Title: Rehabilitation of Child with Cerebral Palsy in the Preoperative and Postoperative Period Author: Renata Šmídová Objective: During my practice I have met with a number of pediatric patients affected by cerebral palsy who underwent corrective orthopedic surgery, and which in some cases unfortunately unsuccessful. Based on the initial acquisition of information on this issue, I found a number of studies and articles on the success of orthopedic surgery in cerebral palsy. Many studies have been correctly chosen physiotherapy great help, so I decided to map physiotherapy approach on the case. In the first part of the thesis I process in detail neurological disorder cerebral palsy (CP) and surgical treatment of deformities resulting from the operation of this disease. The second part includes a case study, which also describes the rehabilitation work of the physiotherapist with a child patient who undergoes corrective surgery on the lower limb. The third section contains qualitative research, conducted on the parents. The aim was to use polling to determine success of the operation and postoperative care. The aim: To determine what aspects affect the outcome of orthopedic surgery in cerebral palsy and what rehabilitation has a key role to the success of the operation. Method: Was a case study of a...

Cerebral palsy is the most common motor disability in childhood. The disorders of movement and posture are characterised by abnormal patterns of movement related to defective movement coordination and regulation of muscle tone. Secondary problems that may develop include perceptions of fatigue and pain. Difficulties with body function and structure affect the levels of activity and participation of the person, such as functional independence, walking ability and participation in leisure activities. These multiple facets of functioning contribute to the known physical inactivity problem apparent in youth with cerebral palsy. In addition, these low physical activity levels contribute to further deterioration of functioning. Hence, a vicious cycle of deconditioning exists. A community-based swimming programme was proposed to combat this vicious cycle. A systematic review on the effect of an aquatic intervention on the multiple facets of functioning of youth with cerebral palsy revealed no studies that measured the effect on pain, coordination and quality of life. Moreover, none of the authors reported the perceived enjoyment of the participants during the intervention. Furthermore, there was a lack of controlled studies reporting the effect of a swimming intervention on walking ability, fatigue, functional independence, self-perception, participation in leisure activities and aquatic skills in ambulatory youth with cerebral palsy. Consequently, the aim of this thesis was to investigate the effect of swimming on these multiple facets of functioning that are associated with the low physical activity levels, in youth with cerebral palsy. A randomised controlled cross-over design was implemented to investigate the effect of a 10-week swimming intervention on pain intensity, fatigue, walking ability, bilateral and upper limb coordination, functional independence, perceived competence, global self-worth, quality of life and swimming skills. A pre-test – post-test design was used to assess the effect of taking part in a swimming programme on participation in leisure activities. Fourteen 7 to 17 year-old youth with cerebral palsy with the ability to walk with or without walking aids completed the tests on all measurement occasions. All youth had a high adherence towards the programme, participated in the intervention with high levels of enjoyment, and most youth continued to participate in swimming after completing the programme. Moreover, no adverse events due to the programme were reported and no participants withdrew from the intervention. Swimming skills improved significantly over the 10-week swimming programme, and improved significantly more than over the control period. The changes were retained throughout a 20-week follow-up period. Positive trends of improvement were evident for walking distance at maximum walking speed, upper limb coordination, functional independence in social functioning and mobility, and perceived motor competence. The intervention was not associated with increases of pain and fatigue. Participation in the swimming programme did not affect bilateral coordination, functional independence in self-care, self-perception and quality of life. The evidence of the pre-test – post-test study suggests that learning the skill of swimming encouraged participation in activities of the formal domain, active-physical and skill-based activities, and facilitated youth to engage in aquatic activities. No control data were obtained in the pre-test – post-test study; however, the results are promising in view of the known deterioration in participation with increasing age. Additionally, the present study showed that the perceptions of youth with cerebral palsy that learning a new skill is too time consuming, and that physical activity is not fun and carries a risk of injury, pain and fatigue, were eliminated in the swimming program. The consolidation of swimming skills and high levels of enjoyment during the programme, are expected to improve participation, engagement and adherence to physical activity, which was confirmed in the present study as youth participated more in aquatic activities after one year than before the start of the study. It was concluded that swimming is an enjoyable and safe community-based physical activity that may have a positive effect on the physical, social and emotional well-being in 7 to 17 year-old youth with cerebral palsy with the ability to walk. The elimination of some of the barriers confronted by youth with cerebral palsy to engaging in physical activity is important with regard to the sustainment of a physically active lifestyle. The findings suggest that participation in swimming may aid in breaking the cycle of deconditioning.

The stiff-knee gait pattern of children diagnosed with cerebral palsy (CP) is assumed to be caused by spasticity of the quadriceps which interferes with knee flexion normally occurring during the swing phase of walking. In current clinical practice, the ability to assess quadriceps spasticity is limited by the lack of an objective and reliable test that discriminates the role spasticity plays in functional limitations. The primary purpose of this series of studies was to assess the pendulum test as an objective measure of quadriceps spasticity. The first study assessed the reliability of the pendulum test. Moderate to very high between day reliability for all thirteen measures of the pendulum test were found. The second study assessed the discriminant ability of the pendulum test to correctly identify a stiff-knee gait pattern. Because most clinicians do not have access to a three dimensional motion analysis system, the third study assessed the reliability and accuracy of visual observation of the pendulum test. Sixty-eight children with a primary diagnosis of cerebral palsy participated. A three-dimensional motion analysis system was used to measure the subjects knee motion while walking, and performing the pendulum test. Spasticity of the quadriceps was also assessed using traditional clinical measures i.e., the modified Ashworth scale (MAS), and the Ely tests. Forty-seven percent of the variance in the stiff-knee gait pattern was explained by a regression model using the pendulum test and traditional clinical measures. The only significant measure in the regression model was the magnitude of knee motion occurring during the first swing of the pendulum test (A1). Discriminant analysis revealed the A1 measure correctly classified 77% of the subjects knee-gait pattern. Four observers demonstrated moderate accuracy and repeatability in estimating A1 value. The visual assessment of A1 correctly classified 72-76% of the subjects knee-gait pattern with no prior knowledge of the subjects gait. This series of studies demonstrated the pendulum test is an objective, repeatable measure of quadriceps spasticity. A negative pendulum test (indicated by an A1 value greater than 45 degrees) is more useful for ruling out a stiff-knee gait pattern compared to the traditional clinical measures.

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Thesis (M.Sc.(Occupational Therapy))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Hand function deficits are associated with Cerebral Palsy (CP), and lead to diminished participation in activities of daily living (ADL’s), play and school. A longitudinal experiment incorporating a pre-test-post-test design was used with a convenience sample of 28 children with spastic quadriplegic CP randomly assigned to two groups. Both groups received monthly occupational therapy and a home programme over the three month period, the intervention group received an additional neoprene thumb abductor splint. The Quality of Upper Extremity Skills Test (QUEST) was administered at baseline and again at 3 months to assess changes in underlying impairments contributing to hand function. There were no statistically significant differences between final scores in the control and intervention groups, but a clinically significant improvement in score with the splint on for the intervention group was found. Wearing the splint during functional tasks may be beneficial in improving underlying impairments.