- developmental
milestones,
- growth
spurts, and
- the
severity and topography of involvement.
This
discussion does not pertain to predominantly athetoid or ataxic
populations.
Continuum
Of Spastic Hemiplegia
Treatment For Children
Beginning
with the most conservative, this progression moves to the more
aggressive treatments for spasticity:
- NDT, PNF and other PT/OT maneuvers
- Inhibitory and support bracing to control musculo-skeletal
alignment and prevent deformity
- Serial casting to lengthen spastic musculature
- BOTOX® injections to temporarily paralyze spastic musculature
- TES, NMES, FES - electrical stimulation to build, facilitate
and functionally fire musculature (listed respectively)
- Selective
neurectomy to create a partial state of hypotonia in
spastic musculature
- Tendon/muscle
transfer for upper extremity to surgically balance spasticity
Conservative
Treatment Options
Conservative
treatments such as PT/OT maneuvers or support bracing should
begin as soon as spasticity is diagnosed. This will typically
mean stretching and developmental patterning.
Electrical
modalities have shown some promise in building weak antagonist
musculature (TES), facilitating antagonist musculature or fatiguing
spastic musculature (NMES) and for functional augmentation/training
during movement (FES), although use remains limited.
Serial
Casting And BOTOX®
If
spasticity is moderate to severe and begins to present both
static muscle shortening and patho-mechanical reach, grasp and
pinch; serial casting and BOTOX® are commonly used to stretch
out the spastic musculature.
Selective
Neurectomy And Tendon Transfer
Selective
neurectomy is used in spastic hemiplegia to reduce pronator
flexor dominated global upper extremity function. It is often
accompanied by facilitation and strengthening of extensors to
equate improved function.
A
tendon transfer is a surgical procedure that sometimes helps
to release and lengthen tendons. They often improve resting
posture, may reduce muscle grade and must be followed by extensive
physical therapy to maintain (if not improve) those patients
that have functional reach, grasp and pinch. Tendon transfers
attempt to aid function by relocating spastic musculature to
aid balance and movement.
Where
Is FirstFlex™ In The
Continuum?
FirstFlex™ is a conservative treatment option because it combines custom bracing and neuromuscular electrical
stimulation (NMES) for a "safe and effective" treatment for spasticity in children (according to a study by researchers
at the Kleinert Institute).
It
does not rely on pharmacological injections or surgical procedures
to achieve patient improvement.
In
summary, there are many other viable treatment options for addressing
Cerebral Palsy induced spastic hemiplegia. We believe, however,
that the FirstFlex™ treatment protocol is particularly
suited to improve global hand function for spastic hemiplegia
(hemiparesis).
Therefore,
FirstFlex™ is a conservative option that
should be considered prior to the more invasive alternatives.
Discover
more about the studies conducted
by the Kleinert Institute and promising results
in the reduction of deformity and spasticity.
You
can contact us for
videos, research studies, or for more information.
