Cerebral palsy (CP) is a disease that develops due to brain damage that occurs in the baby for various reasons during pregnancy, birth or in the first years of life. Premature birth, high blood pressure during pregnancy, infections during pregnancy, blood incompatibility, difficult postpartum The main reasons include the baby's lack of oxygen, some infections and head trauma. Prenatal pathologies play a role in the formation of cerebral palsy in 70-80% of cases, and the most common cause is premature birth.
The brain damage that occurs is not progressive, but the resulting brain damage is not progressive, but secondary to this, muscle contractions called spasticity, balance, sitting problems. and gait disorders are progressive if appropriate treatment and rehabilitation are not applied.
The frequency of CP is reported to be 2 in every 1000 live births. While technology and modern medicine develop, the incidence of some diseases decreases, on the contrary, the incidence of cerebral palsy increases in parallel with the increase in the survival rate of premature children due to developments in neonatal intensive care conditions.
Cerebral palsy is primarily caused by children. It is a disease that requires multidisciplinary work, in which many departments contribute to the treatment, including neurologists, physical therapists, physiotherapists, orthopedists, ophthalmologists, and psychologists. In this sense, ensuring coordination between departments is very important in terms of both diagnosis and direction of treatment.
Joint stiffness and loss of movement, called joint contracture, due to muscle contractions (spasticity) that occur after brain damage in cerebral palsy, shortness of muscles and tendons, gait disorders, especially in the hip joint Joint dislocations, spinal curvatures (scoliosis) and bone deformities are common pathologies.
These pathologies are prevented as much as possible with physiotherapy, botox, orthosis and various medications until a certain stage of development, and permanent deformities are tried to be prevented. Surgical treatment is possible, especially before the age of 6. It is avoided in all cases, and the aim is to bring the child to a higher functional level by applying all kinds of non-surgical treatment to obtain muscle strength and coordination. However, surgical intervention for the hip joint is an exception here. Children with cerebral palsy have a normal hip structure when they are born, but as a result of excessive contraction of some muscles around the hip, semi-dislocation and complete dislocation of the hip may occur. In this case, if surgical interventions for the prevention and treatment of hip dislocation are necessary, they should be applied from infancy. In order to take early precautions, patients will have hip radiographs taken at regular intervals.
The timing of the surgical treatment to be applied in cerebral palsy, other than hip dislocation surgery, is very important. These surgeries are generally performed from the age of 5-6, with certain exceptions. While recurrence is common in early surgery, delay in surgical treatment may result in limited benefit from surgery. Surgical treatment applied at the appropriate time and with appropriate indication will contribute positively to the development of the patient's functional capacity, increasing walking balance and skills, and ensuring range of motion. Pre- and post-operative physical therapy. Evaluating the patient and planning the treatment process together with the treatment specialist and physiotherapists are of great importance in the success of the treatment.
It is also very important to involve the family in every stage of the treatment process and to provide information to the family in a way that they can understand.
Cerebral palsy can show very different clinical features depending on the time, location and severity of the brain damage. The disease can range from a patient with very mild contractions and walking close to normal to a patient who cannot walk at all, whose mental development is delayed and who is wheelchair-bound. It can manifest itself clinically with varying severity depending on the patient. Surgical treatment is not only aimed at enabling walking. Sometimes it is a surgery that only increases the distance between the legs, facilitates the necessary hygiene, allows the patient to lie in bed more comfortably, and relieves painful contractions. Even Rahi can have a great meaning for the patient and his/her relatives.
In the child with cerebral palsy, multidisciplinary decisions made as a result of patient-specific evaluations are applied correctly at the right time, adding new ones to the existing functions and taking the patient to a higher functional level. should be the main goal.
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