Motricite Cerebrale最新文献

The orthopedic surgical indication in the context of polyhandicap should always be made with a comprehensive understanding of the child's medical, family, and social situation. Therefore, it should be determined through extensive consultation with the family and the relevant medical, educational, and rehabilitative teams. The targeted objectives should align completely with the individual plan of the subject. Post-operative follow-ups and constraints should also be considered in the context of the individual's uniqueness, their behavior, and communication style. At times, the surgeon may need to exercise restraint. We will illustrate our practice through some fairly common indications.

The incidence of cerebromotor disorders of cerebral palsied subjects on their orthopedic state is a constant: excess contractions leading to misalignments, muscular and periarticular retractions, displacements of mobility sectors, bone deformations These orthopedic consequences are correlated to the degree motor impairment. Rehabilitation, orthopaedic, medical and surgical treatments find their relevance all the more so if the factors of the disorders are correctly identified, evaluated qualitatively and quantitatively. The contributions of clinical and paraclinical examinations complement each other to provide professionals with the richest range possible. In 1991, Dr Alain Lespargot described a clinical examination allowing to define the sectors of mobility where the hip is in a situation of satisfactory centering or on the contrary, of less centering. This article studies the interest of this examination in addition to radiography. This is a first step to show that this clinical examination effectively accounts for the centering situation of the hips flexed around 90°. It is reliable and reproducible. However, it requires some practice and repetition, like many of our other professional gestures.

The Early Medico-Psychological Action Center (CAMSP) in Montpellier has set up PIPA, which is an accompanied precocious intervention program for children presenting vulnerability factors at birth, and their parents. In this program, between three and four months of corrected age, when a newborn is presenting a very high risk of developing a cerebral palsy, an intensification of the neuromotor follow-up is proposed (MOTOR PIPA). This program is based on on international recommendations concerning: the earliest possible diagnosis with evaluations based on current scientific data, active involvement from parents in the child's therapeutic project, enrichment of the child's environment, intensification of neuromotor stimulations. In addition, we use a partnership notebook as well as filmed session videos.

The multidisciplinary therapeutic and educational team at the Ramdam Inclusive child care centre welcomes 30% of children with cerebral palsy among able-bodied children in the neighbourhood. The facilities of these young children with severe motor disabilities are essential they aim to preserve their orthopedic capital, to avoid choking spells, and to optimize their functional possibilities (motor, visual, communicational and relational) in their environment, at home as well as at their child care centre. They thus participate in their early social inclusion. From the multifactorial assessment of children's disorders and capacities, their occupations and their environment, to the co-construction of relevant objectives, partnership with the different actors is essential. We will emphasize the importance of this transdisciplinary work (and more specifically between the occupational therapist, the physiotherapist and the orthoprothesist, in close partnership with families and doctors), from the first “foam homemade installations” by the occupational therapist in the Ramdam child-care centre, to the orthopedic equipments made by the orthoprothesist. We will illustrate our constructive approach with some clinical vignettes of young children with severe motor disabilities, with the gradual introduction of facilities depending on the child's evolution, the parents’ requests and their progress in discovering their “different” child, proposals from the multidisciplinary team, while taking into account the specific and personalized goals for each child.

The device occupies an important place in the therapeutic arsenal used in cerebral palsy. The molded seat (or seat corset), the pelvic-pedal splints for verticalization, the night splints represent the daily life of a large number of cerebral palsy subjects. Unfortunately, it is a source of pain or discomfort, which limits its use when the initial objectives seemed relevant. The tools allowing the development of the specifications of these devices have evolved in connection with the representation that we have of disability and of the person with a disability. This evolution opens up new perspectives in the representation and design of the device: This would no longer be only a tool for compensating for a deficiency but that of an adaptive and enabling tool.