[Clinical assessment of spasticity in children]. / Evaluation clinique de l'enfant spastique.

This article presents the four principle steps of assessment of children with cerebral palsy. Weakness of some muscles groups and spasticity of others and the subsequent functional impairment can be identified by observation. Analytical assessments of spasticity with the Ashworth and Tardieu scales were compared in 30 children with cerebral palsy, mean age 8.5 years. The results pointed out the complimentary nature of these two scales: The Gross Motor Function Measure, which is a validated scale, is specific for children with cerebral palsy. This measure provides a useful assessment of outcome and a convenient means of evaluating the time-course. Joint assessment is also essential to identify muscle contracture. Assessment of spasticity in children with cerebral palsy must be conducted by a multidisciplinary team to take into account all the aspects involved.

Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study.

In orthopaedic clinical practice hip pain is the main complaint of adults with cerebral palsy (CP). The aim of this descriptive study was to specify prevalence of hip pain and to propose methods of care other than surgery. The study was a cross sectional multicentre one based in the Rhjne-Alpes region. Patients over 15 years of age, with CP who were non-ambulatory were included. Two hundred and thirty-four patients were questioned. Mean age of the patients was 27 years 10 months, median 26 years 1 month, with 59.3% males and 40.7% females. Patients were questioned about pain with precise information about the circumstances of pain, tolerance, and treatment. Pain was judged to be intolerable if it prevented usual activities. Prevalence of hip pain was 47.2%. Pain was judged to be tolerable in 35.6% of the 234 patients, i.e. in 75.5% of patients with hip pain. There were three types of pain: provoked pain, pain linked to position, and spontaneous pain. Medical treatment was given to only 13.6% of patients with hip pain. The first treatment for hip pain is to avoid circumstances where pain occurs; medical treatment is reserved for when daily life cannot be adapted sufficiently to prevent pain. Medical treatment must be appropriate with doses of adequate strength before proposing surgery.

[Prevalence and morbidity of hip excentration in cerebral palsy: review of the literature]. / Prévalence et morbidité de l'excentration de hanche du sujet infirme moteur cérébral: étude de la littérature.

PURPOSE OF THE STUDY: Excentration of the hip is one of the main orthopedic complications of ante and perinatal cerebral palsy. Excentration can progress to dislocation even if tenotomy is performed. What is the prevalence and morbidity of hip excentration? METHODS: We reviewed the pertinent literature on the prevalence and morbidity of hip excentration in patients with cerebral palsy based on the Medline and Reedoc databases. RESULTS: Data presented in the literature vary greatly. Populations are representative of the referral network of the teams reporting the study rather than the cerebral palsy population in general. Signs reported were pain, difficult nursing procedures, difficult sitting position, pressure sores and fractures, but only one sign can be taken fully into account: 50 p. cent of the dislocated hip joints were painful. DISCUSSION: No one study gives a precise assessment of the prevalence of hip excentration and displacement and its consequences in patients with cerebral palsy. In a population of quadriplegic patients who do not walk, the question is whether complementary tenotomy should be performed, knowking the difficult operative and postoperative situation of such procedures. In this population, walking is an exceptional goal of bone surgery, pain relief and patient comfort are more common goals. Data in this literature (50 p. 100 of the dislocated hips are painful) suggest a prudent approach. However, there is no known marker which can be used to distinguish hips which will become painful from those which will remain pain free. In addition, irreversible cartilage degeneration can cause pain contraindicating reconstructive surgery.

[Anti-calcaneus carbon fiber orthosis in children with myelomeningocele]. / Orthèses anti-talus en fibre de carbone chez les enfants atteints de myéloméningocèle.

An anti-calcaneus carbon fibre orthosis (ACCFO) is an appliance combining a plantar orthosis with an anterior counter-support at the tibia and two side supports, medial and lateral, leaving the posterior aspect of the leg and heel free. It is made of polyethylene and polycarbolactone resin reinforced by a covering of tubular carbon fibres and polymerized epoxy-resin. Fifty-five pairs have been used in 18 children aged from one years and five months to 12 years suffering from a paraplegia at L4-L5 or S1 level due to myelomeningocele. Two children were unable to walk before the use of the ACCFO and 16 walked with various aids. All the children were followed-up with regular muscle and joint assessments and video recordings at their respective day-care hospitals. The orthoses were made by the same supplier. Correction of the calcaneo-valgus was improved in all the cases. Balance in standing was improved in 15 cases, including three children who became able to stand without other aids. This orthosis is well adapted to children suffering from spina bifida. It is well accepted because of its lightness and good skin tolerance and was preferred to earlier appliances in all cases.