerebral Palsy
Summary
References
17 Muscle Size, Composition, and Architecture in Cerebral Palsy
Introduction
Natural History
Muscle Anatomy and Typical Muscle Growth and Development
Skeletal Muscle Size and Architecture in Typically Developing Children
Skeletal Muscle Size, Composition, and Architecture in Children with CP
Assessing Muscle in Children with CP
Factors Contributing to Atypical Muscle Growth and Development in Children with CP
Physical Activity
Muscle Spasticity
Medications
Surgery
Treatment
Summary
Cross-References
References
18 Bone Size, Architecture, and Strength Deficits in Cerebral Palsy
Introduction
Natural History
Bone Anatomy and Typical Bone Growth and Development
Bone Growth and Development in Children with CP
High Rate of Fragility Fractures in Children with CP
Assessing Bone in Children with CP
Factors Contributing to Atypical Bone Growth and Development in Children with CP
Gross Motor Function and Physical Activity
Muscle
Nutrition
Medications
Bone Health in Adults with CP
Treatment
Summary
Cross-References
References
Part V: Diagnosis
19 When and How to Evaluate the Child with Possible Cerebral Palsy
Introduction
Etiology and Pathology
Congenital (Antenatal) Etiologies
Neonatal and Perinatal Etiologies
Postnatal Etiologies
Classification of Cerebral Palsy
Diagnosis of Cerebral Palsy
Clinical Diagnosis
Neuroimaging
Metabolic and Genetic Testing
Coagulopathies
Diagnostic Evaluations for Associated Conditions
Conclusion
Cross-References
References
20 Cerebral Palsy Prognosis Based on the Physical and Neurologic Examination
Introduction
Making the Diagnosis
Early Diagnostic Uncertainty Complicates Early Prognosis
Developing a Prognosis
Prognosis: Comorbidities and Life Expectancy
The Challenge of Masqueraders
Early Neurologic Examination Predicting Specific CP Syndromes
Specific Syndromes
Conclusion
Cross-References
References
21 Classification Terminology in Cerebral Palsy
Introduction
Goals and Environment
Technique
Type and Topography of Neuromotor Impairment
Spasticity
Dyskinesia
Ataxia
Hypotonia
Neuroanatomical Classifications
Gait Pattern Classifications
Functional Classification Systems
Gross Motor Function
Manual Ability
Communication
Evidence of Effectiveness
Cross-Reference
References
22 Measuring Outcomes in Children with Cerebral Palsy
Introduction
Generic Versus Disease-Specific Measures
Self-Report Versus Parent Proxy Reporting
International Classification of Functioning
Functional Outcome Measures
Pediatric Outcomes Data Collection Instrument (PODCI)
Gillette Functional Assessment Questionnaire (FAQ)
Shriner´s Hospital Upper Extremity Evaluation (SHUEE)
Pediatric Evaluation of Disability Inventory (PEDI) and Pediatric Evaluation of Disability Inventory Computer-Adaptive Test (P...
Quality of Life/Health-Related Quality of Life Measures
Cerebral Palsy Quality of Life Questionnaire (CP-QOL-Child)
Cerebral Palsy Quality of Life Questionnaire (CP-QOL-Teen)
Caregivers Priorities and Child Health Index of Life with Disabilities (CPCHILD)
Pediatric Quality of Life Inventory (PedsQL) 3.0 Cerebral Palsy (CP) Module
DISABKIDS-CP Module (CPM)
Conclusion
Cross-References
References
23 Biomarker Blood Tests for Cerebral Palsy
Introduction
Types and Classes of Biomarkers
Basics of Diagnostic Biomarker Test Performance
Circulating Biomarkers in the Blood
Epigenetic Biomarkers and DNA Methylation in Blood Cells
Conclusion
Cross-References
References
Part VI: General Medical Concerns
24 General Nutrition for Children with Cerebral Palsy
Introduction
Natural History
Etiology of Impaired Growth in Children with Cerebral Palsy
Evaluating Growth in the Child with Non-ambulatory Cerebral Palsy
Evaluating for Nutritional Deficiencies in the Child with Cerebral Palsy
Role of Diet in Bone Health
Treatment
Nutritional Requirements
Nutrition Interventions
Oral Nutrition
Enteral Nutrition
Bone Health
Follow-Up
Complications of the Treatment and Disease Process
Complications of Calorie Boosting
Complications of Enteral Tube Feedings
Complications of Mineral Supplementation for Bone Health
Cross-References
References
25 Managing the Child with Cerebral Palsy Who Has Medical Complexity
Introduction
Role of Primary Care
Care Coordination
Practice Transformation
Models of Care
Medical Care
Transition
Payments
Cases
Case 1: Agitation
Case 2: Fever
Cross-References
References
26 Managing Bone Fragility in the Child with Cerebral Palsy
Introduction
Natural History
Cerebral Palsy
Medical Effects of CP
Primary Effects
Secondary Medical Problems
Bone Basics
Gross Motor Function Classification System
Relationship of BMD and Fracture
Pathophysiology/Etiology of Compromised Bone Health
Malnutrition/Suboptimal Nutrition
Puberty
Weight Bearing
Medications
Treatment and Complications: Identification and Prevention
Identification of Risk Factors and Prevention
Review Medical Risk Factors
Medication Selection/Consideration
Nutrition Assessment
Laboratory Evaluation
Weight Bearing
Standing
Vibration
Assessment of Bone Density
Handling/Mechanics
Education of Care Providers (School, Nurses/Aides, Families)
Pharmacologic Treatment
Bisphosphonates
Other
Summary/Wrap Up
Case Studies
Cross-References
References
27 Managing Irritability and Nonoperative Pain in the Noncommunicative Child with Cerebral Palsy
Introduction
Natural History
Assessment of Pain
Treatment and Complications
Gastrointestinal Etiologies of Pain
Constipation
Gastroesophageal Reflux
Feeding Intolerance
Visceral Hyperalgesia
Musculoskeletal
Spasticity
Treatment and Complications
Dystonia
Treatment and Complications
CNS Shunt Malfunction
Complications
Surgical Complications
Muscle Overuse Injuries
Occult Fractures
Treatment and Complications
Kidney Stones
Treatment and Complications
Paroxysmal Sympathetic Hyperactivity
Treatment and Complications
Conclusion
Cases
Cross-References
References
28 Palliative Care for Individuals with Cerebral Palsy
Introduction
Natural History
Advance Care Planning
Decision-Making Support
Assessing Medical Understanding
Goals of Care
End of Life Care
Case Discussion
Case Discussion
Pain and Symptom Management
Care Coordination
Anticipatory Grief/Bereavement
Family Support
Treatment
Case Discussion
Complications
Cross-References
References
29 Aging with Cerebral Palsy: Adult Musculoskeletal Issues
Introduction
Spine
Hip
Lower Extremity, Knee, and Foot
Rehabilitation Issues
Health Care System Issues for the Adult
Conclusion
Cross-References
References
30 Life Care Planning for the Child with Cerebral Palsy
Introduction
Definition of a Life Care Plan
Purpose of a Life Care Plan
Goals and Environment
Healthcare Providers
Treatment Interventions
Common Nonsurgical Interventions
Common Orthopedic Surgical Interventions
Diagnostics
Medications
Medication for Spasticity
Antiepileptic Medication
Cognitive and Behavioral Medication
Medication for Incontinence
Medication for Acid Reflux
Medication for Depression/Anxiety
Laboratory
Therapy
Traditional Therapy
Nontraditional Therapy
Mental Health Therapy
Education
School
Educational Advocate
Educational Therapist/Tutor
Vocational Rehabilitation Program
Day Program
Assistive Technology
Activities of Daily Living Equipment
Mobility Equipment
Assistive Technology for Cognition
Orthotic Devices
Nursing/Attendant Care
Care Attendant
Respite Care
Life Skills Coach
Care Facility
Professional Services
Fiduciary/Trustee
Attorney
Conservatorship/Guardianship
Benefits/Resources
Federal and State Benefit Programs
Social Security Benefits (All States) and Supplemental Security Income (SSI)
Social Security Disability Insurance (SSDI)
Medi-Cal (California)/Medicaid (All Other States)
Developmental Disability Services
Department of Social Services
Department of Rehabilitation
Recreation
Camps
Organizations
Home Modifications
Transportation
Technique
Case History
Cross-References
References
Resources
Part VII: Central Neurologic Problems
31 Epilepsy in the Child with Cerebral Palsy
Introduction
Natural History
Seizures and Epileptogenesis
Clinical Features of Seizures and Epilepsy in a Child with Cerebral Palsy
Treatment Considerations
The Diagnosis of Epilepsy in the Cerebral Palsies and the Role of EEG
Treatment of Epilepsy Syndromes and Seizure Categories in Cerebral Palsy
Specific Epilepsy Considerations and Syndromes in Cerebral Palsy
Epilepsy Remission in Cerebral Palsy
Complications of Epilepsy and Its Treatment in Cerebral Palsy
Summary
Cross-References
References
32 Epilepsy Surgery for the Child with Cerebral Palsy
Introduction
Impact
When Should Surgery Be Considered?
Evaluation for Epilepsy Surgery
Studies
Invasive or Intracranial EEG Monitoring
Epilepsy Surgery Conference
Types of Epilepsy Surgery
Resective Surgeries
Hemispherectomy
Selection
Infancy
Outcome
Complications
Other Resective Surgical Techniques Including Lesionectomy and Multilobar and Lobar Resection
Corpus Callosotomy
Indication
Adverse Effect
Neurostimulation
VNS
Minimally Invasive Epilepsy Surgery
Conclusion
Cross-References
Bibliography
33 Hydrocephalus in the Child with Cerebral Palsy
Hydrocephalus in Cerebral Palsy
Introduction
Natural History
Anatomy and Physiology
Physical Findings
Causes
Treatment
Complications
Cross-References
References
Part VIII: Psychologic and Psychiatric Problems
34 Psychiatric Disorders in Children with Cerebral Palsy
Introduction
Natural History
Identification
Incidence/Prevalence
Evaluation
Treatment/Remediation
Illustrative Case Study
Recognition by IEP Regarding Motor Issues/Condition
Conclusion/Areas for Future Studies
Cross-References
References
35 Autism Spectrum Disorder in the Child with Cerebral Palsy
Introduction
Definition of CP and ASD
Epidemiology
Diagnosis
Challenges in ASD Diagnosis for Children with CP
Natural History
Comorbidities and Common Risk Factors
Preterm Birth/Low Birth Weight
Maternal Infection and Inflammation
Perinatal Hypoxia/Ischemia
Genetic Factors
Epilepsy
Intellectual Disability
Motor Coordination Abnormalities
Treatment
Medical Testing
Medical Treatments
Pharmacotherapy
Rehabilitative Therapies
Early Intensive Behavioral Interventions (ABA, Developmental Models)
Complementary and Alternative Medicine
Conclusion
Cross-References
References
36 Family Stress Associated with Cerebral Palsy
Introduction
Parent Stress
Psychological Well-Being
Physical Health Outcomes
Disability Severity
Family Adaptation
Parent Personal Resources: Social Support and Self-Efficacy
Assessment Tools and Interventions
The Role of Respite Care Services
Financial Resources and Socioeconomic Status
Psychosocial Interventions and Parent Stress
Conclusions
Cross-References
References
37 The Impact of Cerebral Palsy on Siblings
Introduction
Children: Playmates, Mentors, and Friends
Challenges
Benefits
Adults: Caregivers, Supports, and Friends
Caregiving
Benefits
Challenges
Advice to Healthcare Professionals
Conclusion
Cross-References
References
Part IX: Neuromotor Function
38 Motor Control and Muscle Tone Problems in Cerebral Palsy
Introduction
Pathophysiology
Anatomic Motor Control Structure
Central Motor System
Peripheral Motor Control
Development of the Anatomic Structure
Central Nervous System
Peripheral Motor System
Controller Mechanisms and Theory
Sensory System Feedback Versus Feed-Forward Control
Controller Options: Maturation Theory
Controller Options: Dynamic Systems Theory
The Cause of Chaotic Attractors
A Unified Theory of Motor Control
Pathology Treatments
Disorders of Muscle Tone
Motor Tone
Measuring Muscle Tone
Spasticity
Effects of Spasticity on Nerves
Effects of Spasticity on Muscles and Tendons
Effects of Spasticity on Bones
Functional Effects of Spasticity on Sitting, Gait, and Activities of Daily Living
Hypotonia
The Effects of Hypotonia
Functional Problems
Treatments of Tone
Movement Disorders
Motor Control: Movement Disorders
Dystonia
Secondary Effects of Dystonia
Athetosis
Sensory Motor Effects of Athetosis
Treatment
Treatment: Therapy
Chorea and Ballismus
Summary of Motor Control Treatments
Disorders of Balance (Ataxia)
Treatment of Ataxia
Orthotics
Summary of Treatment: Ataxia
Cases
Cross-References
References
39 Spasticity Assessment in Cerebral Palsy
Introduction
Joint-Level Assessments to Infer About Muscle Function
Definitions
Measurement Methods
Measurement Errors
Qualitative Assessment Methods
Quantitative Assessment Methods
Passive Muscle Assessments
Active Muscle Assessments
Clinical Interpretation of Instrumented Assessments
Conclusion
Cross-References
References
40 Medical Management of Spasticity in Children with Cerebral Palsy
Introduction
Pathophysiology
Assessment
Treating Spasticity
Therapy Services
Bracing and Positioning
Chemodenervation
Oral Medications
Intrathecal Baclofen
Neurosurgery
Orthopedic Surgery
Summary Discussion
Conclusion
Cross-References
References
41 Focal Management of Spasticity in Cerebral Palsy
Introduction
Natural History
Effects of Spasticity on Nerves
Effects of Spasticity on Muscles and Tendons
Effects of Spasticity on Bones
Functional Effects of Spasticity on Sitting, Gait, and Activities of Daily Living
Treatments
Peripheral Nervous System
Neuromotor Junction and the Muscle
Botulinum Toxin (Botox)
Complications of Botulinum Toxin
Alcohol and Phenol
Direct Surgical Treatment of the Musculotendinous Unit
Orthotics
Therapy
A Global Approach to Managing Spasticity
Cases
Cross-References
References
42 Intrathecal Baclofen Therapy: Assessment and Medical Management
Introduction
History
Pharmacology of Baclofen
Criteria
Screening Trial
Pump Implantation
Pump Management
Complications
Outcomes
Summary
References
43 Intrathecal Medication Administration in Cerebral Palsy
Introduction
Natural History
Treatment
Complications
Cross-References
References
44 Dorsal Rhizotomy for Spasticity Management in Cerebral Palsy
Introduction
Some History
Treatment
Patient Selection
Decision Procedure
General Selection Criteria for SDR
Individual Selection Criteria for SDR
Timing of SDR Surgery
Surgical Procedure
Neurophysiologic Intraoperative Monitoring
Postoperative Rehabilitation Program
Expected Outcome
Complications
Conclusions
References
45 Dystonia and Movement Disorders in Children with Cerebral Palsy
Introduction
Pathophysiology
Dystonia
Athetosis, Chorea, and Choreoathetosis
Natural History
Treatment
Dystonia
Medications
Global Treatment
Focal Dystonia Treatment
Secondary Effects of Dystonia
Athetosis and Choreoathetosis
Treatment
Treating Secondary Effects of Athetosis
Chorea and Ballismus
Conclusion
Cases
Cross-References
References
46 Deep Brain Stimulation for Pediatric Dystonia
Introduction
Epidemiology
Preliminary Management
History of Surgical Interventions for Dystonia
Theoretical Mechanism of DBS
Preoperative Planning and Lead Implantation
Implantable Pulse Generators
Complications
Functional Outcome
Future Directions
Cross-References
References
47 Ataxia and Disorders of Balance in Children with Cerebral Palsy
Introduction
Balance Components
Ataxia
Vestibular System
Common Vestibular Disorders
Conclusion
Cross-References
References
48 Assessing Dynamic Balance in Children with Cerebral Palsy
Introduction
Natural History
Treatment
Testing
Task-Oriented Assessment of Dynamic Balance
Timed or Distance-Based Walking Tests of Dynamic Balance
Marker-Based Assessment of Dynamic Balance
Other Instrumented Assessment of Dynamic Balance
Treatment
Exercise/Therapy
Vestibular Stimulation
Taijiquan
Body Weight-Supported Treadmill Training
Virtual Reality and Interactive Gaming
Hippotherapy
Vibrational Therapies
Electrical Stimulation Therapies
Surgical Interventions
Complications
Cross-References
References
Part X: Gastrointestinal
49 Overview of Feeding and Growth in the Child with Cerebral Palsy
Introduction
Natural History
Prevalence and Pathophysiology
Etiology of Feeding and Growth Problems
Oral-Motor Dysfunction
Inappropriate Dietary Intake
Caregiver Dependency
Abnormal Energy Expenditure
Evaluations/Assessments
Ability to Take in Adequate Nutrition
Growth and Anthropometric Measurements
Physical Examination
Swallow Study
Adequacy of Intake and Energy Needs
Laboratory Evaluation
GI Concerns
Social History
Treatment/Management of Problems
Intake of Nutrition/Feeding Interventions
Nutritional Adequacy
Other Medical Management
Conclusion
Cross-References
References
50 Gastrostomy and Jejunostomy Feedings in Children with Cerebral Palsy
Introduction
Oropharyngeal Dysphagia
Evaluation
Gastroesophageal Reflux
Evaluation
Management
Gastrostomy Tube
Gastrojejunostomy
Complications of Gastrostomy and Gastrojejunostomy Tubes
During Placement
Post-placement Complications
Conclusion
Cases
Cross-References
References
51 Gastroesophageal Reflux in the Child with Cerebral Palsy
Introduction
Natural History
Pathophysiology and Etiology
Clinical Presentation and Symptoms
Treatment
Diagnosis and Testing
Esophagogastroduodenoscopy (EGD) and Biopsy
Esophageal pH Monitoring (EpHM)
Combined Multiple Intraluminal Impedance and pH Monitoring (CMII)
Barium Contrast Radiography/Upper GI (UGI) Series
Nuclear Scintigraphy/Gastric Emptying Scan (GES)
Management
Conservative Management
Pharmacologic Management
Surgical Management
Complications
Reflux Esophagitis and Peptic Strictures
Barrett Esophagus and Adenocarcinoma
Conclusion
Cross-References
References
52 Medical and Surgical Therapy for Constipation in Patients with Cerebral Palsy
Introduction
Natural History
Physiopathology
Treatment
History and Physical Exam
Abdominal Radiography
Sitz Marker Study
Motility Studies
Rectal Biopsies
Medical Therapy
Retrograde Enemas and Fecal Disimpaction
Antegrade Enteral Cleanout at Home
Admission for Bowel Cleanout
Maintenance Therapy
Diet
Medications that Induce Constipation
Complications
Surgical Therapy and Interventions
Medically Refractory Constipation
Volvulus
Perforation
Summary
Case Example
References
Part XI: Ear, Nose, and Throat
53 Medical Management of Sialorrhea in the Child with Cerebral Palsy
Introduction
Natural History
Physiology
Pathophysiology
Clinical Assessment of Drooling
Treatment
Non-pharmacologic Management of Drooling
Pharmacologic Interventions for Drooling
Botulinum Toxin Injections
Outcomes
Technique
Adverse Effects
Surgery
Future Directions
Cross-Reference
References
54 Surgical Options for Sialorrhea Management in Children with Cerebral Palsy
Introduction
Noninvasive Therapies
Pharmaceutical Therapies
Botulinum Toxin Injections
Surgical Management
Conclusion
Cross-References
References
55 Auditory Rehabilitation in Children with Cerebral Palsy
Introduction
Diagnosis of Hearing Loss
Treatment
Conventional Amplification
Cochlear Implantation
Candidacy Assessment with Audiology
Candidacy Assessment with Speech and Language Pathology
Candidacy Assessment with Otolaryngology
Candidacy Assessment with Social Work
Preoperative Counseling
Intraoperative Considerations
Complications
Postoperative Rehabilitation
Conclusion
Cross-References
References
56 Upper Airway Obstruction in the Child with Cerebral Palsy: Indication for Adenotonsillectomy
Introduction
Prevalence
Etiology
Impact on Quality of Life
Diagnostic Considerations
Treatment of OSA in CP
Tonsillectomy
Additional Surgical Interventions
The Role of Tracheostomy
Postoperative Management and Complications
Cross-References
References
57 Surgical Management of Tracheostomies and Tracheal Diversion in Children with Cerebral Palsy
Introduction
History
Natural History and Pathophysiology
Indications
Treatment
Tracheostomy Technique
Diversion Techniques
Complications
Complications After Tracheostomy
Immediate Complications
Early Complications
Late Complications
Complications of Tracheal Diversion
Conclusions
Cross-References
References
Part XII: Genitourinary
58 Toilet Training and Bladder Control in Children with Cerebral Palsy
Introduction
Natural History
Normal Toilet Training and Voiding Review
Voiding Issues in Upper Motor Neuron Versus Lower Motor Neuron Lesions
Factors Influencing Toilet Training in Children with CP
Effect of Constipation on Voiding
Summary of Toilet Training
Treatment
Urologic Evaluation
Noninvasive Testing
Invasive Testing: Urodynamic Studies
Treatment Options
Environmental Modification and Communication
Bowel Management
Medications
Anticholinergic Medications
Desmopressin
Bladder Catheterization
Selective Dorsal Rhizotomy
Complications
Upper Urinary Tract Deterioration
Changes in Adulthood
Cross-References
References
59 Neurogenic Bladder in Cerebral Palsy: Upper Motor Neuron
Introduction
Natural History
Normal Bladder Function
Lower Urinary Tract Dysfunction in Cerebral Palsy
Pathogenesis of Urinary Tract Symptoms in Cerebral Palsy
Diagnostic Work Up and Treatment
Work Up of Urological Symptoms in Children with Cerebral Palsy
Treatment of Lower Urinary Tract Symptoms in Children with Cerebral Palsy
Complications
Cross-References
References
60 Kidney Stones: Risks, Prevention, and Management in Cerebral Palsy
Introduction
Immobilization and Hypercalciuria
The Ketogenic Diet and Kidney Stone Risk
Antiepileptic Medications
Topiramate
Zonisamide
Treatment
Medical Management of Acute Renal Colic
Surgical Management of Kidney Stones
Imaging
Surgical Modalities for the Treatment of Kidney Stones
Extracorporeal Shock Wave Lithotripsy (ESWL)
Endoscopic Lithotripsy
Percutaneous Nephrolithotomy (PCNL)
Prevention of Recurrent Kidney Stones
Adequate Fluid Intake
Sodium
Calcium
Protein
Alkali Therapy/Potassium Citrate
Diuretics
Cross-References
References
61 Undescended Testis in Boys with Cerebral Palsy
Introduction
Natural History
Prevalence
Associated Risk Factors
Treatment and Complications
References
62 Gynecological Issues in Girls and Young Women with Cerebral Palsy
Introduction
Natural History
Puberty and Menstruation
Sexuality in Young Women
The Office Visit
History
Physical Examination
Treatment
Menstrual Suppression
Nonhormonal Treatment
Hormonal Treatment
Surgical Treatment
Contraception
Preventative Health and Screening
Complications
Pregnancy
Cross-References
References
Part XIII: Pulmonary
63 Bronchopulmonary Dysplasia and Cerebral Palsy
Introduction
Natural History
Definition
Incidence
Pathology of BPD
Radiology
Treatment
Prevention of BPD
Antenatal
Postnatal
Surfactant Therapy
Caffeine
Vitamin A
Oxygen Therapy
Corticosteroids
Treatment of Established BPD
Diuretics
Bronchodilators
Nutrition
Immunizations and RSV Prophylaxis
Outcome/Prognosis
Respiratory Outcomes
Neurodevelopmental Outcomes
Conclusion
Cross-References
References
64 Asthma in a Child with Cerebral Palsy
Introduction
Natural History
Pathophysiology for Asthma
Natural History of Risk Factors for Respiratory Illness
Diagnostic Observations and Dynamic Imaging Studies
Role of Historical Information to Treat Asthma
Treatment for Asthma
Complications of Treatment for Asthma
Measurable Parameters for Asthma Symptoms
Validated Surveys as a Diagnostic Tool for Asthma
Laboratory Studies
Limitations of Functional Respiratory Studies
Summary
Cross-References
References
65 Aspiration in the Child with Cerebral Palsy
Introduction
Definitions
Natural History
Aspiration from Above
Aspiration from Below
Screening and Diagnostic Testing
Complications
Aspiration Syndromes
Tracheobronchitis
Aspiration Pneumonitis
Aspiration Pneumonia
Treatment
Summary
Cross-References
References
66 Medical Management of Tracheostomy in the Child with Cerebral Palsy
Introduction: What Is a Tracheostomy?
Natural History of Respiratory Issues in Patients with Cerebral Palsy
Treatment: Indications for Tracheostomy Tube Placement in Patients with CP
Evaluation for Tracheostomy Placement
Complications: Potential Risks of Trach Placement
Care Following Trach Placement
Decannulation of the Tracheostomy Tube
Summary
Cross-References
References
67 Obstructive Sleep Apnea in Children with Cerebral Palsy
Introduction
Prevalence
Normal Breathing During Sleep
Sleep-Disordered Breathing and OSA in Children with Cerebral Palsy
Clinical History
Diagnosis
Treatment Options
Cross-References
References
Part XIV: Endocrine
68 Short Stature in Children with Cerebral Palsy
Introduction
Natural History
Overview of Normal Growth
Measurements of Growth
Growth Charts
Diagnosis and Treatment
Maturational Assessments of Growth
Bone Age
Body Composition: Overview
Body Composition: Skinfold Thickness
Body Composition: DXA Technique
Complications (Non-nutritive Factors Affecting Growth)
Growth Hormone-IGF-1 Axis: Normal
Growth Hormone Axis: Assessment in Cerebral Palsy
Growth Hormone Deficiency Treatment in Cerebral Palsy
Other Non-nutritive Factors in Growth Disorders
Functional Changes with Growth
Approach to Growth Problems in Children with Cerebral Palsy
Cross-References
References
69 Growth Attenuation for the Child with Cerebral Palsy
Introduction
Natural History
Treatment
Complications
Ethical Considerations
Autonomy and Family Preferences
Beneficence, Nonmaleficence, and the Best Interest Principle
Justice and Contextual Features
Perspective of Stakeholders
Conclusion
Cross-References
References
70 Premature and Delayed Sexual Maturation in Children with Cerebral Palsy
Introduction
Normal Pubertal Maturation
Phase of Fetus and Infant Puberty Development
Phase of Childhood Hormonal Suppression
Phase of Adolescent Puberty
Physical Assessment of Puberty
Adrenal Role in Puberty
Natural History
Precocious Puberty
Incomplete Precocious Puberty
Benign Variants
Pathological Variants
Complete Precocious Puberty
Delayed Puberty
Diagnosis and Treatment
Diagnosis of Central Precocious Puberty
Treatment of Central Precocious Puberty
Diagnosis of Delayed Puberty
Treatment of Delayed Puberty
Complications
Studies of Pubertal Milestones in Children with Cerebral Palsy
Studies of Pubertal Hormonal and Metabolic Changes in Children with Cerebral Palsy
Studies of Mechanisms of Pubertal Disruption in Cerebral Palsy
Conclusion
Cross-References
References
71 Endocrine Dysfunction in Children with Cerebral Palsy
Introduction
Natural History
Pituitary Gland
Thyroid Gland
Adrenal Gland
Treatment
Pituitary Gland
Thyroid Gland
Adrenal Gland
Complications
Cross-References
References
Part XV: Eyes
72 Testing Visual Function and Visual Evaluation Outcomes in the Child with Cerebral Palsy
Introduction
Natural History
Vision Disorders Commonly Associated with Cerebral Palsy
Evaluation and Treatment of Ocular and Vision Disorders Associated with Cerebral Palsy
Preparation for the Vision Evaluation
Preliminary Information from Caregiver
Information from Educators and Rehabilitation Therapists
Clinical History
Ocular Health Examination
Visual Skills Evaluation
What Are the Primary Visual Skills that Can Be Helpful for Professionals Working with Children with CP to Be Aware of?
Color Vision
Glare Sensitivity and Dark Adaptation
Vision Evaluation Outcomes
Complications of the Disease Process and Treatment
Treatment and Management of Identified Vision Disorders
Integration of Recommendations into Education and Rehabilitation Plans
Cross-References
References
Further Readings
73 Strabismus Management in the Child with Cerebral Palsy
Introduction
Natural History
Treatment
Nonsurgical Treatment
Surgical Treatment
Complications
Binocular Vision
Amblyopia and Visual Acuity
Strabismus Surgery Failure
Psychosocial Complications
Cross-References
References
74 Cortical Visual Impairment in the Child with Cerebral Palsy
Introduction
Natural History
Case History
Pathophysiology
Etiology
Characteristics
Visual Acuity
Visual Field
Higher Order Deficits
Treatment
Diagnosis
Interventions
Prognosis
Multidisciplinary Team
Complications
Cross-References
References
Part XVI: Dental
75 Dental Hygiene for Children with Cerebral Palsy
Introduction
Goals and Environment
Body Function and Structure
Impact on Oral Hygiene
Environmental Factors
Personal (Family) Factors
Early Intervention and Counseling by Pediatric Services
Technique
Early Establishment of Dental Home
Oral Hygiene
Non-cariogenic Diet
Anticipatory Guidance
Conditioning
Regular Dental Care Management
New Strategies
Evidence of Effectiveness
Conclusion
Cross-References
References
76 General Dentistry for Children with Cerebral Palsy
Introduction
Common Issues
Similarities and Differences to Other Mental and Physical Challenges
Risk Factors
Quality of Life
Dental Awareness and Oral Hygiene Education for Parents and Caregivers
Clinical Concerns
Lip Biting
Bruxism, Clenching, and Grinding
Drooling
Incompetent Lip Seal
Dental Trauma
Caries
Periodontal Disease (Gingivitis, Periodontitis)
GERD, Erosion, and Wear
Malocclusion
Temporomandibular Joint (TMJ) Dysfunction
Dental Treatment for Children with CP
Before Treatment
Oral Drugs
Caregiver in Room
Special Operatory Chairs
Safety Restraint
Nitrous Oxide
Opening the Mouth
Keeping the Mouth Open
Treatment: Oral Exam and Cleaning
Illuminating the Oral Field
Illuminating Inside the Oral Cavity
Intraoral Photos and Video
X-Ray Imaging
Magnification
Isolation
Treatment: Complex Dental Procedures
When Office Efforts Don´t Succeed
IV Sedation
General Anesthesia
OR (Operating Room) Follow-Up in the Office
Oral Hygiene at Home or Institution
Training for Dentist and Dental Staff
Access to Care
Conclusion
Case Studies
Cross-References
References
77 Management of Skeletal Facial Deformation and Malocclusion in Cerebral Palsy
Introduction
Etiology
Functional Deficits and Impact
Assessment
Treatment
Summary
Cross-References
Glossary of Terms
References
Part XVII: Anesthesia Management
78 Medical Evaluation for Preoperative Surgical Planning in the Child with Cerebral Palsy
Introduction
Medical Evaluation/Optimization
General
Musculoskeletal
Neuro/Developmental
Respiratory
Gastroenterology/Nutrition
Cardiovascular
Renal/Urologic/Genitourinary
Endocrinology
Hematology
Psychiatric
Medications
Laboratory Evaluation
Miscellaneous
Summary
Case Histories
Cross-References
References
79 Anesthesia in the Child with Cerebral Palsy
Introduction
Surgical Epidemiology
Perioperative Concerns
Neurologic
Respiratory
Cardiovascular
Gastrointestinal
Fluids and Electrolytes
Musculoskeletal
Thermoregulatory
Pharmacologic
Positioning
Management
Preoperative
Intraoperative
Postoperative
Conclusion
Cross-References
References
80 Postoperative Pain and Spasticity Management in the Child with Cerebral Palsy
Introduction
Epidemiology of Pain
Pathophysiology of Pain
Special Challenges Relating to Pain Management
Chronic Systemic Sources of Pain
Pain Assessment
Multimodal Approach to Pain
Approaches to Pain Management
Opioids
Nonopioid Drugs
Antispasmodics
Regional Approaches
Postoperative Spasticity Management
Monitoring
Pain Management for Specific Procedures
Summary
Cross-References
References
81 Regional Anesthesia in Patients with Cerebral Palsy
Introduction
Caudal Anatomy and Analgesia
Epidural Anatomy/Analgesia
Epidural Placement in Patients with a Baclofen Catheter
Neuraxial Blockade in Patients after Spinal Instrumentation
Peripheral Nerve Blocks
Surgical Site and Type of Regional Blocks
Hip and Thigh Surgeries
Lumbar Plexus Block
Fascia Iliaca Compartment Block
Thigh Surgery and Femur Fracture
Femoral Nerve Block
Lateral Femoral Cutaneous Nerve Block
Knee Surgery
Sciatic Nerve Block
Adductor Canal Block
Foot and Ankle Surgeries
Regional Blocks for the Upper Extremity
Shoulder Surgery
Interscalene Block
Upper Arm, Elbow, Forearm, Wrist, and Hand Surgery
Supraclavicular Block
Infraclavicular Block
Axillary Block
Cross-References
References
82 Anesthetic Management of Spine Fusion
Introduction
Anesthetic Management
Preoperative Care and Workup
Intraoperative Care
Total Intravenous Anesthesia (TIVA)
Procoagulants and Management of Blood Loss
Neuromonitoring and Its Influence on the Anesthetic Management
Anesthetic Choices to Facilitate Neuromonitoring
Postoperative Management
Conclusion
References
83 Postoperative Care of the Cerebral Palsy Patient
Introduction
Respiratory Considerations
Patients at Respiratory Baseline
The Intubated Patient
Upper Airway Obstruction and Respiratory Effort
Impaired Mucociliary Function and Secretion Clearance
Postoperative Respiratory Complications
Liberation from the ICU or Stepdown Unit
Cardiovascular Considerations
Background
Modalities of Monitoring Hemodynamics
Fluid Resuscitation
Vasopressor Support
Norepinephrine
Dopamine
Hydrocortisone
Gastrointestinal Considerations
Nutrition
Nausea and Vomiting
Constipation
Pancreatitis
Genitourinary and Renal
Fluid Management
Electrolyte Abnormalities
Urinary Retention
Hematology
Bleeding/Anemia
Venous Thromboembolism
VTE Prevention
VTE Treatment
Fever and Infectious Disease
Introduction
Fever Timing
Noninfectious Etiologies of Postoperative Fever
Diagnostic Testing
Antibiotics
Neurology
Spasticity
Seizures
Sleep
Mood
Early Mobilization/Postoperative Rehabilitation
Cross-References
References
Part XVIII: Complementary Medical Treatments
84 Complementary and Alternative Medicine in Cerebral Palsy
Introduction
Selected CAM Therapies Utilized in Cerebral Palsy
Acupuncture
Description
Evidence
Myofascial Structural Integration/Rolfing
Description
Evidence
Adeli Suit (TheraSuit) Treatment
Description
Evidence
Craniosacral Therapy
Description
Evidence
Hyperbaric Oxygen Therapy
Description
Evidence
Electrical Stimulation (e-Stim)
Description
Evidence
Cannabinoids
Description
Evidence
Stem-Cell Therapy
Description
Evidence
Summary
References
85 Hyperbaric Oxygen Therapy for Cerebral Palsy: Definition and Principles
Introduction
History of the Development of HBOT
Adverse Effects of HBOT
Current Policy and Regulation of HBOT
Cost
Rationale for Use of HBOT in Cerebral Palsy
Goals and Environment
Technique
Evidence of Effectiveness
Summary and Conclusions
References
86 Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy
Introduction
Treatment
Acupuncture and Moxibustion
Scalp Acupuncture Therapy
Electrical Acupuncture Therapy
Acupuncture Point Injection Therapy
Tui Na Therapy (Massage Therapy)
Supine Position
Prone Position
Alternative Treatment
Triceps Surae Spasticity
Knee Hyperextension
Adductor Muscle Spasticity
Traditional Chinese Medication for Topical Use
Comprehensive Chinese Medicine Therapy and Intervention
Complications
Pain
Infection
Acupuncture Syncope
Allergy
Curved or Fixed Needles
Case 1
Conclusion
Cross-References
References
87 Osteopathic Manipulative Treatment and Acupuncture in Cerebral Palsy
Introduction
Natural History
Treatment
Outlook
Cross-References
References
Part XIX: Gait in Cerebral Palsy
88 Musculoskeletal Physiology Impacting Cerebral Palsy Gait
Introduction
Natural History and Pathophysiology
Central Nervous System
Biomechanics
Muscle Mechanics
Force Production
Muscle Fiber Types
Muscle Anatomy
Muscle Length-Tension Relationship (Blix Curve)
Muscle Control
Muscle Force-Generating Capacity
Muscle Excursion
Increasing Muscle Excursion
Connective Tissue Mechanics
Growth of the Muscle-Tendon Unit
Bone Mechanics
Joint Mechanics
Joint Motor Mechanics
Single-Joint Muscles
Multiple-Joint Muscles
Treatment
Cross-References
References
89 Normal Human Gait
Introduction
Natural History and Pathophysiology
Gait Cycle
Stance Phase
Swing Phase
Body Segments Important in the Gait Cycle
Ankle
Foot Segment
Knee
Hip
Pelvis
HAT Segment
Treatment
Simplified Joint Functions
Simplified Cycle Functions
Global Body Mechanics of Human Gait
Cognitive Subsystem
Balance Subsystem (Chap. 47, ``Ataxia and Disorders of Balance in Children with Cerebral Palsy´´)
Energy Production
Motor Control
Structural Stability
Cases
Cross-References
References
90 Cerebral Palsy Gait Pathology
Introduction
Natural History and Pathology
Balance
The Impact of Growth and Development
Interventions
Motor Control
The Impact of Growth and Development
Interventions
Motor Power
Impact of Growth and Development
Interventions
Musculoskeletal Subsystem
Cross-References
References
91 History and Physical Examination Components of Gait Analysis
Introduction
History Related to Current Disability
Physical Examination
Global Function Measures
Interrater and Intrarater Reliability
Motor Control
Muscle Strength
Muscle Tone
Passive Range-of-Motion Assessment
Reliability
Cross-References
References
92 Diagnostic Gait Analysis Technique for Cerebral Palsy
Introduction
Components of Gait Analysis Assessment
History
Physical Examination
Global Function Measures
Motor Control (Chap. 91, ``History and Physical Examination Components of Gait Analysis´´)
Muscle Strength (Chap. 91, ``History and Physical Examination Components of Gait Analysis´´)
Muscle Tone
Passive Range-of-Motion Assessment
Video Recording
Kinematics (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
Measurement System
Data Reduction Algorithms (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
Measurement Accuracy
Kinetics (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
Measurement Accuracy
Electromyography
Pedobarograph (Chap. 95, ``Pedobarograph Foot Evaluations in Children with Cerebral Palsy´´)
Oxygen Consumption (Chap. 97, ``Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy´´)
Activity Monitoring (Chap. 97, ``Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy´´)
Summary of Gait Analysis
Cross-References
References
93 Kinematics and Kinetics: Technique and Mechanical Models
Introduction
Goals and Environment
Technique
Gait Evaluation
Marker Sets and Models
Calculating Kinematics
Clinical Implications of Kinematics
Calculating Kinetics
Clinical Implications of Kinetics
Evidence of Effectiveness
References
94 Foot Kinematics: Models Used to Study Feet in Children with Cerebral Palsy
Introduction
Measurement Other than Motion Analysis
Motion Analysis: Single-Segment Foot Model
Motion Analysis: Multisegment Foot Model
Normal Multisegment Foot Model Kinematics
Clinical Examples
Summary
Cross-References
References
95 Pedobarograph Foot Evaluations in Children with Cerebral Palsy
Introduction
Natural History
Therapeutic Use of the Pedobarograph
Evaluations Complimentary to Pedobarograph
Complications
Cross-References
References
96 Measuring Femoral and Tibial Torsion in Children with Cerebral Palsy
Introduction
Natural History and Methods
Natural History
Methods
Natural Pathophysiology: Measuring Tibial Torsion
Physical Examination
Trans-Malleolar Axis (TMA)
Thigh-Foot Angle (TFA)
Imaging Technology
Radiography
Plane Radiograph (X-ray)
Fluoroscopy
Computed Tomography, Magnetic Resonance Imaging, and EOS System
CT and MRI
EOS System
Ultrasonography
Three-Dimensional Motion Analysis
Natural Pathophysiology: Measuring Femoral Torsion
Physical Examination
Imaging Technology
Radiography
Computed Tomography, Magnetic Resonance Imaging, and EOS System
Ultrasonography
Three-Dimensional Motion Analysis
Conclusion
References
97 Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy
Introduction
Pathophysiology and Measurement Techniques
Oxygen Consumption and Cost
Cardiovascular Conditioning
Activity Monitors
Treatment Implications
Data Interpretation
Treatment Recommendations
Complications
Cross-References
References
98 Gait Analysis Interpretation in Cerebral Palsy Gait: Developing a Treatment Plan
Introduction
History and Pathophysiology
Outpatient Clinical Assessment
When Is Gait Analysis Needed to Develop Treatment Plan?
How Should Gait Analysis Be Applied?
Treatment Plan Development
Foot Contact-Weight Acceptance
Midstance
Late Stance Phase
Early Swing Phase
Late Swing Phase
Complications
Cross-References
References
99 Gait Treatment Outcome Assessments in Cerebral Palsy
Introduction
Evaluating Individual Domains
Body Function and Structure
Health Condition-Related Quality of Life
Personal Factors
Participation
Environment Factors
Conclusions
Cross-References
References
100 Hemiplegic or Unilateral Cerebral Palsy Gait
Introduction
Natural History and Pathophysiology
Etiology
Treatment
Hemiplegia Type 0
Hemiplegia Type 1
Hemiplegia Type 2
Outcome of Plantar Flexor Tendon Lengthening
Rotational Deformities
Hemiplegia Type 3
Stiff Knee Gait
Rotational Deformities
Hemiplegia Type 4
Rotational Deformities
Limb Length Discrepancy
Complications
Cases
Cross-References
References
101 Diplegic Gait Pattern in Children with Cerebral Palsy
Introduction
Natural History and Treatment
Diplegia in Young Children (The Prancing Toe Walker) (True Equinus)
Mild Involvement
Moderate Degree of Involvement
Severe Involvement
Surgical Treatment of the Prancing Toe Walker (True Equinus)
Middle Childhood, Early Crouch, and Recurvatum of the Knee
Adolescent Severe Crouch
Knee Recurvatum (Back-Kneeing)
Complications
Cases
Cross-References
References
102 Hip and Pelvic Kinematic Pathology in Cerebral Palsy Gait
Introduction
Natural History and Pathophysiology
Hip Joint
Sagittal Plane
Coronal Plane Hip Pathology
Transverse Plane Deformity
Pelvis
Pelvic Rotation
Pelvic Tilt
Pelvic Obliquity
HAT Segment
Treatment and Outcome Summary
Cases
Cross-References
References
103 Crouch Gait in Cerebral Palsy
Introduction
Natural History and Pathophysiology
Pathophysiology
Treatment
Performing the Crouched Gait Surgery
Spasticity Reduction in Adolescents and Young Adults
Complications
Cases
Cross-References
References
104 Knee Deformities Impact on Cerebral Palsy Gait
Introduction
Natural History and Pathophysiology
Knee Position at Weight Acceptance
Midstance Knee
Terminal Stance Knee Position
Early Swing Phase
Terminal Swing Phase
Treatment Summary
Cases
Cross-References
References
105 Foot Deformities Impact on Cerebral Palsy Gait
Introduction
Natural History and Pathophysiology
Secondary Adaptations
Treatment
The Foot as a Functional Moment Arm in Contact with the Ground Reaction Force
Secondary Adaptations
Treatment
The Ankle as a Power Output Joint
Ankle Dorsiflexion in Swing Phase
Treatment Summary and Outcome Expectations
Cases
Cross-References
References
106 Complications from Gait Treatment in Children with Cerebral Palsy
Introduction
Natural History and Pathophysiology
Treatment
Complications of Gait Analysis
Complications of Surgery Planning
Interrelated Effect of Multiple Procedures
Complications of Surgical Execution
Complications of Rehabilitation
Monitoring the Outcome of Gait Development and Treatment
Energy Use Measurement
Cases
Cross-References
References
107 The Evolution of Knee Flexion During Gait in Patients with Cerebral Palsy
Introduction
Current Knowledge
Assumptions
The Concept of the Development of Knee Flexion Gait
Starting with the Foot
Starting with the Knee
Starting with the Hip
Conclusions
Limitations
Cross-References
References
Part XX: Upper Extremity
108 The Upper Extremity in Cerebral Palsy: An Overview
Introduction
Natural History
Normal Development of Function of Children´s Upper Extremities
Classifying Upper Extremity Function
Treatment
Specific Treatments
Complications
Conclusion
Cross-References
References
109 Upper Extremity Assessment and Outcome Evaluation in Cerebral Palsy
Introduction
Mode of Administration
Classifications Versus Tests
Norm-Referenced Versus Criterion-Referenced Tests
Assessing Hand Use in Infants
The ICF Framework
Capacity Versus Performance
Psychometric Properties
Clinical Utility
Final Points
Upper Extremity Evaluation: Examples of Commonly Used Tools
Body Function Assessments
Classifications
Body Function Assessments
Activity and Participation Assessments
Classifications
Questionnaires
Observation Based
Speed and Dexterity
Quality of Movements
Bimanual Performance
Functional Activity Performance
Development of Hand Skills
Individualized Measures
Cross-References
References
110 Physical Examination and Kinematic Assessment of the Upper Extremity in Cerebral Palsy
Introduction
Natural History: Evaluation of Patients
Guidelines for Setting Goals
Early Childhood: Ages 0-6 Years
Middle Childhood: Ages 6-12 Years
Adolescence: Ages 12 Years and Older
Treatment: Assessment to Develop a Plan
Pretreatment Evaluation
Classification of Upper Extremity Involvement
Assessment of Specific Impairment
Physical Examination
Sensation
Selective Motor Control
Muscle Strength
Kinematic Assessment
Electromyography (EMG)
Developing a Treatment Plan
Cross-References
References
111 Spasticity, Dystonia, and Athetosis Management in the Upper Extremity in Cerebral Palsy
Introduction
Natural History of Spasticity and Movement Disorder
Measuring Spasticity and Movement Disorder
Treatment
Spasticity
Movement Disorder: Dystonia, Athetosis, and Chorea
Conclusion
Cross-References
References
112 Single-Event Multilevel Surgery for the Upper Extremity in Cerebral Palsy
Introduction
Natural History: Pathophysiology
Treatment
Patient Age
Neurologic Type
Voluntary Control
Sensibility
Intelligence
Patient Motivation
Developing the SEMLS Plan
Outcome and Complications of SEMLS
Cross-References
References
113 Shoulder and Elbow Problems in Cerebral Palsy
Introduction
Shoulder
Shoulder Contractures
Natural History
Treatment
Outcome of Treatment
Other Treatment
Complications of Treatment
Shoulder Instability
Natural History
Treatment
Elbow
Elbow Flexion Contracture
Natural History
Treatment
Complications of Treatment
Radial Head Dislocation
Natural History
Treatment
Complications of Treatment
Cases
Cross-References
References
114 Forearm, Thumb, and Finger Deformities in Cerebral Palsy
Introduction
Natural History (Pathophysiology and Symptoms)
Regional Treatment
Forearm Pronation
Natural History
Treatment
Outcome of Treatment
Complications of Treatment
Wrist Flexion Deformity
Natural History
Diagnostic Evaluations
Mild Wrist Flexion Deformity
Moderate Wrist Flexion Deformity
Severe Wrist Flexion Deformity
Very Severe Wrist Flexion Deformity
Wrist Extension Contracture
Treatment
Outcome of Treatment
Other Treatment
Complications of Treatment
Thumb
Natural History
Diagnostic Evaluations
Treatment
House Classification
Type 1
Type 2
Type 3
Type 4
Outcome of Treatment
Other Treatment
Complications of Treatment
Finger Flexion
Treatment
Outcome of Treatment
Other Treatment
Complications of Treatment
Finger Swan Neck
Treatment
Outcome of Treatment
Conclusion
Cases
Cross-References
References
115 Upper Extremity Operative Procedures in Cerebral Palsy
Introduction
Individual Procedures
Shoulder Adductor, Extension, and External Rotator Lengthening
Indication
Procedure
Postoperative Care
Humeral Derotation Osteotomy
Indication
Procedure
Postoperative Care
Elbow Flexion Contracture Release
Indication
Procedure
Postoperative Care
Pronator Release or Transfer
Indication
Procedure
Postoperative Care
Flexor Carpi Ulnaris (FCU) Transfer for Wrist Flexion Deformity
Indication
Procedure
Postoperative Care
Carpectomy and Wrist Fusion
Indication
Procedure
Postoperative Care
Thumb Adductor Lengthening
Indication
Procedure
Postoperative Care
Webspace Lengthening and Z-Plasty
Indication
Procedure
Postoperative Care
Metacarpal Phalangeal Joint Fusion of the Thumb
Indication
Procedure
Postoperative Care
Extensor Pollicis Longus Rerouting
Indication
Procedure
Postoperative Care
Palmaris Longus or Brachioradialis Transfer to the Abductor Pollicis
Indication
Procedure
Postoperative Care
Volar Plate Advancement and Sublimis Slip Reinforcement for Swan Neck Deformity
Indication
Procedure
Postoperative Care
Central Extensor Slip Release for Swan Neck Deformity
Indication
Procedure
Cross-References
References
Part XXI: Spine
116 Spinal Deformity in Children with Cerebral Palsy: An Overview
Introduction
Natural History and Treatment
Scoliosis
Kyphosis and Lordosis
Early Onset Scoliosis
Complications
Problems Related to Spinal Deformity
Conclusion
Cross-References
References
117 Cerebral Palsy Spinal Deformity: Etiology, Natural History, and Nonoperative Management
Introduction
Natural History, Incidence, and Etiology
Natural History
Treatment: Nonoperative
Conservative Treatment
Orthotics
Seating
Therapy
Electrical Stimulation
Botulinum Toxin
Conclusion
Cases
Cross-References
References
118 Surgical Treatment of Scoliosis Due to Cerebral Palsy
Introduction
Etiology
Incidence and Natural History
Indications for Scoliosis Surgery
Preoperative Orthopedic Evaluation
Preoperative Management and Preparation
Preparing for Intraoperative Bleeding
Soft Bone
Maintaining Spinal Cord Integrity
Prophylaxis to Prevent Deep Wound Infection
Operative Treatment
Evolution of Instrumentation for Neuromuscular Scoliosis Correction
Unit Rod
Current Methods of Pelvic Fixation, Pre-contoured Rods with Pelvic Screw, and Segmental Spine Fixation
Sublaminar Wires vs. Pedicle Screws
Rigid Scoliosis in the Cerebral Palsy Child
Surgical Outcomes
Functional Outcomes and Quality of Life
Cross-References
References
119 Surgical Management of Kyphosis and Hyperlordosis in Children with Cerebral Palsy
Introduction
Etiology/Pathogenesis/Natural History
Patient Assessment and Preoperative Considerations
Nonoperative Treatment
Surgical Treatment
Medical/Anesthesia Considerations (Anesthesia for Cerebral Palsy Spine Fusion Surgery)
Operative Principles
Preoperative Planning
Current Preferred Surgical Treatment Methods (Spinal Procedure Atlas for Cerebral Palsy Deformities)
Intraoperative Positioning
Instrumentation
Fusion to the Pelvis
Kyphosis Correction
Lumbar and Thoracolumbar Kyphosis
Thoracic Kyphosis
Hyperlordosis
Rigid Kyphotic and Hyperlordotic Deformities
Evidence-Based Outcomes
Summary
Cross-References
References
120 Early-Onset Scoliosis in Cerebral Palsy
Introduction
Natural History and Etiology
Treatment Options for Early-Onset Scoliosis
Early Short Fusion as an Option
Growing Rod Constructs
Spinal Deformity in Very Small Children Who Are Older
Recommendation for Early-Onset Spine Fusion in Children with CP
Long-Term Outcome of Early Spine Fusion
Conclusion
Cases
Cross-References
References
121 Complications of Spine Surgery in Cerebral Palsy
Introduction
Natural History
Overall Risk Factors
Death: Mortality
Transition Time
Immediate Postoperative Period
Preoperative Problems
Poor Nutrition
Intraoperative Complications
Respiratory Problems
Bleeding Problems (Chapter ``Anesthetic Management of Spine Fusion´´)
Epidural Bleeding
Bone Bleeding
Dural Leak
Perforation of the Pelvis with Unit Rod
Medial Pelvic Perforation
Lateral Pelvic Perforation
Acetabular Perforation
Wires Pulling Through Laminae
Rod Either Too Long or Too Short
Spinal Cord Monitoring: Loss of Motor Evoked Potentials
Postoperative Complications
Hypotension
Thrombophlebitis and Pulmonary Embolism
Coagulopathy
Respiratory Failure
Pneumothorax or Hemothorax and Pleural Effusion
Reflux and Aspiration
Pancreatitis
Colicystitis
Duodenal Obstruction
Constipation
Poor Feeding
Seating Adjustments
Hair Loss
Doing Posterior Spinal Fusion When Families Refuse Blood Transfusions
Dealing with Families Who Refuse Spinal Fusion
Handling Families and Children When a No Resuscitation Status Is Requested
Cases
Cross-References
References
122 Neuromonitoring and Anesthesia for Spinal Fusion in Cerebral Palsy
Introduction
Personnel and Practical Aspects of Neuromonitoring
Technical Aspects and Interpretation of IONM
Somatosensory Evoked Potentials (SSEP)
Motor Evoked Potentials (MEP)
Electromyography (EMG)
Stagnara Wake Up Test
Physiological Application and Risk of Neuromonioring
Blood Supply to the Spinal Cord
Risk of Neuromonitoring
Anesthesia
Inhaled Anesthetics
Intravenous Anesthetics
Nonanesthetic Intraoperative Influences
Clinical Application
References
123 Cervical Spine in Children with Cerebral Palsy
Introduction
Treatment: Cervical Spine Problems
Extensor Posturing
Occipital Subluxation, Posturing
Atlantoaxial Instability and Subluxation with or without Os Odontoideum
Congenital Atlantoaxial Displacement with Os Odontiodeum
Cervical Spine Spondylosis
Inability to Hold up the Head
Severe Upper Thoracic Kyphosis with Lower Cervical Lordosis
Complications of Cervical Spinal Deformity
Cervicothoracic Junction Kyphosis
Cross-References
References
124 Pelvic Alignment and Spondylolisthesis in Children with Cerebral Palsy
Introduction
Natural History and Pathophysiology
Pelvic Malalignment
Pelvic Obliquity
Etiology
Natural History
Treatment
Seating Adjustment
Surgical Correction of Pelvic Obliquity
Anterior Pelvic Tilt
Etiology
Natural History
Treatment
Pelvis Rotational Malalignment
Spondylolisthesis
Natural History
Treatment
Conclusion
Cases
Cross-References
References
125 Infections and Late Complications of Spine Surgery in Cerebral Palsy
Introduction
Pathology of Long-Term Complication
Postoperative Infections
Persistent Fevers
Superficial Wound Infections
Acute Deep Wound Infection
Treatment
Mechanical Problems
Pain in the Spine
Proximal End Prominence or Wire Prominence
Nonunion-Pelvic Leg Halos-Rod Fracture
Crankshaft
Neck Stiffness
Decreased Floor or Bed Mobility
Special Problems with Spinal Surgery
Doing Revision Spinal Surgery in Children with Cerebral Palsy
Fall-Off from a Short Fusion
Torsional Collapse
Pseudarthrosis
Hardware Failure
Correcting Deformity Posterior Dorsal Rhizotomy
Correcting Spinal Deformity in Ambulatory Children
Mortality
Conclusion
Cases
Cross-References
References
126 Spinal Procedure Atlas for Cerebral Palsy Deformities
Introduction
Posterior Spinal Fusion with Single Unit Rod or Modular Unit Rod Using Cantilever Correction
Indication
Procedure
Postoperative Care
Special Consideration for Correction of Kyphosis and Lordosis
Anterior Spinal Release
Indication
Procedure
Postoperative Care
Cross-References
References
Part XXII: Hip
127 Hip Problems in Children with Cerebral Palsy: An Overview
Introduction
Natural History, Etiology, and Pathophysiology
Treatment
Typical Posterior Lateral Dislocations in Children with Spasticity
Other Hip Deformities
Femoral Torsional
Complications in CP Hip Management
Surgical Procedures
Conclusion
Cross-References
References
128 Etiology of Hip Displacement in Children with Cerebral Palsy
Introduction
Natural History and Pathophysiology
Posterior-Superior Hip Subluxation
Etiology
Secondary Pathology
Tertiary Changes
Treatment and Outcomes
Conclusion
References
129 Natural History and Surveillance of Hip Dysplasia in Cerebral Palsy
Introduction
Natural History
Childhood
Adolescence
Adult
Diagnostic Evaluations
Hip Radiograph
Computed Tomography Scans
Ultrasound
Bone Scan
Arthrography
Treatment
Surveillance Algorithm
Surveillance Results
Conclusion
References
130 Prophylactic Treatment of Hip Subluxation in Children with Cerebral Palsy
Introduction
Treatment
Specific Prophylactic Treatment
Operative Procedures
The Outcome of Preventative Treatment
Other Treatment
Iliopsoas Transfer
Adductor Transfer
Botulinum Toxin Injection
Intrathecal Baclofen
Dorsal Rhizotomy
Abduction Orthosis
Complications of Preventative Treatment
Pain
Infections
Hyperabduction
Cases
References
131 Hip Reconstruction in Children with Cerebral Palsy
Introduction
Natural History
Treatment
Indications for Reconstructive Treatment
Recommended Surgical Reconstruction Approach
Outcome of Reconstruction Treatment
Other Reconstructive Treatment Options: Varus Osteotomy Without Acetabular Osteotomy
Other Pelvic Osteotomies
Indication for Doing Bilateral Femoral Varus Osteotomy
Complications of Reconstruction
Loss of Fixation
Repeat Early Dislocation
Heterotopic Ossification
Sleep Problems
Prolonged Hip Pain
Avascular Necrosis
Intraarticular Extension of Pelvic Osteotomy
Other
References
132 Palliative or Salvage Hip Management in Children with Cerebral Palsy
Introduction
Natural History
Treatment
Recommended Treatment
Total Hip Replacement
Interposition Arthroplasty
Resection Arthroplasty (Castle Procedure)
Proximal Femoral Valgus Osteotomy (McHale Procedure)
Subtrochanteric Valgus Osteotomy Without Femoral Head Resection (Schanz Osteotomy)
Femoral Head Resection (Girdlestone Procedure)
Hip Fusion
Complications of Palliative Treatment
Chronic Pain Syndrome
Persistent Pain
Conclusion
Cases
References
133 Anterior Dislocation of the Hip in Cerebral Palsy
Introduction
Natural History, Pathophysiology, and Etiology
Treatment
Type I Anterior Hip Dislocation
Treatment
Type II Anterior Hip Dislocation
Treatment
Other Treatment Recommendations
Complications
Type III Anterior Hip Dislocation: Present in Hypotonic and Hypermobile Hips
Treatment
Complications
Inferior Hip Dislocation
Conclusion
References
134 Hypotonic and Special Hip Problems in Cerebral Palsy
Introduction
Natural History and Etiology
Hypotonic Hip Subluxation
The Natural History of Hypotonic Hip Disease
Treatment: Hypotonic Hip
Complications
Hip Dislocation in Children with Down Syndrome and Cerebral Palsy
Developmental Hip Dysplasia (DDH) in Children with Cerebral Palsy
Established Developmental Dislocation
Slipped Capital Femoral Epiphysis
Perthes Disease in Children with Spasticity
Cases
References
135 Femoral Anteversion in Children with Cerebral Palsy
Introduction
Natural History and Pathophysiology
Internal Rotation Posture
Anteversion or Internal Femoral Torsion
Measuring Anteversion and Coxa Valga
Physical Examination
Radiographic Measurement
CT Scan
Ultrasound
Fluoroscopy
Magnetic Resonance Imaging Scan
Femoral Torsion Measurement Summary
Measuring Coxa Valga
Etiology of Femoral Anteversion and Coxa Valga
Muscle Contractures
Etiology of Coxa Valga
Natural History
Treatment
Femoral Anteversion
Methods for Correcting Anteversion
Proximal Femoral Derotation
Midshaft and Distal Femoral Osteotomy
Orthotic Treatment
Muscle Lengthening
Conclusion
Cases
Cross-References
References
136 Windblown Hip Deformity and Hip Contractures in Cerebral Palsy
Introduction
Natural History and Pathophysiology
Treatment
Hyperabducted Hip Deformity
Postoperative Management
Hip Flexion Contracture
Assessment and Measurement of Hip Flexion Contracture
Etiology
Natural History
Treatment
Osteotomy
Windblown Hips
Etiology
Asymmetric Neurologic Involvement
Symmetric Neurologic Involvement
Natural History
Treatment (Table 1)
Indications for Specific Treatment
Middle Childhood
Adolescence
Adult
Other Treatment Options for Windblown Hips
Orthotic Management
Tone Reduction
Hip Pain After Correction of Windblown Hip
Windblown Hip Deformity and Pelvic Obliquity (Hip Problems in Children with Cerebral Palsy: An Overview)
Anteversion, Coxa Valga, and Internal Rotation Contracture
Anteversion and Coxa Valga Relationship
Coxa Valga
Cases
References
137 Complications of Hip Treatment in Children with Cerebral Palsy
Introduction
Natural History and Symptoms
Delayed Treatment
Recurrent Contracture and Dislocation
Hip Wound Infections
Adductor Wound Infections
Femoral Osteotomy Infections
Femoral Osteotomy Nonunions
Fractures of the Femur
Fixation Failure
Trochanteric Fracture
Distal End of Plate Fractures
Leg Length Discrepancy
Caused by Adductor Contracture
Secondary to Varus Osteotomy
Dislocated Hip
Pelvic Obliquity
Heterotopic Ossification
After Adductor Lengthening
Prophylactic Treatment of Heterotopic Ossification
Treatment
Postoperative Hip Pain
Plate Bursitis
Medial Plate Protrusion
Degenerative Arthritis
Sudden Pain in Therapy
Avascular Necrosis
Thrombophlebitis and Pulmonary Embolism
Hip Joint Stiffness
Cases
Cross-References
References
138 Surgical Atlas of Cerebral Palsy Hip Procedures
Introduction
Procedures
Adductor and Iliopsoas Lengthening with Proximal Hamstring Lengthening
Indication
Procedure
Postoperative Care
Iliopsoas Lengthening: Over the Pelvic Brim Approach
Indication
Procedure
Postoperative Care
Proximal Femoral Osteotomy
Indication
Procedure
Postoperative Care
Peri-Ilial Pelvic Osteotomy (Dega Osteotomy)
Indication
Procedure
Postoperative Care
Pemberton-Type Pelvic Osteotomy for Anterior Dislocation
Indication
Procedure
Postoperative Care
Abductor Lengthening
Indication
Procedure
Postoperative Care
Resection Arthroplasty (Castle Procedure)
Indication
Procedure
Postoperative Care
Interposition Arthroplasty
Indication
Procedure
Postoperative Care
Femoral Derotation with an Intramedullary Nail
Indication
Procedure
Postoperative Care
Revision Adductor Lengthening
Indication
Procedure
Postoperative Care
Conclusion
References
Part XXIII: Knee
139 Overview of Knee Problems in Cerebral Palsy
Introduction
Natural History and Pathophysiology
Treatment
Knee Flexion Deformity
Patellar Femoral Instability
Knee Extension Pathology (Chap. 148, ``Ankle Equinus in Cerebral Palsy´´)
Knee Varus-Valgus and Tibial Torsion (Chap. 149, ``Equinovarus Foot Deformity in Cerebral Palsy´´)
Complications
Cross-References
References
140 Anterior Knee Pain and Patellar Subluxation in Cerebral Palsy
Introduction
Natural History
Treatment (Chap. 103, ``Crouch Gait in Cerebral Palsy´´)
Anterior Knee Pain and Extensor Mechanism Insufficiency
Extensor Mechanism Stress
Outcome of Treatment: Anterior Knee Pain
Patellar Subluxation and Dislocation
Outcome of Patellar Dislocation Treatment
Complications
Cases
Cross-References
References
141 Knee Flexion Deformity in Cerebral Palsy
Introduction
Natural History and Etiology
Natural History
Etiology
Secondary Pathology
Tertiary Changes
Treatment
Hamstring Contractures
Indications
Specific Treatments (Atlas of Knee Operative Procedures In Cerebral Palsy)
Outcome of Treatment
Other Treatment
Moderate Knee Flexion Contracture
Indications and Treatments
Outcome of Moderate Knee Flexion Contracture
Severe Knee Flexion Contracture
Indications and Treatments
Outcome of Treatment
Other Treatment
Complications
Cases
Cross-References
References
142 Stiff Knee and Knee Extension Deformities in Cerebral Palsy
Introduction
Natural History and Pathology
Pathology
Inadequate Knee Flexion
Stiff Knee Gait
Knee Extension Contractures
Secondary Pathology
Tertiary Changes
Treatment and Outcome
Diagnostic Studies
Treatment of Dynamic Knee Stiffness
Other Treatment
Outcome of Treatment
Treatment of Fixed Knee Extension Contractures
Outcome of Treatment
Other Treatment
Complications
Cases
Cross-Reference
References
143 Tibial Torsion and Knee Instability in Cerebral Palsy
Introduction
Natural History and Etiology
Knee Mechanical Instability
Intraarticular Pathology
Varus and Valgus Deformity
Tibial Torsion
Natural History
Etiology
Diagnostic Evaluations
Treatment
Ligament Instability
Varus and Valgus Deformity
Tibial Torsion
Outcome of Tibial Osteotomy
Other Treatments
Complications
Cases
Cross-References
References
144 Atlas of Knee Operative Procedures in Cerebral Palsy
Introduction
Treatment
Hamstring Lengthening
Indication
Procedure
Postoperative Care
Rectus Transfer
Indication
Procedure
Postoperative Care
Posterior Knee Capsulotomy
Indication
Procedure
Postoperative Care
Repair of Dislocation of the Patella
Indication
Procedure
Postoperative Care
Tibial Osteotomy with Cast
Indication
Procedure
Postoperative Care
Tibial Osteotomy with Intramuscular Nail
Indication
Procedure
Postoperative Care
Patellar Advancement
Distal Femoral Osteotomy
Indication
Procedure
Postoperative Care
Cross-References
References
Part XXIV: Ankle, Foot, and Toes
145 Foot Deformities in Children with Cerebral Palsy: An Overview
Introduction
Natural History and Pathophysiology (Chap. 146, ``Natural History of Foot Deformities in Children with Cerebral Palsy´´)
Equinus
Equinovarus
Planovalgus
Hallux Valgus with Bunion
Treatment
Equinus Treatment (Chap. 148, ``Ankle Equinus in Cerebral Palsy´´)
Equinovarus (Chap. 149, ``Equinovarus Foot Deformity in Cerebral Palsy´´)
Planovalgus (Chap. 150, ``Planovalgus Foot Deformity in Cerebral Palsy´´)
Hallux Valgus with Bunion (Chap. 151, ``Forefoot and Toe Deformities in Cerebral Palsy´´)
Conclusion
Cross-References
References
146 Natural History of Foot Deformities in Children with Cerebral Palsy
Introduction
Natural History and Pathophysiology
Treatment
Complications
Cases
Cross-References
References
147 Ankle Valgus in Cerebral Palsy
Introduction
Natural History
Treatment
Diagnostic Evaluations
Indications for Intervention
Outcome of Treatment
Complications of Treatment
Conclusion
Cases
Cross-References
References
148 Ankle Equinus in Cerebral Palsy
Introduction
Natural History and Pathophysiology
Etiology
Secondary Pathology
Tertiary Changes
Treatment
Diagnostic Evaluations
Treatment
Cavus and Equinus
Outcome of Treatment
Other Treatment
Complications of Treatment
Cases
Cross-References
References
149 Equinovarus Foot Deformity in Cerebral Palsy
Introduction
Natural History and Pathophysiology
Secondary Pathology
Tertiary Changes
Treatment
Indications and Treatment
Adolescents
Fixed Heel Varus
Severe Fixed Spastic Clubfeet
Outcome of Treatment
Other Treatments
Complications of Treatment
Conclusion
Cases
Cross-References
References
150 Planovalgus Foot Deformity in Cerebral Palsy
Introduction
Natural History (Chap. 146, ``Natural History of Foot Deformities in Children with Cerebral Palsy´´)
Etiology
Pathologic Deformity in Ambulators
Primary Pathology
Secondary Pathology
Tertiary Pathology
Midfoot Break with Rocker Bottom Foot
Pathologic Deformity in Nonambulators
Treatment
Diagnostic Evaluations
Indications
Reconstruction
Lateral Column Lengthening
Subtalar Fusion
Calcaneocuboid Lengthening Fusion
Isolated Talonavicular fusion
Multiple Arthrodesis
Outcome of Treatment
Other Treatments
Complications of Treatment
Surgical Procedures (Chap. 152, ``Atlas of Foot and Ankle Procedures in Cerebral Palsy´´)
Midfoot Supination and Dorsal Bunion
Indications and Treatment
Complications
Cases
Cross-References
References
151 Forefoot and Toe Deformities in Cerebral Palsy
Introduction
Natural History
Dorsal Bunion
Hallux Valgus with Bunion
Pathology
Natural History
Diagnostic Evaluations
Extended Hallux
Minor Toes
Ingrown Toenails
Treatment and Outcome
Dorsal Bunion
Hallux Valgus with Bunion
Outcome of Treatment Hallux Valgus
Extended Hallux Treatment
Minor Toes Treatment
Ingrown Toe Nails (Onychocryptosis) Treatment
Blue Feet: Sympathetic Vascular Dysfunction
Treatment
Complications
Complications of Dorsal Bunion
Complications of Hallux Valgus
Cases
Cross-References
References
152 Atlas of Foot and Ankle Procedures in Cerebral Palsy
Introduction
Ankle Epiphysiodesis Screw
Indication
Procedure
Postoperative Care
Subtalar Fusion
Indication
Procedure
Postoperative Care
Lateral Column Lengthening Through the Calcaneus
Indication
Procedure
Postoperative Care
Lateral Column Lengthening Through the Calcaneocuboid Joint
Indication
Procedure
Postoperative Care
Medial Column Correction: Forefoot Supination and First Ray Elevation
Indication
Procedure
Postoperative Care
Triple Arthrodesis
Indication
Procedure
Postoperative Care
Gastrocnemius Lengthening
Indication
Procedure
Postoperative Care
Achilles Tendon Lengthening
Indication
Procedure
Postoperative Care
Tibialis Posterior Lengthening or Split Transfer
Indication
Procedure
Postoperative Care
Split Tibialis Anterior Transfer
Indication
Procedure
Postoperative Care
Lengthening of the Tibialis Anterior
Indication
Procedure
Postoperative Care
Bunion Correction
Indication
Procedure
Fusion of the First Metatarsal Phalangeal Joint
Indication
Procedure
Postoperative Care
Correction of Clawed Toes
Indication
Procedure
Postoperative Care
Medial Border Great Toenail Resection
Indication
Procedure
Postoperative Care
References
Part XXV: Therapy Management in Cerebral Palsy: Introduction
153 Therapy Management of the Child with Cerebral Palsy: An Overview
Introduction
The Second Edition of Dr. Freeman Miller´s Medical Text: Cerebral Palsy
Therapy Management in the Child with Cerebral Palsy
Introduction: Expert Opinion
Life Span Approaches and Environmental Settings
Body Structure and Functions
Activity and Participation
Adaptive Technology and Supports
Complementary Therapy Approaches
Cross-References
References
154 Physical Therapy Elements in the Management of the Child with Cerebral Palsy
Introduction
Goals and Environment
Technique
Key Points
Adaptations in the Movement System Require Repetition and Repeated Exposure to Stimuli to Induce the Desired Change
PT Interventions Must Address Goals and Outcomes That Are Meaningful to the Child and Family
Motor Learning Is an Active Process: Practice with Variable, Graded Sensory and Task Constraints Should Be Balanced for Engage...
PT Interventions Should Not Only Emphasize the Learning of the Skill but Also the ``Retrieval´´ and Actual Use of the Skill in...
The Timing of Interventions Affects Intervention Outcomes
The Sum of Impairments Does Not Equal the Limits on Activities or Restrictions in Participation
Address the Need for Adherence and Behavior Change Directly with Evidence-Based Approaches
Evidence of Effectiveness
Conclusion
Cross-References
References
155 Occupational Therapy Elements in the Management of the Child with Cerebral Palsy
Introduction
Goals and Environment
Techniques
Body Function and Structure Impact on Activity
Occupational Therapy Intervention Strategies Body Function and Structure Impact on Activity
Upper Limb Strengthening and Orthotics
Tactile and Sensory Integration Interventions for Children with Unilateral Cerebral Palsy
Constraint-Induced Movement Therapy and Hand-Arm Bimanual Training
Occupational Therapy Interventions to Improve Participation in Activity
Specific Occupational Therapy Strategies
Interventions for Feeding, Eating, and Drinking
Approaches to Self-Care Activities
Family Considerations in Occupational Therapy
Evidence of Effectiveness
Cross-References
References
156 Speech, Language, and Hearing Practice Elements in the Management of the Child with Cerebral Palsy
Introduction
Goals and Environment
Technique
Communication Activity and Participation
The Role of Communication in a Child´s Participation in Life Situations
Speech Practice Elements
Language Practice Elements
Hearing Practice Elements
Elements of Environmental and Personal Factors
Evidence of Effectiveness
References
Part XXVI: Lifespan Approaches and Environmental Settings
157 Therapies in Newborn and Pediatric Intensive Care Units for the Neurologic At-Risk Infants
Introduction
Goals and Environment
Technique
Examination
NICU
Positioning
Range of Motion/Active Movement
Developmental Skills
PICU
Positioning
Range of Motion/Splinting and Casting
Mobility
Evidence of Effectiveness
Case Studies
Case 1: NICU
Case 2: PICU
Cross-References
References
158 Early Intervention Services for Young Children with Cerebral Palsy
Introduction
Goals and Environment
Body Function and Structure, Impact on Activity, and Participation in Activity
Personal Factors
Environment Factors
Technique
Evaluation
Interventions
Teaming Models
Evidence of Effectiveness
Cases
Cross-References
References
159 Innovative Approaches to Promote Mobility in Children with Cerebral Palsy in the Community
Introduction
Introduction: Community Mobility Is a Human Right
Mobility Goals and Environments
Community Mobility Approaches Are Built upon a Comprehensive Scientific Foundation
Technique
Assistive and Rehabilitative Tech Approaches to Community Mobility
Evidence of Effectiveness
Modified Ride-On Cars (ROCs): Hybrid Technology for Clinic and Community
General Features of ROCs
Real-World Body Weight Support Systems: Hybrid Technology for Impairments, Functional Activities, and Participation Within EE
Conclusion: Creating the High-Impact Community Mobility Professional
Cross-References
References
160 Outpatient-Based Therapy Services for Children and Youth with Cerebral Palsy
Introduction
The Setting
Accessing Services
Episodic Care
Frequency of Outpatient Therapy Services
Evolving Care
Cross-References
Appendix A
References
161 School-Based Therapy Services for Youth with Cerebral Palsy
Introduction
Educationally Relevant Services Provided by Medical Professionals
Related Service Provision Under IDEA
Section 504 and IDEA
Goals and Environment
IEP as the Structure for School-Based Practice
Educational Environment as a Practice Setting
Technique
Evidence of Effectiveness
Conclusion
Case Study: Christian
Cross-References
References
162 Community Resources: Sports and Active Recreation for Individuals with Cerebral Palsy
Introduction: Promoting Participation in Sports and Active Recreation
Goals and Environment
Techniques
Case Example
Evidence of Effectiveness
Cross-References
References
163 Clinical Therapy Services for Adults with Cerebral Palsy
Introduction
Health Needs
Rehabilitation Needs and Environment
Assessing Rehabilitation Needs
Goals
Techniques
Conclusion
Cross-References
References
164 Community Engagement for Adults with Cerebral Palsy
Introduction
Goals and Environment
Techniques and Evidence of Effectiveness
Transportation
Home Health and Support Services
Assistive Technology and Home and Workplace Accessibility Accommodations
Assistive Technology
Home Modifications and Accessibility Adaptations
Other Assistive Technology Devices
Workplace Modifications
Postsecondary Education, Work, and Vocational Services
Postsecondary Education
Work and Vocational Services
Clinical Case Example
References
Part XXVII: Body Structure and Functions
165 Postural Control in Children and Youth with Cerebral Palsy
Introduction
Systems Underlying Posture
Development and Theory
Categorizing and Testing Posture
Deficits in Posture in Cerebral Palsy
Goals and Environment
Technique
Assessments
Principles of Motor Learning
Interventions
Biomechanical
Strength or Muscle Facilitation
Massed Practice
Enhanced Feedback
Perturbation Training
Evidence of Effectiveness
Evaluation of Research
Improvement
Adaptability
Retention
Consistency
Theoretical Concepts
Professional Practice Reflections with Respect to Device Modifications
Cross-References
References
166 Selective Voluntary Motor Control in Children and Youth with Spastic Cerebral Palsy
Introduction
Goals and Environment
Technique
Evaluation of SVMC
Treatment Approaches
Evidence of Effectiveness
Cross-References
References
167 Using Hippotherapy Strategies for Children and Youth with Cerebral Palsy
Introduction
Goals and the Environment
Environment
Technique
Examination/Evaluation
Plan of Care
Hippotherapy Principles
Evidence of Effectiveness
Cross-References
References
168 Muscle Performance in Children and Youth with Cerebral Palsy: Implications for Resistance Training
Introduction
Central and Peripheral Contributions to Impairments in Muscle Performance
Goals and Environment
Technique: Dosing Guidelines for Resistance Training
Application: What Is the Goal of the Intervention?
Evidence of Effectiveness
Cross-References
References
169 Aquatic Therapy for Individuals with Cerebral Palsy Across the Lifespan
Introduction
Goals and Environment
Body Function and Structure
Impact on Activity
Impact on Participation
Environmental Factors Personal (Family) Factors
Aquatic Properties
Refraction
Hydrostatic Pressure
Density/Specific Gravity
Buoyancy (Archimedes´ Principle)
Drag/Turbulence
Physiological Effects
Assessment and Evaluation
Specialized Aquatic Techniques
Halliwick Concept
Bad Ragaz Ring Method
WATSU/Water Shiatsu
Transitioning to Land-Based Therapy
Evidence of Effectiveness
Case Studies
Case 1 (Longitudinal)
Birth History
7 Years of Age
12 Years Old
14-22 Years of Age
Case 2
Birth History
Cross-References
Bibliography
170 Functional Electrical Stimulation Interventions for Children and Youth with Cerebral Palsy
Introduction
History of Electrical Stimulation
Types of Electrical Stimulation
Goals and Environment
Technique
FES Background
Neuroprosthetic and Neurotherapeutic Mechanisms of FES
Rationale for FES Use in CP
FES Precautions
Risks Associated with External Electrical Stimulation of Muscles
Risks Associated with Exercise
Commercially Available FES Devices
FES for Hand Function
FES-Assisted Walking Devices
FES Cycling Devices
Evidence of Effectiveness
FES for the Upper Extremities and Trunk
FES-Assisted Walking
FES Application to the Ankle Dorsiflexor Muscles
Ankle Dorsiflexor Neuroprosthetic Effects
Ankle Dorsiflexor Neurotherapeutic Effects
FES as an Alternative to Ankle-Foot Orthoses
FES Application to the Ankle Plantar Flexors (APFs)
FES Cycling
FES Tolerance and Acceptability
Conclusion
Limitations and Future Direction
References
171 Aerobic and Anaerobic Fitness in Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
International Classification of Functioning, Disability, and Health (ICF-CY)
Energy Demands
Physical Strain
Physical Fitness
Aerobic Capacity
Aerobic Performance
Anaerobic Performance
Technique
Physical Fitness Testing
Testing Aerobic Fitness
Testing Energy Demands of Walking and Physical Strain
Testing Anaerobic Fitness
Evidence of Effectiveness
Fitness Training
Effect on the Aerobic Capacity
VO2peak
Anaerobic Threshold
Effect on Aerobic Performance
Effect on Anaerobic Performance
The Role of Exercise Testing and Advices on an Individual Basis
References
172 Flexibility in Children and Youth with Cerebral Palsy
Introduction
Neural Contributions to Reduced Flexibility
Nonneural Contributions to Reduced Flexibility
Goals and Environment
Body Function and Structure
Activity
Participation
Environmental Factors
Personal Factors
Measurement Techniques
Measuring Flexibility
Measuring Flexibility: Spasticity
Measuring Flexibility: Increased Passive Muscle Stiffness
Measuring Flexibility: Contracture
Interventions
Interventions to Improve Flexibility in Children and Youth with CP
Interventions to Address Spasticity
Interventions to Address Increased Passive Muscle Stiffness
Interventions to Address Lower Extremity Contracture
Interventions to Address Upper Extremity Contracture
Evidence of Effectiveness
Measuring Flexibility: Spasticity
Measuring Flexibility: Increased Passive Muscle Stiffness
Measuring Flexibility: Contracture
Interventions to Address Spasticity and Their Impact on Spasticity
Interventions to Address Spasticity and Their Impact on Impairments, Activity, and Participation
Interventions to Address Increased Passive Muscle Stiffness and Their Impact on Passive Muscle Stiffness
Interventions to Address Contracture and Their Impact on Contracture
Interventions to Address Contracture and Their Impact on Impairments, Activity, and Participation
Summary of Evidence Effectiveness
References
173 Postsurgical Therapy for the Individual with Cerebral Palsy
Introduction
Goals and Environment: Service Delivery
Preoperative Evaluation and Planning
Postoperative Inpatient Acute Hospital Therapy Model
Home-Based Therapy Model
Rehabilitation Program Therapy Service Model
Outpatient Therapy Service Model
School-Based Therapy
Recovery Expectations
Single Event Multilevel Surgery (SEMLS) for the Individual with Cerebral Palsy
Special Considerations for the Progression of Weight Bearing after Orthopedic Surgeries
Technique
Hip
Knee
Lower Leg & Foot
Spine
Intrathecal Baclofen Pump
Upper Extremity
Summary/Evidence of Effectiveness
Cross-References
References
Part XXVIII: Activity and Participation
174 Fine Motor Skill Development in Children and Youth with Unilateral Cerebral Palsy
Introduction
Goals and Environment
Neural Integrity
Classification of Grip/Pinch, Prehension, and Upper Extremity Function
Atypical Prehension and Upper Extremity Function
Muscle Activation
Prehension Patterns
Sensibility
Anticipatory Control
Selective Motor Control
Technique: Strengthening of Prehension and Upper Extremity Function
Assessment/Outcome Measures
Classification of Functional Hand Use
Effective Intervention Strategies
Evidence of Effectiveness
References
175 Functional Mobility and Gait in Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Technique
Classification
The International Classification of Functioning, Disability, and Health ICF
Gross Motor Function Classification System
Sagittal Gait Patterns: Spastic Hemiplegic Cerebral Palsy
Sagittal Gait Patterns: Spastic Diplegic Cerebral Palsy
Assessment
Instrumented Gait Analysis (IGA)
Video Gait Analysis
Functional Mobility Scale
Functional Assessment Questionnaire
Gross Motor Function Measure
The Pediatric Evaluation of Disability Inventory (PEDI)
Timed Walking Measures
Timed Up and Go Test (TUG)
The Functional Independence Measure for Children (WeeFIM)
Goal Attainment Scale (GAS)
Activity Monitoring
The Canadian Occupational Performance Measure
The Children´s Assessment of Participation and Enjoyment
Gait Outcomes Assessment List
Evidence of Effectiveness
Intramuscular Injections of Botulinum Toxin A
Selective Dorsal Rhizotomy
Single Event Multilevel Surgery
Muscle Strength Interventions
Functional Electrical Stimulation
Robotic-Assisted Gait Training
Summary
Cross-References
References
176 Robot-Assisted Gait Training for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Positioning RAGT Within the ICF
Goals of Robotic Assisted Gait Training
Technique
Equipment
Control Modes
Exergames
Indications, Contra-Indications, Possible Complications
Dosage of RAGT
Evidence of Effectiveness
Cases
References
177 Treadmill Training for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Body Functions and Structures
Activity
Participation
Contextual Factors
Technique
Treadmill Training for Children with Hemiplegic CP or Unilateral Impairment
Treadmill Training for Children with Diplegic (Bilateral) CP and GMFCS Levels I-II
Treadmill Training for Children with Diplegic or Quadriplegic CP (Bilateral) and GMFCS Levels III and IV
Evidence of Effectiveness
Cross-References
References
178 Functional ADL Training for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Technique
Mental Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
Sensory Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
Neuromusculoskeletal and Movement-Related Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
Evidence of Effectiveness
Cross-References
References
179 Constraint-Induced Movement Therapy for Children and Youth with Hemiplegic/Unilateral Cerebral Palsy
Introduction
The Problem to Be Addressed
What Is CIMT: The Theoretical Concepts
Principles for Training
Goals and ICF
Technique and Environment
Intensive Group Models/Day-Camps
Distributed Individual-Based Models Home/Preschool Models
Combined Models CIMT/Bimanual Training/GOAL
Distributed Internet/Phone Models
Evidence of Efficacy
Natural History of the Development of Hand Function
Early Plasticity and Early Training
Strength, Limitation, and Cost Effectiveness
In Summary: CIMT in a Life Perspective
Cross-References
References
180 Assessment and Treatment of Feeding in Children and Youth with Cerebral Palsy
Introduction
Natural History
Assessment
Examples of How the Health Condition (CP) May Impact Feeding
Diet History and Bowel/Bladder Elimination
Feeding History/Caregiver Interview
Clinical Assessment
Oral Motor Assessment
Feeding Observation
Self-Feeding
Trial Therapy
Cervical Auscultation
Instrumental Assessments
Intervention
Caregivers and the Child
Physicians, Dentists, and Physician Assistants
Psychologist
Dietitian
Speech and Language Pathologist (SLP)
Occupational Therapist (OT)
Physical Therapist (PT)
Social Worker
Educational/Support Staff
Elements of Treatment
Tube Feeding
Goals of Treatment
Conclusion
References
181 Communication in Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Speech Intelligibility
Language
Literacy
Technique
Assessment
Assessment of Speech
Connection Between Speech and Language
Assessment of Language
Assessment of Early Language
Assessment of Conventional Language
Assessment of Emergent and Conventional Literacy
Intervention
Speech Intervention
Language Intervention
Language Modeling
Partner-Focused Intervention Approaches
Intervention for Emergent and Conventional Literacy
Modifications
Evidence of Effectiveness
Cross-References
References
182 Mobility Supports in Educational Curriculum for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Techniques to Determine Services, Dosing, and Transition/Discontinuation
Interventions and Evidence of Effectiveness
Positioning
MOVE Program
Mobility Training
Fitness Interventions (Strengthening, Stretching, and Aerobic Conditioning)
CMT
Consultation
Case Studies
Cross-References
References
183 Gaming Technologies for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Body Function and Structure Goals
Activity Goals
Participation Goals
Technique
Technology and Equipment
Fine Motor Function and Activity Protocol Parameters
Gross Motor Function and Activity Protocol Parameters
Postural Control and Balance Protocol Parameters
Fitness Protocol Parameters
Participation
Summary of Evidence of Effectiveness and Future Applications
VR/AVG as a Supplement to Rehabilitation Interventions
VR/AVG Systems in Development
VR/AVGs in Clinical Practice
Case Examples
Conclusion
Cross-References
References
Part XXIX: Adaptive Technology and Supports
184 Wheeled Mobility Options and Indications for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Overview of Current Issues
Technique
Wheeled Mobility Examination and Evaluation
Wheeled Mobility Options
Wheeled Mobility Training
Transfer of Behavior
Practice
Feedback
Evidence of Effectiveness
Case Scenarios
Cross-References
References
185 Ambulatory Assistive Devices for Children and Youth with Cerebral Palsy
Introduction
Standing Devices
Ambulatory Devices
Types of Ambulatory Devices
Gait Trainer
Walkers
Crutches
Canes
Therapeutic Ambulation Devices
Cross-References
References
186 Seating and Positioning Approaches for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Technique: Seating and Positioning Components - Definition of Terms (Fig 1)
Evidence of Effectiveness
Cross-References
References
187 Activities of Daily Living Supports for Persons with Cerebral Palsy
Introduction
Technique: ADLs
Evidence of Effectiveness
Cross-References
References
188 Lower Extremity Orthoses for Children and Youth with Cerebral Palsy
Introduction
History and Terminology
Treatment and Expected Outcome
Hip Frontal Plane
Hip Transverse Plane
Twister Cables
Derotation Elastic Wraps
Hip Multiplane
SWASH Brace
Knee Orthoses
Knee Sagittal Plane
Recurvatum: Back-Kneeing
Knee Flexion Contracture
Ankle-Foot Orthoses
Equinus in Stance and Swing Phase
Ankle Hyper-Dorsiflexion with Stance Knee Flexion (Crouch)
Swing Phase Ankle Equinus with Normal Stance Ankle Posture
Foot Deformities
Specific Orthotic Design Considerations by Age and Special Conditions
Preambulatory Stage
Articulated Ground Reaction AFO
Wraparound AFO Design
Anterior Ankle Strap
Foot Plate
Off-The-Shelf (Ready-To-Fit) Shoe Inlays and Arch Supports
Complications, Risks, and Benefits of Lower Extremity Orthotic
Cross-References
References
189 Upper Extremity Orthotics for Children and Youth with Cerebral Palsy
Introduction
Goals and Environment
Technique
General Principles of Splinting
Postoperative Orthotic Intervention
Contracture Management
Functional
Motor Reeducation and Exercise Orthoses
Evidence of Effectiveness
References
190 Augmentative and Alternative Communication for Cerebral Palsy
Introduction
Goals and Environment
Technique
AAC Evaluation
Identifying Communication Needs to Increase Participation
Determining AAC System Including Symbols, Aids, Techniques, and Strategies
AAC Intervention
Being Able to Carry Out One´s Communication Rights
Interventions Using the WHO ICF Framework
Communication Competencies
For Beginning Communicators
Evidence of Effectiveness
Conclusion
Cross-References
References
Part XXX: Complementary Therapy Approaches
191 Neurodevelopmental Treatment Clinical Practice Model´s Role in the Management of Children with Cerebral Palsy
Introduction
Goal and Environment
Body Function and Structure
Activity and Participation
Contextual Factors in the ICF
Technique
Information Gathering
Examination
Evaluation
Intervention
Pretest
Set Up
Handling
Preparation
Simulation
Posttest
Home Program and Carryover
Important Factors
Frequency
Indications, Contraindications, and Possible Complications
Evidence of Effectiveness
Cross-References
References
192 Complementary Therapy Approaches for Children and Youth with Cerebral Palsy
Introduction
Therapeutic Suits and Garments
Therapeutic Suits: Goals and Environment
Therapeutic Suits: Technique
Therapeutic Suits: Evidence of Effectiveness
Therapeutic Garments: Goals and Environment
Therapeutic Garments: Techniques
Therapeutic Garments: Evidence of Effectiveness
Therapeutic Taping
Goals and Environment
Techniques
Evidence of Effectiveness
Yoga
Goals and Environment
Technique
Evidence of Effectiveness
Pilates
Goals and Environment
Technique
Evidence of Effectiveness
Myofascial Release
Goals and Environment
Technique
Evidence of Effectiveness
Craniosacral Therapy
Goals and Environment
Technique
Evidence of Effectiveness
Conductive Education
Goals and Environment
Technique
Evidence of Effectiveness
Patterning
Goals and Environment
Technique
Evidence of Effectiveness
Feldenkrais
Goals and Environment
Technique
Evidence of Effectiveness
Vojta Therapy
Goals and Environment
Technique
Evidence of Effectiveness
Medical Marijuana
Goals and Environment
Technique
Evidence of Effectiveness
Cross-References
References
Index