Cerebral Palsy Freeman Miller, MD Co-Director, Cerebral Palsy Program Alfred I duPont Hospital for Children Nemours Foundation Wilmington, Delaware Cerebral Palsy With CD-ROM With 1116 Illustrations, 777 in Full Color Illustrations by Erin Browne, CMI Springer Freeman Miller, MD Co-Director, Cerebral Palsy Program Alfred I duPont Hospital for Children Nemours Foundation Wilmington, DE 19899 USA Library of Congress Cataloging-in-Publication Data Miller, Freeman Cerebral palsy / Freeman Miller p ; cm Includes bibliographical references and index ISBN 0-387-20437-7 (hc : alk paper) Cerebral palsied children—Rehabilitation Movement disorders in children Cerebral palsy I Title [DNLM: Cerebral Palsy—rehabilitation—Child Cerebal Palsy—surgery—Child Disabled children—rehabilitation WS 342 M647ca 2004] RJ496.C4M535 2004 618.92′836—dc22 2003065734 ISBN 0-387-20437-7 Printed on acid-free paper © 2005 Springer Science+Business Media, Inc All rights reserved This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed in Singapore springeronline.com (AI/KYO) SPIN 10948378 Preface Cerebral palsy is a lifelong condition that affects the individual, family, and immediate community Therefore, the goal of allowing the individual with cerebral palsy to live life with the least impact of the disability requires complex attention to the individual and the family Furthermore, society needs to be sensitive and to accommodate individuals with disabilities by limiting architectural impediments and providing accessible public transportation and communication The educational system provides the key means for helping the individual prepare to function in society to his or her maximum ability In many ways, the medical care system probably has the least significant role in preparing the child with cerebral palsy to function optimally in society However, the medical care system is the place where parents first learn that their child has developmental issues outside the expected norm It is almost universally the place where parents also expect the child to be made normal in our modern society In earlier times, the parents would expect healing to possibly come from the doctor, but also they would place hope for healing in religion As this belief in spiritual or miraculous healing has decreased, a significant font of hope has decreased for parents of young children with disabilities The text aims to help the child with cerebral palsy to develop into an adult in whom the effects of the disability are managed so that they have the least impact possible on adult function This intention is in the context of the fact that the magnitude of improvement in the disability that occurs with ideal management of the musculoskeletal system during growth may be only a small improvement Probably the more significant aspect of good musculoskeletal management through childhood is helping the child and family to maintain realistic hope for the successful adult life of the growing child This aim requires the medical practitioner to get to know the child and family and to communicate in a compassionate way realistic expectations of the child’s function For many reasons, the greatest difficulty in providing this kind of care is the limited time practitioners have to spend with the individual patient There is also the sense, especially among orthopedic physicians, that cerebral palsy cannot be cured (cannot make the child function normally), and thus it is a frustrating condition with which to work The physician must maintain a balance between communicating hopelessness to the patient and family; and feeling the need to something, usually a heel cord lengthening, because the parents are frustrated that the child is not progressing All medical decisions, including a surgical option, should always consider both the short- and long-term impact With every decision the medical practitioner should ask, “What will be the impact of this recommendation by the time the child is a mature adult?” This is the most difficult perspective, especially vi Preface for young practitioners with little experience This text is intended to provide this insight as much as possible Another issue is the poor scientific documentation of natural history and treatment response in cerebral palsy, which has become clearer to me in the course of writing this book With little scientifically based natural history and few long-term studies, much of what is written in this text is expertbased observation The goal of writing this is not to say that it is absolute fact, but to provide the starting point of gathering information with the hope that others will be stimulated to ask questions and pursue research to prove or disprove the concepts The research, which is of help in treating children with cerebral palsy, needs to be planned and evaluated with consideration of its long-term impact on the child’s growth and development All treatment should also consider the negative impact on the child As an example, a number of moderately good studies have analyzed the impact of wearing ankle orthotics on the young child Although the orthotics may provide an immediate benefit by improving the child’s gait, there is probably no long-term benefit Thus, if the child develops a strong sense of opposition to wearing the brace at 10 years of age because of peer pressure, the brace wear cannot be justified on a cost–benefit analysis It is also important to consider the quality of the scientific evidence, ranging from double-blinded protocols to case reports, but it is equally important not to get up on this being the final answer For example, excellent double-blinded studies show that botulinum toxin decreases spasticity and improves gait for a number of months Therefore, these studies need to be considered in the context of our goal, which is to give the child the maximum possible function at full maturity Because no evidence currently suggests that botulinum has either a negative or a positive effect on this long-term goal, the family and physician should decide together if botulinum injection has a positive cost–benefit ratio, as its effects will last only for approximately months In comparison, no double-blind studies show that Achilles tendon lengthenings improve gait three or six months after the surgery, and no such studies are needed because the goal of surgery is to make an improvement in gait several years later and to have improvement at maturity Most important is that surgery create no disability at maturity From this perspective, it would be much more useful to have a good controlled case series with a 15-year follow-up than a double-blinded study with six months follow-up This book should stimulate research that will improve the knowledge base which is focused on the long-term outcome of treatments However, just because the scientific knowledge base is poor does not mean that we should not apply the best knowledge available to current patients In addition to research, an individual professional can best extend his or her knowledge base through personal experience This means that the child and family should be followed over time by the same practitioner with good documentation By far, my best source of information has been the children whom I have followed for 10 to 20 years with videotapes every year or two Practitioner experience is extremely important for augmenting the relatively poor scientific knowledge base for musculoskeletal treatment Careful ongoing follow-up is also crucial to providing hope for the families and the individuals with cerebral palsy How to Use This Text and CD The text of Cerebral Palsy is set up in three sections, with the first section containing 11 chapters that deal with specific aspects of cerebral palsy from Preface the perspective of managing the motor impairment The first four chapters address primarily global issues of the child and family The fifth chapter provides an overview of the medical and community care system and philosophy The sixth chapter addresses the myriad options of equipment encountered in the treatment of the musculoskeletal impairment, and the seventh addresses the problems related to gait The last four chapters are related to problems encountered in anatomical regions These chapters also include management of the deformities and management of complications of medical treatment These chapters are followed by treatment algorithms relevant to the issues discussed within the chapter Also included in the chapters are patient case examples Many of the case examples have videos and are designated by a video symbol Each case has a unique name assigned to the patient and the video is accessed by opening the CD followed by opening the movies section, then opening the video with the same name The second section of the book includes descriptions of techniques in rehabilitation often used with children with cerebral palsy The third section is a surgical atlas with the procedures organized by anatomical area The CD included with this text is opened with a Web browser Because the data on the CD is coded with XML and JAVA, only browsers released after 2002, such as Netscape 7.0, Explorer 6.0 or Safari, will be fully able to access this data Some of the text in the book is organized in topics and is displayed in the section entitled “Main.” All references on the CD have the abstract available on the CD by activating the link associated with the reference Cases can also be activated from these references in the Main section There is also a section called “Cases,” which lists all the cases by name as listed in the text of the book Following these cases are short quiz questions, which can be used to test understanding or study the material on line There is also a section called “Quizzes,” which lists the quizzes by name of the cases These quizzes can be opened and answered referring to the full case descriptions The answers from the quizzes will be tabulated to keep a running total of correct answers for each session After a quiz is accessed, it will also change color to remind the reader that he has already reviewed that quiz The section entitled “Decision Trees” is the treatment algorithms, which are present at the end of each chapter in the book These decision trees are set up so that area of interest is linked to the text in “Main” for further reading The section called “Search” is an electronic index to search for specific subjects with in the chapter of the section “Main.” Because of space limitations, only individual chapters can be searched at one time So if you want to search for “crutches,” you first should activate the Durable Medical Goods chapter, and then search The results of the search allow you to directly link to the area of interest The section “History” keeps a running history of the areas that have been assessed, so if you want to return to an area you were reading earlier in the session you can open the history and it will allow you to return to that area The section “About” includes information on the use of the CD and acknowledgments In summary, the CD includes videos, case study quizzes, and reference abstracts, which are not inclnded in the book The book includes significant portions of text not included on the CD, sections on rehabilitation techniques, and a surgical atlas The book and the CD are intended to complement each other but each can also be used alone Acknowledgments The production of this book and CD was only possible because of an extensive network of support that was available to me The support of the vii viii Preface administration of the Nemours Foundation, especially the support of Roy Proujansky and J Richard Bowen in giving me time to work on this project was crucial It was only through the generous support in caring for my patients by my partners and staff, Kirk Dabney, Suken Shah, Peter Gabos, Linda Duffy, and Marilyn Boos, that I was able to dedicate time to writing I am very grateful for the generous material provided by all the contributors and for the extensive and extremely important role of the feedback given to me by the consultants In spite of having an extremely busy practice, Kirk Dabney still found time to read all of the first section, making very valuable improvements, and writing major sections of the upper extremity chapter With his wide experience, Michael Alexander made an excellent contribution in the editorial support of the section on rehabilitation The task of writing and editing would have been impossible without the dedicated work of Kim Eissmann, Linda Donahue, and Lois Miller Production of the CD involved a significant amount of detailed editing and HTML coding, most of which was performed by Linda Donahue To add a personal touch to the cases, a unique name was assigned by Lois Miller The CD required a great effort of technical programming to make it work intuitively on all computer formats Tim Niiler patiently persisted with this frustrating task until it all worked Videos were masked and formatted by Robert DiLorio Production of the graphics was a major effort in understanding the complex material in which Erin Browne excelled This production would have been impossible without her dedication to understanding the concepts and bringing them to visual clarity I would also like to thank the staff of Chernow Editorial Services, especially Barbara Chernow Without the long support through out the evolution of this book by Robert Albano and his staff at Springer, this project would also have been much more difficult And finally, I am most grateful for the many families and children who have allowed me to learn from them what it is like to live with the many different levels of motor impairments It is to the families and children that I dedicate this work in the hope that it will lead to improved care and understanding by medical professionals Freeman Miller, MD Contents Preface v Contributors xi Section I Cerebral Palsy Management The Child, the Parent, and the Goal Etiology, Epidemiology, Pathology, and Diagnosis 27 Patient Management 51 Neurologic Control of the Musculoskeletal System 95 Therapy, Education, and Other Treatment Modalities 151 Durable Medical Equipment 181 Gait 251 Upper Extremity 387 Spine 433 10 Hip 523 11 Knee, Leg, and Foot 667 Section II Rehabilitation Techniques Neurodevelopmental Therapy 805 Elizabeth Jeanson Strengthening Exercises 806 Diane Damiano Balance Interventions 808 Betsy Mullan Electrical Stimulation Techniques 809 Adam J Rush Hippotherapy 810 Stacey Travis Aquatic Therapy 811 Jesse Hanlon and Mozghan Hines x Contents Assistive Devices 818 Mary Bolton Seating Systems 821 Denise Peischl, Liz Koczur, and Carrie Strine M.O.V.E.™ (Mobility Opportunities Via Education) Curriculum 828 Kristin Capone, Diana Hoopes, Deborah Kiser, and Beth Rolph 10 Occupational Therapy Extremity Evaluation 831 Marilyn Marnie King 11 Intrathecal Baclofen Pumps 851 Maura McManus References 858 Section III Surgical Techniques Upper Extremity Procedures 865 Spinal Procedures 894 Hip Procedures 913 Knee Operative Procedures 955 Foot and Ankle Procedures 979 Index 1025 1041 Index tibial osteotomy with casting, 968–969, 969f with intramuscular nails, 970–971, 970f Knee orthoses, 189–190, 189f Knee recurvatum, 361–362 Knee subluxation, rotatory, 695f Knupfer exercises, in aquatic therapy, 815–816 Krabbe’s disease, 34t Kufs’ disease, 35t Kyphosis, 452–457 dorsal rhizotomy-related, 116 etiology of, 452–453 hamstring contracture-related, 227, 227f, 452, 452f, 453 hamstring spasticity-related, 227f lumbar, seating-related pressure in, 217f midthoracic, anterior hip dislocationrelated, 579, 580–582f, 583 natural history of, 453 thoracic, with lower cervical lordosis, 507–508, 509f thoracolumbar junctional, 499 rhizotomy-related, 480–481, 480–481f treatment of, 453 with anterior spinal release, 904 conservative, 453–456, 455f, 456f with spinal orthoses, 187, 187f surgical, 456–457, 904 wheelchair seating in, 227, 227f L Labyrinthine reflex, 41, 42f Laminectomy with dorsal rhizotomy, 115, 115f as lordosis cause, 453, 460–464, 462–464f Fazano technique in, 115, 115f, 453, 453f, 499 as kyphosis cause, 453, 453f as spondylolithesis and spondylolysis cause, 499 Lamotrigine as seizure treatment, 84t as spasticity treatment, 110 Lateral block test, 726–727, 729f Lateral column fusion, 774, 775f Lateral column lengthening, 753, 754–755f complications of, 766, 768f outcome of, 760 through the calcaneocuboid joint, 989–991, 990–991f, 999 through the calcaneus bone, 985–989, 985–989f “Lazy eye” (ambylopia), 30–31 eye patch treatment of, 158 Least restrictive environment, for education, 171 Leg drop test, 54f, 103, 105 Leg length discrepancy, 351–352, 353, 353f hip surgery-related, 645–646 Leigh syndrome, 37t Leri’s sign, 839t Lesch-Nyhan syndrome, 37t Lesioning procedures See also Neurectomy as dystonia treatment, 129 Leukodystrophy globoid cell (Krabbe’s disease), 34t metachromatic, 34t Lever arm disease, 314, 317–318, 684 Levodopa, as dystonia treatment, 129 Life-saving treatment, parental refusal of, 449 Lifts, 240–241 for gait trainers, 239f Limb deficiencies, congenital, power wheelchair use in, 210 Lioresal See Baclofen Lissencephaly, 27, 30, 30f, 126 Little, William John, 667, 708 Local anesthetics, as postoperative pain treatment, 82 Loose bodies, in the knee, 696 Lorazepam, 84t, 87t half-life of, 88 Lordoscoliosis, windblown hip deformity-related, 600 Lordosis See also Hyperlordosis anterior spinal release treatment of, 904 cervical, thoracic kyphosis associated with, 507–508, 508f dorsal rhizotomy-related, 116, 116f lumbar, 457–466 conservative treatment of, 460 etiology of, 457, 459 natural history of, 459–460 orthotic treatment of, 460 surgical treatment of, 460–464, 462–464f thoracic kyphosis-associated, 512, 516, 516f wheelchair seating modifications in, 458, 460 postoperative neuritic pain associated with, 487 wheelchair seating in, 227, 458, 460 Low back pain, flexion lumbosacral orthosis treatment of, 188, 188f Low-carbohydrate diet, for seizure control, 89 Lower-extremity orthoses, 188–200 ankle-foot orthoses (AFO), 190–196, 191–192f, 193f, 194f, 195f, 198f elastic wraps, 189 foot orthoses, 197–200, 199–201f hip orthoses, 188, 189f knee orthoses, 189–190, 189f twister cables, 188–189 Lumbar flexion jacket, 188, 188f Lumbar sacral flexion orthoses (LSO), as spondylolithesis treatment, 509, 510, 510f Luque system, of spinal instrumentation scoliosis progression associated with, 488–489 as scoliosis treatment, 443, 444, 444f Lyme disease, knee involvement in, 696 M Macroencephaly, 28, 30 Magnetic resonance imaging (MRI) for cerebral palsy diagnosis, 47, 48f for femoral anteversion measurement, 615–616 for gait impairment diagnosis, 285 Malacia, tracheal, 485 Malnutrition, as spinal surgery contraindication, 467–468 Malpractice lawsuits, Mannosidosis, 35t Maple syrup urine disease, 35t Marijuana, as spasticity treatment, 110 Maroteaux-Lamy’s syndrome, 34t Martial arts, 175 Massage therapy, 175–176 in Votja therapy, 156 Mathematical modeling, in kinetic measurement, 280–281 Maturation theory, of motor control, 100, 103 Mayer’s sign, 839t Meckel’s syndrome, 28 Medial column correction, 992–998, 992–998f in triple arthrodesis, 998, 999, 999f Medicaid, 207 Medical equipment See also Durable medical equipment definition of, 169 Medical system, relationship with special education system, 168–169 Megaloencephaly, 28, 30 Meningitis, bacterial, 38 Meningomyelocele, 6, 28 Menisci, tears of, 694–695, 696 Menstrual cycling, 76 Mental retardation inappropriate synaptic remodelingrelated, 31 sensory integration treatment in, 155 Mephenytoin, 84t Mephobarbital, 84t 1042 Mesoderm, 29f Metabolic neurologic disorders classification of, 33, 34–37t intermedullary metabolism disorders, 33, 38 metallic metabolism disorders, 33 storage disorders, 33, 38 Metacarpal phalangeal joint fusion, of the thumb, 886–887, 887f Metachromatic leukodystrophy, 34t Metallic metabolism disorders, 33 Metatarsal bones lateral, equinovarus-related fractures of, 724 stress fractures of, 62, 726f Metatarsal phalangeal joints extended, 787 fusion of as bunion treatment, 781, 785–786f nonunion of, 781, 784 Methosuximide, 84t Methylphenidate, 87t, 88 Microencephaly, 28 Middle cerebral artery, occlusion of, in neonates, 27 Middle childhood occupational therapy during, 165 physical therapy during, 161–162 planovalgus during, 743 upper-extremity functional development during, 391 windblown hip deformity treatment during, 602 Midfoot, subtalar fusion-related collapse of, 768 Midfoot break, 309 Midfoot deformities See also Subtalar and midfoot deformities midfoot supination, 768–771 outcome of treatment of, 775–776 Minnesota Rate of Manipulation (MMRT) Test, 840 Mitochondrial cytopathy, 37t Mitochondrial fatty acid defects, 37t Mitochondrial myopathy, 37t Mobility Opportunities Via Education (MOVE) Program, 164, 164f Mobilization, postoperative, 84–85 MODEMS questionnaire, 378 Monoplegia, definition of, 41 Mood stabilizers, 87t, 88–89 Moro reflex, 42, 42f Morphine in combination with diazepam, 88 as hypoxia cause, 81 as postoperative pain treatment, 81, 82, 83t, 87t, 88 Morquio’s syndrome, 34t Motor activity, neurologic control of, 95–150 Index Motor development hierarchical theory of, 152–153, 154, 155 impairment of, developmental aspects of, 44–47, 45t, 46f recapitulation theory of, 155 subsystems theory of, 153 Motor evoked potentials (MEPs), intraoperative, 479 Motor function, importance of, 95 Motor function control assessment of, in gait analysis, 273, 274t central motor program generator concept of, 45 development of, 306 Motor function control disorders as gait abnormalities cause, 305–307 treatment of, 136–137 Motor function control system center of gravity positioning by, 342, 342f neurologic control of, 95–96 automatic, 96 chaotic attractors in, 101–102, 101f dynamic systems model of, 100–102, 101f, 103, 107–108, 805 feedback control mechanism of, 98–100, 99f feed-forward control mechanism of, 99–100, 99f fuzzy logic model of, 100 maturation theory of, 100, 103 open-loop control mechanism of, 99 unified theory of, 102–103 volitional, 96 as peripheral nervous system component, 96 subsystems of, 103 Motor impairments diagnostic implications of, 27–28 durable medical equipment-based treatment of, 181–249 encephalocele-related, 28 encephalopathy-related, 95 Motor neurons, alpha, excitability of, 105 Motor skills, maturation of, 97 Movement, evaluation of, 838 Movement disorders See also Athetosis; Ballismus; Chorea; Dystonia definition of, 45, 127 as gait disorders, 373–374 pathology of, 127 M.O.V.E.(TM) (Mobility Opportunities Via Education) curriculum, 828–831, 830f contraindications to, 829 Mucolipidosis, 34t Mucolipidosis IV, 34t Mucopolysaccharidoses, 34t Multiple births, as cerebral palsy risk factor, 39 Multiple carboxylase deficiency, 36t Muscle lengthening See also specific muscle lengthening procedures dystonia as contraindication to, 129 Muscle length-tension relationship (Blix Curve), 257–259, 259f Muscle modeling, of hamstring contractures, 673 Muscles See also specific muscles effect of spasticity on, 106f, 107–108 hypotonic, 126 Muscle strength, 107 assessment of, in gait analysis, 275 Muscle-strengthening exercises, 158, 806–808 aquatic, 813–814 Muscle tone abnormalities of, 47 definition of, 103, 104 evaluation/measurement of, 104–105, 105t, 838 in gait analysis, 275 reduction of, as windblown hip deformity treatment, 605–606 in spasticity, 106 viscoelastic dampening in, 103–104 Muscle transfers See also specific muscle transfers dystonia as contraindication to, 129, 131 electromyography prior to, 392 Muscle weakness, 107 as gait abnormalities cause, 307–307 Musculoskeletal surgery, as athetosis treatment, 133 Myelotomy, as spasticity treatment, 118 Myofascial lengthening of the biceps, 398, 398f of the brachialis, 398, 398f as hip flexion contracture treatment, 599 Myofascial release therapy, 175 N Naloxone, 87t, 88 Naltrexone, 87f, 90 Naproxen, 73, 85 as postoperative pain treatment, 87t, 88 use in self-injurious patients, 89 Nasogastric tube feedings for nighttime feedings, 468 postoperative, 486 National Center for Medical Rehabilitation Research, 39–40 Navicular tuberosity excision, 992, 993, 994f 1043 Index Naviculo-cuneiform joint excision, 992, 996 996f Near drowning, 38, 621 Near hanging, 38 Neck stiffness, spinal surgery-related, 489 Necrosis, avascular, hip reconstructionrelated, 563–564 Nemours Foundation, 172 Neonates, cerebral palsy in, 11 Nerve conduction velocity, age-related increase in, 98 Nerve injuries, hamstring lengtheningrelated, 679, 680 Nerve palsies, hamstring lengtheningrelated, 679, 680 Nerves, effect of spasticity on, 106–107 Nervous system See also Central nervous system; Peripheral nervous system anatomy of, 95–96 Neural tube, 97 Neural tube defects, 28, 29f Neurectomy anterior branch obturator, 118 of forearm motor nerves, 415 of gastrocnemius, as ankle equinus treatment, 118, 175 Neuritic pain, lumbar lordosis treatmentrelated, 464 Neurodevelopmental Therapy (NDT), 154, 805–806, 816 Neurologic disease, progressive, 76–77 Neurologic maturity, development of, 44 Neuromotor junction injections, as spasticity treatment, 120–122, 121f Neuromuscular electrical stimulation (NES), 809–810 as ankle equinus treatment, 716 Neurovascular monitoring, postoperative, 82–83 Niemann-Pick disease, 34t Nonsteroidal anti-inflammatory drugs, 87f injectable, 87t, 89 as postoperative pain treatment, 87t, 88 Nonunion of metatarsal phalangeal joint fusions, 781, 784 osteotomy-related, 683 spinal fusion-related, 488, 488f, 489f subtalar fusion-related, 766, 768f tibial, 703–704 No resuscitation order/status, 447, 504–505 North American Riding for the Handicapped Association (NARHA), 810 Nutrition in quadriplegic patients, 56–58 in spinal surgery patients, 467–468 postoperative, 485, 486, 490 Nutritional assessment, 57 preoperative, 79 Nutritional supplementation, in spinal surgery patients, 449 O Obturator nerve ablation, as spasticity treatment, 118 Occupational therapist assistants (OTAs), 166 Occupational therapists, preoperative evaluations by, 392 Occupational therapy cerebral palsy scoring scales used in, 834–838, 835t, 836t extremity evaluations in, 831–851 functional abilities evaluations in, 834–836, 835t, 836t overall evaluations in, 836–838, 837f overlap with physical therapy, 151 speech therapy, 152 postoperative goals in, 848 prescriptions for, 165–166 upper-extremity evaluations in of functional development, 391 functional outcome prediction in, 848, 850 informational/instructional handouts in, 848, 850t, 851t postoperative, 844–851, 849f, 850–851t preoperative, 838–844, 841–844f Olendronates, 68 Opisthotonic patterning, 128 Optical measurements, in kinematic evaluations, 276–277, 277f Oral motor dysfunction management, 166 Oral motor reflex, 839t Orthopedist-educator relationship, 170 Orthopedists interaction with physical therapists, 166–167 interaction with special educational system, 168 role in physical therapy, 166–167 therapy prescriptions from, 169–170 Orthoses, 181, 182–200 ankle as ankle equinus treatment, 713, 713f as ankle plantar flexion prepositioning treatment, 320 as hypotonia treatment, 127 as spasticity treatment, 123 ankle-foot (AFO), 182, 190–196, 191–192f, 193f, 194f, 195f, 198f contraindication as lordosis treatment, 460 as dystonia treatment, 132 elastic wraps, 189 elbow, 183, 184f foot, 197–200, 199–201f, 199f as foot progression angle malrotation treatment, 318 as hypotonia treatment, 127 intramalleolar, 198, 200f prescriptions for, 245–247f supramalleolar, 198, 200f, 727 hand and wrist, 183–184, 184f resting splints, 184–185, 185f swan neck splints, 185–186, 186f thumb splints, 185, 186f hip, 188, 189f hip abduction, 188 as windblown hip deformity cause, 603, 606f as windblown hip deformity treatment, 603, 605 knee, 189–190, 189f knee-ankle-foot (KAFO), 189–190, 189f for kyphotic patients, 455–456 lower-extremity, 188–200 as plantar flexion treatment, 140 problem-based understanding of, 197t purpose of, 182 shoulder orthoses, 183 as spasticity treatment, 123, 124–215 spinal, 186–188, 187f, 188f terminology of, 182 twister cables, 188–189 upper-extremity, 182–186 as varus foot deformity treatment, 736 as windblown hip deformity treatment, 601–602, 603, 605, 607f Ossification, heterotopic, postoperative, 545, 546 dorsal rhizotomy-related, 116 hip surgery-related, 646–650 adductor lengthening-related, 646–647, 648–649, 648–649f as hip joint stiffness cause, 656 as hip pain cause, 648–649f, 650 hip reconstructive proceduresrelated, 563, 568 prophylactic treatment of, 647, 649, 650 treatment of, 649–650, 650f resection arthroplasty-related, 573–574 Unit rod instrumentation-related, 474, 477f Osteochondroma, 285 Osteogenesis imperfecta patients, power wheelchairs for, 210 Osteomalacia quadriplegia-associated, 57, 58 treatment of, 66–68 1044 Osteopenia as distal femoral knee extension fracture cause, 679 hypotonia-related, 126 knee flexion contracture-associated, 683 quadriplegia-associated, 57, 58 Osteoporosis diagnosis and treatment algorithm for, 90f as distal femoral knee extension fracture cause, 679 hypotonia-associated, 126 knee flexion contracture-associated, 683 as low-energy fracture cause, 64 quadriplegia-associated, 57–58 treatment of, 66–68 Osteotomy calcaneal as fixed heel varus treatment, 733, 734, 735f as midfoot supination cause, 770 as planovalgus treatment, 760, 761, 761f, 766, 767, 767f as recurrent varus foot deformity treatment, 741–742 as varus foot deformity treatment, 740 calcaneal tuberosity, 985–989, 985–989f Chiari, 557f, 558 as limited hip range-of-motion cause, 656 poor outcome of, 560, 560f, 656 Dega, 550, 556–557 distal extension, as patella alta treatment, 691 distal femoral in combination with patellar advancement, 971 in combination with varus-valgus realignment, 972 as femoral anteversion treatment, 624 operative procedure in, 972–978, 973–977f distal femoral extension, as knee flexion contracture treatment, 682–683 extension, as hip flexion contracture treatment, 599 extraarticular, as planovalgus treatment, 760 femoral complications of, 637–645, 638f, 640–645f as hip pain cause, 651–652, 651f medial plate protrusion in, 651–652 nonunion of, 637–639, 638f Index as plate bursitis cause, 651, 651f, 652, 652f proximal, 920–930, 921–930f as windblown hip deformity treatment, 602 wound infections associated with, 561, 561f, 635, 636–637 femoral derotation, 554 as femoral anteversion treatment, 623, 624 varus, 552–553f femoral proximal, 920–930, 921–930f femoral valgus, 574, 575, 575f of first cuneiform, 771, 773f in hip reconstruction, 550 as hip subluxation treatment, 559–560 humeral derotation, 869, 870–871f as shoulder contracture treatment, 397, 398, 398f medial cuneiform, 992, 994–995, 996f midshaft, as femoral anteversion treatment, 624, 625f pelvic, 554, 556f as infection cause, 560, 562 intraarticular extension of, 564 wound infections associated with, 635–636 Pemberton, 556–557, 557f as anterior acetabular dysplasia treatment, 551, 556 as anterior hip dislocation treatment, 585–587f, 587, 590, 936–940, 937–904f complications of, 564 operative procedure in, 936–940, 937–904f use in hip reconstruction, 551, 556 peri-ileal, 550, 556–557, 557f, 558 complications of, 564 as hypotonic hip disease treatment, 629–631, 630–631f, 632–633, 632–633f operative procedure in, 931–936, 931–936f proximal femoral, 920–930, 921–930f proximal phalangeal, 771, 773f as bunion treatment, 781 Salter redirectional, 557f, 558 San Diego, 550 Steel, 557f, 558 subtrochanteric valgus, 574, 576, 576f Sutherland, 557f tibial with cast, 968–969, 969f as compartment syndrome cause, 792 foot-to-thigh angle as indication for, 318 as peroneal nerve palsy cause, 792 as tibial torsion treatment, 700–704, 701–702f as vascular infarction cause, 791 valgus palliative, 574, 576, 576f shortening, as windblown hip deformity treatment, 603, 604–605 varus, as leg length discrepancy cause, 645–646 varus repositioning as hip subluxation treatment, 551 as inferior hip dislocation treatment, 593, 593f, 594 Outpatient clinics, physical environment of, 51 Outpatient management, 51–53 Outpatient setting, for physical therapy, 163 Oxazolidindione, as seizure treatment, 84t Oxcarbazepine, 84t Oxycodone hydrochloride, as postoperative pain treatment, 88 Oxygen consumption measurement, in gait analysis, 282–285, 284f Oxygen saturation, postoperative monitoring of, 81 P Pain crouch gait-related, 691, 692f hip pain, 651, 651f, 653 hip dislocation-related, 547–548, 548f, 549, 550f, 551 hip reconstructive proceduresrelated, 563, 565–566f hip subluxation-related, 529f, 530–531, 548, 549, 550f hip subluxation surgery-related, 545 in noncommunicative children, 69–74 neuritic pain, lumbar lordosis treatment-related, 464 nonoperative, in noncommunicative children, 68–74, 91t gastrointestinal, 69, 71–74 genitourinary, 74–75 hip pain, 69–74 pain workup algorithm in, 91t palliative treatment-related, 576, 578 patellofemoral, 693–694 postoperative, 78, 79, 81–83, 83t in severely mentally retarded patients, 87t for sleep disturbance management, 85 spinal fusion-related, 480–481, 487 Palliative treatment, of painful, dislocated or degenerated hips, 72, 73, 73f, 566–578 complications of, 576, 578 1045 Index with femoral head resection, 571, 571f, 574 with femoral valgus osteotomy, 574, 575, 575f with Girdleston resection, 571, 571f, 574 goals of, 566 with hip fusion, 574, 577, 577f with interposition arthroplasty, 569, 571–572, 571f, 572f, 575, 575f with resection arthroplasty, 567–568f, 570–571, 573–574, 573f with subtrochanteric valgus osteotomy, 574, 576, 576f with total hip replacement, 568, 569–570f with valgus osteotomy, 574, 576, 576f Pallidotomy as dystonia treatment, 129 as extensor posturing treatment, 506 Palmaris longus transfer to the abductor pollicis, 890–891, 891f as type thumb deformity treatment, 420 Palmo-mental reflex, 839t Pamidronate disodium, 67, 68 Pancreatitis chemical, 485 hemorrhagic, 483, 485 postoperative, 485, 491 Parachute reflex, 42, 43f absence of, 44 Paralysis, meningomyelocele-related, 28 Paramethadione, 84t Paraplegia, definition of, 41 Parapodiums, 233, 235 Parents, of cerebral palsy patients care-providing community for, 5–6, 5f divorce rate in, emotional response patterns of, 8–11 medical decision-making by, 15–20 about spinal fusion surgery, 446–447, 449 need to assign blame, 8, 9, 11, 15, 18, 19–20 stress experienced by, 4–5, Passive stretching exercises, 124 as ankle equinus treatment, 716 Patella catastrophic failure of, 687 dislocation of, 693–694 treatment of, 966–968, 967–968f proximal migration of, in knee extension contractures, 686, 687 stress fractures of, 62, 687, 688, 688f subluxation of, 693–694 Patella alta, 690–692, 692f, 693 Patellar advancement, 971, 972f Patellar ligament, plication of, 691–692 Patellar tendon, elongated, in crouched gait syndrome, 691 Patient management, 51–93 in diplegic and hemiplegic pattern patients, 78–87 outpatient management, 78 surgical management, 78–87, 80f, 83t, 84t, 86f, 86t medication use during postoperative period, 87–89, 87t nonoperative pain management, in noncommunicative children, 68–74 gastrointestinal pain, 69, 71–74 genitourinary pain, 74–75 hip pain, 69–74 pain workup algorithm in, 91t outpatient, 51–53, 78 in quadriplegic pattern patients of concurrent diseases, 77–78, 78f gastroesophageal reflux and aspiration, 72–73 hip dislocation prevention, 54, 56 low-energy fractures, 58, 59–66, 60f, 61f, 62f during maturation and puberty, 76 of neurological deterioration, 76–77 of osteoporosis and osteomalacia, 66–68 poor peripheral blood flow, 75–76 temperature regulation problems, 75–76 Patterning therapy, 30–31, 156 Peabody Developmental Scales of Fine Motor Skills, 809, 835, 840 Pectineus myotomy, as hip flexion contracture treatment, 599 Pediatric Evaluation of Disability Inventory (PEDI), 378 Pediatric therapists, training programs for, 153 Pedicle screws in dorsal rhizotomy, 499 in lordosis spinal surgery, 461, 462f Pedobarograph, 282, 283f, 309, 726, 729f, 751 Pelvic malalignment, 509–516 anterior pelvic tilt, 338t, 340, 512–515 diplegia-related, 360 etiology of, 512–513 natural history of, 513 treatment of, 515 pelvic obliquity, 341, 341f, 509–512 asymmetric, 338t definition and measurement of, 509–510, 511f Dwyer instrumentation-related, 497, 498f etiology of, 510–511 fixed, 509–510 flexible, 509 Harrington rod instrumentationrelated, 497, 498f hip abduction-related, 331 in hip subluxation, 530 infrapelvic, 510–511, 513–515, 513–515f, 606, 608f, 609 as leg length discrepancy cause, 646 natural history of, 511 in normal gait, 300, 301f seating accommodations in, 512 seating-related pressure in, 217f spinal fusion-related, 495, 497–498f suprapelvic, 510, 606, 608f, 609 treatment of, 469, 470f, 511–512, 513–515, 513–515f wheelchair seating management of, 228 windblown hip deformity-related, 600, 601, 606, 608f, 609–610f pelvic rotation asymmetric, 339–340 excessive, 335, 338t malalignment in, 515 torsional malalignment in, 311 posterior pelvic tilt, 340–341 Pelvic obliquity See Pelvic malalignment, pelvic obliquity Pelvis in gait abnormalities, 335, 338t, 339–342 gait analysis of, 335 in normal gait, 291–292, 292f, 293f, 298–300, 301, 301f osteoporotic, 475 Unit rod-related perforation of, 473–474, 475f, 476–478 acetabular, 476–478 lateral, 474, 476, 477f medial, 474, 475, 475f Pennsylvania Bi-Manual test, 840 Pentaplegia, 41 Peptic ulcers, 72 Perception, evaluation of, 838 Percoset, 88 Peripheral nerve lesioning, as spasticity treatment, 118 Peripheral nervous system development of, 198 role in motor control, 96 Peripheral nervous system surgery, as dystonia treatment, 130–131 Peritonitis, 74 Perkins’ line, 532f Peroneal muscle electromyographic activity in, 742 spastic and overactive, 742 varus deformity of, 131 1046 Peroneal nerve biceps tendon lengthening-related injury to, 679 tibial osteotomy-related palsy of, 792 Peroneal tendon contractures, planovalgus-related, 750 Peroneus brevis muscle in equinovarus foot deformity, 723–724 in foot stability, 769f Peroneus longus muscle, 724 in foot stability, 769f in forefoot supination, 768, 770 in medial arch maintenance, 770f Peroxisomal disorders, 37t Personality characteristics, evaluation of, 838 Perthes’ disease, 635 arthrography in, 533 Peto, Andreas, 157 Peto technique, 157 Phenacemide, 84t Phenobarbital, 83, 84t as intraoperative hemorrhage risk factor, 471 Phenol injections, as spasticity treatment, 118, 119, 122 Phensuximide, 84t Phenyl blocks, as windblown hip deformity treatment, 606 Phenylketonuria (PKU), 35t Phenyltriazine, as seizure treatment, 84t Phenytoin, 84t Photography, use in occupational therapy evaluations, 848, 849f Physical Capacities Evaluation (PCE), 840 Physical examination in gait analysis, 272–275, 285 global function measures in, 272–273, 274t motor control assessment in, 273, 274t of motor control function, 306 muscle strength assessment in, 275 muscle tone assessment in, 275, 275t in outpatient evaluations, 52–53, 52f, 53f, 54f, 55f in pain evaluations, 69–70 preoperative, 79 Physical therapist assistants (PTAs), 166 Physical therapists “grandmother” role of, 12–13 relationship with orthopedists, 166–167 Physical therapy, 151, 152–164 for ataxia, 138–139 for athetosis, 135–136, 137 current approach in, 159–163 evaluation of effectiveness of, 152 goal setting in, 159–160 Index home-based, 163 inpatient, 163–164 orthopedist’s role in, 166–167 outpatient, 163 overlap with occupational therapy, 151 postoperative, 84, 85 postoperative pain experienced during, 653–654 school-based, 164 settings for, 163–164 for shoulder contractures, 398 for spasticity, 123–124 during specific age periods adolescence, 162 early childhood, 160–161 infancy, 160 middle childhood, 161–162 young adulthood, 163 techniques in conductive education (Peto technique), 157 electrical stimulation, 157–158 enforced-use, 158–159 muscle-strengthening exercises, 158 Neurodevelopmental Therapy (NDT), 154, 805–806 patterning therapy (Doman-Delacato technique), 156 sensory integration approach (Ayers technique), 155 sensory motor treatment approach (Rood technique), 155 tone-reducing casts, 158 Votja therapy, 155–156, 175 theoretical basis for, 145, 152–153, 155 therapeutic relationship in, 153 Physician-educator relationship, 170 Physician-parent relationship, 12, 13–15 dysfunctional, 14–15 Pinch strength, 840 Piriformis muscle contractures, 619 Pituitary hypophyseal axis, 76 Planovalgus, 77, 108, 309, 312, 719, 742–768, 753, 979–985 ankle plantar flexor contractureassociated, 710, 710f ankle valgus associated with, 704, 705, 705f, 707–708, 707–708f diagnostic evaluation of, 750–751, 751f diplegia-associated, 725, 727–728f, 737–738, 738f etiology of, 742–743 external foot rotation-associated, 314, 317 foot orthotic treatment of, 197 genetic factors in, 743 hemiplegia-associated, 345–346, 730, 730f, 731, 731f indication for, 979 natural history of, 743, 744–745f orthoses treatment of, 198, 200f, 766 pathologic anatomy of in ambulators, 743, 745–749, 746f, 747f, 748f in nonambulators, 749–750, 750f pathology of primary, 745–747, 747f secondary, 718–720, 718–720f, 748, 750 tertiary, 748–749, 748f, 749f, 750 postoperative care in, 985 quadriplegia-associated, 372 racial factors in, 743 spontaneous correction of, 743, 744–745f surgical treatment of, 751–768 with calcaneal osteotomy, 760, 761, 761f, 766, 767, 767f with calcaneocuboid lengthening fusion, 758, 759, 759f complications of, 766, 768 indications for, 752 with lateral column lengthening, 753, 754–755f, 760 outcome of, 760 with reconstructive procedures, 752–760, 754–757f, 759f with sinus tarsi implants, 760 with subtalar fusion, 753, 756–757f, 756–758, 764, 771, 772–773f, 980–984f, 980–985 sutures in, 792 with triple arthrodesis, 758, 760, 767, 767f torsional malalignment in, 311 varus overcorrection-related, 742 Plantar fascia in planovalgus, 743 role in medial arch maintenance, 770, 770f Plantar flexion, 769f ataxia-related, orthotics treatment of, 140 premature, 727 in ankle equinus, 711–712, 712f Plantar flexion-knee extension couple, 317f Plantar flexor contractures, 726f Plantar flexor muscles equinus surgery-related insufficiency of, 717–722, 718–719f surgical overlengthening of, 721 Play chairs, 230, 231f Pleural effusions, postoperative, 484, 484f Plica, 696 Pneumonia aspiration, dorsal rhizotomy-related, 116 1047 Index fractures as risk factor for, 59, 60, 60f as mortality cause, 448 Pneumothorax postoperative, 484–485 spinal surgery-related, 468, 471 Polymicrogyria, 30 Pompe’s disease, 35t Pool walking, 813f, 814 Popliteal angle in diplegia, 359 in hamstring length measurement, 671, 673, 673f, 674, 676 measurement of, 53, 55f Porencephaly, 32 Positioning chair, for radiographic evaluation of scoliosis, 433, 434f Positive pressure nasal ventilation, postoperative, 483–484 Postoperative management, 81 commonly used medications in, 87–89, 87t Posturing, cervical, 505–506, 506f, 507f Premature infants, intraventricular hemorrhage in, 28 Prematurity, as cerebral palsy risk factor, 31 Preoperative assessment, 79 Pressure mapping, 216, 217f Pressure sores, 216 Primidone, 84t Primitive reflexes, 41–43f, 41–44 development of, 97 persistent, 43–44, 47 preoperative evaluation of, 838 relationship with high-functioning cortical motor activities, 152–153 Pronation, muscles involved in, 769f Pronator quadratus contractures, 401 myotomy treatment of, 408 Pronator tendon release, as forearm pronator contracture treatment, 407 Pronator teres contractures of, 401 myotomy of, 408 release or transfer of, 407, 408, 873–874f Prone hip rotation test, 611, 612f Prone standers, 56, 233, 819, 819f Propoxyphene, as postoperative pain treatment, 88 Proprioceptive neuromuscular facilitation (PNF), in aquatic therapy, 815–816 Proprioceptive reflexes, 41–43 Proteus infections, postoperative, 496 Protrusio acetabuli, 70, 70f, 594, 595, 595f windblown hip deformity-related, 603 Proximal interphalangeal joints fusion of, 427 hyperextended, splint treatment of, 185–186, 186f Proximal pronator flexor slides, 407 Pseudoarthrosis, spinal fusion revision of, 488f, 498–499 Pseudo-Galezzi deformity, windblown hip deformity-related, 605 Psychosocial skills, evaluation of, 838 Puberty, premature or prolonged, 76 Public Law 010-476, 168 Public Law 94-142, 168 Purdue Pegboard, 840 Pyruvate dehydrogenase deficiency, 37t Q Q-angle, 694 Quadriceps, 683 Quadriceps lengthening, as fixed knee extension contracture treatment, 692–693 Quadriplegia, 388 Achilles’ tendon lengthening in, 1003 bacterial meningitis-related, 38 definition of, 40 diagnosis of, 54 elbow flexion contractures associated with, 400 forearm pronation contractures associated with, 401 functional deformities associated with, 387 gait abnormalities associated with, 371–373 management of, 54, 56–68 osteomalacia associated with, 57, 58 osteopenia associated with, 57, 58 osteoporosis associated with, 57–58 patient management in of concurrent diseases, 77–78, 78t of gastroesophageal reflux and aspiration, 72–73 of low-energy fractures, 58, 59–66, 60f, 61f, 62f during maturation and puberty, 76 of neurological deterioration, 76–77 of osteoporosis and osteomalacia, 66–68 of poor peripheral blood flow, 75–76 of temperature regulation problems, 75–76 peroneal muscle in, 742 prevalence of, 39 scoliosis associated with, 436–452, 436f, 437f, 438f, 439f shoulder instability associated with, 397 windblown hip deformity associated with, 605 Quality of Upper Extremity Skills Test (QUEST), 834–835 R Radial head dislocation, 400–401 natural history of, 400–401 treatment of, 401, 402–405f Radiation therapy, for heterotopic ossification, 568, 574, 650 Radiography for gait impairment diagnosis, 285 for hip subluxation evaluation, 531, 532f pelvic, in Unit rod instrumentation, 477–478 Radius, fractures of, 408 Ragged red muscle fibers, 37t Range of motion, spasticity-related decrease in, 106f Range-of-motion exercises, passive, 124 Range-of-motion measurement, upperextremity, 388, 838–839 Reactive airway disease aspiration-related, 468 postoperative management of, 78–79 Recapitulation of species theory, 156 Rectus contractures, 685, 689 Rectus femoris contractures, 330 Rectus femoris lengthening, 599 Rectus femoris transfer, anterior thigh scars caused by, 790 Rectus muscle function of, 684 as knee stiffness/stiff gait cause, 326, 328, 328f, 684–685, 689, 689t Rectus transfer, 958–962, 959–962f in dystonia, 131 indication for, 684, 684f postoperative care in, 962 as stiff knee treatment, 326, 328, 328f, 689–690, 958–962, 959–962f Reflexes preoperative evaluation of, 838 upper-extremity, evaluation of, 838, 839t Reflexology, 175 Refsum’s disease, 37t Rehabilitation inpatient programs, physical therapy component of, 163–164 Rehabilitation techniques, 803–861 See also Occupational therapy; Physical therapy aquatic therapy, 811–816, 813f Bad Ragaz Ring Method of, 815–816 contraindications to, 814t, 815 Halliwick Method of, 815 multidisciplinary approach n, 816, 818 1048 Rehabilitation techniques (continued) pool design/accessibility in, 816, 816t, 817f precautions in, 814t Watsu, 815 assistive devices, 818–821 balance interventions, 808–809 electrical stimulation techniques, 809–810 horseback riding (hippotherapy), 123–124, 173–174, 810–811, 811t, 812f M.O.V.E.(TM) (Mobility Opportunities Via Education) curriculum, 828–831, 830f contraindications to, 829 muscle-strengthening exercises, 806–808, 807t, 808t Neurodevelopmental Therapy (NDT), 805–806 Resistive exercises, aquatic, 813–814 Respirators, wheelchairs supports for, 222 Respiratory chain disorders, 37t Respiratory compromise, postoperative, 81 Respiratory depression, diazepam/ morphine-induced, 88 Respiratory failure, postoperative, 483–484 Respiratory infections, postoperative, 490 Respiratory problems, spinal surgeryrelated, 468, 471 as death cause, 467 Rett syndrome, 27, 31 Rheumatoid arthritis diplegia-associated, 77 knee involvement in, 696 Rhizomelic chondrodysplasia punctata, 37t Rhizotomy, central, as spasticity treatment, 115–116 Rhizotomy, dorsal, 115–117 complications of, 116–117, 116f dural tears, 473 hyperlordosis, 461–463, 462–463f, 499 kyphosis, 453, 453f, 459–460 lordosis, 453, 460–464, 462–464f thoracolumbar kyphosis, 480–481, 480–481f contraindication in mild quadriplegia, 371 versus intrathecal pump-administered baclofen, 851, 857 as knee recurvatum treatment, 362 with laminaplasty, 116, 116f with laminectomy, 115, 115f, 116 Fazano technique in, 115, 115f, 453, 453f, 499 Index outcome of, 116–117, 116f posterior, as spinal deformity cause, 499 as windblown hip deformity treatment, 605–606 Rhythmic activities, as spasticity therapy, 124 Rickets, 58, 58f Riluzole, as spasticity treatment, 110 Ritalin See Methylphenidate Rood, Margaret, 155 Rood technique, 155 Rooting reflex, 41 S Salla disease, 35t Sandhoff’s disease, 34t Sanfilippo’s syndrome, 34t Sartorius muscle, 668 Sartorius muscle lengthening, as hip flexion contracture treatment, 599 Scar formation, knee wound infectionrelated, 790 Scheie’s syndrome, 34t Schizoencephaly, 28 School-based therapy, 164, 164f, 169–170 Sciatica, spinal fusion-related, 487 Sciatic nerve, proximal hamstring lengthening-related injury to, 679, 680 Sciatic nerve palsy, 134 knee capsulotomy-related, 680, 681 treatment of, 789–790 Scissoring gait, 331 control of, 188, 189f definition of, 334f differentiated from hip internal rotation gait, 333 quadriplegic gait-related, 372 Scoliosis, 108 armspan measurement in, 56 as aspiration risk factor, 485 diplegic pattern cerebral palsy-related, 499 etiology of, 433–434 flexibility assessment in, 446, 447f floor positioning devices use in, 232 gastroesophageal reflux associated with, 72–73, 485 hemiplegic pattern cerebral palsyrelated, 499 idiopathic, 437 idiopathic pattern of, 433 kyphosis associated with, 452 lordosis associated with, 457 lumbar, 436, 436f, 437f myelomeningocele, 443 natural history of, 434–435 neuromuscular pattern of, 433 prevention of with bracing, inefficacy of, 437 with thoracolumbar spinal orthoses, 440–442, 440f, 441f, 442f quadriplegia-related, 430–452, 436f, 437f, 438f, 439f radiographic examination of, 433, 434f, 436f, 438f positioning chair use in, 433, 434f seating methods in, 442 as spinal fusion revision surgery cause, 488–489 spinal instrumentation and fusion treatment of anesthesia during, 450 complications of See Spinal instrumentation and fusion, complications of end-to-end rod connector failure rate in, 469, 470f indications for, 446–447 intraoperative preparation in, 450 outcome of, 452 postoperative management in, 450–451, 451t preoperative preparation for, 449–450 preoperative workup in, 449 as revision surgery, 488–489 with Unit rod instrumentation, 436, 437f, 438, 439f, 443, 444–445, 444f, 452 tracheal collapse in, 485 treatment of, 435, 435f See also Scoliosis, spinal instrumentation and fusion treatment of with anterior spinal release, 451–452, 904 botulinum toxin, ineffectiveness of, 443 electrical stimulation, ineffectiveness of, 442 with hook and rod spinal instrumentation, 452 with posterior spinal fusion with Unit rod, 894–903, 895–903f in revision surgery, 488–489, 501, 503–504, 503–504f with spinal orthotics, 186–187 surgical, 443 with thoracolumbar orthoses, 440–442, 440f, 441f, 442f with Unit rod instrumentation, 436, 437f, 438, 439f, 443, 444f treatment refusal in, 502, 504 wheelchair adaptations for, 442 wheelchair seating in, 223–226, 224f, 225–226f windblown hip deformity-related, 600, 601, 606, 609 1049 Index Scoring scales, for cerebral palsy evaluation for functional ability evaluation, 834–836, 835t, 836t for overall evaluation, 836–838, 837f Screws, ankle epiphysiodesis, 979, 979f Seat belts, for wheelchairs, 218 Seating See Wheelchairs, seating Seating clinics, occupational therapists in, 166 Seating systems See Wheelchairs Seat restraint laws, 228 Sebaceous nevus syndrome, 28, 30 Second opinions, 15 Seizures antiepileptic medication treatment of side effects of, 57, 58, 66–68, 83–84, 84t in surgical patients, 79, 83–84, 84t, 468, 471 electroencephalographic evaluation of, 69 ketogenic diet treatment of, 89 postoperative management of, 78–79, 83–84, 84t in spinal surgery patients, 468 Self-injurious behavior, naltrexone treatment of, 87f, 89 Semimembranous muscle in knee flexion contractures, 669 in knee function, 669–670 Semitendinosus muscle in knee flexion contractures, 669 in knee function, 669–670 surgical lengthening of, 676, 678 transfer to the femur, 678 Sensory deficiencies, 46 preoperative evaluation of, 393 Sensory integration, assessment of, 838 Sensory integration approach, in physical therapy, 155 Sensory motor treatment, in physical therapy, 155 Sensory system, effect of aquatic exercise on, 813 Sepsis, postoperative, 490, 491 Shaken baby syndrome, 32–33, 33f Shiatsu, water-based version of, 815 Shoes, orthopedic, 182 Short stature, 76 Shoulder dislocation of, 397 painful, 397, 399 treatment of, 399, 833t elevation and protraction of, 395 excessive external rotation of, 831, 833t instability of, 397 treatment of, 399, 833t splints for, 833t subluxation of, 397 treatment of, 399 Shoulder adductor lengthening, 398, 865, 866–869f Shoulder contractures, 108, 394–397 extension and external rotation abduction, 395, 397 internal rotation, 395, 396, 396f natural history of, 395, 395f treatment of, 396–397, 396f Shoulder orthoses, 183 Shriners’ Hospital (South Carolina) Upper Extremity Test (SHUE), 835–836 Shriners’ Hospital System, 172 Shunts intraventricular, preoperative assessment of, 449, 450f ventriculoperitoneal implications for baclofen therapy, 854 as pain cause, 68, 69, 74 preoperative assessment of, 79, 80, 80f Sialidosis, 34t type 1, 34t Side bending test, 446, 447f Silfverskiold test, 708, 709f, 710 Sinusitis, 68–69, 69f, 74 Sinus tarsi implants, as planovalgus treatment, 760, 764 Sitting difficulties, kyphosis-related, 453, 454, 454f Skin breakdown effect of wheelchair seating on, 206 wheelchair footrest-related, 733, 736 Sleep disturbances postoperative, 85, 86f, 86t, 87t, 563 spasticity-related, 125 Slipped capital femoral epiphysis, 635 Sly’s syndrome, 34t Soccer, as therapy, 175 Societal limitations, 40 Soleus muscle contractures of Achilles’ tendon lengthening treatment of, 713–714, 1003–1004, 1003–1004f differentiated from gastrocnemius contractures, 708–709, 709f, 710 effect on gait, 319, 320 as subtalar joint collapse cause, 742 measurement of, 711 Somatosensory evoked potentials (SSEPs), intraoperative, 479 Somatosensory system, role in balance development, 808 Souque’s sign, 839t Space suit therapy, 176 Spasticity in adolescents, treatment of, 371 adverse effects of, 852 assessment of, 105 with Ashworth Scale, 104–105, 105f ataxia associated with, 137 athetosis associated with, 133–134 benefits of, 108–109 as chaotic attractor, 105, 106, 107–108 definition of, 47, 104, 852 differentiated from dystonia, 45, 104, 128–129, 374 in upper-extremity surgery patients, 394 dystonia associated with, 128 effect on bones, 108 effect on muscle, 106f, 107–108, 109 effect on nerves, 106–107 effect on tendons, 107–108 evaluation of, 141t, 838 functional effects of, 105–106, 108, 128 gait disorders associated with, 125 global, 124, 125 idiopathic, 31 local, 124–125 postoperative, 81 management of, 81–83, 83t prevalence of, 852 severe, 853 treatments for, 108–125 alcohol injections, 122 aquatic therapy, 811–812 baclofen, 853–857 botulinum toxin injections, 120–122, 120f, 121f, 124–125, 392–393, 852 dantrolene sodium, 119–120 dorsal rhizotomy, 115–117 115f electrical stimulation, 117–118 evaluation for, 124 global approach in, 124–125 horseback riding therapy, 174 intrathecal medication, 110–114, 113f local treatments, 124–125 muscle tendon lengthening, 122 myelotomy, 118, 119, 119f oral medication, 109–110, 109t orthotics, 123 phenol injections, 122 physical therapy, 123–124 surgery, 852–853 windblown hip deformity-related, 605–606 in young adults, treatment of, 371 Special education, 168–169, 171, 172 physician-educator relationship in, 170 1050 Special education (continued) relationship with medical system, 168–169 transitional planning in, 171–173 Speech impairment, athetosis-related, 133 Speech therapy, 151–152, 166 Sphingomyelinase deficiency, 34t Spielmeyer-Vogt-Sjogren disease, 35t Spina bifida, external rotation planovalgus collapse in, 704 Spinal cord, role in motor control, 96, 97f Spinal cord-mediated activities, relationship with primitive reflexes, 152 Spinal cord paralysis, as paraplegia, 41 Spinal cord stimulators, 16 Spinal deformities, 433–522 See also Kyphosis; Lordosis; Scoliosis comfort care for, 504–505 diagnosis and treatment algorithm in, 517t dorsal rhizotomy-related, 499 Spinal fusion See Spinal instrumentation and fusion Spinal instrumentation and fusion in ambulatory children, 499–500, 500f blood loss during, 501 in children on ketogenic diet, 89 as comfort care, 504–505 complications of, 465–505 acetabular perforation, 476–478 air embolism, 466 aspiration, 485 bleeding problems, 471–473 bursitis, 487–488 cardiac arrest, 466–467 coagulopathy, 483 colicystitis, 485–486 constipation, 486 crankshaft, 488–489 duodenal obstruction, 486 dural leaks, 473 floor or bed mobility decrease, 489–490 gastroesophageal reflux, 485 hair loss, 486, 487f hemorrhage, 466 hypotension, 482–483 during immediate postoperative period, 467 infections, 490–495 intraoperative, 468–482 mechanical problems, 487–490 mortality, 465–466, 467 neck stiffness, 489 nonunion, 488, 488f, 489f nutritional factors in, 467–468 operative wound infections, 490–495, 493–494f Index pancreatitis, 485 pelvic leg halos, 488 pelvic wall perforation, 473–474, 476 during perioperative transition time, 466–467 persistent fevers, 490–491, 493–494 pneumo- or hemothorax and pleural effusion, 484–485 poor nutrition, 486 poor nutrition as risk factor for, 465 postoperative, 482–495 proximal end prominence, 487–488 respiratory failure, 483–484 respiratory problems, 468, 471 rod fractures, 488, 489f rods of incorrect length-related, 478–479, 479f, 480–481, 480–481f self-limiting, 465 sitting height changes, 489 spinal cord dysfunction, 479, 482 spinal pain, 480–481f, 487 thromboembolism, 465 wire prominence-related, 487–488 wires pulling through laminae, 478 families’ refusal of, 502, 504 families’ refusal of blood transfusions for, 501–502 as gastroesophageal reflux treatment, 73 as kyphosis treatment, 456–457 as lordosis treatment, 458–459f posterior, postoperative femoral neck fractures associated with, 62, 65, 65f revision, 495, 497–505 of hardware failure, 499 of pseudoarthrosis, 488f, 498–499 of short spinal fusion, 495–497, 497–498f of torsional collapse, 444–445, 444–445f, 498 as scoliosis treatment, 443 in adolescents, 446 anesthesia during, 450 end-to-end rod connector failure rate in, 469, 470f family’s decision-making about, 446–447 Galveston technique, 443 indications for, 446–447 intraoperative preparation in, 450 Luque technique, 443, 444, 444f postoperative management in, 450–451, 451t preoperative preparation for, 449–450, 450 preoperative workup in, 449 Unit rod instrumentation, 436, 437f, 438, 439f, 443, 444–445, 444f in very young children, 446 somatosensory evoked potential monitoring during, 479, 482 in very small older children, 501 Spinal orthoses, 186–188, 187f, 188f thoracolumbar sacral orthosis (TLSO) bivalved, 187, 187f custom-molded, 440–441, 455–456 lumbar flexion jacket, 188, 188f soft, 186–187, 187f, 441–442, 442f weaning from, 813 Spinal pain, spinal fusion-related, 480–481, 487 Spinal procedures, 894-912 See also Spinal instrumentation and fusion anterior spinal release, 904–908, 904–908f baclofen pump implantation, 908–912, 909–912f posterior spinal fusion with Unit rod, 894–903, 895–903f Spine compression fractures of, 61, 64, 64f flexibility assessment of, 52–53, 52f, 53f physical examination of, 52–53 presentation as abdominal mass, 457 Splints/splinting Benik thumb abductor, 832–833, 834 dorsal wrist extension, 183–184 as elbow contracture treatment, 833t as elbow flexion contracture treatment, 399 as hamstring contracture treatment, 674, 674f, 676 for hand, 184–186, 185f, 186f, 391 nighttime ankle, for prevention of recurrent ankle equinus, 717 for swan neck deformity prevention, 426, 427f upper-extremity, 832–834 for contractures, 832–834 dorsal wrist cock-up, 832, 833t following muscle transfer surgery, 832 volar, 183–184 wrist, 183–184, 184f wrist cock-up, 840, 844 Spondylolisthesis, 508–509 dorsal rhizotomy-related, 116 lumbar, 508–509 athetosis-related, 134–135 laminectomy-related, 499 lordosis associated with, 457 as low back pain cause, treatment of, 188, 188f orthotic treatment of, 509, 510, 510f 1051 Index Spondylolysis, 509 cervical, 507 lumbar, 508, 509 athetosis-related, 134–135, 509 dorsal rhizotomy-related, 116 laminectomy-related, 499 as low back pain cause, 188, 188f Sports participation, 175 Stair lifts, 241 Standers, 232–233, 234f for quadriplegic patients, 371 parapodiums, 233, 235 prone, 233, 819, 819f for quadriplegic patients, 56 supine, 233, 234f, 819 for hypotonic children, 127 for quadriplegic patients, 56 upright, 819–820 weight bearing in, 64, 66 Staphylococcus aureus infections, postoperative, 494 Starvation, as surgery contraindication, 449 Stepping reflexes, 42–43, 43f Step reflex, 42–43, 43f Stereognosis, evaluation of, 838 postoperative, 844 Sterling’s sign, 839t Steroids as arthritis-related pain treatment, 653 as degenerative arthritis treatment, 563, 565 Stiff knee gait, 326–328, 350, 684–685, 689–690, 689t rectus transfer treatment of, 326, 328, 328f, 689–690, 958–962, 959–962f Stiffness, of hindfoot, varus deformityrelated, 741 Stimulants, 87t, 89 Stomach distention, 486 Stomach ulcers See Gastric ulcers Storage disorders, 33, 34t, 38 Strabismus, eyepatch treatment of, 158 Strengthening exercises, for muscle weakness, 308 Stretchers mobile, 448, 448f reclined, 226, 226f Stretching exercises as femoral neck fracture cause, 62, 65, 65f as low-energy fracture cause, 790 as windblown hip deformity treatment, 601 Stretch reflex, 104 Strohmeyer, Louis, 667, 708 Strokes, neonatal, 32 Strumpell’s pronation sign, 839t Subanterior superior iliac spine (SUBASIS) bar, 218–219, 218f Sublimis slip reinforcement, as swan neck deformity treatment, 891–893, 892–893f Subtalar and midfoot foot deformities, 722–733 equinovarus, 108, 723–733 etiology of, 722–723 Subtalar joint anatomy of, 743, 746, 746f arthrodesis of, 760, 762–763, 762–765f collapse of, 742 function of, 295 fusion of, 753, 756–757f, 756–758, 764, 979–985 as calcaneal valgus treatment, 777 complications of, 766, 768f indication for, 979 with internal fixation, 766 as planovalgus treatment, 730f, 771, 772–773f postoperative care in, 985 procedure, 980–984f, 980–985 in triple arthrodesis, 998, 999, 999f motion of, 295 valgus of, 667–668 Succinimides, as seizure treatment, 84t Succinylcholine, spasticity-related resistance to, 107 Sucking reflex, 41, 41f development of, 97 Sulfite oxidase deficiency, 36t Sunburn, effect on anterior thigh scars, 790 Supine position during intraoperative cardiac arrest, 473 scoliosis-related, 447 Supine standers, 233, 234f, 819 for hypotonic patients, 127 for quadriplegic patients, 56 Surgery complications of management plan for, 20 physician-family discussion of, 20, 21 recommendations for, 18, 20 Sutures, in planovalgus deformity correction, 792 Swallowing studies, 166 Swan neck deformity, 390f, 426–427, 831 finger and wrist extension in, 838 finger contracture treatment-related, 426 treatment of, 390f with volar plate advancement and sublimis slop reinforcement, 891–893, 892–893f Swan neck splints, 185–186, 186f Swimming for physical conditioning, 308 as therapy, 174, 810–811, 811t, 812f Symmetric tonic neck reflex (ATNR), 41–42, 838 Symmetry impulse index, 726 Sympathetic reflex dystrophy, 791 Synapses, formation and remodeling of, 30–31 Synaptic plasticity, 30 Syndrome of inappropriate antidiuretic hormone (SIADH), 483 T Talar plateau, in planovalgus deformity, 747f Talectomy, 725, 725f, 736 Talonavicular joint, 770 excision of, 992, 997 Talus, low-energy fractures of, 60 Tay-Sachs disease, 34t Tegretol, 83–84, 87t, 88–89 Tendon lengthening, 831 as hemiplegic gait treatment, 345–347 as spasticity treatment, 122 Tendons See also specific tendons effect of spasticity on, 107–108 Tenotomy Achilles tendon, 667 historical background of, 708 adductor, wound infections of, 636 of proximal gastrocnemius, 714–715, 715f of semitendinosus muscle, 676, 678 Tensor fascia lata muscle, as external rotator muscle, 619f Testicles, undescended, 74 Tetrahydrobiopterin deficiencies, 36t Tetrazepam, as spasticity treatment, 109t Therapeutic relationship with physical therapists, 12–13 with physicians, 13–15 dysfunctional, 14–15 Therapist assistants, 166 Therapy See also Occupational therapy; Physical therapy; Speech therapy acupuncture, 175 alternative medicine, 176–177 for athetosis, 135–136 hippotherapy (horseback riding), 123–124, 173–174, 810–811, 811t, 812f hydrotherapy (swimming), 174, 308, 810–811, 811t, 812f hyperbaric oxygen therapy, 176 martial arts, 175 massage and myofascial release therapy, 175–176 prescriptions for, 169–170 1052 Therapy (continued) space suit therapy, 176 sports, 175 Thigh-foot axis, measurement of, 53, 55f Thoracolumbar sacral orthoses (TLSO) bivalved, 187, 187f custom-molded for kyphotic patients, 455–456 for scoliosis prevention, 440–441 lumbar flexion jacket, 188, 188f for scoliosis prevention, 440–442, 440f, 441f, 442f inefficacy of, 440 soft, 186–187, 187f corset-type, 441–442, 442f weaning from, 813 Thrombin, 471 Thromboembolism, spinal surgeryrelated, 465 Thrombophlebitis, postoperative, 654, 656 Thumb cortical position of, 420, 422 functional development of, 387 metacarpal phalangeal joint fusion of, 886–887, 887f physical examination of, 388–389 Thumb abduction evaluation of, 840 palmaris longus or brachioradialis transfer treatment of, 890–891, 891f passive, 389 splint treatment of, 185, 186f Thumb adduction, 831 extensor pollicis longus rerouting treatment of, 887–890, 888–890f metacarpal with metacarpophalangeal joint flexion, 420 with metacarpophalangeal joint hyperextension, 420 with metacarpal extension, 418 Thumb adductor contractures, 389 Thumb adductor lengthening, 883–884, 883–884f Thumb deformities House classification system-based treatment of, 419–422, 419–424, 419f type deformity, 419–420, 421, 421f type deformity, 420 type deformity, 420, 422, 422f type deformity, 420, 422, 423, 423f splinting of, 832–833 surgical treatment of, 833t thumb-in-palm deformity, 389 diagnostic evaluation of, 418 Index natural history of, 418 treatment of, 419, 424 Thumb hyperextension, metacarpal, 422, 422f Thumb splints, 185, 186f Tibia fractures of during hip rehabilitation, 566 low-energy, 59–61, 62, 63–64 subtalar fusion-related, 766 torsional malalignment of, 108 Tibialis anterior in equinovarus foot deformity, 724 in foot stability, 769f in hemiplegic gait pattern type 1, 344, 344f in hemiplegic gait pattern type 2, 347 lengthening of, 1012–1014, 1013f in medial arch maintenance, 770f transfer of, in forefoot supination treatment, 993, 993f Tibialis anterior contractures, planovalgus-related, 750 Tibialis anterior transfer as midfoot supination treatment, 771 split operative procedure, 1010–1012, 1010–1012f as varus foot deformity treatment, 733, 740 as varus foot deformity treatment, 741–742 Tibialis posterior in equinovarus foot deformity, 723–724 in foot stability, 769f in hemiplegic gait type 2, 346, 347 transposition of, as varus foot deformity treatment, 740 varus deformity of, 131, 740 Tibialis posterior advancement, as midfoot supination treatment, 771 Tibialis posterior contractures, hemiplegic varus foot position associated with, 729 Tibialis posterior lengthening, 1004–1010, 1005–1010f as varus foot deformity treatment, 736, 740, 741–742 Tibialis posterior transfer, split operative procedure, 1004–1010, 1005–1010f as varus foot deformity treatment, 736, 737–739, 737–739f, 740 Tibial metaphysis distal, low-energy fractures of, 60 proximal, low-energy fractures of, 59–60 Tibial osteotomy with cast, 968–969, 969f as compartment syndrome cause, 792 foot-to-thigh angle as indication for, 318 with intramuscular nails, 970–971, 970f as peroneal nerve palsy cause, 792 as tibial torsion treatment, 700–704, 701–702f as vascular infarction cause, 791 Tibial shaft, low-energy fractures of, 60 Tibial torsion, 667–668, 696–704, 698f ankle equinus-associated, 711 ankle valgus-associated, 705, 706, 706f diagnostic evaluation of, 698–700, 700f diplegia-related, 359 external, 316 planovalgus-related, 749 femoral anteversion-associated, 622 foot progression angle in, 699–700 internal, 316 intrauterine positioning-related, 696, 698, 698f kinematic definition of, 699 measurement of, 311, 314 natural history of, 698 planovalgus-associated, 742–743 tibial osteotomy treatment of, 700–703, 701–702f complications of, 703–704 outcome of, 703 pre- and postoperative kinetics in, 701, 702f torsional malalignment in, 311 transmalleolar axis in, 699 transmalleolar axis-to-thigh angle in, 699, 700, 700f Tibia-to-fibula cross-union, tibial osteotomy-related, 704 Tilt boards, 234f Tizanidine, as spasticity treatment, 109t, 110, 853 TLSO See Thoracolumbar sacral orthoses (TLSO) Toe deformities, 667–668, 779 cock-up toes, 787, 788 of the great toe extended hallux, 784–788 hallux valgus, 779–784 of minor toes, 787–788 Toe dragging inadequate ankle dorsiflexion-related, 322 rectus transfer treatment of, 958–962, 959–962f Toe grasp reflex, 97 Toe grip reflex, 41f Toenails, ingrown, 788 Toe strike, as initial foot contact, 319 1053 Index Toe walking ataxia-related, 139, 140 ballerina-type, 777 diplegia-related, 352, 354–360, 712f, 737 compared with idiopathic walking, 712 mild, 352, 354 moderate, 354–355 severe, 355–356 treatment of, 356–360, 357f, 358f hemiplegia-related, 309, 310–311f, 345 as planovalgus cause, 748 Toilet seating, 230–231, 232f Tonic neck reflexes, 838 Top-Down Motor Milestone Test, 829 Total hip replacement, palliative, 568, 569–570f Toxic agents, as neurologic deficit cause, 38 Toxoplasma gondii, 38 Toy cars, battery-powered, 211, 211f Trachea, malacia of, 485 Tracheostomy, postoperative, 483 Transcutaneous electrical nerve stimulation (TENS), 157–158, 809 Transitional planning, 171–173 Transmalleolar axis, 698 measurement of, 53, 55f Transmalleolar axis-to-thigh angle, 699, 700, 700f Transverse plane deformities, of the hip, 333–335, 335f hemiplegic gait type 2-associated, 347 hemiplegic gait type 3-associated, 350 hemiplegic gait type 4-associated, 351 Trauma, as brain injury cause, 32–33, 33f Tremor, definition of, 45 Trendelenburg gait, 341, 341f Triceps release, 398 Tricycles, therapeutic, 241, 241f Trihexiphenidyl, as dystonia treatment, 119, 129, 130, 130f, 131 Trimethadione, 84t Triplegia, 40 Tromner’s sign, 839t Trunk, hyponia of, as kyphosis cause, 452–453 Trunk orthoses, for kyphotic patients, 455–456 Twins, cerebral palsy prevalence rate in, 39 Twister cables, 188–189 as femoral anteversion treatment, 624–625 Two-point discrimination test, 389 Tyrosinemia, 36t U Ulcers, on sole of foot, 791 Ultrasound for developmental hip dysplasia evaluation, 532 for femoral anteversion measurement, 532, 613–615, 614f, 616 for tibial torsion evaluation, 698–699 Unit rod instrumentation in ambulatory children, 500 as colon perforation cause, 474 as kyphosis treatment, 456–457 as lordosis treatment, 458–459f, 460–461, 462–464f, 463f pelvic leg-related halo effect associated with, 487, 488f as pelvic perforation cause, 473–474, 475f, 476–478, 477f acetabular perforation, 474, 476–478 lateral perforation, 474, 476, 477f medial perforation, 474, 475–476f as pleural effusion cause, 484f resistance to grand mal seizures, 468 rod fractures associated with, 488, 489f as scoliosis treatment, 436, 437f, 438, 439f, 443, 444–445, 444f, 452, 894–903, 895–903f end-to-end rod connector failure rate in, 469, 470f University of California Biomechanics Laboratory (UCBL) orthotic, 198, 200f Upper-extremity deformities diagnosis and treatment algorithm for, 428–429t functional classification of, 389–390 functional development of, 387, 388t functional evaluation of, 388 physical examination of, 388–389 surgical treatment of, 831–832, 833t occupational therapy evaluations following, 844–851, 849f, 850–851f occupational therapy evaluations prior to, 838–844, 841–844f Upper-extremity denervation, as dystonia treatment, 119, 119f Upper-extremity occupational therapy evaluations functional abilities evaluations, 834–836, 835t, 836t functional development evaluations, 391 functional evaluations, 834–836, 835t, 836t during adolescence, 391 during early and middle childhood, 391 goal setting in, 390–391 functional outcome prediction in, 848, 850 informational/instructional handouts in, 848, 850t, 851t overall evaluations, 836–838, 837f postoperative, 844–851, 849f, 850–851t preoperative, 838–844, 841–844f Upper-extremity orthoses, 182–186 elbow orthoses, 183, 184f hand and wrist orthoses, 183–184, 184f shoulder orthoses, 183 spinal orthoses, 186–188, 187f, 188f Upper-extremity reflexes, evaluation of, 838, 839t Upper-extremity surgical procedures, 865–893 age considerations in, 394 elbow flexion contracture release, 871, 872f extensor pollicis longus rerouting, 887–890, 888–890f flexor carpi ulnaris transfer for wrist flexion deformity, 874–880, 875–879f humeral derotation osteotomy, 869, 870–871f metacarpal phalangeal joint fusion of the thumb, 886–887, 887f palmaris longus or brachioradialis transfer to the abductor pollicis, 890–891, 891f preoperative evaluation for, 392 of intelligence and mental status, 393–394 occupational therapy-based, 838–844, 841–844f of sensory deficits, 393 of voluntary control, 393, 394f pronator teres release or transfer, 873–874f proximal row carpectomy and/or wrist fusion, 880–883, 880–883f shoulder adductor lengthening, 865, 866–869f spasticity control during, 392–393 thumb adductor lengthening, 883–884, 883–884f webspace lengthening and Z-plasty, 884–886, 885–886f Upper motor neuron syndrome, 852 Urea cycle disorders, 36t Urinary calculi, 74 Urinary catheterization epidural anesthesia-related, 81 as urinary tract infection risk factor, 82 Urinary incontinence, 74 Urinary retention, 74 dorsal rhizotomy-related, 116 intrathecal baclofen-related, 856 1054 Urinary tract infections postoperative, 82, 490 recurrent, 74 V Valgus, 696, 697, 697f cavus associated with, 776 of femoral neck, 524 determination of, 525, 527, 527f hip dislocation-associated, 525, 527, 527f, 529f of foot, 667–668 of forefoot, 769f of hindfoot, 743, 769f as bunion cause, 779 diplegia-associated, 743 of knee, 696, 697, 697f orthotic treatment of, 198, 200f pedobarograph measurement of, 283f of subtalar joint, 667–668 Valgus foot collapse, 729 Valium See Diazepam Valproate sodium, as intraoperative hemorrhage risk factor, 471 Valproic acid, 84t Vans, with wheelchair lifts, 489 Varicella zoster infection, in utero, 38 Varus, 696 in adolescents, 732–733 with the appearance of clubfeet, 725, 725f, 733, 736 fixed heel, 733, 734–735f of foot, 309 of forefoot, 724, 769f differentiated from hindfoot varus, 729f tibialis anterior transfer treatment of, 1010 of heel, 724 fixed, 733, 734–735f hemiplegia-associated, 729, 731, 732f tibialis posterior transfer treatment of, 736 of hindfoot, 724, 769f differentiated from forefoot varus, 729f stiffness associated with, 741 overcorrection of, 741, 742 pedobarograph measurement of, 283f with tibialis posterior and peroneal muscles, 131 tibialis posterior-related, 1004 treatment of, 727, 729 complications of, 741–742 with orthotics, 198, 736 with tibialis posterior tendon lengthening, 736, 740 Varus-valgus realignment, in combination with distal femoral osteotomy, 972 Index Vascular infarction, osteotomy-related, 791 Vastus muscle contractures of, 685 in knee flexion contractures, 684 Vault, 320, 320f, 321f Vestibular system effect of aquatic exercise on, 813 role in balance development, 808 Vests, weighted, 136 Vibrators, 124 Videotaping, in gait analysis, 276, 276f, 286 Viral infections See also specific viral infections prenatal and neonatal, as neurologic disorder cause, 38 Viscoelastic dampening, in muscle tone, 103–104 Visual system, role in balance development, 808 Vitamin B12 metabolism defect, 36t Vitamin D deficiency, 57 Vitamin D supplementation, 66, 68 Vitamin metabolism disorders, 36t Volar plate advancement, as swan neck deformity treatment, 891–893, 892–893f Votja therapy, 155–156, 175 V-Y lengthening, of quadriceps muscle, as fixed knee extension contracture treatment, 692 W Waking aids canes, 237–239, 240f, 820–821 contraindication in ataxia, 139 Walkers, 235–236, 235f, 236f, 237f front, 820 for hemiplegia type patients, 352 initial evaluation for use of, 818–819 mechanical lift, 831f posterior, 820 thigh and foot guide attachments on, 188, 189f Walking See also Gait balance deficits during, 138 neurologic control of, 99–100 prognosis for, 43–44 Walking aids, 235–239, 242t, 820 for ataxia patients, 139 canes, 239, 820–821 crouched gait patients’ use of, 363, 364–366, 364–366f crutches, 235, 237–239, 240f, 820–821 for ataxia patients, 139 gait trainers, 237, 238–239f, 240f, 820 walkers, 235–236, 235f, 236f, 237f Walking speed, velocity attractors in, 101 Watsu, 815 Webspace lengthening, 884–886, 885–886f Weight bearing effect on bone growth, 57–58 in spasticity, 108 in standers, 64, 66 Weight gain, adverse effects of, 77 Weight measurement, 56 Weights, therapeutic use of, by athetosis patients, 136 Wheelchair lifts, 229 Wheelchairs, 200–232, 821–828 abduction wedges on, 217–218, 218f abductors on, 822t anterior knee blocks on, 227, 227f anterior knee pads on, as windblown hip deformity treatment, 603, 605, 607f armrests on, 214, 214f attachments on, 222 backrests on, 824t base of, 206, 216, 216f standard, with large wheels, 207–208, 207f standard, with one-arm selfpropelling feature, 209 standard, with small wheels, 207 stroller-base, 203–205, 203f, 206–207 for blind children, 210 children’s attitudes toward, 200, 201 for children who are dependent in all transfers, 205–206 for children who are exercise ambulators/transfer standers, 204–205, 205f for children with some ambulatory ability, 203–204 for clubfeet patients, 733, 736 cosmetic appearance of, 222–223 cost of, 826f crutch holders on, 222 cushions on, 825t desks on, 231–232 documentation of medical need for, 823–824, 827–828 effect on cardiovascular endurance, 307–308 effect on walking ability, 200–201, 208, 208f, 208t foot buckets on, 733, 736 foot positioners on, 825t footrests on, 213–214, 213f as skin breakdown cause, 733, 736 frames of, 213, 213f guidelines for, 821–823t for hamstring contracture patients, 228 headrests on, 221, 221f health insurance coverage for, 207, 223 for hemiplegia type patients, 352 1055 Index for hip disorder patients, 227–228 hip guide restraints on, 216 hip guides on, 822t inappropriate, 202 knee adductors on, 822t knee blocks on, 822t for knee flexion contracture patients, 228 as knee flexion contracture risk factor, 671 for kyphosis patients, 227, 227f, 453–454, 456f lap trays on, 205, 205f, 222, 826t for kyphotic patients, 455, 456f laterals, 821t for lordosis patients, 227 low-energy fracture occurrence in, 61–62 Medicaid coverage for, 207 parental attitudes toward, 200–201 for pelvic obliquity patients, 228, 512 pelvis positioning straps on, 823t postoperative adjustments on, 451 power, 209–213 battery-powered toy cars as, 211, 211f controller mechanisms of, 209–210, 210f criteria for, 211t use by athetosis patients, 135–136 wheel base of, 212–213, 212f prescriptions for, 202–203, 223, 243–244t for scoliosis patients, 223–226, 224f, 225–226f, 442 seatbelt rigidizers on, 823t seat belts and restraints on, 218–219, 218f, 823t seating, 214–221, 214f for anterior trunk support, 219–221, 220f for back support, 204f, 219 back-to-seat angle of, 222 barrel-shaped, 229 base for, 216, 216f as bath chairs, 231, 233f with closed-cell t-foams, 216 customized modular, 214–215, 216 durability of, 222–223 feeding seats, 230, 230f for foot deformity management, 228 formfitting, custom-molded, 214–216 with gel pads, 216 inappropriate, 214, 214f for lateral trunk support, 219, 220f as play chairs, 230, 231f pressure mapping of, 216, 217f seating clinics, 201–202 toilet seating, 230–231, 232f shoulder harnesses on, 220–221, 822t for kyphotic patients, 453, 454, 455 shoulder retractor pads on, 822t shoulder straps on, 822t special, 229–232 for spinal deformity patients, 489 summer/winter bracket hardware on, 821t swing-away hardware on, 821t during transportation, 228–229, 229f trunk positioners on, 822t van lifts for, 489 for windblown disorder patients, 227–228, 227f for windblown hip deformity patients, 603, 605 Wheelchair swings, 241, 241f Wheelchair vans, 229 Wilson disease, 37t Windblown hip deformity, 600–607 abduction contracture treatment in, 940–943, 941–943f adducted posture in, 607–608 coxa valga associated with, 620 etiology of, 600 in asymmetric neurologic involvement, 600, 601, 602 in symmetric neurologic involvement, 600–601 hip reconstructive surgery-related, 551, 552–553f treatment of with abductor lengthening, 940–943, 941–943f in adolescence, 602–603 in adults, 603 indications for, 602 in middle childhood, 602 with muscle lengthening, 602–603 with orthotics, 603, 605 with tone reduction, 605––606 wheelchair seating management of, 227–228, 227f Wolff’s law, 620 World Health Organization, “Classification of Impairments, Disabilities, and Handicaps” report, 39, 40, 40t Wound infections baclofen intrathecal pump-related, 112–113, 113f on the feet, 792 in the knee, 790 postoperative, 490–495 acute deep, 491–495, 493–494f antibiotic therapy for, 491, 493, 494, 495 as fever cause, 490–491 hamstring lengthening-related, 678–679 hip reconstructive procedures-elated, 559–562, 561f hip subluxation surgery-related, 545–546 hip surgery-related, 635–637 physician-patient discussion of, 21 superficial, 491 Wrist contractures, 108 Wrist deformities, surgical treatment of, 833t Wrist extension patterns of, 393 physical examination of, 388, 389f Wrist extension contractures, 410–418 finger flexion contractures associated with, 410, 412 treatment of, 410–418 Wrist flexion, range-of-motion in, 838 Wrist flexion contractures, 396, 396f, 408–410, 831, 833t finger flexion contracture-associated, 424, 425 flexor carpi ulnaris transfer treatment of, 874–880, 875–879f natural history of, 409 orthotic treatment of, 182, 183–184 severity classification, 409 treatment of, 396, 396f, 410–414, 411f, 412f, 413–414f, 424 treatment-related complications in, 415, 418 Wrist fusion, 880–883, 880–883f as wrist extension contracture treatment, 413–414, 413–414f, 415 as salvage procedure, 418 Wrist orthoses, 183–184, 184f Wrist splints, 832, 833t postoperative, 840, 844 Y Young adults back-kneeing in, 370 crouched gait in, 362–371 treatment of, 363–370 occupational therapy for, 165–166 physical therapy with, 163 Z Zellweger syndrome, 37t Z-lengthening of biceps, as elbow flexion contracture treatment, 400 as finger flexion contracture treatment, 425 of gastrocnemius, as ankle equinus treatment, 713–714, 714f of quadriceps, as fixed knee extension contracture treatment, 692 of semitendinous muscle, 678 as varus foot deformity treatment, 740 Z-plasty, 884–886, 885–886f for web space deepening, 420, 421 .. .Cerebral Palsy Freeman Miller, MD Co-Director, Cerebral Palsy Program Alfred I duPont Hospital for Children Nemours Foundation Wilmington, Delaware Cerebral Palsy With CD-ROM... 0-387-20437-7 (hc : alk paper) Cerebral palsied children—Rehabilitation Movement disorders in children Cerebral palsy I Title [DNLM: Cerebral Palsy? ??rehabilitation—Child Cerebal Palsy? ??surgery—Child Disabled... with cerebral palsy How to Use This Text and CD The text of Cerebral Palsy is set up in three sections, with the first section containing 11 chapters that deal with specific aspects of cerebral palsy