Orthopedic

ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS

ORTHOPEDIC

Cerebral palsy is caused by an injury to the brain or abnormal brain development. Even though the injury is neurologic in nature, it produces affects to the body that are orthopedic in nature. Orthopedics is the branch of medicine that specializes in the condition of bones, ligaments, joints, tendons, muscles, and nerves. The primary orthopedic conditions most affected in cerebral palsy are:

• Muscle tone
• Movement coordination and control
• Reflexes
• Posture
• Balance
• Fine motor function
• Gross motor function
• Oromotor function

Cerebral palsy affects muscles and a person’s ability to control them. Sometimes the muscles contract too much, too little, or all at the same time. Limbs can be stiff and forced into painful, awkward positions. Fluctuating muscle contractions can make limbs tremble, shake, or writhe.

Balance, posture, and coordination can also be affected by cerebral palsy. For some, this makes tasks such as sitting, standing, rolling or walking difficult. Others have difficulty grasping objects or tying shoes. Various forms of cerebral palsy cause posture disorders that lead to spine curvature, hip dislocation, gait-abnormalities, and other conditions that affect joints and bones.

Impairment can differ from one individual to another. It can affect arms, legs, and even the face (oromotor). It can affect one limb, several, or all. It can affect one side of the body, right or left, as well as the upper or lower torso.

Treatment Plans are Comprehensive

The type of movement disorder; the location and number of limbs involved; and the severity of impairment will vary, but must be taken into consideration when designing a treatment plan. Other considerations include the individual’s age, functional ability, associative conditions, pain level, previous treatments, access to treatment, and family dynamics for rehabilitation.

Treatment will likely involve an interdisciplinary team of specialists, including, for example, an orthotist, orthopedic surgeon, pediatrician, physical therapist, occupational therapist, and speech and language pathologist.

Treatment techniques for orthopedic concerns may include physical therapy/physiotherapy, occupational therapy, massage therapy, surgery, medications, and orthotics. About 25% of children with cerebral palsy are unable to move on their own and will require equipment such as motorized wheel chairs or walking aids, while another 25% experience no significant movement impairment. The remaining 50% fall somewhere in between, and may require assistive technologies or adaptive equipment.

Orthopedic treatment goals for cerebral palsy often include:

• pain management
• minimizing impairment
• maximizing motor function
• achieving posture stability and balance
• increasing muscle strength
• optimizing muscle tone
• decreasing spasticity
• minimizing joint deformity while maximizing joint functionality
• optimizing oromotor functioning to eat properly and communicate
• achieving functional activities of daily living skills
• promoting self-care

Orthopedic conditions are the primary challenge in managing cerebral palsy. The number of impairments can affect quality of life. Identifying the conditions is the first step in optimizing the child’s health. Pain control and behavior towards treatment regimins can impact treatment success.

Common orthopedic conditions found in cerebral palsy include:

Every Child’s Condition Is Unique

The list of possible primary, secondary, and associative conditions, as well as co-mitigating factors, can be grouped into categories, but not all conditions will be experienced by an individual with cerebral palsy. Some may encounter conditions not listed, as well.

Cerebral palsy can take a mild, moderate, or severe form depending on a host of factors. The type, location, and extent of impairment are considered, as well as any associative conditions and co-mitigating factors, when creating a treatment plan. Over the course of the person’s life, he or she may encounter any number of associative or co-mitigating factors.

Cerebral palsy is non-progressive, meaning the brain injury or malformation will not progress in severity. However, secondary conditions resulting from the brain damage may develop and change over time. For example, brain injury can cause facial muscle impairment which doesn’t change over time. Chewing, swallowing and aspiration can occur when facial muscles are impaired. Aspiration can lead to pneumonia, and pneumonia is a health condition that can become worse or better over time.

Impairments can change with – or without – proper management. As a person ages, the muscular-skeletal structure may age prematurely depending on postural conditions, care, treatment and therapy. Other health conditions or life circumstances may also affect the individual’s condition over time. These can include access to health care, health insurance benefits, exposure to toxins, new health conditions, socialization, exercise, and traumatic accidents or events.

MyChild™ lists the possibilities in hope of providing families with a better understanding of the types of conditions – and categories of conditions – an individual with cerebral palsy may encounter over their lifespan. An overview of the different types of professionals likely to treat these conditions is also contained here. It should be noted that MyChild™ does not dispense medical advice. Any conditions your child may experience should be discussed with his or her medical team for proper diagnosis and treatment. In the case of emergencies, contact 911 immediately.

ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS Proper Terminology

Because the terminology used is so specific, yet remarkably similar, terms such as primary, secondary, associative and co-mitigating conditions are used interchangeably, yet incorrectly. It is helpful to know the difference between the terms when attempting to understand cerebral palsy.

Primary condition - These are a direct result of the brain lesion or brain malformation. Primary conditions affect motor coordination, motor control, muscle tone, posture and balance. Gross motor, fine motor, and oromotor functioning are also considered primary conditions of cerebral palsy.

Secondary condition - Primary conditions, in turn, may lead to secondary conditions such as inability to chew, inability to swallow, breathing difficulties, bladder and bowel control issues, and communication difficulties. If the brain lesion or malformation that caused cerebral palsy did not exist, these secondary conditions would not be present.

Associative conditions - Research has shown that individuals with cerebral palsy often have associative conditions not caused by the same brain injury or malformation which caused cerebral palsy, but proven to be common with individuals who have cerebral palsy. If the brain injury or malformation that caused the cerebral palsy did not occur, these conditions may still be present in the individual. Associative conditions include intellectual impairment, epileptic seizures, hearing impairment, and vision impairment.

Co-mitigating factors - An individual may also have health conditions separate from cerebral palsy. Unlike associative conditions, researchers have not concluded that these conditions have a high correlation to cerebral palsy. Co-mitigating factors exist regardless of cerebral palsy. Examples of co-mitigating conditions of cerebral palsy include autism, attention deficit hyperactivity disorder (ADHD), and asthma.

Associative Conditions and Co-Mitigating Factors

There are eight major categories of associative conditions and co-mitigating factors. To learn more about them, click one of the following:

• Associative Conditions
  and Co-Mitigating Factors
• Cognitive, Psychological and Behavioral
• Gastrointestinal, Nutritional and Dietary
• Neurologic
• Oral Health
• Orthopedic
• Respiratory
• Sensory
• Skin Health