Management of hand problem in cerebral palsy by tendon transfer and SEMLOSSS

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Upper extremity involvement in cerebral palsy interferes with proper use of hand and it is most challenging for therapist and surgeon to deal with it. In upper extremity they can have problem in shoulder, Elbow, wrist, and fingers. Problem can be of combination of lifting of upper limb above the shoulder, reaching out to object or not able to perform fine activity by hand.  It is also very important that preference of hand became fixed at the age of two year so it became imperative to start therapy at earliest to get maximum outcome before the age of 2-3 year age.  We have many ways of therapy for hand like Bimanual, CIMT, sensory integration & proper occupational therapy. Affected hands in cerebral palsy have manifold problem like weakness, spasticity, contracture & sensory problem.  Most difficult to treat problem in upper limb is non recognition of fine motor activity by cortical center in brain so that they are not able perform activity at their own in coordinated manner. Most important problem that interferes in therapy is contracture and spasticity in extremity that is too being managed at early. In early age (2-5 year), it can be managed by botulinum toxin but child develop fixed contracture then they require surgical intervention. earlier we use to do tendon lengthening of all affected tendon require long rest of hands and rehab can be started after months and recovery was not so good every time. But with the new concept of OSSCS & SEMLOSSS we use to relieve spasticity & contracture by aponurotic (facial coverage at musculo-tendinous junction) release by this technique we can start therapy early and child regain function in very short time. Some time these children also have weakness in few group of muscle so we also utilized the concept of tendon transfer. This tendon transfer help in regaining muscle power and good functional recovery.

Video of outcome of tendon transfer in cerebral palsy affected hand of few children & adolescent

few children It is very important to continue therapy for log duration till complete recovery. Child should wear brace as advised their operating surgeon and therapist concerned. By use of all this modality we can give good functional recovery to child.

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Benefit of early intervention in children with cerebral palsy

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Most of the time it has been said that child with cerebral palsy will improve on his natural progress and there is no need of any intervention but it is not true as a whole . truth is that if you are not giving proper therapy to child , child is not going to have good quality of progress. By the use of good quality of therapy, different intervention modality and judicious use of bracing can help the child with cerebral palsy in getting good functional improvement and they can change the natural progress of the child .

on of the parents rightly written on his testimonial as ——–

My son  Shivansh Pandey (31/2 years) was a premature baby who could not sit, stand and walk till 21/2 yrs.  Consultants in Faizabad referred him to Dr. J.K. Jain.  On his advise we stayed in Allahabad for 3 months during which Shivansh was treated at Samvedna Trust.  In these 3 months he has improved drastically and started sitting and crawling independently.  He was further injected Botulinum Toxin followed by vigorous physiotherapy.  Today Shivansh can walk 20 – 25 steps independently.  Thanking Samvedna for such unbelievable results. link to you tube video of this child

Vipin Pandey – Faizabad (U.P.)

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Cerebral Palsy Treatment Surgery pediatric orthopedics rehab center minor orthopedic clinic

Cerebral Palsy Treatment Surgery pediatric orthopedics rehab center minor orthopedic clinic

Do you know what is Cerebral Palsy? Are you affected or your known one affected from Cerebral Palsy then you really need to read this and share it and make aware to all about Cerebral Palsy http://www.samvednatrust.com/cerebral-palsy/
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Cerebral palsy awareness is very much needed in countries India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka

Cerebral palsy treatment India

Cerebral palsy treatment India

Cerebral palsy awareness is very much needed in countries India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka etc etc..

We really need to get ware about it. Read this complete blog here http://www.samvednatrust.com/cerebral-palsy-awareness-is-very-much-needed-in-countries-india-us-uae-europe-pakistan-nepal-bangladesh-sri-lanka/

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BEHAVIOR MANAGEMENT in Cerebral Palsy Children

BEHAVIOR MANAGEMENT in Cerebral Palsy Children

Behavior management is similar behavior modification. It is a less intensive version of behavior therapy. In behavior modification the focus is on changing behavior, while in behavior management the focus is on maintaining order.

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ORTHOSIS MANAGEMENT IN CHILDREN WITH CEREBRAL PALSY

A multidisciplinary team including an orthotist, physical therapist and an orthopedist can advance a child with cerebral palsy along the continuum of care throughout his development. This team, coordinating with a family-centered approach to care, should encourage optimal use of an orthosis within the prescribed treatment plan.

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If you encounter a pediatric patient with cerebral palsy chances you may find the solution to orthotics treatment with some customized adjustment. To make a truly useful orthosis for a child with cerebral palsy you may also need to know body mechanics and kinematics.

Spastic cerebral palsy is the common type cerebral palsy, found approximately in 80% of children with the disability. Although orthotics intervention has adjusted in small ways to accommodate new research in the body mechanics and gait, the overall goals are the same. The goal of lower limb orthotic management of cerebral palsy is to correct and/or prevent deformity; to provide a base of support to facilitate training in skills and to improve the efficiency of gait. Other goals include increasing range of motion, maintaining or improving levels of function and stability, maintaining length as the bone grow, and preventing and overcoming some the secondary effects of the disability leading into adulthood, no single treatment is appropriate for every child, but it is generally agreed that sooner the intervention is started the better the outcome. Orthoses prescribed to prevent or correct the deformities can pose addition activity limitation by restricting movement . normal functional development can be impeded by impairment of coordination and movement. Orthoses can maintain optimum biomechanical aligment of body segments enable children to overcome activity limitations by focusing training on unrestricted parts for their bodies over which they have better control.

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Botox in cerebral palsy

Clinical use of botulinum was recognized by Bergen et al. in 1949 by identifying the effect of botulinum toxin on neuromuscular transmission. Once it was thought to be potent biological toxin to human body, now its potential is being utilized as therapeutic agent for different clinical problems specially spasticity & cosmetic purpose. In all variety of botulinum toxin, type A is used for the clinical application. This is being utilized in Mx of cerebral palsy since 20 years .This toxin is used as intramuscular injection at most condensed site of neuromuscular junction of affected muscle. This toxin block acetylcholine release from neuromuscular junction & causes local temporary chemo- denervation and effect last for 4-6 month .Even after disappearance of drugs, some modulation of nerve transmission has been seen, so effect persist beyond the time limit and dystonic posture also get corrected due to slight diffusion of drugs in systemic manner. It is being commonly used for spastic & dystonic cerebral palsy.
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Usually botulinum toxin injection are used in all affected muscle in a single setting and it is better to give it under anesthesia, because it require multiple injection puncture and is painful and it also save the toxin from wastage. Most commonly botulinum toxin is used in Gastrocnemius, Hamstring, Rectus Femoris, Adductor, Pronator Teres, and Flexor Digitorum. Injection can be repeated every three monthly but if proper postoperative therapeutic protocol has been taken into consideration it may not be so frequent. At Samvedna, we rarely require repetition of toxin due to good therapeutic protocol and use of braces. It reduces pain; facilitate therapy, better cooperation of child, better functional and motor gain .By the use of toxin, surgery also can be delayed till the maturity of gait. Antibodies to toxin have been one of the possible problems with repeated injection that can interfere in next injection of toxin. Otherwise it is well tolerated. Side effects are very -2 rare.

Botulinum toxin in cerebral palsy

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Participation and barriers in Cerebral Palsy

Participation is involvement in life situations and everyday activities. Participation includes the domains of self-care, productivity and leisure. In fact, communication, mobility, education, home life, leisure and social relationships require participation and are indicators of the extent to which a child functions in his or her environment.

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Barriers can exist on three levels: micro, meso and macro. First, the barriers at the micro level involve the person. Barriers at the micro level include the child’s physical limitations (motor, sensory and cognitive impairments) or their subjective feelings regarding their ability to participate. For example, the child may not participate in group activities due to lack of confidence. Second, barriers at the meso level include
the family and community. These may include negative attitudes of people toward disability or lack of support within the family or in the community. One of the main reasons for this limited support appears to be the result of a lack of awareness and knowledge regarding the child’s ability to engage in activities despite his or her disability. Third, barriers at the macro level incorporate the systems and policies that
are not in place or hinder children with CP. These may be environmental barriers to participation such as architectural barriers, lack of relevant assistive technology and transportation difficulties due to limited wheelchair access or public transit that can accommodate the children with CP. For example, a building without an elevator may prevent the child from accessing higher floor levels.

As conceptualized in the child and youth version of the International Classification of Functioning, aspects of the environment may influence a child’s participation:

(1) products and technology.

(2) the natural and built environment.

(3) support and relationships.

(4) attitudes, values, and beliefs.

(5) services systems and policies.
At the community level, fewer municipal resources and public services (eg, inclusive schools, transportation, recreation programs, programs with adaptive equipment) have been shown to impede the community participation of children with physical disabilities.

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Cerebral palsy- multimodality treatment

Cerebral palsy has no definite treatment and this fact makes the condition even more daunting for the families of the patients. A multi-dimensional treatment approach is followed to manage the condition. The approach may vary on the basis of how the condition differs in different patients. While some may require more of physiotherapy, others may demand surgical treatment. The cerebral palsy treatment protocol can be rightly named as combination treatment. Below discussed are some of the main parts of this treatment approach.

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Physical Therapy for Improvement in Movements

The main goal of physical therapy among cerebral palsy affected individuals is to improve movements and gait. This type of treatment helps in:

  • Development of muscles and motor skills among the affected children.
  • Improving the abilities to walk independently, sit, rise and use bathroom.
  • Preventing weakness and stiffness in limbs and dislocation of joints.
  • Encouraging participation in routine activities.

 

The use of aids like stick, rollater and elbow crutches is an important part of this treatment approach.

 

Occupational Therapy to Promote Self-dependency

One of the important parts of cerebral palsy treatment is occupational therapy that requires essential participation of the patient’s parents and other family members. The main goal is to make the patients self-dependent in various activities like writing, eating, dressing up and others.

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Speech Therapy for Communicational Improvements

Cerebral therapy patients are expected to face problems in eating, talking, swallowing, breathing and so on. This happens because of the imbalance and weakness of muscles present in jaw and mouth. Speech therapy is conducted to teach these individuals to control over these muscles. It helps the patients to learn how to talk clearly, bite and chew properly, swallow the food and to breathe conveniently.

 

Treatment Using Drugs

The role of medications in cerebral palsy treatment can’t be overlooked. One common occurrence among the patients is that of seizures that call for the need of administering drugs. Muscle relaxants, antispasmodic drugs, anti-spastic drugs, laxatives and anti-cholinergic drugs are among the common ones used in the treatment but not without side effect so it should be used cautiously.

 

Surgical Treatments

Surgical procedures in cerebral palsy sufferers are done to treat certain conditions and also to improve the overall quality of life among these individuals. Relaxing joints and stiff muscles is possible by performing surgery on knee, hip, ankles and other body parts. These procedures are also followed to release contractions; to straighten the abnormal leg twists & dislocation of joint. Earlier traditional surgeries were used often in these conditions but outcome was not so good always. Nowadays with the use of SEMLS by the concept of OSSCS we can expect excellent outcome in most of our children if they were selected properly and good post operatively rehab programme has been given to them .Few neurosurgical procedures like selective dorsal rhizotomy & selective nerectomy has also been used but results are good only in experienced hand otherwise child is left out with permanent weakness in the extremity.

Other Treatment Approaches

Behavioral therapy is another important part of the treatment to improve behavior among the patients. Psychotherapy is done to improve the productivity level of the mind among these individuals.

Stem cell treatment is among the latest in this direction and it involves production of new cells in the damaged tissues of the body but results are awaited and still under research. Counseling, emotional therapy and educational therapy are the important add-ons that can make treatment much more effective for the patients. The following of a multi-dimensional treatment approach can definitely improve the living state of cerebral palsy patients.

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Cerebral Palsy… Parent’s Experiance

Every parents try all their effort so that their child should get maximal functional improvement to nearly normal level but functional improvement based on many factor like level of physical disability, age of presentation, quality of care given to them, type of surgical and therapeutic intervention and cooperation of child. children with cerebral palsy can get lots if they have been managed by integrated approach including SEMLOSSS, Tendon transfer and supervised therapy programme. visit http://www.samvednatrust.com for more detail.

 

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Treatment surgery center children symptom Mobility Exercises in Cerebral Palsy children Treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka Afghanistan Bhutan Russia Canada United States PR China Brazil Australia Argentina Kazakhstan Sudan Algeria Greenland Saudi Arabia Indonesia Mongolia Peru Niger South Africa Colombia Egypt Nigeria Venezuela Turkey Chile Zambia Ukraine Kenya France Thailand Spain Sweden Uzbekistan Morocco Iraq Japan Zimbabwe Germany Finland Malaysia Philippines Ecuador New Zealand Netherlands Switzerland Denmark Qatar
Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
Dr. Jitendra Kumar Jain
jjain999@gmail.com
www.samvednatrust.com

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