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Cerebral palsy in childrenCerebral palsy in children
Prevalence:Prevalence: 3-4 / 1000; 3-4 / 1000;
Clinical forms: following evident motor Clinical forms: following evident motor involvement:involvement: spasticspastic: : diplegia;quadriparesia;Hemiplegia; diplegia;quadriparesia;Hemiplegia; triplegia;triplegia; ataxic;ataxic; dyskynetic: dyskynetic: dystonic; athetoid;dystonic; athetoid;Hypotonic;Hypotonic;
Prof Battisti O, Bot-Tox-a
Muscles contraction: relevant anatomyMuscles contraction: relevant anatomy
Cortex primary motor area
Basal gangliaBulbar reticular structurecerebellum
-
Adjacent structures
+
Alpha / gamma motoneurons of anterior horn
+
+
musclesSensory receptors:Muscles, tendons, bones, peritoneum
-
Posterior horn
+
+
2
Prof Battisti O, Bot-Tox-a
Muscles contractions:Muscles contractions:1 nerve per motor unit, componed of 3-15 interlaced muscles fibers 1 nerve per motor unit, componed of 3-15 interlaced muscles fibers
that cann’t be individualized )that cann’t be individualized )
D membrane Pot
Release of Ac Cho
Na+ influx
SRE Ca++ efflux Troponin ( actin+myosin ) overlap=Muscles contraction
nicotin
Curare, Ach esterase
ATP, glycogen, Pcri = energy
3
Prof Battisti O, Bot-Tox-a
Clinical presentationClinical presentation Motor involvementMotor involvement: spasticity, ataxia, : spasticity, ataxia,
dyskinesia, hypotonia;dyskinesia, hypotonia; Vision impairement and disorder of Vision impairement and disorder of
communicationcommunication Feeding disorderFeeding disorder EpilepsyEpilepsy Orthopedic disorderOrthopedic disorder Emotional and psychological Emotional and psychological
disturbancesdisturbances
4
Prof Battisti O, Bot-Tox-a
Therapeutics in CPTherapeutics in CP
PhysiotherapyPhysiotherapy « castings »« castings » Botulinum toxinBotulinum toxin Intrathecal baclofenIntrathecal baclofen Improve daily life Improve daily life
functionfunction Mental patternMental pattern Self-esteemSelf-esteem NutritionNutrition PainPain convulsionsconvulsions
Increase in forceIncrease in force Increase in Increase in
dexteritydexterity Better movementsBetter movements Better equilibriumBetter equilibrium Better self-conceptBetter self-concept More More
independencyindependency
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Prof Battisti O, Bot-Tox-a
Muscles concerned by the injections: Muscles concerned by the injections: example for one side…example for one side…
Iliopsoas: 2 sites;Iliopsoas: 2 sites; Hamstrings: 4 Hamstrings: 4
sites;sites; Adductors: 2 sites;Adductors: 2 sites; Gastrecnomius: 4 Gastrecnomius: 4
sites;sites; Tibialis anterior: 2 Tibialis anterior: 2
sites;sites; Other:…Other:…
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Prof Battisti O, Bot-Tox-a
Then normal Then normal programprogram of physiotherapy of physiotherapy
But with another But with another energy and energy and motivation…motivation…
More interaction More interaction between infant, between infant, family, physio, family, physio, doctor, friends and doctor, friends and school;school;
7
Prof Battisti O, Bot-Tox-a 8
Prof Battisti O, Bot-Tox-a
En « résumé »…En « résumé »…
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