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CEREBRAL PALSY

PARALYSIE CÉRÉBRALE
Objectives / Objectifs
① Definition / Définition
② Possible Pathologies / Pathologies Possible
③ Clinical Picture / Image Clinique
④ Classification / Classification
⑤ Examination / Examen
⑥ Evaluation / Evaluation
⑦ PT Interventions / Intervention de kinésitherapie
⑧ Counseling Parents of Children with Cerebral Palsy
les conseils pour les parents d’enfant atteint de
cerebral palsy
① Definition / Définition
 An interruption of voluntary control
Une interruption du contrôle volontaire
 Attributed to non-progressive disturbances in the developing fetal or
infant brain / Attribuée à des troubles non progressifs dans le cerveau
du fœtus ou de l'enfant en développement

 Most common cause of physical disabilities for children


La cause la plus commune des déficiences physiques chez
les enfants
 Group of permanent disorders causing activity limitations
Groupe de troubles permanents causant des limitations
dans les activités
② Possible Pathologies
Pathologies possibles
• Infection – maternal or infant
Infection - maternelle ou infantile
• Toxins – teratogens / Toxines - tératogènes
• Trauma – placental abruption, shaken baby syndrome
Traumatisme - décollement placentaire, syndrome du
bébé secoué
• Anoxia - hypoxia / anoxie - hypoxie
• CNS Malformations* / Anomalies congénitales du
Système Nerveux central (SNC) *
• Intraventricular Hemorrhage*
Hémorragie intraventriculaire *
② Possible Pathologies / Pathologies possibles

 CNS Malformations* / Malformation du SNC*


• Genetic or developmental
Génétique ou de développement
• Cystic lesions may affect white matter of
cerebral corticospinal tract resulting in spasticity
Kystes pouvant affecter la substance blanche
du faisceau cortico-spinal cérébral provoquant
de la spasticité
• Hemorrhagic or anoxic lesions possible
Possibilité de lésions hémorragiques ou anoxiques
• Drug ingestion / La drogue
• Radiation / Radiation
• Viruses / Virus
② Possible Pathologies / Pathologies possibles

 Intraventricular Hemorrhage*
Hémorragie intraventriculaire*
• Primarily grade III and IV
Principalement du grade III et IV
• Hemorrhage into lateral ventricle is most common
blocks the CSF hydrocephalus
L’hémorragie dans le ventricule latéral est la plus
courante  bloque le fluide corticospinale 
l'hydrocéphalie
• Anoxia/hypoxia encephalopathy
in gray and white matter
Anoxie / hypoxie encéphalopathie
dans la matière grise et blanche
Risk Factors / Facteurs à risque
• Premature birth / Naissance prématurée
• Low birth weight / Poids du corps très bas
• 500-1500g / 500-1500g

• Placental insufficiency / Placenta insuffisant


• Fetal malnutrition / Malnutrition du foetus
• Hyperbilirubinemia / Hyperbilirubinémie
• Multiple births (i.e. twins, etc.)
Gestation multiple, p. ex. des jumeaux
• Mother’s age at first birth
Age de la mère au premier accouchement
③ Clinical Picture / Image Clinique
• Visual / Visuelle
• Cognitive / Cognitive
• Hearing / Auditive
• Speech / La parole
• Seizures / Convulsions
• Sensory / Sensoriel
• Behavioral / Comportement
• Respiratory / Respiratoire
• Orthopedic / Orthopédique
• Hydrocephalus / Hydrocéphalie
• Bowel and bladder conditions
Etat physiologique des intestins et de la vessie
③ Clinical Picture / Image Clinique

 Visual / Visuelle
• Nystagmus / Nystagmus
• Strabismus / Strabisme
• Hemianopsia / Hémianopsie

Cognitive / Cognitive
• Learning disability / Trouble d'apprentissage
• Mental retardation / Retard mental

 Hearing / Auditive
• Central processing impairment
Trouble auditif central de traitement
• Deafness / Surdité
③ Clinical Picture / Image Clinique
 Speech / La parole
• Suck and swallow reflex / Réflexe de succion et de déglutition
• Difficulty finding words / Difficulté à trouver ses mots
• Non-verbal / Non verbal
 Seizures / Convulsions
 Sensory: / Sensoriel:
• Tactile impairment / Déficience tactile
• Stereognosis and/or proprioception, unilateral or bilateral
Stéréognosie et / ou la proprioception, unilatérale ou bilatérale
 Behavioral / Comportement
• Dependency / Dépendant
• Hyperactive / Hyperactif
• Anxious / Anxieux
③ Clinical Picture / Image Clinique

 Respiratory / Respiratoire
• Possible chronic lung disease
Possibilité d’une maladie pulmonaire chronique
 Orthopedic / Orthopédique
• Growth abnormalities / Croissance anormale antéversion
• Rate, muscle atrophy, femoral anteversion, fémorale
femoral/tibial torsion
Vitesse de croissance, atrophie musculaire,
antéversion fémorale, torsion fémorale / tibiale
 Hydrocephalus / Hydrocéphalie
• Common with hemorrhage / Associé à une hémorragie
 Bowel and bladder conditions
Etat physiologique des intestins et de la vessie
④ Classification / Classification
• Area of body involved
Zones du corps impliquées

• Muscle Tone
Tonus musculaire

• Level of Severity
Niveau de gravité
④ Area of Body / Zones du corps impliquées
 Diplegia / Diplégie
• Both lower extremities
Les deux extrémités inférieures
 Hemiplegia / Hémiplégie
• One side of the body, upper and lower
Un côté du corps, supérieure et inférieure
 Triplegia / Triplégie
• 3 limbs impaired / Facultés affaiblies des 3 membres
 Quadriplegia / Quadriplégie
• All four limbs impaired /
Facultés affaiblies des 4 membres
④ Muscle Tone / Tonus musculaire
 Hypotonia – excessively relaxed muscle
Hypotonie - muscle excessivement détendue

 Spastic – stiffness and increased tone


Spastique - rigidité et une augmentation du tonus

 Dyskinesia – difficulty with voluntary movements


Dyskinésie - la difficulté pour les mouvements volontaires
• Athetoid: continuous writhing movements at rest
Athétosique: mouvements de contorsions continues au repos
• Dystonia: fluctuating or intermittent tension
Dystonie: des tensions fluctuantes ou intermittentes

 Ataxia – uncoordinated and instability of movements


Ataxie - manque de coordination et de l'instabilité des mouvements
Ataxia – uncoordinated and instability of movements
Ataxie - manque de coordination et de l'instabilité des mouvements
④ Severity / Niveau de Gravité
 Mild / Faible
• Minimal physical impairments / Déficiences physiques minimes
• Visual disturbances / Troubles visuels
• Single system involved / Implication d’un seul système

 Moderate / Moyenne
• Tonal involvement and weakness
Implication sur la tonicité, Faiblesse
• Difficulty with walking / Difficulté pour marcher
• Mental retardation / Retard mental

 Severe / Sévère
• Multiple systems / Implication de plusieurs systèmes
• Non-ambulatory / Pas de capacité ambulatoire
• Severe tone / Une tonicité importante/ sévère
⑤ Examination / Examen
• History / Historique
• Systems Review / Examen des systèmes
• Tests and Measures / Tests et mesures
• Neuromuscular / Neuromusculaire
• Musculoskeletal / Appareil locomoteur
• Posture / Position
• Sensory / Sensoriel
• Cardiopulmonary / Cardio-pulmonaire
• Cognitive/social/emotional
Cognitive / sociale / émotionnelle
• Locomotion / Locomotion
• Assistive device / Dispositif/Appareils d'assistance
⑤ Examination – Tests and Measures
Examen – Tests et Mesures

 Neuromuscular System / Système neuro-musculaire


• Level of motor development: gross motor testing
Niveau du développement moteur : Test de mobilité de grands
mouvements

• Spasticity: hyper or hypo / La spasticité: hyper ou hypo


• Modified Ashworth Scale: 0-4, higher = increased tone
Echelle Ashworth Modifiée : 0-4, supérieur = augmentation du tonus

• Strength / Force

• Reflexes / Réflexes
⑤ Examination – Tests and Measures
Examen – Tests et Mesures

 Neuromuscular System / Système neuro-musculaire


• Level of motor development: gross motor testing
Niveau du développement moteur : Test de mobilité de grands
mouvements

• Spasticity: hyper or hypo / La spasticité: hyper ou hypo


• Modified Ashworth Scale: 0-4, higher = increased tone
Echelle Ashworth Modifiée : 0-4, supérieur = augmentation du tonus

• Strength / Force

• Reflexes / Réflexes
⑤ Examination – Tests and Measures
Examen – Tests et Mesures

 Neuromuscular System /
Système neuro-musculaire
• Selective motor control / Control moteur sélectif

• Decreased ability to learn new skills


Diminution de la capacité à apprendre de nouvelles compétenc
• Motor Planning / Planification motrice

• Balance, equilibrium and righting reactions


Balance, équilibre et modification des réactions
⑤ Examination – Tests and Measures
Examen – Tests et Mesures

 Musculoskeletal / Système loco-moteur


• Joint Integrity: hyper or hypomobile
Intégrité des joints: hyper ou hypomobile

• Range of motion: two-joint muscles


Amplitude de mouvement:
les muscles qui relient 2 articulations

• Muscle performance: extensibility


La performance musculaire: l’extensibilité
⑤ Examination – Tests and Measures
Examen – Tests et Mesures
 Musculoskeletal / Système loco-moteur
• Foot position: pes valgus, PF contracture
Position du pied : pes valgus (pied en pronation),
Contracture des muscles qui font la flexion plantaire

• Knee: flexion contracture, tibial/fibular torsion


Genou: contracture des muscles qui plient le genou (flexion), torsion
tibial/péroné

• Hip: flexion contractures, anteversion, coxa valga, shallow


hip socket, subluxation/dislocation
Hanche: Contractures des muscles qui plient la hanche (flexion),
antéversion, coxa valga, surface semi-lunaire de l’acetabulum (qui
accueille la tète du fémur) peu profonde, subluxations/luxations
May result
rib hump vertebra from unequal Ma
⑤ Examination – Tests and Measures paralysis of from
May result bac
rib back muscles
Examen – Tests et MesuresMay result or from from weak or f
from unequal May result a hip tilt stomach pos
p aralysis of from weak dueMayto result
one muscles, (be
back muscles back muscles from unequal from hip
shorter leg. Ma
pos
 Posture / Posture or from or from poor paralysis
Sometimes of contractures,
fro
Look along
a hip tilt The rib humpposture
is formed or from the wh
theback
causemuscles
is ba
way a child stan
• Scoliosis, lordosis,the linedue
of to one
kyphosis, cervical, shoulder
because where the
(bent over swayback
or from
not known. orors
the backshorter
with leg. spine is curved, the
position walks to
Scoliose, lordose, the
cyphose,
child cou/les
Sometimes cervicales,
vertebrae are l’épaule due to one
when
also
a hip tilt
make up for
po
the cause is
bent over. twisted to onestanding
side. a weak leg (be
not known.
shorter leg. po
or sitting). or hip.
Sometimes wh
the cause is sta
 Sensory System / Systême sensiorelle not known. or
CHECK FOR:
• Diminished/abnormal sensory info, increased sensitivity When you exam
one To see the
Informations
shoulder
sensorielle diminuée
curve better,
ou anormale, une sensibilité accrue
scoliosis, also c
see if the curve
lower mark the overhead
than the tip of each view of can be
 Cardiopulmonary System / Système Cardio-pulmonaire
other vertebra. vertebrae straightened
• Chest mobility/expansion, The actual (non-fixed),
hip increased energy
spinal curve
expenditure,
tilt decreased lung volume,
is greater
than the For example, A non
endurance & aerobic capacitycurve you a child with can us
La mobilité de la poitrine/expansion,
Forhave marked. augmentation
example, actualA curve
non-fixed
(as curve a shorter leg straigh
a child with seen canX-rays)
in usually be from
tips polio will puttin
des dépenses d'énergie, diminution du
a shorter leg volume straightened by stand with his under
du poumon, de l'endurance et
from polio la
willcapacitéputting
stand with his
aérobic
blocks
under the foot
Fortilted.
hips example,
For A by
or non
canchu
a child
him to standwith the
hips tilted. For or by holding a shorter leg straig
under
⑤ Examination – Tests and Measures
Examen – Tests et Mesures
 Cognitive / social / emotional
Cognitive / sociale / émotionnelle

 Assistive device / Dispositif/Appareils d'assistance

strong
ng Licoweak
Lico has has weak Anna hasAnna
weak has weak
odgood elbowselbows and poor
and poor legs and poor
legs and poor
.trol. balance or body
balance or body balance. balance.
She She
se control. He needs
control. He needs does bestdoes
with best with
low a higher walkerwalker
a higher underarmunderarm
with armrests. crutches built
with armrests. crutches built
into the
walker.
into the
walker.
⑤ Examination – Tests and Measures
Examen – Tests et Mesures
 Locomotion / Gait Analysis / Locomotion / Analyse de la marche
• Bony deformity / Déformation des os
• Internal femoral torsion / Torsion fémorale interne
• External tibial torsion / Torsion tibiale externe
• Pes valgus of the foot/ankle / Pied/cheville en valgus (en pronation)
• Inadequate ROM; Spasticity
Amplitude du mouvement inadéquat et de la spasticité
• PF and knee extension / Flexion plantaire et extension du genou
• Limited swing / balancement limité
• Weakness / Faiblesse
• Hip abductor / Abducteur de la hanche
• Gastroc-soleus / Gastrocnemius-soléaire
• Crouched posture / Posture arrondie
• Scissor Gait / une démarche cisaillante
où les membres inférieurs en varus équin viennent
alternativement se poser devant le pied controlatéral
⑥ Evaluation / Evaluation
• Diagnosis / Diagnostique
• Subjective history / Historique subjective

• Constellation of signs and symptoms


Constellation/sommaire des signes et symptômes

• Exclusion of other abnormalities


Exclusion d’autres anormalies
⑥ Evaluation / Evaluation
• Diagnosis / Diagnostique
• GMFCS: Gross Motor Function Classification
System
Système de classification des fonctions motoriques globals
(des grands mouvements)
• Level I – V: mild to severe / Niveau I-V: faible à sévère
⑥ Evaluation / Evaluation
• Prognosis / Pronostique
• Depends on multiple factors
En fonction de multiples facteurs
• Severity of condition
Gravité de l'état
• Early healthcare treatments and interventions
Traitements et interventions médicales précoces
• Assistive device, equipment, and therapy accessibility
Support technique/appareils, accès aux
équipements et aux thérapies
⑦ Interventions and Management
Interventions et Gestion
• Age Dependent / Dépendant de l’âge
• Goals: / Objectifs:
• Facilitate function and new skills
Faciliter la fonction et les nouvelles compétences
Prevent and treat complications
Prévenir et traiter les complications
• Provide typical developmental experiences
Offrir des expériences de développement typiques
• Multidisciplinary teams
Equipes multidisciplinaires
⑦ PT Interventions
Intervention des Kinesithérapeutes
• General guidelines / Règles générales
• Infant: handling skills and positioning
Bébé : Apprendre comment bouger l’enfant et le positionner
correctement
• Children/young adults: / Enfants/jeunes adultes
• Mobility and playtime / Mobilité et périodes de jeux
• Musculoskeletal disorders / Trouble du système locomoteur
• Toilet training & ADLs / Education de continence & activités journaliers
• Social and community tasks / Tâches sociales et communautaires
• Adult-life skills / Habilités dans la vie d’adulte
• Adults: increasing secondary conditions, maintaining
independence, managing staff who provide physical assistance
Adultes: augmentation de conditions secondaires, maintenir
l'indépendance, la gestion du personnel, qui apporte de l’aide
Infant: handling skills and positioning
Bébé : Apprendre comment bouger l’enfant et le
positionner correctement
⑦ PT Interventions
Intervention des Kinesithérapeutes
• General guidelines / Règles générales
• Infant: handling skills and positioning
Bébé : Apprendre comment bouger l’enfant et le positionner
correctement
• Children/young adults: / Enfants/jeunes adultes
• Mobility and playtime / Mobilité et périodes de jeux
• Musculoskeletal disorders / Trouble du système locomoteur
• Toilet training & ADLs / Education de continence & activités journaliers
• Social and community tasks / Tâches sociales et communautaires
• Adult-life skills / Habilités dans la vie d’adulte
• Adults: increasing secondary conditions, maintaining
independence, managing staff who provide physical assistance
Adultes: augmentation de conditions secondaires, maintenir
l'indépendance, la gestion du personnel, qui apporte de l’aide
Mobility and playtime / Mobilité et périodes de jeux
DO NOT / Ne faites pas DO / Faites
⑦ PT Interventions
Intervention des Kinesithérapeutes
• General guidelines / Règles générales
• Infant: handling skills and positioning
Bébé : Apprendre comment bouger l’enfant et le positionner
correctement
• Children/young adults: / Enfants/jeunes adultes
• Mobility and playtime / Mobilité et périodes de jeux
• Musculoskeletal disorders / Trouble du système locomoteur
• Toilet training & ADLs / Education de continence & activités journaliers
• Social and community tasks / Tâches sociales et communautaires
• Adult-life skills / Habilités dans la vie d’adulte
• Adults: increasing secondary conditions, maintaining
independence, managing staff who provide physical assistance
Adultes: augmentation de conditions secondaires, maintenir
l'indépendance, la gestion du personnel, qui apporte de l’aide
EXERCISE
SHEET
1

calf
mu scles

tight
he el
cord

With one hand hold Use your arm to hold


up the knee so the foot in position
that it does not like this. Gently
bend bac kward. lift but do not force
the foot upw ard.

Push up on
the foot.

While you push up on the


foot, keep pressing hard
on the arch of the foot like
Hold the foot like this. this. (This helps prevent a
Turn heel inward a little. dislocation of the foot—a
Then pull the heel do wn hard. common complication of
stretching exercises.)

WARNING: Pushing here Pushing like this can hurt


can injure the knee or disloc ate the foot instead
or cause it to bend of stretc hing the cord—
backward—especially especially if the foot is
if the upper leg is paralyzed or very weak.
weak. WRO NG W RO NG
EXERCISE
SHEET
2

tight cord

short muscle

Push down the


thigh with
one hand here.

With your arm,


support the leg
and bend the
foot forward.

Use pressure here just below


the knee to raise the leg.

LIKE TH IS N O T LIKE TH IS

dislocation

BE CAREFUL. Never try to straighten


the leg by pulling the foot. Instead of
stretching the cord, this could dislocate
the knee or break the leg. The danger is
When you get the knee as straight as you can with the especially great when the leg is very weak
hip extended, gradually lift the leg higher, keeping the or when the child cannot w alk.
knee straight.
EXERCISE
SHEET
3

tight cord

Rest the
Push down on the butt. (If the
thigh
hip dislocates easily, hold in
against your
the hipbone as you push down.)
thigh, and
support the
leg with
your arm.

With firm and


steady force,
pull the leg
up while
counting
slowly to 25.

Hold the other leg


bent to keep the
hips from lifting.
⑦ PT Interventions
Intervention des Kinesithérapeutes

• Specific Guidelines / Règles spécifiques


• Dynamic ‘Active Movement’ Interventions
Intervention dynamique des mouvements actifs
• NDT / NDT (thérapie de développent neurologique)
• Sensory feedback with active movements
Feedback sensorielle avec des mouvements actifs
• Sensory Integration / Intégration sensorielle
• Tapping, brushing, deep pressure, joint traction/compression
Tapotement, brossage, pression profonde,
traction ou compression des articulations
• Manual Therapy / Thérapie manuelle
• Strength Training / Entrainement pour augmenter la force musculaire
• Dynamic ‘Active Movement’ Interventions
Intervention dynamique des mouvements actifs

• NDT / NDT (thérapie de développent neurologique)


Sensory feedback with active movements
Feedback sensorielle avec des mouvements actifs
⑦ PT Interventions
Intervention des Kinesithérapeutes
• Specific Guidelines / Règles spécifiques
• Dynamic ‘Active Movement’ Interventions
Intervention dynamique des mouvements actifs
• NDT / NDT (thérapie de développent neurologique)
• Sensory feedback with active movements
Feedback sensorielle avec des mouvements actifs
• Sensory Integration / Intégration sensorielle
• Tapping, brushing, deep pressure, joint traction/compression
Tapotement, brossage, pression profonde,
traction ou compression des articulations

• Manual Therapy / Thérapie manuelle

• Strength Training / Entrainement pour augmenter la force musculaire


• Joint compression / compression des articulations
⑦ PT Interventions
Intervention des Kinesithérapeutes
• Specific Guidelines / Règles spécifiques
• Mobility / Mobilité
• Transitional movements first,
then walking skills with/without ambulatory aids
Mouvements transitoires, puis la marche avec / sans aides ambulatoires
• Floor, gait / exercises au sol, la marche
• Functional Training / Entrainement fonctionnel
• Self care and home management
Gestion des soins de soi et du domicile
• Prescription / Prescription
• Designing and applying devices & equipment
Conception et application des appareils et équipements
Mobility / Mobilité
Transitional movements first, then walking skills with/without ambulatory aids
Mouvements transitoires, puis la marche avec / sans aides ambulatoires
a game. at the
shoulders.
Move her
gently from
DO NOT / Ne faites pas
side to side, CP
so that she
learns to The legs stiffen
shift her and the feet

ideways
go into a rigid
weight from
one leg to It is better to h tiptoe position.

This child is not


almost ready to walk.
the other.
A CO MMO N MISTAKE

LIKE TH IS
When a child with severe brain damage is held
like this, her legs may automatically stiffen
and her feet point down—the so-called ‘tiptoe
reflex’. Because the feet sometimes take jerky
N
‘steps’, parents think the child is ‘almost ready
to walk’. This is not so. The tiptoe reflex must be

DO / Faites
overcome before the child can begin to learn to
To encourage a child to pull up to When a child can almost walk alone
walk. Do not hold the child in this position or

standing, put a toy he likes on the His balance


but is afraid of falling,
make her try to walk. It will only strengthen this
disabling reaction. (See p. 291.)

edge of a table. tie a cloth around H


to his chest. is centered
In a Mexican village, we kno w 2 brothers, both with cerebr al palsy.
i
g cloth, but in his body.
(Not only does
Petronio walks Hold the
His brother, Luis,
the donkey take
but with great cannot walk. But
difficulty. since he was small, Luis where he
Walking tires he has loved to wants to go, but
him and makes
let it hang
ride a donkey. by keeping his
him feel so completely
He uses a wall to legs apart, it helps
prevent knock-
⑦ PT Interventions Velcro
(or buckle)

Intervention des Kinesithérapeutes


• Specific Guidelines / Règles spécifiques
Fil space
• Mobility / Mobilité between
A child who has difficulty containers Sometimes you can help the child
• Transitional movements first, then walking skillswithwith/without
controlling her hand for eating fine avoid twisting to one side by
may gain better control by sand, plaster, bending the less-usedtin
ambulatory aids
resting her elbo w on the table.
arm across
or cement. the belly, and turning the palm up.
Mouvements transitoires, puis la marche avec / sansSealaides with wax or ambulatoires
waterproof glue.
• Floor, gait / exercises au sol, la marche
• Functional Training / Entrainement fonctionnel
• Self care Ifand home management
he sits with a tortil a
Gestion des
rounded soins
back, de soi et du domicile
it may help to Ask a local
• Prescription / Prescription
support the
rubber
potter to strip of tire
rubber
lower back. make
tube ball one. tube (wrapped)
• Designing and applying devices & equipment
Conception et application des appareils et équipements
piece of wood
From UPKARAN Manual.
(See p. 642.)

From UPKARAN Manual.


comb

Sometimes you can help the child


Self care and home management
avoid twisting to one side by
Gestion des soins de soi et du domicile
bending the less-used arm across
the belly, and turning the palm up.
CP
uc kles)

A child who has difficulty


controlling her hand for eating
Ask a
Sometimes local
you can help the chil
avoid twisting to one side by
loth
n the
easier
e.
may gain better control by
resting her elbo w on the table. potter to
bending the less-used arm across
the belly, and turning the palm u
g shoes

e too
make one.

If heon
Placing your hand Ask a local
sits with a
This keeps the
her lower backrounded
will back,
legs relaxed
help keep her hips potter to
it may help to
and gives her Ask a local
and legs bent. support the better control. potter to
lower back.make one. make one.
O r you can help keep
her knee bent with
your hand.
⑦ PT Interventions
Intervention des Kinesithérapeutes
• Specific Guidelines / Règles spécifiques
• Mobility / Mobilité
• Transitional movements first, then walking skills with/without
ambulatory aids STANDARD ADJUSTABLE
Mouvements transitoires, puis la marche avec / sans aides ambulatoires
metal band thick bamb
covered by
• Floor, gait / exercises au sol, la marche leather or
padding

• Functional Training / Entrainement fonctionnel bamboo


joint that
• Self care and home management allows
movement
Gestion des soins de soi et du domicile of elbow
band
bolt

• Prescription / Prescription adjustable


bamboo
• Designing and applying devices & equipment
thin
Conception et application des appareils et équipements steel or
aluminum
tube
• Designing and applying devices & equipment
Conception et application des appareils et équipements
• Designing and applying devices & equipment
Conception et application des appareils et équipements
• Designing and applying devices & equipment
Conception et application des appareils et équipements

weak Anna has weak


Anna has weak
nd poor
oor legs and poor
legs and poor
or
dy body balance. balance.
She She
He needs
eeds does bestdoes
with best with
walker
er underarmunderarm
rests. crutches crutches
built built
into the into the
walker.
walker.
Orthotic Management
Traiment utilisant des orthèses

 Serial casting / plâtres sériels


 Contracture management
Traitements classiques pour soigner une contracture
Orthotic Management
Traiment utilisant des orthèses

 AFO = Ankle Foot Orthosis / Orthèse cheville/pied


⑧ Counseling Parents of Children
with Cerebral Palsy
Conseils pour les parents d’un enfant atteint de paralysie cérébrale

• The condition is not reversible


La condition n’est pas réversible

• There will be lifelong challenges to mobility &


function
Il y aura toute leur vie des défis à propos de la mobilité
et des fonctions
⑧ Counseling Parents of Children
with Cerebral Palsy
Conseils pour les parents d’un enfant atteint de paralysie cérébrale

• Encourage the parents to involve the child in play, school,


& family activity
Encouragez les parents à associer l’enfant aux jeux et aux activités
scolaires et familiales

• Children with cerebral palsy can & do benefit from exercise,


mobility, & play just like children who do not have cerebral
palsy
Les enfants atteints de paralysie cérébrale savent bénéficier et
bénéficient des exercises, de la mobilité, des jeux tout comme les
enfants qui ne sont pas atteints de paralysie cérébrale
THANK YOU!
MERCI!
References / Références
Disabled Village Children
David Werner (1987, 2009)

Hesperian Health Guides


www.hesperian.org
Chapters 4, 5, 8, 9, 20, 29, 34, 35,
36, 37, 40, 42, 43, 58, 59, 62, 63
-------------------------------------------------------------------------------------------------------------------
L’Enfant Handicapé au Village
traduit par Handicap International

Disabled Village Children


(French Version, online PDF copy)
David Werner (1992)
Translated by Handicap International
Chapters 34, 42
References / Références
Matsuo T.Cerebral palsy: spasticity-control and orthopaedics. An introduction to
orthopaedic selective spasticity-control surgery (OSSCS). Soufusha, Tokyo;
2002.

Steele, K. M., van der Krogt, M. M., Schwartz, M. H., & Delp, S. L. (2012). How
much muscle strength is required to walk in a crouch gait? Journal of
Biomechanics, 45(15), 2564–2569.
http://doi.org/10.1016/j.jbiomech.2012.07.028

Gillick, B.; Bisson, T. Cerebral Palsy: From a PT’s Perspective. Course PT


6288, Summer 2015