The upper limb in children with cerebral palsy. Evaluation and treatment

Orthop Traumatol Surg Res. 2024 Feb;110(1S):103763. doi: 10.1016/j.otsr.2023.103763. Epub 2023 Nov 20.

Abstract

Management of the upper limb in children with cerebral palsy is often complex and must be carried out by a team experienced in this field. Several clinical parameters must be taken into consideration, such as higher functions, visual problems, overall upper limb function, motor control, sensitivity, presence of hemineglect or synkinesis, limb position at rest and during walking. And last but not least, a complete analysis of the upper limb is required. It is only after this exhaustive assessment - which often includes occupational therapy, physiotherapy and in some cases, video and electromyography evaluations - that a treatment indication can be discussed with the patient's family. Other than baseline treatment consisting of rehabilitation, occupational therapy and bracing, botulinum toxin injections could be an option, targeting specific muscle groups. Surgical treatments, which are often indicated in severe forms with contractures, are proposed after the patient's case is presented at a multidisciplinary meeting. These include selective neurotomy, muscle-tendon release, transfer or lengthening, and procedures on bone and joints (osteotomy, arthrodesis). LEVEL OF EVIDENCE: Expert opinion.

Keywords: Arthrodesis; Cerebral palsy; Muscle-tendon lengthening; Neurotomy; Upper limb spasticity.

Publication types

  • Review

MeSH terms

  • Botulinum Toxins, Type A* / therapeutic use
  • Cerebral Palsy* / complications
  • Cerebral Palsy* / therapy
  • Child
  • Humans
  • Muscle Spasticity
  • Neuromuscular Agents* / therapeutic use
  • Upper Extremity

Substances

  • Botulinum Toxins, Type A
  • Neuromuscular Agents