Cerebral Palsy affects 1-2 children in every 1000 born and the most common among it is Spastic Cerebral Palsy.
There are 2 components of HYPERTONIA:
- Neurogenic : Overactive Muscle Contraction
- Biomechanical: Stiffening and shortening of the muscle and soft tissue.
If above components are left untreated, it might lead to abnormal limb posture, soft tissue shortening and biomechanical changes in the contracted muscles.
Various therapies like myofascial release, Pediatric IASTM, Pediatric Dry Needling, Aquatic therapy can reduce tone immediately for a while.
Passive stretches, splinting and positioning are all essential to prevent further deterioration of body alignment.
Facilitation of active control of limbs and strengthening exercises to the trunk and limb muscles are essential in promoting Functional Movement in Children with CP.
But sometimes Physiotherapy alone is not sufficient to overcome HYPERTONICITY or its biomechanical component, especially in moderate to severe Spasticity.
At this stage Medical Treatment and other Surgical Treatment should be considered as soon as possible.
Among many medical and surgical treatment, Botulinum toxin injection is commonly used. Its effect remains for 3 to 6 months depending upon dosage.
After administration of Botulinum Toxin, intensive therapy is provided to get better motor control. Functional gain can be observed even after the effect wears off.
Early Botulinum Toxin intervention followed by casting at the level of gastro – soleus spastic muscles had shown major improvement in prevention of medial foot arch prolapse and foot deformity when children are learning weight bearing and independent walking .
When a spastic child is able to walk, with or without aids, 3-D Gait Analysing is very good for assessing movement pattern and for deciding which muscle groups need botulinum toxin injection at a single or multiple levels.
After Botulinum toxin intervention, intensive physiotherapy is must, followed by proper orthosis to provide optimal effect on muscle strength and length.
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