Lenox D. Baker

A Rational Approach to the Surgical Needs of the Cerebral Palsy Patient

This paper, as stated in the introduction, is presented to redirect attention to a primary orthopaedic problem; to describe techniques to correct triceps surae dysfunction; to emphasize the importance of correcting deformities caused by spasticity or tension in the tensor fasciae latae; to point out deformities in the foot which can be corrected and controlled by the Grice bone block; and to emphasize the importance of correcting all deformities before instituting rehabilitation in the cerebral palsy patient. The examination of 977 cerebral palsy patients at the North Carolina Cerebral Palsy Hospital and an uncalculated number in associated clinics from February 1950 to May 1954 has afforded an opportunity to evaluate many cerebral palsy problems. The opinions expressed are based on the results seen following 590 operative procedures carried out in 186 patients. The type of surgery performed is shown in Table II. With the present widespread and professional lay interest in cerebral palsy, it is hoped that these and other well established orthopaedic surgical procedures can be used to the benefit of the cerebral palsy patient, and that new procedures will be developed that will further advance surgery in this difficult field.

Pathological Changes in the Hip in Cerebral Palsy: Incidence, Pathogenesis, and Treatment

The purposes of t.his paper are to emphasize the frequmemicy of coxa valga amid acetabular changes in the pat ient uiith cerebral palsy, to (‘all attentholmi t (I the forces that may cause such defonmuities, and to) stress the imuportance (If early (‘olrre(’tiomm of these forces iii t.hie prevention of deformities. The indications aum(l advantages of distal teliotolniy of the gnacilis amid medial hiamst nimig teiidomis in the corre(’t i(IIi of (Ifl (If the mnamiy def(Inmiiiuig forces on the hip in cerebral palsy will also 1)e discussed. Numnerous theories have beemt proposed as to the factolns that may o’ause pat hololgical changes in the hip in the patient uiith cerebral palsy. One theory (‘(1mmeerns the role that tractiomi l.y the hip abductors plays imi stimiiulating epiphyseal grouvth (If the greater t..rochantem’ amid shaping the coiitoumn of the neo’k of the femur.

Correction of Adduction, Flexion and Internal Rotation Deformities of the Hip in Cerebral Palsy

The current surgical treatment of hip deformities in cerebral palsy in the North Carolina Cerebral Palsy Hospital–Duke University Medical Center Program is described. Such procedures are rewarding when they are done in well‐selected patients and after thorough preoperative analysis of the patients neuromuscular potentials. The surgery must be combined with adequate preoperative and postoperative physical therapy, bracing, traction and splinting as needed. Surgical efforts must be combined with therapy for the childs other needs, such as correction of eye defects, treatment of speech disorders, formal education and occupational therapy.

Marie-Strümpell arthritis; follow-up study of roentgenographic, physical, and orthopaedic therapy.

From clinical observations it appears that the roentgen irradiation affects the cellular changes of Marie-Strumpell arthritis, but we have no evidence that. it affects the associated ossifying process once it is under way. In a series of 100 patients with Marie-Strumpell arthritis, treated by roentgenotherapy plus corrective measures, the results, based on relief of pain, range of motion, and roentgenographic changes, indicate that the therapy can be expected to give approximately the same relief from pain during any stage of the disease. Increase in range of motion can be expected in a fair percentage of the mild and moderately advanced cases. Although there is relief from pain, a decrease in range of motion and further ossification may occur. In the mild or moderately advanced cases, the process can be arrested and in some instances cleared by the roentgenotherapy. Of the forty-seven patients in the mild and moderately advanced groups, fifteen showed roentgenographic clearing of the bone changes; twenty-four sholved no change or advance in the disease; only seven showed advance with additional ossification. Comparison with the advanced group of thirty-two patients shows that roentgenographic improvement can be expected in the earlier cases more frequently than in the advanced cases, where the changes are no longer reversible.

Vitamin therapy in progressive muscular dystrophy: Vitamin B6, other factors of the B complex, and vitamin E

Summary When careful muscle tests were performed, no improvement was noted in six patients with progressive hypertrophic muscular dystrophy after administration of wheat germ oil, α-tocopherol, vitamin B6 orally and intravenously, and combinations of the vitamin B complex orally. In our small series we were unable to confirm reports of favorable results with these materials.

Surgery in the Rehabilitation of Cerebral Palsied Patients

‘There never has been and we doubt there ever will be adequaie guidelines by which surgical results can be evaluated in cerebral palsy patients. Statistical reports therefore are often inaccurate and worthless.’