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Cerebral Palsy Treatments

Unknowns of Cerebral Palsy Treatments

In cerebral palsy and other conditions where spasticity is present (stroke, head injuries, etc), orthopedic surgical treatment is aimed at minimizing sequelae. Although this type of treatment does not address the aethiology, it can result in significant quality of life improvements. As a first step, a less aggressive approach is normally advised; it is when the patient condition fails to improve or even deteriorates that an advanced option is sought, always as indicated by experienced professionals. As long as properly indicated and carried out, medium to long term physiotherapy treatment can achieve good results, which allows for the best possible quality of life in each situation.

Many different patient or family factors have to be taken into account, making it difficult to determine both best treatment option and timing: financial resources, availability of therapies, diverse and sometimes exotic professional opinions and interpatient variability liken the decision-making process to standing at a crossroads. As medical services providers, we have always made it a point to consider a full range of alternatives and to keep up to date in order to offer our best service. We never “perform any surgery” just for the sake of it or for considering it the only valid treatment. Our first aim is to offer guidance at the crossroads to the extent of our ability and, when the situation goes beyond our expertise, we try to refer you to the appropriate health care provider, always in the best interest of patient and families. Among the varied alternatives, we have chosen to focus on the development and practice of a surgical technique which can sometimes lead to truly impressive outcomes. We have the necessary knowledge, a multidisciplinary team and the experience of hundreds of patients treated with very many different goals achieved among them.

The questions arising from this type of situations are many, but we will try to summarize.

What do we offer?
Basically, a minimally invasive surgical treatment to improve both spasticity and joint and muscle function. Depending on clinical condition and physical status, this surgical treatment is aimed at
Increasing the range of movement both in upper and lower limbs, which in turn leads to gait improvement and a greater number of physical medicine and rehabilitation options, thus facilitating the work of other health care professionals, mainly physiotherapists.
Helping reduce muscle pain, with prevention or improvement of antalgic posture.
Joint disorders prevention. This is perhaps a less striking benefit from the patient point of view, but useful to prevent or minimize dislocations or joint malpositions in the future.
Drooling reduction and swallowing improvement.

How is it performed?
Gradual fibrotomy, selective myotenofasciotomy or myofibrofasciotomy are surgical techniques and, as such, they are carried out in an operating room, usually under general anaesthesia without endotracheal intubation. The technique requires specially designed surgical instruments and it is performed by a surgeon with the assistance of trained nursing staff. As well as performing the surgery, it is the surgeon who determines the exact  procedure and extent as best indicated in each case.

Compared to other surgical techniques, what differences does it offer?
The main aim of this technique is complete or partial muscle or myofascial fibrosis removal, which in turns results in joint release and pain and/or function improvement. Neither lengthening nor shortening or transpositions are performed at all, either at a muscle, tendon or other soft tissues level. It is performed using specially designed surgical instruments which leave no scar; sutures are not needed and postoperative immobilization devices are not required.

What are the advantages over other techniques? There are several:
1- Postoperative care: it can be done at home with no need for special measures.
2- Low infection risk, since no significant open wounds or scars are produced.
3- Early return to daily activities. Both the minimal trauma caused and the non-use of immobilization devices allow for an easy and quick recovery.
4- Very low incidence of allergic reactions and overdose, since no drugs are injected locally.
5- Facilitation of rehabilitation techniques. Bed rest is not required and usually a few days are enough for gradually returning to previous activities.

What complications can be expected?
1 Local haematoma, which can usually be treated applying ice or bruise creams; if needed, specific medical treatment may be required.
2 In case of bleeding problems, appropriated treatment will be used both pre and postoperatively.
3 THOSE RELATED TO ANAESTHESIA, AS IN ANY OTHER SURGICAL PROCEDURE.

Which conditions can be treated?
The majority of our patients are either cerebral palsy ones or those with acquired brain injuries (stroke, road traffic accident sequelae, head injuries…) in which patient clinical status resembles cerebral palsy. We could classify them as follows:
Congenital brain damage with secondary spasticity: cerebral palsy, spastic paraparesis, diplegia, quadriplegia…
Acquired brain injuries: secondary to stroke, road traffic accidents, work related injuries…
Other clinical conditions. Sometimes this surgical technique results in an effective treatment for conditions that do not respond to less aggressive therapies such as those used in physical medicine and rehabilitation. In these cases, anaesthetic techniques other than general anaesthesia are often used (local anaesthesia, regional or epidural blocks…). Some examples are severe muscle contractures, myofascial chronic pain, fibromyalgia, chronic muscle pain, carpal tunnel syndrome.

What is the recommended age for intervention in cases of cerebral palsy, paraparesis or the like?
That is one of the issues the surgeon will address, taking into account your physical status and treatments followed at that particular moment. Since there are not two identical cases, there are not two identical answers. Best outcomes and fastest recoveries are usually obtained in early childhood (from three or four years of age)

What are the goals to be achieved?
That is another issue to be addressed in the outpatient clinic. Again, as there are no identical cases, there are no identical goals. We have already discussed the overall benefit the technique may provide, but particular outcomes vary in individual cases depending on patient condition as well as experience of the professionals involved. The surgeon will be able to provide you with an objective overview so that you can make your decision after receiving complete information from our multidisciplinary team.

What are our goals?
We aim at providing guidance to the patient and, if able to help, proposing suitable treatment. For this, we rely on a high level team of experts in our field, qualified professionals with wide experience worldwide who are committed to excellence and continuous improvement for better outcomes.

More info:  http://www.serviciosmedicosecon.com/en/

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