The Adult with Cerebral Palsy

https://doi.org/10.1016/j.ocl.2010.06.007Get rights and content

Section snippets

Spasticity

Botulinum toxin A (BTX-A) continues to have a positive role in adults for relaxing hypertonic muscles for functional gain in the absence of fixed contractures. The toxin can be particularly helpful for individuals with dystonia in relieving painful spasms, improving vertical posture, and controlling unwanted upper extremity motions or tremors that interfere with functional tasks. BTX-A inhibits the release of acetylcholine from the nerve terminal, causing partial paralysis of the muscle lasting

Spine

Scoliosis can be present in up to 60% of adults with CP and is particularly likely in those with nonambulatory status having spastic quadriparesis.25 Progression with aging can occur to approximately 1° per year and should be monitored carefully over time. Decompensation can be accompanied by loss of function, improved somewhat with custom molded seating or postural thoracolumbar orthosis, depending on the individual. Pain, when it occurs, is often associated with thoracolumbar soft tissue

Hip

Hip displacement occurs in approximately 1% of patients with spastic hemiplegia, up to 15% of those with diplegia, and more than 50% of those with quadriplegia.23, 55, 56 It has been shown that children who function at GMFCS level I have almost no chance of hip subluxation57, 58 and those who function at GMFCS levels IV and V have up to a 70% to 90% chance of hip dysplasia. As the GMFCS level increases, the degree of hip abnormality increases and the ability to walk decreases.23 Pain with

Summary

The conditions that have been discussed in this article are not uncommon to the adult with CP and should be anticipated by the specialty medical provider. Other yet-to-be-identified secondary and associated conditions are most certainly present in the adult and require further clinical definition and research. Interventions to the child with CP need to be weighed carefully over the lifetime, with functional outcome variables presenting themselves into the adulthood years. The need to look

First page preview

First page preview
Click to open first page preview

References (79)

  • M.A. Turk et al.

    The health status of women with cerebral palsy

    Arch Phys Med Rehabil

    (1997)
  • D. Strauss et al.

    Causes of excess mortality in cerebral palsy

    Dev Med Child Neurol

    (1999)
  • K.P. Murphy

    Medical problems in adults with cerebral palsy: case examples

    Assist Technol

    (1999)
  • K.M. Granet et al.

    Adults with cerebral palsy

    N J Med

    (1997)
  • K.P. Murphy et al.

    Medical and functional status of adults with cerebral palsy

    Dev Med Child Neurol

    (1995)
  • N.L. Young et al.

    Use of healthcare among adults with chronic and complex disabilities of childhood

    Disabil Rehabil

    (2005)
  • J.H. Rimmer

    Physical fitness levels of persons with cerebral palsy

    Dev Med Child Neurol

    (2001)
  • K. Hemming et al.

    Long-term survival for a cohort of adults with cerebral palsy

    Dev Med Child Neurol

    (2006)
  • C.E. Rapp et al.

    The adult with cerebral palsy

    Arch Fam Med

    (2000)
  • D. Strauss et al.

    Life expectancy of adults with cerebral palsy

    Dev Med Child Neurol

    (1998)
  • D. Strauss et al.

    Decline in function and life expectancy of older persons with cerebral palsy

    NeuroRehabilitation

    (2004)
  • D. Strauss et al.

    Survival in cerebral palsy in the last 20 years: signs of improvement?

    Dev Med Child Neurol

    (2007)
  • D. Strauss et al.

    Life expectancy in cerebral palsy: an update

    Dev Med Child Neurol

    (2008)
  • J.H. Rimmer

    Health promotion for people with disabilities

    Phys Ther

    (1999)
  • T. Heller et al.

    Determinants of exercise in adults with cerebral palsy

    Public Health Nurs

    (2002)
  • A.L. Albright

    Principles & practice of pediatric neurosurgery

    (2008)
  • J.R. Gage et al.

    The identification and treatment of gait problems in cerebral palsy. Clinics in Developmental Medicine Nos 180-181

    (2009)
  • P. Rosenbaum et al.

    Prognosis for gross motor function in cerebral palsy: creation of motor development curves

    J Am Med Assoc

    (2002)
  • L.J. Michaud et al.
    (2009)
  • K.J. Bell et al.

    Natural progression of gait in children with cerebral palsy

    J Pediatr Orthop

    (2002)
  • S.E. Hanna et al.

    Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years

    Dev Med Child Neurol

    (2009)
  • T.D. Sanger et al.

    Prospective open-label clinical trial of trihexyphenidyl in children with secondary dystonia due to cerebral palsy

    J Child Neurol

    (2007)
  • B.E. Fredrickson et al.

    The natural history of spondylolysis and spondylolisthesis

    J Bone Joint Surg Am

    (1984)
  • D.S. Morrell et al.

    Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy

    Radiographics

    (2002)
  • T. Sakai et al.

    Lumbar spinal disorders in patients with athetoid cerebral palsy: a clinical and biomechanical study

    Spine

    (2006)
  • T. Harada et al.

    Lumbar spine and patients with spastic diplegia

    J Bone Joint Surg Br

    (1993)
  • J.C. Peter et al.

    Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy

    Childs Nerv Syst

    (1990)
  • Z. Li et al.

    Deformity of lumbar spine after selective dorsal rhizotomy for spastic cerebral palsy

    Microsurgery

    (2008)
  • J.C. Peter et al.

    Spondylolysis and spondylolisthesis after five level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy

    Childs Nerv Syst

    (1993)
  • Cited by (29)

    • Factors associated with walking activity in adults with cerebral palsy

      2021, Gait and Posture
      Citation Excerpt :

      Cerebral palsy (CP) is a disorder affecting posture and movement resulting from a non-progressive disturbance to the neonatal or fetal brain [1,2].

    • Cerebral Palsy

      2020, Encyclopedia of Infant and Early Childhood Development
    • Muscle fibre morphology and microarchitecture in cerebral palsy patients obtained by 3D synchrotron X-ray computed tomography

      2019, Computers in Biology and Medicine
      Citation Excerpt :

      As a secondary response to the brain injury, individuals with cerebral palsy experience various muscular symptoms including muscle weakness [3], impaired muscle growth [4], spasticity [5] and increased passive stiffness [6]. Increased muscle stiffness, also called muscle contractures is, however, the most limiting factor that influences individuals with CP since it hinders normal movement [7]. The mechanisms that lead to the development of contractures are still poorly understood.

    • Cerebral Palsy

      2018, Braddom's Rehabilitation Care: A Clinical Handbook
    View all citing articles on Scopus
    View full text