1/5. Long term course of the H reflex after selective tibial neurotomy.OBJECTIVES: This study was conducted to evaluate the long term clinical and electrophysiological outcome by recording the H reflex in a consecutive series of six patients treated by selective tibial neurotomy for spastic equinus foot. METHOD: The amplitudes of Hmax reflexes, Mmax responses, and Hmax:Mmax ratio were recorded in six patients with chronic lower limb spasticity, before and after surgery, at day 1 and 8 months and 24 months after selective tibial neurotomy. The passive range of movement, the stretch reflex score according to the Tardieu scale, the osteoarticular and tendon repercussions, and the quality of motor control of dorsiflexion were evaluated preoperatively and postoperatively. RESULTS: At the end of the study, all patients presented a reduction of equines. gait and Tardieu's score of spasticity had improved in all patients. Active dorsiflexion of the ankle was unchanged in four patients, but two improved by 5 degrees to 12 degrees. In five cases, fascicular resection of the superior nerve to soleus was, alone, sufficient to reduce spastic equinus foot, without recurrence, for a mean follow up of 28 months. Two patients were reoperated on, one for remaining spasticity related to an underestimated spasticity of the gastrocnemius muscles, and the other for painful claw toes. Hmax, Mmax, and Hmax:Mmax ratios were significantly lower the day after surgery. The reduction of Hmax and Hmax/Mmax ratio remained stable over time and was still statistically significant two years after the operation. However, the value of Mmax eight months postoperatively was no longer significantly different from the preoperative value. CONCLUSION: This study shows the long term efficacy of the selective tibial neurotomy as treatment of spastic equinus foot. Neurotomy confined to fibres supplying the soleus muscle is sufficient in most cases and acts by decreasing sensory afferents without significant long term motor denervation.- - - - - - - - - - ranking = 1keywords = spastic (Clic here for more details about this article) |
2/5. Does fascicular neurotomy have long-lasting effects?OBJECTIVE: To determine whether fascicular neurotomy has long-lasting effects on spasticity. DESIGN: We present 4 clinical cases and a critical analysis of the literature. patients: This is a retrospective study on 4 patients referred to our department for spastic equinovarus foot deformity. For all 4, neurotomy was successful not long after surgery, but spasticity reappeared after a few months. methods: We compared our results with those in the pubmed database. RESULTS: Most publications acknowledge the immediate effectiveness of this surgery, but do not study the long-term effects of neurotomy. No publication proved long-lasting effects of neurotomy for spastic equinovarus foot deformity. The only long-term follow-up with a sufficient population is the one of Berard et al. who reported 61% recurrence. CONCLUSION: There is no study showing that tibial nerve neurotomy has long-lasting effects. The 4 cases reported are an illustration that recurrence of spasticity may occur after neurotomy. These findings have to be taken into account for treatment decision-making and for provision of information to patients.- - - - - - - - - - ranking = 0.71428571428571keywords = spastic (Clic here for more details about this article) |
3/5. Managing equinus in a child with cerebral palsy: merits of hinged ankle-foot orthoses.A comparison of hinged versus solid ankle orthoses in a child with moderate spastic diplegia demonstrated that solid ankle braces blocked needed foot and ankle mobility. The loss of movement forced the child to use extraneous movement patterns in order to move the upper body over the foot. These iatrogenically induced deviations were considered reasons for surgery. When ankle and foot mobility were increased by the use of hinged ankle braces, the gait improved and with physical therapy the reasons for surgery were removed. This case study shows that significant biomechanical changes can be achieved by simply switching from solid to articulated or hinged ankle-foot orthoses.- - - - - - - - - - ranking = 409.35551965912keywords = cerebral palsy, palsy, spastic, cerebral (Clic here for more details about this article) |
4/5. Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle.A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand-held remote switch stimulated an active muscle gait cycle. Results are discussed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.- - - - - - - - - - ranking = 613.8189937744keywords = cerebral palsy, palsy, cerebral (Clic here for more details about this article) |
5/5. Treatment of cerebral palsy with botulinum toxin A: functional benefit and reduction of disability. Three case reports.Three patients with cerebral palsy are described suffering, respectively, of pes equinus, spasm of the m. teres major and flexion spasm of the hand, who were treated with botulinum toxin A. These patients demonstrate not only the local reduction of the muscular hyperactivity following treatment with botulinum toxin A but also the potential functional benefit resulting from such a treatment. Thus, local intramuscular injection of botulinum toxin A in children with cerebral palsy should be considered as part of a multidisciplinary treatment concept, since reduction of the disability and the functional improvements could have high impact on daily living activities.- - - - - - - - - - ranking = 613.8189937744keywords = cerebral palsy, palsy, cerebral (Clic here for more details about this article) |