Although the injury to the brain
is static and non-progressive, clinical effects and symptoms
of CP, such as increased muscle tone, and the impact on
functional ability may be subject to change as children
develop and their nervous systems mature.
Spasticity may also evolve over time.
Below the age of 5 years, contractures are rare with spasticity
often presenting as intermittent episodes, relaxed during
sleep and rest, but aggravated when stimulated or when
the child is ill. Around the time of the first growth spurt
from 8 to 10 years of age contractures can become a feature.
These contractures can cause the joints to become stiff,
affect their range-of-movement making posture, seating,
positioning and general handling difficult.
In general, the lower limbs,
ankles and knees are affected first. This leads to the nearly
constant feature of the “equinus foot”. The
heel can’t be put on the floor and the child tiptoes.
Later the anklebones displace. Knees and hips follow by
bending. The effect in the upper limbs is less noticeable
at the start but soon wrists and elbows become flexed,
sometimes to the point that the hands are no longer functional
and the elbow can no longer be stretched.
BEGAN RECEIVING ITB THERAPY: Age 12
HISTORY: “Before I had my baclofen pump I was very stiff, extremely uncomfortable and I needed to have botulinus injections in both arms as my elbows kept dislocating and my arms would get stuck in awkward positions. I was also unable to use my communication aid as I could not use my switches. I was very unhappy as everything was so difficult for me as I was so stiff and sore.”
OUTCOME AFTER RECEIVING ITB THERAPY: “After getting my baclofen pump I was much more comfortable, it was easier for my parents to do my personal care and position me in my wheelchair. I no longer needed the botulinus injections as my elbows no longer dislocated and I could use my communication aid as I am able to use my switch.”
COMMENT: “I would not like to be the way I was before I had ITB Therapy. I was miserable, sore and uncomfortable. Now I am happier, more comfortable and it is easier for my parents to help me.”