Orthopedic Surgery

Cerebral Palsy Care

We care for many children with cerebral palsy and offer the only cerebral palsy clinic in Philadelphia with interdisciplinary services. Our treatment team includes orthopedic surgeons; developmental pediatricians; physical, occupational and speech therapists; seating experts; consulting neurosurgeons; podiatrists; nurse practitioners and social workers.

Children with the greatest needs are cared for at Children's Seashore House, a medical care and rehabilitation facility at The Children's Hospital of Philadelphia for children with chronic illnesses and severe developmental disabilities.

Cerebral palsy musculoskeletal conditions

For more detailed information about the musculoskeletal conditions associated with cerebral palsy and their treatment options, visit our health information pages for:

Bracing and orthotics

About half of the people who have cerebral palsy need to use devices such as braces, walkers, or wheel chairs to get around.

Leg orthotics may help a child's walking and standing from an early age. An ankle-foot orthosis (AFO) or an MAFO (molded ankle-foot orthosis) fits in a shoe. The brace may serve one or more functions, including stretching the tight Achilles tendon and calf muscles, substituting for a weak muscle or providing a stable base of support for children who are just starting to stand. It supports the ankle and foot and reaches just below the knee.

Braces also may be used after certain surgeries until the surgical healing is completed.

Surgical options

Surgery for spasticity

Spasticity is the involuntary tightening of muscles in response to their movement. In cerebral palsy, the brain's control of the nerves that control movement is altered. Spasticity may be helped in several ways:

Muscle lengthening procedures

These procedures may be performed surgically to improve joint motion and gait (walking), and to prevent deformities.

In order to allow a child to stand up straight, the hamstrings — the large muscles on the back of the thighs, may be lengthened. The lengthenings are usually performed behind the knees, and involve cutting the tendons and allowing them to stretch.

The hip muscles (hip adductors) also may need to be released to treat problems with walking or hip subluxation or both. Surgery may be performed on both the muscle and bone to relocate the hip in the socket and help keep it there.

Selective dorsal rhizotomy (SDR)

This procedure seeks to reduce the spasticity of your child's legs by resecting (cutting) the dorsal roots of spinal nerves as they leave the spinal column. Here's how it works:

 Your child will be under full anesthesia in our fully equipped operating suites. An electrical device called an intraoperative EMG is used to guide the surgeon. The EMG electrically stimulates and records each dorsal sensory nerve ending that comes from the muscles entering the spinal cord. This allows our neurosurgeons to identify the nerve endings that are causing the spasticity. The neurosurgeon then cuts the severely abnormal sensory nerve endings and leaves normal nerve endings intact.

Once spasticity has been reduced by SDR, your child is likely to have notable improvements in motor function and balance. Common deformities such as hip subluxation, foot deformities and in-toeing may also be reduced. Our experienced neurosurgeons will perform the procedure.

Baclofen pump

Baclofen (LIORISOL) is an oral medication for the treatment of muscle spasticity. Baclofen works by blocking overstimulated neurotransmitters from the brain to the spinal cord.

Although the drug is easily absorbed when taken orally, the body's blood-brain barrier protects it from getting to its target — the spinal cord area. High concentrations of the drug are necessary to push it across the barrier, but the high levels also have undesirable side effects.

We have found that injecting Baclofen into the lower back is useful in treating both limb spasticity and limb spasms. If your child is felt to be a candidate for intrathecal (pump) Baclofen, we first will carry out a drug trial. If spasticity lessens without undesirable side effects, we can then implant a pump to periodically deliver the drug to the desired area. Our experienced neurosurgeons will perform the procedure.

Make an appointment

To make an appointment to have your child's condition evaluated, please call us at 215-590-1527.

  • Print
  • Share

Contact Us