Surgery of the spastic hand in cerebral palsy: improvement of stereognosis after surgery

Dahlin, Lars B.; Komoto-Tufvesson, Y.; Sälgeback, Stig

doi:10.1016/s0266-7681(97)80101-5

Cited by 23 publications

(39 citation statements)

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“…In different studies stereognosis is assessed in various ways, for example, by identification of what are effectively 2-dimensional geometric shapes, like flat plastic forms (Bolanos et al1989, Gordon andDuff 1999) or with more 'solid', three-dimensional figures like cubes and spheres (Wilson and Wilson 1967b). Sometimes commonly encountered familiar objects like combs, toothbrushes, or keys are used (Van Heest et al 1993, Yekutiel et al 1994 or a combination of familiar objects and shapes (Mihran and Tachdjian 1958, Cooper et al 1993, Dahlin et al 1998. Sometimes the task is to match the object with a seen corresponding object or with a photograph or drawing of the object (Cooper et al 1993, Gordon andDuff 1999) and again others ask the child to verbally describe or name the object (Bolanos et al 1989, Yekutiel et al 1994, Dahlin et al 1998).…”

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“…Sometimes commonly encountered familiar objects like combs, toothbrushes, or keys are used (Van Heest et al 1993, Yekutiel et al 1994 or a combination of familiar objects and shapes (Mihran and Tachdjian 1958, Cooper et al 1993, Dahlin et al 1998. Sometimes the task is to match the object with a seen corresponding object or with a photograph or drawing of the object (Cooper et al 1993, Gordon andDuff 1999) and again others ask the child to verbally describe or name the object (Bolanos et al 1989, Yekutiel et al 1994, Dahlin et al 1998). Further differences emerge between the methods because in some assessments the participants are allowed to examine the objects visually and by touch before the test and sometimes they are not.…”

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Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

Krumlinde‐Sundholm

Eliasson

2002

Develop Med Child Neuro

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Children with hemiplegic cerebral palsy (CP) commonly exhibit tactile sensory deficiencies in their hands in addition to their motor problems. The aim of this study was to compare and evaluate the usefulness of some common tests of tactile sensibility for use with children with hemiplegic CP. Twenty‐five children with hemiplegia aged between 5 and 18 years, and 19 control individuals participated. All children were examined with Semmes‐Weinstein monofilaments, two‐point discrimination (2PD), stereognosis of familiar objects, stereognosis of forms, and functional sensibility. Dexterity, spasticity, and bimanual task performance were also assessed. Results from the different sensory tests deviated greatly. We found three tests to be useful: 2PD of 3mm spacing, which was the most sensitive test, stereognosis of familiar objects, and functional sensibility assessed through the Pick‐up test (comparing performance with and without the influence of vision). Stereognosis of forms and threshold values of touch (Semmes‐Weinstein monofilaments) are seemingly less useful tests for children with CNS impairments. Deficient sensibility was strongly related to dexterity. Aspects concerning the testing methodology are discussed.

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Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

Krumlinde‐Sundholm

Eliasson

2002

Develop Med Child Neuro

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“…Involvement of the upper extremity in cerebral palsy often results in a typical pattern of spasticity, with elbow flexion, forearm pronation, ulnar deviation and flexion of the wrist, and adductionflexion posture of the thumb (2). Cerebral palsy can be classified into spastic, dyskinetic, ataxic, or mixed types.…”

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Upper Extremity Surgery in Spastic Cerebral Palsy

Özkan

Tunçer²

2012

JAREM

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Involvement of the upper extremity in cerebral palsy often results in a typical pattern of spasticity, with elbow flexion, forearm pronation, ulnar deviation and flexion of the wrist, and adduction-flexion posture of the thumb. Although only a relatively small subset of cerebral palsy patients are candidates for surgery, properly selected patients and procedures yield a reasonable improvement. Nonsurgical treatment modalities include physical therapy, orthoses, and medications aimed at decreasing spasticity. Surgical options for the management of the spastic upper extremity vary with the specific parts, however they are focused around three basic principles: weakening the overactive muscle/tendons, strengthening the underactive muscle/tendons, and stabilizing non-stable joints. Surgical management of the spastic upper limb in cerebral palsy requires meticulous evaluation and planning. It is important to know that upper extremity deformities are secondary manifestations of the cerebral injury. Therefore, in addition to evaluation of upper extremity function, consideration should be given to the intelligence and motivation of the patient, and voluntary use of the upper extremity. Prior to surgery, the overall level of function needs to be considered. These are also important details for the patients and their families, who should know that surgery is aimed at improving the upper extremity deformity, and not the primary disorder. Appropriately indicated surgery can significantly contribute to upper extremity function. (JAREM 2012; 2: 43-54) Key Words: Cerebral palsy, spasticity, upper extremity surgery, tendon transfers ÖZET Serebral paralizide üst ekstremite tutulumu, tipik bir spastisite paterni oluşturur. Bunun sonucunda da sıklıkla dirsek fleksiyonu, önkol pronasyonu, el bileğinde fleksiyon ve ulnar deviasyon, başparmakta adduksiyon-fleksiyon postürüyle karakterize bir deformite meydana gelir. Serebral paralizi hastalarının yalnızca az bir kısmı cerrahi için uygun adaylar olsa da, uygun seçilmiş hastalarda cerrahi tedavi yüz güldürücü sonuçlar verebilmektedir. Cerrahi dışı tedaviler arasında fizik tedavi, ortezler ve spastisiteyi azaltmaya yönelik ilaçlar vardır. Spastik üst ekstremite tedavisindeki cerrahi seçenekler deformitenin bulunduğu bölgeye göre değişir, ancak üç temel özellik üzerinde odaklanır: aşırı aktif kas ve tendonların zayıflatılması, yetersiz aktiviteye sahip olan kas ve tendonların güçlendirilmesi ve stabil olmayan eklemlerin stabilizasyonu. Dirsek fleksiyon deformitesi serebral paralizide nadiren bir cerrahi endikasyon oluşturur, ancak ileri derecede olup işlevi engellediğinde biceps ve brachialis gevşetilmesi, fleksor pronator kas kaydırma gibi işlemler ile düzeltilebilir. Önkol pronasyon postürü, supinasyon gerektiren, ele alınan bir cismin avuç içinde tutulması veya kişisel hijyen gibi görevlerin yapılama-masına neden olabilir. Bu durumlarda ideal olan, mevcut pronasyonu bozmadan hastaya supinasyon hareketi kazandırmaktır. Fleksor karpi ulnarisin ekstansor karpi radialis brevis'...

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“…Термин «спастическая рука» часто встречает-ся в литературе [1][2][3][4][5][6] и характеризует нарушение функциональных возможностей верхней конеч-ности у детей с детским церебральным парали-чом (ДЦП). Характерными контрактурами для такого состояния являются сгибательная кон-трактура в локтевом суставе, пронационная кон-трактура предплечья, сгибательная контрактура в луче запястном суставе и суставах пальцев ки-сти, а также сгибательно-приводящая контракту-ра первого пальца кисти [4][5][6][7][8][9].…”

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Conservative treatment of pronational contracture of the forearm in children with cerebral palsy

Novikov

Александрович²,

Umnov

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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Целью работы являлась оценка эффективности консервативного лечения пронационной контрактуры пред-плечья в зависимости от степени выраженности контрактуры. Материалы и методы. Настоящее исследование основано на результатах обследования и лечения детей, стра-дающих ДЦП с поражением верхней конечности. Основным критерием отбора пациентов было наличие про-национной контрактуры предплечья, как изолированной, так и в сочетании с другими контрактурами в суста-вах верхней конечности. Сформированы три группы пациентов на основании выраженности пронационной контрактуры предплечья. Результаты и выводы. На основании проведенных исследований установлено, что по мере увеличения степе-ни выраженности пронационной контрактуры снижается эффективность консервативного лечения в целом. Консервативное лечение пациентов с дефицитом активной супинации предплечья более 90° неэффектив-но. Применение ботулотоксинов типа А и РЧД во II и III группах малоэффективно. На хороший результат консервативного лечения с применением ботулотоксинов типа А можно рассчитывать только у пациентов I группы. Метод РЧД обладает более долговременным эффектом, но имеет значительно большее количество осложне-ний. Применение ботулотоксинов типа А (m. pronator teres) среди пациентов с пронационной контрактурой предплечья с возможностью активной супинации предплечья более 90° достоверно улучшает результат базо-вого консервативного лечения.Ключевые слова: ДЦП; верхняя конечность; спастическая рука; пронационная контрактура; хирургическое лечение. Aim. We aimed to evaluate the effectiveness of conservative treatment for pronational contracture of the forearm, depending on the contracture severity. Materials and methods. This study was based on the results of the examination and treatment of children experiencing cerebral palsy with upper limb involvement. The main criterion for patient selection was the presence of pronational contracture of the forearm, both isolated and in combination with other contractures in the upper limb joints. Three patient groups were formed based on the pronounced pronation contracture of the forearm. Results and conclusions. Previous research has established that with the increase in the degree of severity of pronation contracture, the effectiveness of conservative treatment decreases in general. Conservative treatment of patients with a deficiency of active supination of the forearm of > 90° is ineffective. The use of botulinum toxins type A and RFD in groups II and III is ineffective. Conservative treatment with botulinum toxins type A achieved good results only in patients of group I. CONSERVATIVE TREATMENT OF PRONATIONAL CONTRACTURE OF THE FOREARM IN CHILDREN WITH CEREBRAL PALSY©

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Surgery of the spastic hand in cerebral palsy: improvement of stereognosis after surgery

Cited by 23 publications

References 0 publications

Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia

Upper Extremity Surgery in Spastic Cerebral Palsy

Conservative treatment of pronational contracture of the forearm in children with cerebral palsy

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