Neuroorthopaedics Z. Rozkydal Cerebral palsy Obstetric paralysis Stroke patients Neuromuscular atrophies Spinal dysraphism (spina bifida occulta myelomeningocele, diastematomyelia Neurogenic artropathies Poliomyelitis Peripheral nerve palsy 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 Orthopaedic surgeon Psychology Social worker Prosthetics Orhopaedic procedures Hip joint Adductor 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 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 Therapy- physiotherapy 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 Noha- RST 1 Triplearthrodesis 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 C:\Users\PC\Pictures\EPFL 2.jpg Upper arm Recovery of upper arm function following stroke is a real problem. A high proportion of people who had 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 C:\Users\PC\Pictures\spinal cord stim 2.jpg C:\Users\PC\Pictures\spinal cord stimulation1.jpg Neurostimulation to stop pain C:\Users\PC\Pictures\EPFL 1.jpg C:\Users\PC\Pictures\EPFL 3.jpg C:\Users\PC\Pictures\EPFL 4.jpg Neurosurgical implantation Swiss researchers at École Polytechnique Fédérale de Lausanne (EPFL) and Lausanne University Hospital in 2018 their devices had restored movement to the legs of paraplegic patients with partial spinal injuries. Grégoire Courtine holds up the array that's implanted on the spinal cord of paralyzed patient.