Cerebral Palsy: a critical approach to theories and treatment plans
Main Article Content
Abstract
The treatment strategies are based on hypotheses about the aetiology of the pathology. These hypotheses remain unchanged, even if our treatment does not always bring the desired success. The cause of these less satisfactory results is often not investigated. New findings from modern literature can also go unnoticed for a long time. We should question our traditional concepts more often and be open to new and novel possibilities. As examples, we describe the treatment of hamstrings in squatting gait, femoral osteotomy in internal hip rotation during walking and the importance of spasticity. The problem of outdated working hypotheses also calls into question clinical evidence-based papers on outcome.
Keywords:
Cerebral Palsy, Treatment Strategies, Spasticity Management, Femoral Osteotomy, Gait Abnormalities, Clinical Hypotheses
Article Details
How to Cite
BRUNNER, Reinald; JÜNEMANN, Stephanie.
Cerebral Palsy: a critical approach to theories and treatment plans.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6112>. Date accessed: 17 mar. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6112.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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19. Brunner, R. and G.-N. K., A critical view on the importance of treating spasticity and new options to improve function in patients with cerebral palsy GMFCS I-III. Medical Research Archives, 2023. 11(4).
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24. Multani, I., et al., Botulinum Toxin in the Management of Children with Cerebral Palsy. Paediatr Drugs, 2019. 21(4): p. 261-281.
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26. Brandenburg, J.E., M.J. Fogarty, and G.C. Sieck, A Critical Evaluation of Current Concepts in Cerebral Palsy. Physiology (Bethesda), 2019. 34(3): p. 216-229.
27. Rosenbaum, P., Cerebral palsy: is the concept still viable? Dev Med Child Neurol, 2017. 59(6): p. 564.
28. Brunner, R. and W. Strobl, Sensory function in CP: an overview and considerations for consequences. Medical Research Archives, 2023. 11(12).
29. Alves-Pinto, A., M. Emch, and R. Lampe, Effects of Piano Training in Unilateral Cerebral Palsy Using Probabilistic and Deterministic Tractography: A Case Report. Front Hum Neurosci, 2021. 15: p. 622082.
30. Trivedi, R., et al., Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy. Neuroradiology, 2010. 52(8): p. 759-65.
31. Yoshida, S., et al., Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy. Dev Med Child Neurol, 2010. 52(10): p. 935-40.
2. Wolff, J., Die Lehre von der functionellen Knochengestalt. Archiv für pathologische Anatomie und Physiologie und für klinische Medicin, 1899. 155(2): p. 256-315.
3. Arnold, A.S., et al., The role of estimating muscle-tendon lengths and velocities of the hamstrings in the evaluation and treatment of crouch gait. Gait Posture, 2006. 23(3): p. 273-81.
4. Frigo, C., E.E. Pavan, and R. Brunner, A dynamic model of quadriceps and hamstrings function. Gait Posture, 2010. 31(1): p. 100-3.
5. Brunner, R., The Evolution of Knee Flexion during Gait in Patients with Cerebral Palsy, in Cerebral Palsy, F. Miller, et al., Editors. 2018, Springer International Publishing: Cham. p. 1-14.
6. Kay, R.M., et al., Comparison of proximal and distal rotational femoral osteotomy in children with cerebral palsy. J Pediatr Orthop, 2003. 23(2): p. 150-4.
7. Boyer, E.R., et al., Long-term functional outcomes after an external femoral derotation osteotomy in individuals with cerebral palsy. Gait Posture, 2021. 87: p. 184-191.
8. Dreher, T., et al., Long-term outcome of femoral derotation osteotomy in children with spastic diplegia. Gait Posture, 2012. 36(3): p. 467-70.
9. Ounpuu, S., et al., Long-term effects of femoral derotation osteotomies: an evaluation using three-dimensional gait analysis. J Pediatr Orthop, 2002. 22(2): p. 139-45.
10. Brunner, R. and J.U. Baumann, Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: an 11- to 18-year follow-up study. J Pediatr Orthop, 1997. 17(5): p. 585-91.
11. Brunner, R., et al., Effects of plantarflexion on pelvis and lower limb kinematics. Gait Posture, 2008. 28(1): p. 150-6.
12. Gaston, M.S., et al., Transverse plane rotation of the foot and transverse hip and pelvic kinematics in diplegic cerebral palsy. Gait Posture, 2011. 34(2): p. 218-21.
13. Brunner, R., W.R. Taylor, and R.M.S. Visscher, Restoration of Heel-Toe Gait Patterns for the Prevention of Asymmetrical Hip Internal Rotation in Patients with Unilateral Spastic Cerebral Palsy. Children (Basel), 2021. 8(9).
14. Steele, K.M., A. Rozumalski, and M.H. Schwartz, Muscle synergies and complexity of neuromuscular control during gait in cerebral palsy. Dev Med Child Neurol, 2015.
15. MacWilliams, B.A., et al., Causal factors affecting gross motor function in children diagnosed with cerebral palsy. PLoS One, 2022. 17(7): p. e0270121.
16. MacWilliams, B.A., et al., Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy. Dev Med Child Neurol, 2021.
17. Marsden, J., V. Stevenson, and L. Jarrett, Treatment of spasticity. Handb Clin Neurol, 2023. 196: p. 497-521.
18. Gourdine-Shaw, M.C., et al., Equinus deformity in the pediatric patient: causes, evaluation, and management. Clin Podiatr Med Surg, 2010. 27(1): p. 25-42.
19. Brunner, R. and G.-N. K., A critical view on the importance of treating spasticity and new options to improve function in patients with cerebral palsy GMFCS I-III. Medical Research Archives, 2023. 11(4).
20. Mathevon, L., et al., Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review. Ann Phys Rehabil Med, 2019. 62(4): p. 283-290.
21. Milne, N., M. Miao, and E. Beattie, The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. BMC Pediatr, 2020. 20(1): p. 324.
22. Mills, P.B., et al., Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity. Clin Rehabil, 2016. 30(6): p. 537-48.
23. Niklasch, M., et al., Superior functional outcome after femoral derotation osteotomy according to gait analysis in cerebral palsy. Gait Posture, 2015. 41(1): p. 52-6.
24. Multani, I., et al., Botulinum Toxin in the Management of Children with Cerebral Palsy. Paediatr Drugs, 2019. 21(4): p. 261-281.
25. Kim, H. and K. Kolaski, Is botulinum toxin type A more effective and safer than other treatments for the management of lower limb spasticity in children with cerebral palsy? A Cochrane Review summary with commentary. NeuroRehabilitation, 2021. 49(1): p. 161-164.
26. Brandenburg, J.E., M.J. Fogarty, and G.C. Sieck, A Critical Evaluation of Current Concepts in Cerebral Palsy. Physiology (Bethesda), 2019. 34(3): p. 216-229.
27. Rosenbaum, P., Cerebral palsy: is the concept still viable? Dev Med Child Neurol, 2017. 59(6): p. 564.
28. Brunner, R. and W. Strobl, Sensory function in CP: an overview and considerations for consequences. Medical Research Archives, 2023. 11(12).
29. Alves-Pinto, A., M. Emch, and R. Lampe, Effects of Piano Training in Unilateral Cerebral Palsy Using Probabilistic and Deterministic Tractography: A Case Report. Front Hum Neurosci, 2021. 15: p. 622082.
30. Trivedi, R., et al., Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy. Neuroradiology, 2010. 52(8): p. 759-65.
31. Yoshida, S., et al., Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy. Dev Med Child Neurol, 2010. 52(10): p. 935-40.