>Date: Sun, 20 Feb 2000 21:11:44 +0200
>To: "mdne adams" <[log in to unmask]>
>From: Harries <[log in to unmask]>
>Subject: Re: Re:problem patient
>In-Reply-To: <01bf7b14$c04d0a60$LocalHost@default>
>
>At 20:06 19/02/00 -0000, you wrote:
>>Hello
>>
>>I know this is a bit cheeky of me but......
>>
>>I'm interested in your reply to Owen, as I am currently trying to help a 17
>>year old young man who has cerebral palsy and has just had extensive
>>surgical correction ( out of plaster Dec 99) of the deformities you
>>describe. Orthopaedically, the result is brilliant - he can assume a nicely
>>alligned position in lying - however, neurologically he still tries to
>>recruit his faulty movement patterns as a way of gaining some stability, and
>>his gait is disappointing. He hyperextends his lumbar spine, flexes ,
>>laterally rotates and adducts his hips, is unable to achieve full knee
>>extension in standing, and his ankles remain overly dorsiflexed.
>>
>>So far, I have been helping him to concentrate on his trunk and pelvic
>>control, with lots of posture correction and tilting in sitting, which he
>>can do quite well when he thinks about it. I have also been with him to a
>>sports centre, and advised him which upper limb weight training equipment he
>>can use (with the aim of further increasing his trunk control, rather than
>>upper limb strength). He's keen, and is doing well with this. His standing
>>is slowly improving. I feel sure we're on the right lines but as this is the
>>first person I've seen as recently post-operatively as this I'd be really
>>grateful for any other suggestions you might have. Most of my other CP
>>patients are much older and have not had this type of surgery. I work in a
>>multidisciplinary community physical disability team for the 16-65 age
>>group, in what has to be a predominantly patient education and review,
>>rather than hands-on, role. It is proving rather difficult to communicate
>>with the orthopod who did the surgery as this was in a specialist unit out
>>of our area.
>>
>>Thanks - I hope this doesn't put you off making other contributions to the
>>Physiomailbase list !
>>
>>Nikki Adams [log in to unmask]
dear nikki,
because you do not mention if the youngster had any functional walking
before the operation, i assume he had. if so, you must help him with
stability of his feet on the ground and prevent the rotation of the tibia
forward on his foot, meaning help him to use the ground reaction forces.
the thing to do is to fit him with G.R.F, A.F.Os at 90 degrees at the
ankle, so when putting his heels to the ground the orthoses will push his
knees back into extension. muscle strengthening is very important for his
extensors - glutei, quad. also using the bicycles at the sports centre is
very good. if he is still in crouch, i would consider knee immobilizers for
the night and for walking. it is not a good policy to let his muscles work
in over lengthened position. do not expect him to gain his walking very
soon, sometimes it takes months, up to 6, to get these patients on their
feet in a functional way, and maximal gain is even later, like 1 year. try
to convince him to sleep on his tummy and spend as many hours prone as he
spends in his wheel chair. if all the torsional malalignments have been
corected your patient should benefit from hard work and perseverance.
good luck to you and him,
netta harries
israel
can you tell me from what country you write?
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