Clinical Feature of CP
Primary : - (due to the brain lesion) Muscle tone (spasticity, dystonia)
Balance
Strength
Selectivity
Sensation
Secondary : - due to
the primary impairments causing the movement disorder)
Contractures (equinus, adduction)
Deformities (scoliosis)
Tertiary : - Adaptive mechanisms (knee
hyperextension in stance)
Problems / deformities commonly seen in CP
Upper
limb
Shoulder - flexion, adduction
and internalrotation deformity
Elbow
– flexion and pronation of forearm
Wrist – flexion and ulnar
deviation
Lower
limb
Windswept deformity (hip joint)
Occiput side – limb in flexion,
abuction and external rotation
Face side – limb in flexion,
abduction and internal rotation
Knee joint
Flexion deformity
Valgus
Genu recurvatum
Ankle joint
Equinus
Valgus/ Varum deformity
Clinching of toes
MANAGEMENT OF CP
PHYSIOTHERAPY ROLE
P.T. especially when started
early in life, is helpful in promoting normal motor development, and preventing
deformity and contractures.
A)
Medical MX
Management
of Spasticity
Drugs
a. Baclofen
b. Diazepam
c. Botulinum toxin
Surgical
Tendon
lengthening and transfer and arthrodesis are some of the procedures commonly performed.
Dorsal
rhizotomy: which involves selective resection of posterior nerve
roots from L2 to S2. It may be helpful in children with severe lower limb
spasticity, with sufficient trunk control and some form of forward locomotion.
B)PhysiotherapyMX
1.Handling and positioning
2.
Therapeutic exercise
- Gentle range of motion exercises
- Strengthening exercises
- Functional progressive resistance exercises
- Stretching
3.Therapeutic handling
- To influence the quality of motor response
- To use sensory information and adapt movements
4.
Facilitation
- Process of intervention which uses postural tone in
a goal directed activity
5.
Proprioceptive neuromuscular facilitation[PNF]
PNF uses the body’s proprioceptive system to
facilitate or inhibit muscle contraction.
CP is the major the problem seen in young child, so different
techniques has been and one of them is Bobath technique, roods approaches and
play therapy.
Bobath
technique
is used to improve neuromotor development.
Roods
approaches
for muscle tone management by inhibitory technique (Slow rolling, prolong
stretch, slow stroking) and facilitatory technique(fast stroking, quick icing,
joint compression/weight bearing, stretching).
Play
therapy will
encourage the child to move on.
As the aim of physiotherapist
should be on functional activity to make the child practice it in a real life
situation.
6. Assistive
and adaptive devices
Angled spoons: two handled cups
Old stools and boxes: to
provide support during sitting
Standing frames: are used in
the stage of mobilization
Parallel bars: for gait
training
Splints, Casts and Calipers:
Specially designed shoes, ankle-foot orthoses (AFO) and calipers
