Chapter 25 Lower Extremity Surgical Intervention in Patients with Cerebral Palsy
Bone and Musculotendinous Procedures
Cerebral palsy (CP) is defined as a condition characterized by a chronic, nonprogressive disorder of movement or posture of early onset. It presents as abnormal control of motor function/coordination as a result of damage to one or more specific areas of the brain. The damage to the brain can occur during the prenatal, perinatal, postnatal, as well as the infancy period. The primary lesion is static; however, the manifestations can change, especially in the musculoskeletal system, because of muscle imbalances, growth, development, and the effects of gravity.
Rehabilitation Overview
Preoperative Considerations
Postoperative Considerations
The following pages provide postoperative guidelines following bone and joint tissue surgical procedures commonly performed at HSS for the management of CP. For the sake of clarity, only one anatomical deformity/surgery is presented at a time. The reader must realize that, characteristically, many of the deformities coexist in patients with CP and therefore multiple surgical procedures are typically performed simultaneously. The total rehabilitation course must reflect this and be coordinated/modified according to the surgical procedures performed on each individual patient. As always, the physical therapist should maintain open communication with the treating surgeon on how to progress each individual patient.
Varus Rotational Osteotomy
Rehabilitation Overview
Postoperative Rehabilitation of VRO: Phase I (Days 2 to 4) with Spica Cast
GOALS
Postoperative Rehabilitation of VRO: Phase I (Days 2 to 4) with Jordan Splints; No Casting
GOALS
PRECAUTIONS
Therapeutic Strategies
Postoperative Rehabilitation of VRO: Phase II (Days 5 to 21) with Spica Cast
Postoperative Rehabilitation of VRO: Phase II (Days 5 to 21) with Jordan Splints
PRECAUTIONS
TREATMENT STRATEGIES
Postoperative Rehabilitation of VRO: Phase III (Weeks 3 to 6) with Spica Cast-Cast Removal
Note: If there is adequate bone healing on radiograph at 3 weeks, the orthopedist may choose to remove the cast. Following cast removal, physical therapy will begin when prescribed by the physician.
TREATMENT STRATEGIES
Postoperative Rehabilitation of VRO: Phase III (Weeks 3 to 6) with Jordan Splints
Note: If there is adequate healing on radiograph at 3 weeks, the orthopedist may allow the patient to begin weight-bearing.
PRECAUTIONS
TREATMENT STRATEGIES
Hip Flexors Release
Surgical Overview
Rehabilitation Overview

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