Musculoskeletal Pain And Cerebral Palsy-Buy Your Plane Ticket

2016-05-22 18:15:36 (GMT) ( - News Providers Press Release News)

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Musculoskeletal Pain And Cerebral Palsy-Buy Your Plane Ticket

Sacramento, CA, 05/20/2016 /SubmitPressRelease123/

Cerebral palsy (CP) is the most common disabling motor condition in childhood.   The literature that relates to orthopedic care in adults with CP indicates there continues to be a need for ongoing specialty care as these individuals age.  Studies indicate adults with CP present with early onset in musculoskeletal complaints compared to aged matched controls causing decreased function, decreased strength, increased spasticity, increased fractures, and arthritis.  Particularly significant is the fact that fifty percent of patients with CP without cognitive impairment report that there is a decline in walking ability before their mid-thirties and more disturbing is that ten percent stop walking all together.


Approximately ninety percent of adults with cerebral palsy require a musculoskeletal surgical procedure to improve their quality of life, decrease the energy associated with ambulation, improve contractures, and decrease pain.  Unfortunately very few specialty clinics across the country combine the specialties required to treat these complex patients.  State of the art clinics that combine all the necessary services including orthopedic surgery, neurosurgery, neurology, orthotics, and physiatry are necessary to provide comprehensive solutions that are individualized to meet the needs of the adult patient with CP.  Unfortunately, because of logistics, payment issues, and the general lack of interests the availability of these clinics is scare, and only those with the resources to travel are able obtain the comprehensive services they require.


Orthopedic surgical intervention for foot and ankle deformities represents the most common surgery in adults with CP.  This relates to progressive problems related to the equinovarus deformity that causes ankle plantar flexion, foot inversion, and pronation of the foot.  Spasticity worsens with age causing soft tissue contractures at the ankle and foot that prevents weight bearing, interferes with shoe wearing, and prevents heel strike with gait.  Proper management must include neurosurgeons with training in peripheral neurotomies for spasticity, physiatrist with training in utilizing Botox and Phenol injections, and orthopedic surgeons.  Gait analysis may be necessary with dynamic electromyography and is rarely performed except at specialty clinics.  In addition, complex cases may require a consensus regarding the proposed treatment plan by way of a case conference with all the above specialties to best devise a treatment plan for the adult with equinovarus caused by CP.


Knee contractures are also a common acquired deformity in the adult population with CP.  Contracture at the knee contributes to poor posture during gait; increase energy with ambulation, and knee pain.  This is a complex deformity that like equinovarus results from spasticity and soft tissue contractures.  Proper management may again involve neurosurgery for peripheral neurotomies, physiatrist for Botox, physical therapist for serial casting, and orthopedic surgeons.  Only with a comprehensive spasticity clinic composed of these specialist can an individual plan be tailored to best meet the needs of the patient.


A life care plan provided by an Academic Physician Life Care Planner is necessary for a child with CP considering the impact of pain, progressive spasticity, progressive joint contractures, and the likelihood of decreased function as they age with CP.   An Academic Physician Life Care Planner understands that these children will need to continue their care at a comprehensive clinic that combine the expertise of a neurosurgeon, neurologist, physiatrist, and an orthopedic surgeon to their life expectancy to ensure complications are prevented and their psychosocial health is optimized.  Early intervention with Botox, Phenol, neurotomies, tendon releases, and physical therapy will need to be considered and accounted for in the life care plan.  In addition, mobility devices such as custom electric wheelchairs may need to be included in the life care plan of an ambulatory child with CP.



Press Contact

Dr. Greg Vigna, MD, JD Academic Physician Life Care Planner

T: 800-761-9206

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