الفهرس 
Anatomical & physiological considerations of muscleOnly 14 pages are availabe for public view
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Abstract
Although there’s no cure for cerebral palsy, many of its
symptoms can be treated and managed in ways that will improve
children’s functional abilities. Treatment needs vary widely,
depending on the nature and extent of brain damage. Therefore,
treating cerebral palsy requires coordinated care from an
interdisciplinary team of health‐care professionals.
The anatomical and physiological consideration, clinical
presentation and pathological mechanisms should be well
known. The different assessment modalities including the
electrophysiological techniques, the physical methods, spasticity
rating scales and measures for disability are also crucial for those
who work in this field.
A prospective study was done at Ain Shams University Hospitals
and Dar El‐Shefa Hospital on 30 children with spasc cerebral
palsy, 19 of them with diplegia, 8 with quadriplegia, two with
hemiplegia and one with triplegia, the mean age was 7.9 years
and the mean follow up duraon was 9.9 months.
All children were subjected to an arsenal of routine
investigations, instrumented and manual physical evaluation,
electrophysiological evaluation and orthopedic evaluation for
concomitant joint deformities.
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All children were selected according to standard inclusion
criteria for each modality of treatment used in this work.
Children were grouped into two groups according to the modality
used.
Intra‐operative electrophysiological monitoring was used in all
surgical cases, either neurostimulation for selective neurotomies
or EMG monitoring in selective dorsal rhizotomy and
somatosensory evoked potentials in microsurgical DREZotomy.
Selective peripheral neurotomy is applied to (15) children;
statistically significant physical and functional improvement was
shown in those children. There was only one case of reported
clinical recurrence of reflex activity during the follow‐up period
for those underwent neurotomy.
The sciatic nerve is the most commonly operated; 24
neurotomies, the bial is the second; 22 neurotomies, the
obturator; four neurotomies, and the median nerve; two
neurotomies.
Selective dorsal rhizotomy was performed in thirteen spastic
children due to cerebral palsy with diffuse spasticity in both
lower limbs. Spasticity control is achieved in all children
immediately post operatively.
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Intensive physical rehabilitation program (in the form of
gradual stretching, casting, splinting, standing and gait training
for lower limbs, occupational therapy for upper limb) was done
starting from the second post‐operative day and continued as an
outpatient program for at least four to six months.
Follow‐up measurements are documented in follow‐up charts
for each patient. Statistical analysis for results and interrelations
were found to be more or less around international figures. The
best results regarding function was found in those underwent
neurotomies, perhaps due to the returning regain motor balance
between agonist and antagonist immediately post operative.
Functional outcome assessment is done for both groups, and
comparison between the results of different procedures was
made, which had close net results regarding tone reduction, joint
range of motion and functional improvement.
Cost/benefit evaluation in terms of low cost – high benefit is
best presented with group (A): selective peripheral neurotomy in
comparison to the centrally directed procedures.