Whenever cerebral palsy affected child does not start standing or walking at the 5 year of age & develops sever disability and then the affected child require intensive therapy as early as possible so that their potential for walking can be saved and they can be prevented from ending into permanent disability. If child is not able to stand & walk in spite of all physical exercises, then he surely have some problem that interfering in his walking ability. Reason can be spasticity & contracture, weakness in muscle, co contraction of muscle, bony deformity, misalignment of extremity & lots more.
All these children require good evaluation in making the etiology of his problem, therapy protocol & brace. If child don’t have contracture or malalignment of body then child should be managed by vigorous therapy. But if the cause of disability is persistent contracture & deformity then child will surely need some surgical intervention to correct that. Routine orthopedic surgery does not help much in these children. We are very cautious in doing surgery on muscles . We always prefer to do repeated examination of child along with gait analysis before embarking on surgery and even we reconfirm our surgical planning under anesthesia. now days we more focus on correction of deformity by bony surgery in place of muscle surgery so that weakness do not come. they need good post surgical therapeutic planning. Each child requires different set of therapy. In early phase (2-4 week) child need joint mobilization, relaxation exercises. Proper therapy will start after 4 week of surgery. Most of the children require good therapeutic exercise minimum for 6 month.
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