Cerebral Palsy & Neuromuscular Disorder Program

Cerebral palsy is defined as a nonprogressive abnormality affecting the central nervous system that occurs during infancy or early childhood. This can be caused by either a developmental problem or an injury to the central nervous system. Cerebral palsy commonly results in a movement disorder that is expressed in a variety of forms, ranging from mild incoordination and muscle stiffness to disordered and uncontrolled movements in the trunk and limbs. Over time, the muscle stiffness can lead to muscle contraction, deformities in bone growth and dislocation of bone joints. Our program also manages other neuromuscular diseases that often require similar strategies and approaches.

A tendon is made up of very strong, specialized collagen fibers that attach muscle to bone. In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, the muscles can shorten, resulting in pain and deformity. When muscle-stretching exercises and medicines are not successful in alleviating this tightness, surgical intervention can be considered.

Tendon lengthening is a surgical procedure designed to partially or completely cut a tendon to create a longer, more functional one. Tendons that are commonly lengthened include the Achilles, hamstrings and hip flexors. Achilles lengthening allows for improved foot positioning and brace wear, hamstring lengthening permits extension of the knee and hip flexor lengthening allows for improved hip extension.

As tendon lengthening is a minimally invasive surgery that employs small incisions, the patient can frequently return home the same day. Tendon lengthening must be combined with stretching and bracing to be effective, but in many cases, it can significantly improve function and minimize deformity.

A tendon is made up of very strong, specialized collagen fibers that attach muscle to bone. In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, the muscles can shorten, resulting in pain and deformity. When muscle-stretching exercises and medicines are not successful in alleviating this tightness, surgical intervention can be considered.

Sometimes the tight muscles in cerebral palsy and other conditions result in a patient being unable to move a joint, such as the knee, elbow or wrist, from one position to another. Together with tendon lengthening, tendon transfer can be used to reroute a tendon so that it becomes helpful rather than harmful with respect to a desired movement.

A tendon transfer is a procedure designed to reroute the path of a given tendon from one part of the body to another. This enables a change to the movement pattern of a muscle as it contracts and relaxes.

As tendon transfer is a minimally invasive surgery that employs small incisions, the patient can frequently return home the same day. Tendon transfer is often combined with other treatment techniques, such as stretching and bracing. In many cases, this approach can significantly improve function and minimize deformity.

In cerebral palsy and other neuromuscular disorders, the muscles and their tendons may become tighter as a result of disorganized nerve signals to the muscles. Over time, muscles can shorten, resulting in abnormal forces across numerous joints. This, in turn, can lead to abnormal limb positioning and eventual joint dislocation. When muscle-stretching exercises and medicines are not successful, realignment of affected bones or joints can be considered.

An osteotomy is a surgical procedure designed to cut a bone to change its shape, length or alignment. Bones that are commonly osteotomized include the pelvis, femur, tibia and bones within the foot. Osteotomy and fixation of the pelvis and/or femur allow for improved positioning of the femoral head (ball) within the acetabulum (socket). Osteotomy and fixation of the tibia correct rotational alignment, helping the foot point in the proper direction. Osteotomy and fixation of the foot bones allow for better shoe and brace fitting and can help restore the typical appearance of the foot.

Surgery may require a short hospital stay or, in some cases, may be scheduled as an outpatient procedure. Sometimes casting or bracing is needed following surgery, which is determined on a case-by-case basis.