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Media Inquiries: 434-924-5679 NEW RESEARCH CASTS DOUBTS ON BENEFITS OF COMMON TREATMENTS IN PATIENTS WITH SPASTIC CEREBRAL PALSY |
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Joint motion and muscle tone measurements help doctors determine appropriate treatments for patients with spastic cerebral palsy (CP). And while surgery and drugs have long been the standard treatments to improve joint and muscular function a new study suggests targeting treatments based upon these physical examination measurements may not be as helpful as once thought. The pre-treatment study, conducted by pediatric orthopedic surgeon Dr. Mark Abel of the University of Virginia Health System and colleagues at 6 other institutions, examined 155 patients with CP over a ten-month period to determine whether the amount of deformity documented at one or more joints affected functional performance. The study, published in the current issue of the Journal of Pediatric Orthopaedics, found that the relationships between joint contractures (restricted motion) were only weakly related to functional performance. The study suggests that using an intervention such as surgery or drugs to treat the contracture would result in only limited improvement in functional performance. Future pre-post operative studies are necessary to confirm this prediction, Abel said. “Based on this research, I think many of the movement characteristics exhibited at the joint level really reflect the way the brain is compensating for the brain injury. Postural abnormalities per se may not be necessarily deleterious to the performance of the subject,” Abel said. “We have to be very careful in making the assumption that changing the motion of a joint by lengthening a tendon or cutting the nerve will result in functional gains in this population.” According to Abel, physicians have held the general belief that improving impairments towards “normal”, either surgically, by cutting the root of the nerve that controls muscle tone or by lengthening the muscle-tendon unit, or medicinally, using botox or valium, would produce posture and ambulatory benefits in patients with CP. However, Abel said that when you look at a specific joint deformity, such as ankle stiffness, you can see the effects on surrounding joints. “There are definitely compensations in the knee and the hip and you have to be very careful that you don’t assume the knee and hip are pathologic, but rather that they are just adjusting to optimize function with the foot and ankle deformity,” Abel said. Surgical and medicinal treatments have tradeoffs in that the techniques have a tendency to irrevocably weaken the muscle, he said. Because of this Abel believes there should be a threshold level of deformity reached before a major intervention should be undertaken to change it. “I now approach these subjects in a very different way and look not to how to make them normal, but rather to try and get a better appreciation of how the severity of their deformity influences their function,” Abel said. “Mild deformities that you change will not have major impacts on these subjects because the underlying problem is at the level of the brain.” According to Abel, the study doesn’t provide a great deal of insights as to the best treatment, but it does point out the importance of relying more on functional performance measures rather than characteristic measurements of motion or tone of one joint that physicians have typically relied on when assessing patients. Cerebral Palsy is a group of disorders characterized by loss of movement or loss of other nerve functions, which is caused by injuries to the brain during fetal development or near the time of birth. It affects 500,000 people in the U.S.; and one in 1000 infants is born with CP, of which, 50 percent have spastic CP. CP occurs more often in children who are born prematurely, or as a result of illness (encephalitis, meningitis, herpes simplex infections). Also, children who suffer head injuries that result in bleeding around the brain and blood vessels are more likely to suffer from CP. July 29, 2003 |