Motricite Cerebrale最新文献

The Multihandicap Resource Center (CRMH) is dedicated to polyhandicap. The CRMH carries out activities aimed at families and professionals and is involved in various institutional and associative groups. Orthopedic disorders caused by neurological impairments significantly impact the quality of life of children with polyhandicap. Therefore, we have chosen this theme for the 2023 day of sharing and reflection. The purpose of this meeting is to enhance the care of individuals with PIMD.

The medical management of orthopedic disorders in children with polyhandicap is inseparable from the care provided for all aspects of their general health. Cutaneous, oral-dental, digestive, respiratory, bladder, and intestinal disorders are intricately linked to the neuro-orthopedic condition of the individual. Therefore, it is essential to assess the state of these organs and the functioning of these functions in order to unravel the cause-and-effect relationships of these impairments. Orthopedic disorders develop in their own right. The primary disorder generates secondary impairments. The pursuit of functional strategies may further deteriorate the orthopedic condition in the long run. Various rehabilitative approaches, combined with the use of orthoses, can help prevent or limit deterioration of the body's physical capabilities. Medical and surgical interventions aim to minimize the expression of spasticity and restore orthopedic function (joint mobility and muscle length) as much as possible. All proposed therapies should be part of the individualized plan for the person with PIMD.

The fabrication of a molded orthopedic seat for a child with PIMD is carried out in our practice as orthoprosthetists through a series of successive steps. The proper functioning of each step is crucial for the final quality of the product. Precision in the specifications is essential: the reasons for considering the seat and the characteristics expected from its fabrication. The perspective of users (families, educational teams) is essential. The presence of a therapist who is familiar with the child and the specifications is also necessary. The quality of assessments performed by the medical and rehabilitative team, as well as those carried out by the orthoprosthetists, is necessary to validate the specifications based on the unique situation of each child. The orthoprosthetist has various technical means to create the molding of the specific body part and then to manufacture the seat. Different additions are used to finalize the customization of the installation.

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.

One of the goals of physiotherapy in facilities for children with polyhandicap is to combat the onset and development of orthopedic disorders. We aim to actively engage each child based on their abilities. Additionally, we implement installations and orthoses in the child's daily life. Our work is inherently collaborative with parents and other members of the educational team, in order to share observations, technical expertise, and to determine responsibilities throughout the child's daily life.

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.