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Spasticity, which is seen in 12 million people around the world, is also frequently seen in our country. Spasticity, which becomes more difficult to treat when late German Hospital Neurosurgery Specialist Contact Salih directly aksine Contrary to popular belief in society, not every spastic child has mental retardation. However, in some cases learning disabilities, mental retardation, referral, vision and hearing problems may accompany the disease. ”
: What is Spasticity?
Dr. Salih Bilgiç: Spasticity is the increase in the consistency of the muscles due to damage to the brain or spinal cord. As a result, the patient's mobility is limited and painful spasms occur.
: How does this damage occur?
Dr. Salih Bilgiç: Electrical stimuli that enable the movement of the muscles originate from the brain's motor field. These electrical impulses reach the muscles through the spinal cord and peripheral nerves. Spasticity is a symptom of central nervous system damage.
Diseases causing spasticity:
Spinal cord diseases (traumatic injuries, tumors, hereditary diseases)
• Serbral palsy
• Multiple sclerosis
• Amyotrophic lateral sclerosis
• Traumatic brain injury, brain tumors, brain abscesses and infections
• Prolonged oxygen deficiency of the brain
• Paralysis caused by bleeding or clots.
: Does a spastic child have a mental problem?
Dr. Salih Bilgiç: Contrary to popular belief, not every spastic child has mental retardation. However, in some cases learning disabilities, mental retardation, referral, vision and hearing problems may accompany the disease. A hyperactive holding reflex causes the baby's hands to form a well-clenched fist. As the baby grows, the arms and legs become more spastic and solid. The disease may involve both arms and both legs. If this is the case, there is usually some degree of intelligence delay. Convulsions are common. If the disease involves all arms and legs, but the arms are affected to a lesser degree, this is known as diplegia (bilateral paralysis). It can also be seen that children with diplegia use their hands quite well. Intelligence levels are usually normal or close to normal, but they may face some difficulties in learning to draw and write letters. One third of all children with cerebral palsy suffer from spastic hemiplegia (paralysis, half paralysis). Although children with spastic hemiplegia usually have a level of intelligence that falls into the sub-normal group, some children in this situation may have moderate or even higher levels of intelligence.
: How often is it seen?
Dr. Salih Bilgiç: The incidence of spasticity is unknown. However, it is estimated that there are over half a million patients in the United States and over 12 million in the world.
: What are the considerations in early diagnosis?
Dr. Salih Bilgiç:
• Delay in sitting, crawling or walking according to peers
• Muscles too hard or too loose
• Low mobility according to peers
• Muscle weakness and insufficient muscle control
• Presence of reflexes that should not be present
• Difficulty in maintaining balance
• Suction and swallowing problems
: How is the treatment applied?
Dr. Salih Bilgiç: Treatment of spasticity requires a multidisciplinary approach. The follow-up of a child with spasticity is carried out jointly by many branches such as pediatrician, pediatric neurologist, physiotherapist, pediatric development specialist, psychologist, speech therapist, neurosurgeon and orthopedist. Spasticity should be treated if it disrupts daily functions, positioning, self-care activities, and painful spasms disturb the patient. Treatment approaches in spasticity treatment include physical therapy, pharmacological treatment (local or systemic) and surgical treatment.
: What does intrathecal baclofen pump mean?
Dr. Salih Bilgiç: An intrathecal baclofen pump is a battery-operated device that mediates the administration of the desired dose of baclofen muscle relaxant to the cerebrospinal fluid in the desired dose and for a long term. It is a very effective treatment method especially in patients with severe spasticity who do not benefit from oral baclofen and other drugs or cannot tolerate side effects.
With intrathecal baclofen pump application, spasm, pain regresses, mobility increases, speech, sleep quality, and urinary functions improve.
Intrathecal baclofen pump is thought to be given to the patient and baclofen is given in test dose by lumbar puncture. Methods can be applied to positive responders.
The pump is placed on the abdominal wall. The catheter at the end of the pump is advanced from the lumbar region to the region of the cerebrospinal fluid. The reservoir of the pump is filled with baclofen every 4-12 weeks depending on the drug dose. The battery life of the pump is approximately 5 years.
: What is the importance of physiotherapy before and after surgery?
Dr. Salih Bilgiç: The main principle of treatment is to soften the solid consistency of the patient and improve the quality of life of the patient before deformities due to spasticity develop. Especially in the period of 0-3 years under the supervision of a specialist in the correct treatment of children who have successfully applied to the surgical treatment of the success rate is increasing. The sooner the physical therapy process starts, the sooner the child regains its health. Although posture is prevented, spasticity can still occur in these children. In this respect, surgical intervention may be needed. However, surgical treatment is more successful because spasticity decreases. After the operation, the physiotherapist has big duties. Physiotherapist who is trying to solve preoperative spasticity should have a different treatment since postoperative spasticity is eliminated. Active resistance movements should be applied to the child during this period.