Dr. Carbonell is a specialist in Child Traumatology in Alicante and professor of this same specialty at the Miguel Hernández University of Elche. In this article he explains how cerebral palsy in children is treated from the traumatological point of view.
Cerebral palsy is an affectation of the brain that causes important motor alterations in some parts or in the whole body. Basically there are 3 types of infantile cerebral palsy:
– Hemiplegia: half of the body is affected (one leg and one arm).
– Diplegia: both lower limbs and to a lesser degree some of the upper limbs are affected.
– Tetraplegia: all 4 upper and lower extremities are affected.
Symptoms of cerebral palsy
The most frequent are an alteration of the strength of the muscles, which are permanently contracted, and an alteration of the muscular reflexes. This makes it impossible to stand upright, due to imbalance and deformities in the lower extremities, and sometimes it is even difficult to sit in a wheelchair.
This causes affectation of the spine, hips, knees and feet. In the upper extremities they cause dysfunction of the fingers when holding objects, wrist in flexion position and forearm in excessive pronation.
Causes of cerebral palsy
The cause in more than 2/3 of patients is due to prematurity and low birth weight (less than 2500 grams at birth). The rest may be due to erythroblastosis fetalis (Rh incompatibility between parents), cytomegalovirus, rubella, toxoplasmosis and hereditary.
Predisposition to cerebral palsy
Predisposition exists when there are risk factors at birth: abnormal presentation of the fetus, low birth weight, virus infection during pregnancy in the mother, etcetera.
Treatment of cerebral palsy
To begin with, a complete orthopedic clinical evaluation is necessary initially and every six months for the evolution of deformities: clubfoot, hip dislocation, scoliosis, etcetera. In addition, patients who have been paralyzed benefit from orthopedic aids such as canes, walkers, orthopedic chairs, standing frames and anti-equinus devices depending on the degree of involvement.
In some cases, surgery will be used in some parts of the body such as:
– Hips: to avoid complete dislocation of the hips and the impossibility of walking.
– Knees: the rigid flexion of the knees makes it impossible for them to stand, use canes or be in a wheelchair.
– Feet: equinus and deformities in rigid plane (in diplegia) or cavus (hemiplegia) are the deformities that frequently require surgery.
– Forearm pronation: tendon transposition to improve this disabling position.