Article

Patients with spastic cerebral palsy of the upper limb typically present with
various problems including an impaired range of motion that affects the
positioning of the upper extremity. This impaired range of motion often develops
into contractures that further limit functioning of the spastic hand and arm.
Understanding why these contractures develop in cerebral palsy will affect the
selection of patients suitable for surgical treatment as well as the choice for
specific surgical procedures.
The generally accepted hypothesis in patients with
spastic cerebral palsy is that the hyper-excitability of the stretch reflex
combined with increased muscle tone result in extreme angles of the involved
joints at rest. Ultimately, these extreme joint angles are thought to result in
fixed joint postures. There is no consensus in the literature concerning the
pathophysiology of this process. Several hypotheses associated with inactivity
and overactivity have been tested by examining the secondary changes in spastic
muscle and its surrounding tissue. All hypotheses implicate different secondary
changes that consequently require different clinical approaches. In this review,
the different hypotheses concerning the development of limited joint range of
motion in cerebral palsy are discussed in relation to their secondary changes on
the musculoskeletal system.

Langue : ANGLAIS

Tiré à part : OUI