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Integrated Management in Cerebral Palsy: Musculoskeletal Surgery and Rehabilitation in Ambulatory Patients

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Book cover Cerebral Palsy

Abstract

In this chapter, current treatment concepts for ambulatory children with cerebral palsy (CP) will be introduced and discussed. The Gross Motor Function Classification System (GMFCS) was the first of the family of classification systems, which have given clinicians a common language with which to communicate about cerebral palsy.

In 1987 Winters et al. classified the sagittal gait patterns in unilateral spastic CP (USCP or spastic hemiplegia) in a cross-sectional study, based on three-dimensional kinematics. Rodda and Graham extended the Winters, Gage and Hicks classification to include the coronal and transverse planes. Classification of sagittal gait patterns in bilateral spastic CP (BSCP) is also useful to guide integrated management including the selection of target muscles for injection of botulinum toxin A, the choice of ankle-foot orthoses and surgical procedures in single-event multilevel surgery (SEMLS). In the SEMLS approach, the gait pattern is identified and evaluated by instrumented gait analysis (IGA) as part of the diagnostic matrix. A comprehensive plan is then developed for the correction of all muscle-tendon contractures, torsional malalignments and joint instabilities in one operative session. Rehabilitation requires at least 1 year, and improvements continue into the second year postoperatively. In non-ambulatory children with CP, spine problems such as scoliosis and hip dislocation are the most important problems to deal with.

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Authors and Affiliations

  1. Orthopaedic Department, University Children’s Hospital Basel, The University of Basel, Basel, Switzerland

    Erich Rutz M.D.

  2. Hugh Williamson Gait Laboratory, The Royal Children’s Hospital, Parkville, VIC, Australia

    Pam Thomason

  3. Orthopaedic Department, The Royal Children’s Hospital, Murdoch Childrens Research Institute, Parkville, VIC, Australia

    Kate Willoughby & H. Kerr Graham M.D., F.R.C.S. (Ed.), F.R.A.C.S.

  4. Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia

    H. Kerr Graham M.D., F.R.C.S. (Ed.), F.R.A.C.S.

Authors
  1. Erich Rutz M.D.
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  2. Pam Thomason
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  3. Kate Willoughby
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  4. H. Kerr Graham M.D., F.R.C.S. (Ed.), F.R.A.C.S.
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Correspondence to Erich Rutz M.D. .

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Editors and Affiliations

  1. Division of Paediatric Neurology, Aristotle University of Thessaloniki Division of Paediatric Neurology, Thessaloniki, Greece

    Christos P. Panteliadis

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Rutz, E., Thomason, P., Willoughby, K., Kerr Graham, H. (2018). Integrated Management in Cerebral Palsy: Musculoskeletal Surgery and Rehabilitation in Ambulatory Patients. In: Panteliadis, C. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-67858-0_22

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