In cerebral palsy (CP), numerous primary problems are observed including muscle tone problems, muscle weakness, insufficient selective motor control, postural control, and balance problems. In the persistence of these problems for a long period, secondary problems including torsional deformities, joint contractures, scoliosis, and hip dysplasia can occur in time, and strategies formed by children to cope with these problems make up the tertiary problems. Hence, the most accurate and brief assessment of all of these problems mentioned above is crucial to determine an effective and precise physiotherapy program. In the assessment of children with CP, it is very important to receive a detailed story consisting of the birth story, to question underlying medical situations and to carry out physical assessment. In clinics, gross motor function, muscle tone, muscle length, muscle strength, and joint range of motion assessments are the most preferred ones.
Part of the book: Cerebral Palsy
Cerebral Palsy (CP) is a clinical condition that describes impairments of motor and sensory systems due to a lesion in immature brain. CP‐related disorders effect movements, balance and posture of the child. Spasticity is most frequent motor disorder seen in CP and effects 70–80% of the children with CP. Spasticity can lead to abnormalities in all motor system levels involving muscles, joints, bones and tendons. If spasticity exists for long period of time, immobilization of muscles in short position and changes in the connective tissue around joints lead to shortening of the muscles and connective tissue. Various methods are used for spasticity management in children with CP. Botulinum neurotoxin (BoNT) injections, oral medications, selective dorsal rhizotomy and intrathecal baclofen applications are the foremost among them. BoNT injections are most prevalently used one among these applications. BoNT, which is a neurotoxin obtained from Clostridium botulinum bacteria, is frequently used in children with CP to decrease muscle tone for a certain period in the selected muscles, prevent contractures, postpone surgery and decrease frequency of surgeries. During this time frame that muscle tone decreased, it is very important to increase activity and participation levels of children. For achieving better motor outcomes and functional independence, BoNT injections should be combined with physiotherapy (PT) and occupational therapy (OT).
Part of the book: Botulinum Toxin Therapy Manual for Dystonia and Spasticity