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REVIEWS  UPPER MOTOR NEURON SYNDROME: EVALUATION AND TREATMENT OF SPASTICITY
Guest Editor: FRANCO MOLTENI
 Freefree

Europa Medicophysica 2004 June;40(2):145-56

Copyright © 2004 EDIZIONI MINERVA MEDICA

lingua: Inglese

Neuro-orthopedic management of the dysfunctional extremity in upper motor neuron syndromes

Hebela N., Keenan M. A. E.

Department of Orthopaedic Surgery University of Pennsylvania, Philadelphia, PA, USA


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Orthopedic sur­gery can ­help ­restore extrem­ity func­tion to ­many ­patients ­with ­upper ­motor neu­ron syn­dromes (UMN). Impairments are divid­ed ­into ­those ­that ­cause prob­lems ­with the ­active func­tion of the extrem­ity ver­sus ­those ­that ­impede pas­sive func­tion. Limb defor­mities com­mon­ly ­result ­from ­both dynam­ic (spas­tic) and stat­ic (con­trac­tu­ral) com­po­nents. Clinical exam­ina­tion sup­ple­ment­ed ­with dynam­ic elec­tro­myo­graph­ic stud­ies pro­vides the opti­mal infor­ma­tion for plan­ning the ­most effec­tive sur­gi­cal pro­ce­dures. In the ­upper extrem­ity, selec­tive length­en­ing of the shoul­der adduc­tors and exten­sors com­bined ­with ­elbow flex­or length­en­ing can ­improve for­ward ­reach. Lengthening of the fore­arm pro­na­tors and fin­ger flex­ors ­will ­improve ­hand use. In the low­er extrem­ity, stand­ing bal­ance is ­improved ­with wid­en­ing the ­base of sup­port by cor­rect­ing hip adduc­tion con­trac­tures and equi­nov­ar­us ­foot defor­mities. Improvement of ­knee flex­ion dur­ing ­swing ­phase by a rec­tus fem­or­is to grac­i­lis trans­fer ­will ­enhance the fluid­ity and effi­cien­cy of walk­ing. Correction of hip and ­knee flex­ion con­trac­tures ­will ­allow a ­upright pos­ture and dra­mat­i­cal­ly ­decrease the ener­gy require­ment of walk­ing.

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