Key Points
1. 
2. 
3. 
4. 
How do we diagnose and define Cerebral Palsy?
What is spasticity?
When should I refer my patients?
Where and who should I refer my patients?
Page 1
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Cerebral Palsy Definition
What is Cerebral Palsy?
1. 
2. 
3. 
First, cerebral palsy is the result of a lesion in the
immature brain, which is nonprogressive; it is a
static encephalopathy.
Secondly, cerebral palsy results in a disorder of
posture and movement, which is permanent
but not unchanging.
Third feature is that it results in progressive
musculoskeletal pathology.
Graham HK, Selber P. Musculoskeletal aspects of cerebral palsy. J Bone Joint Surg Br
2003; 85-B: 157-166. Page 2
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Spastic Diplegia
•  Affecting right and left side
equally.
•  Minimal spasticity in upper
limbs, lower limb spasticity
predominates.
•  IQ may be near normal.
•  Generally premature birth
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Spastic Hemiplegia
•  Perinatal stroke the most common cause of hemiplegic CP
•  Arms and legs on one side of the body affected, usually with spasticity
•  Most will walk, regardless of treatment.
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Spastic Quadriplegia
•  More diffuse brain lesion
throughout brain
•  All four extremities affected,
usually with spasticity
•  Typically more profoundly
impacted cognitively and
physically
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Key Points
1. 
2. 
3. 
4. 
How do we diagnose and define Cerebral Palsy?
What is spasticity?
When should I refer my patients?
Where and who should I refer my patients?
Page 6
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Page 7
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Movement Disorders-Spasticity
•  Spasticity is the most
common movement
disorder
•  Velocity dependent
resistance to stretch
•  The slower you move an
extremity, the easier it is
to perform range of
motion with that extremity
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Key Points
1. 
2. 
3. 
4. 
How do we diagnose and define Cerebral Palsy?
What is spasticity?
When should I refer my patients?
Where and who should I refer my patients?
Page 9
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Caveats
•  Children with cerebral
palsy are normal at birth
musculoskeletally.
•  Spasticity prevents normal
bone and muscle
development.
•  The earlier the better,
usually 2 years of age
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Key Points
1. 
2. 
3. 
4. 
How do we diagnose and define Cerebral Palsy?
What is spasticity?
When should I refer my patients?
Where and who should I refer my patients?
Page 11
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Key Strategies
Physical
Therapy
Medical Center
832.826.2138
Tenisha, RN
Woodlands
936.267.7245
Nicole, RN
Selective
Dorsal
Rhizotomy
Botox
SEMLs
Baclofen
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Orthotics
Who can we help?
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2 Different Populations…2 Different Goals
• Cognitively impaired,
total body involvement
•  Care and comfort
• Cognitively aware,
varying involvement
•  Improve functional
deficits
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Gait Lab
Dedicated space for evaluation of gait:
•  Optical motion capture cameras
•  Kinetic or force data
•  Kinematic or range of motion data
•  EMG
•  Energy Consumption
•  Video
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Page 17
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Conclusion
1
Early spasticity management reduces the need for
musculoskeletal surgery and improves outcomes .
2
Surgery should be reserved as a salvage procedure.
Properly done, excellent results.
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Right care. Right place. Right time.
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