Cerebral palsy in childrenCerebral palsy in children

Prevalence:Prevalence: 3-4 / 1000; 3-4 / 1000;

Clinical forms: following evident motor Clinical forms: following evident motor involvement:involvement: spasticspastic: : diplegia;quadriparesia;Hemiplegia; diplegia;quadriparesia;Hemiplegia; triplegia;triplegia; ataxic;ataxic; dyskynetic: dyskynetic: dystonic; athetoid;dystonic; athetoid;Hypotonic;Hypotonic;

Prof Battisti O, Bot-Tox-a

Muscles contraction: relevant anatomyMuscles contraction: relevant anatomy

Cortex primary motor area

Basal gangliaBulbar reticular structurecerebellum

-

Adjacent structures

+

Alpha / gamma motoneurons of anterior horn

+

+

musclesSensory receptors:Muscles, tendons, bones, peritoneum

-

Posterior horn

+

+

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Prof Battisti O, Bot-Tox-a

Muscles contractions:Muscles contractions:1 nerve per motor unit, componed of 3-15 interlaced muscles fibers 1 nerve per motor unit, componed of 3-15 interlaced muscles fibers

that cann’t be individualized )that cann’t be individualized )

D membrane Pot

Release of Ac Cho

Na+ influx

SRE Ca++ efflux Troponin ( actin+myosin ) overlap=Muscles contraction

nicotin

Curare, Ach esterase

ATP, glycogen, Pcri = energy

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Prof Battisti O, Bot-Tox-a

Clinical presentationClinical presentation Motor involvementMotor involvement: spasticity, ataxia, : spasticity, ataxia,

dyskinesia, hypotonia;dyskinesia, hypotonia; Vision impairement and disorder of Vision impairement and disorder of

communicationcommunication Feeding disorderFeeding disorder EpilepsyEpilepsy Orthopedic disorderOrthopedic disorder Emotional and psychological Emotional and psychological

disturbancesdisturbances

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Prof Battisti O, Bot-Tox-a

Therapeutics in CPTherapeutics in CP

PhysiotherapyPhysiotherapy « castings »« castings » Botulinum toxinBotulinum toxin Intrathecal baclofenIntrathecal baclofen Improve daily life Improve daily life

functionfunction Mental patternMental pattern Self-esteemSelf-esteem NutritionNutrition PainPain convulsionsconvulsions

Increase in forceIncrease in force Increase in Increase in

dexteritydexterity Better movementsBetter movements Better equilibriumBetter equilibrium Better self-conceptBetter self-concept More More

independencyindependency

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Prof Battisti O, Bot-Tox-a

Muscles concerned by the injections: Muscles concerned by the injections: example for one side…example for one side…

Iliopsoas: 2 sites;Iliopsoas: 2 sites; Hamstrings: 4 Hamstrings: 4

sites;sites; Adductors: 2 sites;Adductors: 2 sites; Gastrecnomius: 4 Gastrecnomius: 4

sites;sites; Tibialis anterior: 2 Tibialis anterior: 2

sites;sites; Other:…Other:…

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Prof Battisti O, Bot-Tox-a

Then normal Then normal programprogram of physiotherapy of physiotherapy

But with another But with another energy and energy and motivation…motivation…

More interaction More interaction between infant, between infant, family, physio, family, physio, doctor, friends and doctor, friends and school;school;

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Prof Battisti O, Bot-Tox-a 8

Prof Battisti O, Bot-Tox-a

En « résumé »…En « résumé »…

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