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Reasons why Children with Spastic Cerebral Palsy move differently : a therapist view

A child born with an injury or lesion in the brain e.g. Cerebral Palsy starts life with lack of physiological flexion -(foetal position ) as a baby which results in weakening of muscles supporting posture in human (postural muscles) . When an infant attempts to move against gravity they recruit whatever muscles possible to move. The muscles which are mostly recruited are the phasic muscles which are multi joint muscles e.g.: Hamstrings & calves. The phasic or multi joint muscles overtime does postural muscles work where there are chance for muscle fibres to change type and gets adapted e.g. child bending elbow or hip or knee for stability and to function. In child with brain injury or lesion development generally start with floppiness and slowly physiological stress in the brain trigger firing of neurones at the spinal cord level resulting spasticity . This child move with over firing neurones all the time e.g. lifts head with the strong burst of neck extension and with increased effort from time to time, moves lower limb or legs in a whole synergy pattern with increased stiffness ( scissoring or crossing over legs), achieves sitting with compensation where the child initially learn to sit on their sacrum with holding shoulders in raised position and neck in extension . When learning transition the child with spasticity accommodates with the phasic burst of hip flexion and extends the head pushing back over the pelvis, and during floor movement the child prefers bunny hop and or drag the lower extremities behind, to pull to stand the child uses hands to support on furniture and drags the leg behind to balance the upper body, Eventually adapts standing and walking on an narrow base of support with either toes or knees hyper extended . OTHER POSSIBLE REASONS :

In our human body bio mechanically there are areas in the skeleton that are fragile or weaker and unstable this includes area of first cervical joint atlanto occipital joint, cervical thoracic joint C6-C7, C7-T1 (Lower Neck), and joint at the lower back L4-5 . When child with spasticity attempts to move against the gravity there are forces produced in the above unstable/weaker joints and this region becomes hyper-mobile and affects the structure as well where the child moves . Hence the movement eventually looks different from typically developing movement and becomes less efficient in spastic muscles.

This child results in hypokinesis 'Poverty of Movement' and end up with limited number of movement options resulting stereotypic movements which are always limited to Flexion and Extension without Rotation of the Trunk in their function . SPECIFIC TREATMENT STRATEGIES Focus on activating base of support from narrow to wide Gain muscle length than you strengthen , working in mid ranges and emphasis wide excursion of movement. Emphasis diagonal and rotational postures in movements activating the trunk muscles which is the centre to connect upper and lower extremity .

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