Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.79619
Moneer K. Faraj
Programmable baclofen pump implantation is used to provide the patient with minimal intrathecal dose of baclofen to provide relaxation when the oral permitted doses are no longer withstand able by the patient. We discussed the efficiency of programmable baclofen pump implantation in treating spasticity by reviewing several international papers. Satisfactory relaxation was noticed in most of the patients. The complications following intrathecal baclofen (ITB) surgeries are not uncommon. ITB is an advised method for treating spasticity whether due to cerebral or spinal causes. It has significant improvements with minor complications. It needs special trained multidisciplinary team to manage it.
{"title":"Baclofen Pump Implantation for Cerebral Palsy","authors":"Moneer K. Faraj","doi":"10.5772/INTECHOPEN.79619","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79619","url":null,"abstract":"Programmable baclofen pump implantation is used to provide the patient with minimal intrathecal dose of baclofen to provide relaxation when the oral permitted doses are no longer withstand able by the patient. We discussed the efficiency of programmable baclofen pump implantation in treating spasticity by reviewing several international papers. Satisfactory relaxation was noticed in most of the patients. The complications following intrathecal baclofen (ITB) surgeries are not uncommon. ITB is an advised method for treating spasticity whether due to cerebral or spinal causes. It has significant improvements with minor complications. It needs special trained multidisciplinary team to manage it.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129522964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.80442
João Lameiras-Campagnolo
Hip pathology is one of the main orthopedic concerns in cerebral palsy (CP) patients. It has been demonstrated that correctly applied hip screening programs could significantly diminish the incidence of hip pathology. Unfortunately, in several countries, hip dislo- cation is significantly prevalent and is still a major concern in these patients. Depending on the age, the disability grade, the rehabilitation support, and the surgical strategies, results of hip treatment are variable. The ideal outcome of a stable, reduced, and long-lasting pain-free hip are not always achieved. In this chapter, we discuss theoretical and practical strategies used to treat specific CP hip dislocation. In younger children, simple femoral reorientation procedures (tenotomies with or without femoral osteotomies) promote correct acetabular remodeling. Later, surgical hip reduction can be an option even in late adolescents, and the use of capsuloplasty can lead to greater hip stability, in spite of eventual pelvis obliquity caused by associated spine pathology. Several technical tips for hip surgery are presented. It is essential that patients with CP hip problems receive proper follow-up, including rehabilitation medicine, physiotherapy, anti-spastic medication, on-time orthosis availability, and real teamwork concerned with this kind of pathology.
{"title":"Hip Surgery in Cerebral Palsy","authors":"João Lameiras-Campagnolo","doi":"10.5772/INTECHOPEN.80442","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80442","url":null,"abstract":"Hip pathology is one of the main orthopedic concerns in cerebral palsy (CP) patients. It has been demonstrated that correctly applied hip screening programs could significantly diminish the incidence of hip pathology. Unfortunately, in several countries, hip dislo- cation is significantly prevalent and is still a major concern in these patients. Depending on the age, the disability grade, the rehabilitation support, and the surgical strategies, results of hip treatment are variable. The ideal outcome of a stable, reduced, and long-lasting pain-free hip are not always achieved. In this chapter, we discuss theoretical and practical strategies used to treat specific CP hip dislocation. In younger children, simple femoral reorientation procedures (tenotomies with or without femoral osteotomies) promote correct acetabular remodeling. Later, surgical hip reduction can be an option even in late adolescents, and the use of capsuloplasty can lead to greater hip stability, in spite of eventual pelvis obliquity caused by associated spine pathology. Several technical tips for hip surgery are presented. It is essential that patients with CP hip problems receive proper follow-up, including rehabilitation medicine, physiotherapy, anti-spastic medication, on-time orthosis availability, and real teamwork concerned with this kind of pathology.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115958188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.80369
J. A. Rubio, J. López
The use of plasma growth factors is opening a new field of clinical application in medicine, developing a new discipline called regenerative medicine. In many fields such as trauma -tology, dental implantology or anesthesia, the use of this biotechnology is improving the quality of life of patients, through techniques that are not invasive but with extraordinary functional results. A discipline where this type of procedure opens an interesting field of application is undoubtedly neurology, especially those processes of ischemic or hypo-anoxic origin such as cerebral palsy, where recent studies point to an improvement of cognitive abilities in patients, together with specific neurorehabilitation therapies.
{"title":"Plasma Growth Factors in Cerebral Palsy","authors":"J. A. Rubio, J. López","doi":"10.5772/INTECHOPEN.80369","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80369","url":null,"abstract":"The use of plasma growth factors is opening a new field of clinical application in medicine, developing a new discipline called regenerative medicine. In many fields such as trauma -tology, dental implantology or anesthesia, the use of this biotechnology is improving the quality of life of patients, through techniques that are not invasive but with extraordinary functional results. A discipline where this type of procedure opens an interesting field of application is undoubtedly neurology, especially those processes of ischemic or hypo-anoxic origin such as cerebral palsy, where recent studies point to an improvement of cognitive abilities in patients, together with specific neurorehabilitation therapies.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127652535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.79565
A. Kholin
The frequency of epilepsy in children with cerebral palsy is 40 times higher than the com- mon population rate. The presence of epilepsy aggravates the clinical course of cerebral palsy, complicates the rehabilitation, affects the prognosis of motor and intellectual func - tions, and could be life-threatening. Another problem is the possibility of aggravation of epileptic seizures and their appearance de novo due to application of some neuro- rehabilitation methods (electrophoresis, acupuncture, nootropic drugs, brain stimula-tors, etc.). Children with cerebral palsy have a broad spectrum of epilepsies—varying from favorable combinations with benign idiopathic forms to extremely severe epileptic encephalopathies. Frequent combination of epileptic and non-epileptic paroxysms causes difficulty in their interpretation and differential diagnosis. Video-EEG monitoring is the “golden standard” for differential diagnostic of epileptic and non-epileptic events, and it is very useful for investigation of patients with cerebral palsy. Treatment of epilepsy in combination with cerebral palsy strictly requires an individual approach due to the form of epilepsy, seizure types, age of the patient, comorbidity, and somatic and mental condition of the patient.
{"title":"Cerebral Palsy and Epilepsy","authors":"A. Kholin","doi":"10.5772/INTECHOPEN.79565","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79565","url":null,"abstract":"The frequency of epilepsy in children with cerebral palsy is 40 times higher than the com- mon population rate. The presence of epilepsy aggravates the clinical course of cerebral palsy, complicates the rehabilitation, affects the prognosis of motor and intellectual func - tions, and could be life-threatening. Another problem is the possibility of aggravation of epileptic seizures and their appearance de novo due to application of some neuro- rehabilitation methods (electrophoresis, acupuncture, nootropic drugs, brain stimula-tors, etc.). Children with cerebral palsy have a broad spectrum of epilepsies—varying from favorable combinations with benign idiopathic forms to extremely severe epileptic encephalopathies. Frequent combination of epileptic and non-epileptic paroxysms causes difficulty in their interpretation and differential diagnosis. Video-EEG monitoring is the “golden standard” for differential diagnostic of epileptic and non-epileptic events, and it is very useful for investigation of patients with cerebral palsy. Treatment of epilepsy in combination with cerebral palsy strictly requires an individual approach due to the form of epilepsy, seizure types, age of the patient, comorbidity, and somatic and mental condition of the patient.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115584371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.5772/INTECHOPEN.79452
R. Akhter, N. Hassan, M. Nadkarni, Elizabeth F. Martin, G. Khandaker
Cerebral palsy (CP) is a neurodevelopmental condition comprising a group of permanent disorders of movement and posture that are attributed to nonprogressive disturbances of the developing brain. The neuromuscular problems inherent in CP can affect oral health significantly in several ways. These can include changes in structure of the oro facial region, feeding problems, difficulties with maintaining oral hygiene; additionally, people with CP can encounter barriers in accessing oral health care. Several studies have examined caries rates in individuals who have CP. However, to date, no population- based studies have been published defining the risk factors for dental caries experience among children with CP. There is a high prevalence of orofacial motor dysfunction among people with CP, which can hinder oral hygiene and hence increase dental biofilm formation and retention. Factors such as food consistency, snacking between meals, and associated oromotor dysfunction have also been reported to contribute to the high incidence of caries found in those with CP. Therefore, this chapter will aim to describe the oral health status and factors affecting dental caries experience of children with CP, while also providing preventative and restorative recommendations to combat the prevalence of this disease.
{"title":"Oral Health in Children with Cerebral Palsy","authors":"R. Akhter, N. Hassan, M. Nadkarni, Elizabeth F. Martin, G. Khandaker","doi":"10.5772/INTECHOPEN.79452","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79452","url":null,"abstract":"Cerebral palsy (CP) is a neurodevelopmental condition comprising a group of permanent disorders of movement and posture that are attributed to nonprogressive disturbances of the developing brain. The neuromuscular problems inherent in CP can affect oral health significantly in several ways. These can include changes in structure of the oro facial region, feeding problems, difficulties with maintaining oral hygiene; additionally, people with CP can encounter barriers in accessing oral health care. Several studies have examined caries rates in individuals who have CP. However, to date, no population- based studies have been published defining the risk factors for dental caries experience among children with CP. There is a high prevalence of orofacial motor dysfunction among people with CP, which can hinder oral hygiene and hence increase dental biofilm formation and retention. Factors such as food consistency, snacking between meals, and associated oromotor dysfunction have also been reported to contribute to the high incidence of caries found in those with CP. Therefore, this chapter will aim to describe the oral health status and factors affecting dental caries experience of children with CP, while also providing preventative and restorative recommendations to combat the prevalence of this disease.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125204451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.80293
S.M.D. Day, R. Reynolds
Cerebral palsy (CP) is a heterogenous condition, with level of disability ranging from immaterial to profound. In concert with the continuum of level of severity of disability/ independent functioning, health care needs, therapies, medications, surgical interven- tions, costs of care, daily demands on parents and other family members, and expectations for the future in terms of education, employment, and other milestones of life all vary widely. Similarly, life expectancy in CP follows a continuum, from far lower than to potentially as high as general population life expectancy, that parallels the continuum of levels of disability. Here we review the literature documenting this, and examine the specific factors that are known to be strongly associated with mortality and longevity in CP. We also examine the evidence regarding causes of death in CP, and present some new findings related to this. Finally, we outline important methodological considerations for future research in this area.
{"title":"Survival, Mortality, and Life Expectancy","authors":"S.M.D. Day, R. Reynolds","doi":"10.5772/INTECHOPEN.80293","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80293","url":null,"abstract":"Cerebral palsy (CP) is a heterogenous condition, with level of disability ranging from immaterial to profound. In concert with the continuum of level of severity of disability/ independent functioning, health care needs, therapies, medications, surgical interven- tions, costs of care, daily demands on parents and other family members, and expectations for the future in terms of education, employment, and other milestones of life all vary widely. Similarly, life expectancy in CP follows a continuum, from far lower than to potentially as high as general population life expectancy, that parallels the continuum of levels of disability. Here we review the literature documenting this, and examine the specific factors that are known to be strongly associated with mortality and longevity in CP. We also examine the evidence regarding causes of death in CP, and present some new findings related to this. Finally, we outline important methodological considerations for future research in this area.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126653591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79466
Ali A. Al-Mayahi
Cerebral palsy (CP) is a term referring to a nonprogressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still evolving. Secondary effects of spasticity on growth may, however, be progressive. There may be additional disturbances of sensation, perception, cognition, communication, and behavior. Babies who are neurologically abnormal as newborns are at increased risk of neurologic abnormality in later months and years. Being born preterm (born <37 weeks of gestation) or with a very low birth weight (weighing <1500 g/<32 weeks of gestation) or extreme low birth weight (<1000 g/<28 weeks of gestation) is associated with significant motor impairment. Which specific signs in the neonate are of greatest predictive power, what long-term disability these signs predict, and how well they predict it remain unclear? Physician’s major concern is to identify specific risk factors for severe impairment in early infancy so as to predict the developmental outcome of those children that may manifest later on with neurological deficit especially if they have perinatal insult. Parents on the other hand are also concerned about their growing infants, their development, and neurological outcome. Since cerebral palsy is a permanent disorder, early detection of signs of motor impairment is crucial to assist physicians to give close follow-up of those infants and to reassure parents whose children are normal. It has been shown that intervention may be most efficient when the plasticity of the brain is high, and an early detection of brain impairment is therefore crucial. An earlier follow-up and training program can have a positive effect of the motor development of the child with CP, in particular through prevention of limb contractions, and might make a difference in the child’s ability to handle everyday challenges. In addition, an early detection of CP gives the parents more time for adjustment and preparation. Since clinical manifestations of cerebral palsy do not emerge before a child is at least 6 months, the general movement (GM) is considered the most reliable early markers for monitoring of fetal and infant movement. Abnormal General movements and absence of the so-called fidgety movements at 3-5 months post-term carries a high risk of developing cerebral palsy. Beside a high specificity (82–99%) and sensitivity (95–100%), the assessment of the general movements (GMs) is quick, nonintrusive, and easy to acquire.
{"title":"Early Markers for Cerebral Palsy","authors":"Ali A. Al-Mayahi","doi":"10.5772/INTECHOPEN.79466","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79466","url":null,"abstract":"Cerebral palsy (CP) is a term referring to a nonprogressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still evolving. Secondary effects of spasticity on growth may, however, be progressive. There may be additional disturbances of sensation, perception, cognition, communication, and behavior. Babies who are neurologically abnormal as newborns are at increased risk of neurologic abnormality in later months and years. Being born preterm (born <37 weeks of gestation) or with a very low birth weight (weighing <1500 g/<32 weeks of gestation) or extreme low birth weight (<1000 g/<28 weeks of gestation) is associated with significant motor impairment. Which specific signs in the neonate are of greatest predictive power, what long-term disability these signs predict, and how well they predict it remain unclear? Physician’s major concern is to identify specific risk factors for severe impairment in early infancy so as to predict the developmental outcome of those children that may manifest later on with neurological deficit especially if they have perinatal insult. Parents on the other hand are also concerned about their growing infants, their development, and neurological outcome. Since cerebral palsy is a permanent disorder, early detection of signs of motor impairment is crucial to assist physicians to give close follow-up of those infants and to reassure parents whose children are normal. It has been shown that intervention may be most efficient when the plasticity of the brain is high, and an early detection of brain impairment is therefore crucial. An earlier follow-up and training program can have a positive effect of the motor development of the child with CP, in particular through prevention of limb contractions, and might make a difference in the child’s ability to handle everyday challenges. In addition, an early detection of CP gives the parents more time for adjustment and preparation. Since clinical manifestations of cerebral palsy do not emerge before a child is at least 6 months, the general movement (GM) is considered the most reliable early markers for monitoring of fetal and infant movement. Abnormal General movements and absence of the so-called fidgety movements at 3-5 months post-term carries a high risk of developing cerebral palsy. Beside a high specificity (82–99%) and sensitivity (95–100%), the assessment of the general movements (GMs) is quick, nonintrusive, and easy to acquire.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130647592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79246
C. C. Ogoke
The classification of cerebral palsy (CP) remains a challenge; hence the presence of so many classifications and a lack of consensus. Each classification used alone is incomplete. Therefore, a multiaxial classification gives a more comprehensive description of a child with CP. The recent WHO International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of focusing on the functional consequences of various states of health and has stimulated the development of newer functional scales in CP. It is widely accepted that the functional classification is the best classification for the patient because it guides management. The objectives of this chapter are to review the various classifications of CP, to highlight the clinical features used in the various classifications, to outline the recent functional classifications of CP and to highlight how these recent classifications guide current management. It is expected that at the end of this chapter, the reader should be able to understand the difficulties in classifying CP, enumerate and discuss the various classifications of CP, understand the merits and short - comings of each classification scheme, clinically evaluate and classify a child with CP multiaxially and understand how functional scales predict current and future needs of children with CP.
{"title":"Clinical Classification of Cerebral Palsy","authors":"C. C. Ogoke","doi":"10.5772/INTECHOPEN.79246","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79246","url":null,"abstract":"The classification of cerebral palsy (CP) remains a challenge; hence the presence of so many classifications and a lack of consensus. Each classification used alone is incomplete. Therefore, a multiaxial classification gives a more comprehensive description of a child with CP. The recent WHO International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of focusing on the functional consequences of various states of health and has stimulated the development of newer functional scales in CP. It is widely accepted that the functional classification is the best classification for the patient because it guides management. The objectives of this chapter are to review the various classifications of CP, to highlight the clinical features used in the various classifications, to outline the recent functional classifications of CP and to highlight how these recent classifications guide current management. It is expected that at the end of this chapter, the reader should be able to understand the difficulties in classifying CP, enumerate and discuss the various classifications of CP, understand the merits and short - comings of each classification scheme, clinically evaluate and classify a child with CP multiaxially and understand how functional scales predict current and future needs of children with CP.","PeriodicalId":326086,"journal":{"name":"Cerebral Palsy - Clinical and Therapeutic Aspects","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116150213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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