Cerebral Palsy: What You Need to Know
Injuries to the brain before, during or after birth can cause cerebral palsy.
What is cerebral palsy?
Cerebral palsy (CP) is a condition that is a result of a brain injury. This injury can occur before, during or shortly after birth. Cerebral palsy affects movement and muscle tone.
What are the symptoms of cerebral palsy?
Signs of CP are usually noticed during infancy or in toddlers. It can be associated with exaggerated reflexes, floppiness in the trunk or limbs, or stiffness in the trunk and limbs. It can present with involuntary movements and abnormal gait.
There is no cure for CP, but there are many treatment options to help with the orthopaedic problems associated with CP.
Common Orthopaedic Conditions Seen in Children with Cerebral Palsy
This is a deformity of the hip that can be found on one or both hips in children with an underlying neuromuscular condition, such as CP. Increased or decreased tone in the muscles can lead to migration of the femoral head out of the hip socket, requiring additional treatment.
Neuromuscular scoliosis is a condition of the spine associated with an underlying neuromuscular condition, such as cerebral palsy, muscular dystrophy or spinal cord injury. The underlying condition typically causes changes in the muscles, leaving them unable to support the spine adequately. This leads to a curvature of the spine. The typical presentation is an abnormal S- or C-shaped curvature. The spine can also have rotation creating a multidimensional curve. The curvature can be progressive, especially with growth spurts.
This is a foot deformity commonly seen in children with CP. Due to muscle imbalance, the deformity can make weight-bearing activities challenging.
This is a deformity of the foot due to an underlying neuromuscular condition. The abnormality of the muscles in the feet leads to a flat foot with minimal or no arch. This condition is commonly seen in children with hypotonia or low tone.
Orthotics: In children with flexible flatfoot, a brace or orthotic may be helpful to provide better arch support and decrease pain. In children with rigid or painful flatfoot, a surgery may be recommended to correct this deformity and improve the alignment of the foot.
This is a condition in children with an underlying neuromuscular disorder that leads to high tone or muscle tightness in a child’s ankles, and can cause them to walk on the toes or balls of the feet.
Limb Length Inequality
Limb length inequality is a difference in the lengths of a child’s lower extremities (legs). The difference in length can be found in children with hemiplegic CP.
The application of a shoe lift inside a child’s shoe on the shorter side assists in lessening the discrepancy. Surgical treatment to shorten the longer leg is also a way to decrease the discrepancy in children with a greater than 2-centimeter discrepancy. The procedure is called epiphysiodesis, and it is a carefully calculated surgery to close the growth plate in the longer leg and allow the shorter leg to continue to grow and balance out the discrepancy.
Some children with CP develop an inward or outward twist in their lower extremities. When this is excessive, it can interfere with their gait pattern.
Tibial or femoral rotational osteotomy: This surgical procedure is used to correct deformity of the tibia or femur bone. The bone is cut, placed in a corrected position and secured with hardware. The deformities can be surgically corrected with different techniques to provide improved function, especially with gait.
In a child with an underlying neuromuscular disorder, muscle tone can be increased, which can lead to a contracture of the muscle. This means the muscle does not stretch well. Common muscles involved are the hamstrings, adductors, hip flexors and gastrocnemii.