Cerebral Palsy: Changes in Muscles

Amitesh Narayan

Skeletal Muscles_ Effects of Spasticity

Fewer muscle fibers, Shorter fiber length, and Longer tendon.

Muscle Strength in Cerebral Palsy

Muscles in children with CP are always very thin & short, means these muscles are also weak.

Understanding strength_ extremely confusing topic in spastic muscle evaluation.

Various stages of muscle work_ Histological Orientation

Length of Muscle Fiber

Muscle fiber length determines muscle excursion length and therefore active ROM of Joint E.G. If gastrocnemius usually produces 60 of active ankle joint ROM , and the muscle loses 50% of its fiber length, it can generate only 30of active ankle ROM.

When Stretching the Muscle

When the goal is to stretch the gastrocnemius, it is very important to realize that this cannot be done without also keeping the knee extended. This means nighttime ankle bracing Without bracing the knee into extension is worse than not bracing because it only stretches the soleus, which is usually not contracted, and allows the gastrocnemius to further contract because the child will sleep with severe knee flexion.

Spastic Muscle_ Principle of Tendon Lengthening

Spastic Muscle_ Force Generation

Equinous Contracture_ Mechanism of Muscles

Hamstring Effect on Knee Flexion

Role of Gluteus Maximus

Role of Hip Flexors

Role of Quadriceps

Crossing over of Knee

Gait Anomalies and COM Displacement

Dorsal Spinal Rhizotomy

4 Yrs Post Rhizotomy

BtX in Gastroc_soleus
Botulinum toxin is diluted with 1 to 2 ml saline and injected into the neuromotor junction-rich zone of the muscle to be blocked. This neuromotor-rich zone is usually in the proximal onethird and two-thirds junction area. The botulinum is injected in a fan-shaped pattern with an understanding that it diffuses over approximately 3 cm from the injection site. For the gastrocnemius, separate medial and lateral injections may be made

Beclofen Pump in Situ

Thank You!!!!