Page 129 - ASOP ROT Study Guide

a reasonable size. Many children manage to walk aided by splints and hand-held aids until then. As they
reach adolescence many go into a wheelchair as they fmd this easier for themselves socially. The care
of such children and adults is the responsibility of a team of specialists in which the doctor's
contribution is minor. The care team must support the family as a whole.

8 . 3 . 2 Cerebral palsy

Cerebral palsy is a condition caused by an abnormality of the brain. This is often caused by damage to
the brain at birth and results in delayed, or arrested development of the nervous and musculoskeletal
systems. The spinal tissue develops normally and such children have uninhibited spinal reflexes but
lack the co-ordination and purpose of movement normally controlled by the brain. This results in a
spastic type of paralysis. Some muscles contract strongly in an uncoordinated way (spastic) whilst
others are very weak and flaccid. This imbalance leads to abnormal muscle and bone growth, with
secondary deformities of joints.

Some patterns of this condition are common. When one arm and the leg on the same side are
affected this is called hemiparesis. Two legs are often affected (paraparesis), and sometimes all limbs
are affected (quadraparesis). Most, but not all, spastic children are mentally retarded and some are
blind and/or deaf. Occasionally affected children do not suffer mental and sensory impairment and
tragically this may go unrecognised, to the utter frustration of the individual.

It is important to recognize that some people have very minor degrees of spasticity which may only affect
one muscle group. A common sign is toe-walking in adolescence. Examination reveals a calf muscle
spasticity and some sufferers may need tendo-achilles lengthening before growth ceases.

Orthopaedic problems for children with this condition during growth and development are similar to
those with spina bifida but often much more severe. Deformities can be minimized by careful
physiotherapy. Splintage should only be used with caution as overzealous splintage can lead to
increased muscle spasm and, ultimately, deformity. Careful use of surgery, to either lengthen tight
muscles or to denervate them or (occasionally) to move them, may maintain acceptable posture and help
maintain some function.

Again there is a need to recognize the need to be part of a much wider supportive team who will provide
regular day to day contact.

8 . 4 Scoliosis

Curvature of the spine with a rotatory abnormality of the vertebrae is known as scoliosis. It is a
three dimensional deformity based on an abnormal lordosis of the spine which leads to buckling and
twisting of the vertebral column as a result of the action of muscles and gravity.

Etiology
It may be caused by congenital abnormalities of the vertebrae or by neuromuscular imbalance but most
cases have no known causes (i.e. they are idiopathic).

Most cases of idiopathic scoliosis occur in adolescence although it may occur in infants and, rarely,
in adults. It is far commoner in girls than boys. Its principal effects are cosmetic (poor appearance
due to spinal contracture), but this must not to be underrated as a cause of distress. It rarely causes
physiological disturbances.

Clinical presentation
The child usually complains of the twisting of the ribs which causes a hump on one side of the
shoulder. Girls may also complain that their skirts hang crookedly. It may be painful although this is
usually secondary to the anxiety and distress caused by what is commonly known as a sinister condition.