Neuroorthopaedics Z. Rozkydal •Cerebral palsy • •Obstetric paralysis • •Stroke patients • •Neuromuscular atrophies • •Spinal dysraphism (spina bifida occulta •myelomeningocele, diastematomyelia • •Neurogenic artropathies • •Poliomyelitis • •Peripheral nerve plasy •Cerebral palsy •Perinatal damage of CNS • •1-5 /1000 new born babies • •Causes: prenatal (rubeola, toxoplasmosis, cytomegalovirus, • drugs, alcohol) • perinatal (premature newborn, anoxia, • intracerebral bleeding) • postnatal (meningitis, encefalitis, injuries of the head) • • •Types •Spastic paralysis 50 % • •Athetosis 25 % • •Ataxia 7 % • •Tremor 1 % • •Rigidity 7 % • •Combinations 10 % • •Hemiparesis •30 % of all cases • •½ normal intelligence • •Good walking ability • N diparesis 1 •Diparesis •Both lower extremities are involved •more than upper extremities • •Retarded motoric and psychologic •development • •Strabismus •Scissors gait •Flexion and adduction contracture in hip •Flexion contraction of the knee •Equinosity of the feet, tip toe walking • N diparesis spastica 1 •Quadruparesis, triparesis •Severe paralysis of both extremities •Head nerves involvement, debilitated patients N quadruparesis 1 •Management •Neonatology •Pediatrics •Neurology •Physiotherapy •Ortopaedic surgeon •Psychology •Social worker •Prosthetics •Orhopaedic procedures •Adductos tenotomy •Transposition of adductor of the hip •Iliopsoas recession •Open reduction of dislocated hip •Varus osteotomy of the femur •Acetabuloplasty, shelf procedures •Osteotomy of the pelvis •Girdlestone •Schanz •THA • N tenotomie add 1 •Adductor tenotomy N atlanta 1 •Atlanta orthesis N tenotom 2 •Flexion contracture of the hip and knee joints •Before surgery, after surgery •Procedures in the knee region •Prolongation of flexors • •Transposition of distal insertion of rectus femoris muscle • •Eggers transposition of flexors • •Plication of patelar tendon • •Patellar advancement N koleno 1 •Flexion contracture of the knee joints N Baker 1 •Distalisation of patelar tendon- Baker procedure •Deformities of the foot Boha- deformity nohy •Pes varus •Pes valgus •Pes cavus •Pes equinus •Pes calcaneus •Pes equinovarus •Flail foot •Vertical talus N noha 1 •Deformities of the foot N noha 2 •Paralytic flat foot N noha 3 •Prolongation of Achillis tendon •Procedures in the foot •Prolongation of Achillis tendon •Vulpius •Strayer •Silverskiold •Transposition of tibialis anterior •Grice procedure •Dwyer procedure •Young procedure •Triple arthrodesis •Procedures for deformities of the toes •Clawing of the toe •Talipes calcaneus … N Vulpius •Vulpius procedure N grice 1 •Grice procedure Noha- RST 1 •Triple arthrodesis •Ryerson Noha- RST 2 Noha - RST 3 •Triple arthrodesis Noha- Lambrinudi •Triple arthrodesis Noha - pes equinus Noha pes equinus rtg •Equinus deformity Noha •Correction for equinus deformity N ruka 1 •Spastic hand in cerebral palsy •Releas of adduction and flexion •of the thumb • •Swan nack deformity correction • •Releas of flexion in the wrist joint • •Arthrodesis of the wrist joint • •Releas of flexion contracture •of the elbow • •Z prolongation of biceps muscle •Procedures in the hand N ruka 2 •Prolongation of flexors of the hand •Deformities of the spine •in neurological diseases •Cerebral palsy •Friedreich ataxia •Charcot- Marie- Tooth- Hoffmann •Poliomyelitis •Spinal muscle atrophy •Arthrogryphosis multiplex congenita •Duchenne muscle dystrophy N kyfoskoliosis s DMO •Kyfoscoliosis in cerebral palsy N kyfoskoliosis s DMO N artrogryphosis •Scoliosis in arthrogryphosis congenita N milwaukee •Millwaukee orthesis N skoliosa 1 •Luque technique •Obstetric paralysis of brachial plexus •Injury of the brachial plexus during birth • •Proximal type C4-C6 Erb- Duchenne • •Distal type C7-T1- Klumpke • •Total paralysis C4-T1 •Neurogenic artropathy •Severe damage of the joints •Limited feeling of the pain •and limited deep sensation • • •Syndrom of posterior columns •Tabes dorsalis •Syringomyelia • •Therapy- conservative • Artropatie- Charcot rtg Artropatie- Charcot rtg Artropatie Charcot •Neurogenic arthropathy • Neur, •Peripheral nerve palsy •N. medianus • •N. ulnaris • •N. radialis • •N. peroneus N perthes •Perthes procedure •New therapeutical tool in neurorehabilitation, •particularly for stroke patients and •spinal cord lesions patients • •Premise: repeating limb movements can help •to recover motor control. • •Initial trials of a robot-assisted arm •and shoulder exercises •were with sub-acute patients •with a localised lesion. •Robophysiotherapy, robot-assisted rehabilitation http://irr-nancy.fr/IMG/Image/LSCGaitTRAINERweb.jpg •Neuroplasticity is the basic mechanism •underlying improvement in functional outcome •after stroke and after spinal cord disease. •These patients benefit from using robots. • • •Principles of stroke rehabilitation: •high-intensity practice •multidisciplinary team care •task-specific training •repetitive practice of specific functional tasks • • •Robot-assisted therapy in combination with •conventional physiotherapy produces •greater improvement in gait function •than conventional gait training alone. • http://www.fondation-hopale.org/var/hopale/storage/images/media/images/kinesitherapie6/6109-1-fre-F R/kinesitherapie.jpg •Robotic rehabilitation therapy can deliver •high-dosage and high-intensity training, •making it useful for patients with motor disorders. • •Robotic devices used for motor rehabilitation •include end-effector and exoskeleton types. • http://www.rennes-atalante.fr/uploads/pics/BA_Healthcare_web_02.jpg •Upper arm • •Recovery of upper arm function following stroke •is a real problem. • •A high proportion of people who have a stroke •regain their ability to walk, •but only 14 per cent of people with the upper arm •problem. • •Positive impact of robotics and the efficacy •of electrical stimulation • http://images.mid-day.com/images/2014/mar/27C143101.jpg http://www.cmpr-pionsat.com/Files/62574/Img/20/reeducation.png http://www.lejournaldelorne.fr/files/2015/10/photo-test-v3-03-630x0.jpg •Wheel chair case