Publish Date: Sunday,26 April, 2009, at 12:27 PM Doha Time
Dr Shaarani: ‘Two to three years of age is the time to show an affected child to a surgeon
By Bonnie JamesSurgical interventions improve the quality of life of children with cerebral palsy, Hamad Medical Corporation’s consultant orthopaedic surgeon Dr Mohamed Shaarani said yesterday.“Surgery enables many wheelchair-bound children to be transferred to walkers and those who are crippled to get on to wheelchairs,” he explained to Gulf Times on the sidelines of the first cerebral palsy symposium in Qatar.
Children with cerebral palsy have spasticity (stiff or rigid muscles with exaggerated, deep tendon reflexes, for example, a knee-jerk reflex), which can interfere with walking, movement, or speech.“We elongate some muscles and cut some others to make them loose and allow movement and flexibility,” pointed out Dr Shaarani, also a consultant paediatric orthopaedic.
Between two to three years of age is the ideal time to show an affected child for the first time to a surgeon, he added.In a presentation about dental problems in cerebral palsy, Primary Healthcare Department’s senior consultant Dr Mutaz Ahmed observed that incidence of dental decay is higher in this group, mainly due to poor oral hygiene.“Dental caries, gum disease, malocclusion, enamel defects, increased incidence of dental trauma, drooling, and grinding of teeth are among the main problems,” he explained.The incidence of gum disease is three times more among those with cerebral palsy than in the general population. The affected group also have a higher rate of dental enamel defects.“The increased risk for dental trauma can be attributed to problems with balance and muscle weakness in legs,” Dr Ahmed pointed out.Giving sedation, including general anaesthesia, is a very important option when doing dental procedures on an individual with cerebral palsy, as it may otherwise be difficult to control the patient.Highlighting the significance of maintaining proper dental hygiene in those with cerebral palsy the senior consultant suggested that parents should be instructed by dentists in this regard.“Cerebral palsy patients should be seen by a dentist every six months,” Dr Ahmed recommended while observing that electric toothbrush can be very useful for them.
Radiology, seizure disorders, growth and nutrition, medical management of spasticity, roles of physiotherapy, occupational therapy, orthotic, speech therapy and dietician, and education were the other topics of presentations at the symposium.
Showing posts with label Orthopaedic. Show all posts
Showing posts with label Orthopaedic. Show all posts
26 April 2009
06 December 2008
New stapling treatment may help reverse scoliosis
Morgan Stanley Children's Hospital of NewYork-Presbyterian is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for young people with scoliosis, an abnormal curvature of the spine that is painful and can restrict breathing.
The Center for Early Onset Scoliosis, led by Dr Michael Vitale, sees about 400 patients per year under the age of 5 with the condition. Spinal stapling is one of a number of new techniques that promise improved outcomes.
Tens of thousands of children in the U.S. are diagnosed with scoliosis each year. When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine.
Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30?) who are still growing (girls up to age 14 and boys up to age 16).
"Stapling not only stops scoliosis from getting worse, but can even correct the curve," says Dr. Michael Vitale, chief of pediatric spine and scoliosis surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons. "While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis. "
Braces can be uncomfortable and embarrassing for children, notes Dr. Vitale. The custom-made plastic corset is usually worn all but one or two hours a day, and its tight fit presses against the stomach, making eating and any sports difficult.
Spinal fusion, too, has its drawbacks. "We recently presented evidence that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term," says Dr. Vitale, who presented the findings at the International Conference on Early Onset Scoliosis in Montreal. The study followed 27 patients who received spinal fusion, which permanently connects several vertebrae. After 10 years, their pulmonary function, measured by lung volume, and reported quality of life were significantly less than that of a healthy child.
"While stapling is very new," adds Dr. Vitale "it promises to have a major effect on how we treat young people with scoliosis." Additional therapies may include:
VEPTR. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient procedure.
Growing Rod. Attached to the spine and affixed to vertebrae at the top and the bottom, growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly allows lung development to occur to preserve a normal life span for the patient.
Scoliosis
Scoliosis is a musculoskeletal condition that primarily affects children and adolescents, in which there is an abnormal lateral curvature of the spine, causing the spinal column to bend to the left or right. The name is derived from the Greek word "skoliosis," which means "crookedness." Scoliosis affects approximately 3 percent of the population. The Adam's bend test is performed to gauge the amount of curvature a scoliosis patient has. Scoliotic curve is said to exist when the angle of the curve measure is at least 10 degrees. Curves of more than 40 degrees are considered severe. Most patients are diagnosed between ages 10 and 15, although those with severe cases may be detected earlier. Dr. Vitale is a proponent of school screening of adolescents for scoliosis, and authored an informational statement on the subject that was published in the January 2008 issue of the Journal of Bone and Joint Surgery. His position is shared by American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA) and the American Academy of Pediatrics (AAP).
http://www.nyp.org
The Center for Early Onset Scoliosis, led by Dr Michael Vitale, sees about 400 patients per year under the age of 5 with the condition. Spinal stapling is one of a number of new techniques that promise improved outcomes.
Tens of thousands of children in the U.S. are diagnosed with scoliosis each year. When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine.
Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30?) who are still growing (girls up to age 14 and boys up to age 16).
"Stapling not only stops scoliosis from getting worse, but can even correct the curve," says Dr. Michael Vitale, chief of pediatric spine and scoliosis surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons. "While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis. "
Braces can be uncomfortable and embarrassing for children, notes Dr. Vitale. The custom-made plastic corset is usually worn all but one or two hours a day, and its tight fit presses against the stomach, making eating and any sports difficult.
Spinal fusion, too, has its drawbacks. "We recently presented evidence that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term," says Dr. Vitale, who presented the findings at the International Conference on Early Onset Scoliosis in Montreal. The study followed 27 patients who received spinal fusion, which permanently connects several vertebrae. After 10 years, their pulmonary function, measured by lung volume, and reported quality of life were significantly less than that of a healthy child.
"While stapling is very new," adds Dr. Vitale "it promises to have a major effect on how we treat young people with scoliosis." Additional therapies may include:
VEPTR. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient procedure.
Growing Rod. Attached to the spine and affixed to vertebrae at the top and the bottom, growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly allows lung development to occur to preserve a normal life span for the patient.
Scoliosis
Scoliosis is a musculoskeletal condition that primarily affects children and adolescents, in which there is an abnormal lateral curvature of the spine, causing the spinal column to bend to the left or right. The name is derived from the Greek word "skoliosis," which means "crookedness." Scoliosis affects approximately 3 percent of the population. The Adam's bend test is performed to gauge the amount of curvature a scoliosis patient has. Scoliotic curve is said to exist when the angle of the curve measure is at least 10 degrees. Curves of more than 40 degrees are considered severe. Most patients are diagnosed between ages 10 and 15, although those with severe cases may be detected earlier. Dr. Vitale is a proponent of school screening of adolescents for scoliosis, and authored an informational statement on the subject that was published in the January 2008 issue of the Journal of Bone and Joint Surgery. His position is shared by American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA) and the American Academy of Pediatrics (AAP).
http://www.nyp.org
18 February 2008
Rotational movements fantastic changes occur
Over the last couple of days I have been browsing the web in my quest to learn more about endless possibilities of Living with Cerebral Palsy, I have a friend who is currently having Spider therapy you may of read about him anyway he is an inspiration to me and also inspires we more to want to achieve more myself. We chat quite a lot and compare our progress and I have even been in communication with the therapists there, they are as impressed with the things that have been happening to me of late.
This inspired me to want to find out as much as I can to how and why they things are happening the way they are, anyway I have sent out a few emails to different conductive education websites and physiotherapy sites and I am please to say have had quite an interesting response
One particular one has given me food for thought I sent out the following email out
Reciprocal walkers for people with CP
Please let me give you a little background as to what has been happening to me recently, I have Spastic Diplegia Cerebral Palsy since birth which effects mainly my lower limbs and a little in my arms although its not really that noticeable. I was also diagnosed with Neuromuscular Scoliosis in my 20's and under went a Posterior correction with Harrington rods and a spinal fusion T10-L5 in 2003 which was hugely successful and the best thing to happen to me as I have been pain free from the minute I woke in the recovery room and its great.
I have had different types of surgery throughout my life a lot of them were orthopaedic ones and in 2004 I had an athrodesis done of my left knee where it was fused straight and again was hugely successful and it has allowed me to walk again after many years of pain and not walking it is nice to be able to walk again with the frame.
Over the years I have walked with frames wheeled and non wheeled, crutches, and last October my physiotherapist and I decided to give a reciprocal walker a try as that to me seemed a more natural way of walking compared to the Zimmer frame I had been using, I maintained for a long time that it never felt right to me because it didn't feel to me that I was walking normally. The last year I started to use this frame and wow what a difference I can't quite believe what is happening. It took me a while to get used to the pattern but within the first week I was away I then noticed after a couple of days I felt totally different in myself all my spasticity had gone and has remained gone my movement has improved 100% and I can do more and more each day and cant quite understand why its happening my physiotherapist thinks I have been doing my own conductive education and it has open up nueropathways reconnecting making things happen as they should be.
In your work as a Neuro-Physiotherapist / conductor have you ever worked with reciprocal walkers with people with CP ?
I hope you don't mind me asking the question and would like to thank you for taking the time to read my email
And this is some of the reply that has interested me greatly:
I have not used the reciprocal walkers with any of my clients . I am interested to hear the difference that has made for you. I believe because it is creating rotation in your trunk and pelvis ,the rotation also crates eye movements side to side which reduces the spasticity. nearly all Dipelgia fix their eyes as they are walking. when the eye movement’s changes due to rotational movement’s fantastic changes occur
This inspired me to want to find out as much as I can to how and why they things are happening the way they are, anyway I have sent out a few emails to different conductive education websites and physiotherapy sites and I am please to say have had quite an interesting response
One particular one has given me food for thought I sent out the following email out
Reciprocal walkers for people with CP
Please let me give you a little background as to what has been happening to me recently, I have Spastic Diplegia Cerebral Palsy since birth which effects mainly my lower limbs and a little in my arms although its not really that noticeable. I was also diagnosed with Neuromuscular Scoliosis in my 20's and under went a Posterior correction with Harrington rods and a spinal fusion T10-L5 in 2003 which was hugely successful and the best thing to happen to me as I have been pain free from the minute I woke in the recovery room and its great.
I have had different types of surgery throughout my life a lot of them were orthopaedic ones and in 2004 I had an athrodesis done of my left knee where it was fused straight and again was hugely successful and it has allowed me to walk again after many years of pain and not walking it is nice to be able to walk again with the frame.
Over the years I have walked with frames wheeled and non wheeled, crutches, and last October my physiotherapist and I decided to give a reciprocal walker a try as that to me seemed a more natural way of walking compared to the Zimmer frame I had been using, I maintained for a long time that it never felt right to me because it didn't feel to me that I was walking normally. The last year I started to use this frame and wow what a difference I can't quite believe what is happening. It took me a while to get used to the pattern but within the first week I was away I then noticed after a couple of days I felt totally different in myself all my spasticity had gone and has remained gone my movement has improved 100% and I can do more and more each day and cant quite understand why its happening my physiotherapist thinks I have been doing my own conductive education and it has open up nueropathways reconnecting making things happen as they should be.
In your work as a Neuro-Physiotherapist / conductor have you ever worked with reciprocal walkers with people with CP ?
I hope you don't mind me asking the question and would like to thank you for taking the time to read my email
And this is some of the reply that has interested me greatly:
I have not used the reciprocal walkers with any of my clients . I am interested to hear the difference that has made for you. I believe because it is creating rotation in your trunk and pelvis ,the rotation also crates eye movements side to side which reduces the spasticity. nearly all Dipelgia fix their eyes as they are walking. when the eye movement’s changes due to rotational movement’s fantastic changes occur
Major Improvement beyond believe
Well like I said I couldn't wait for Monday and was it worth the wait, I just about amazed everyone in the department even my Consultant. I walked into the room and my Physio could believe how good I was walking. After we had had a discussion about it she checked out passively the movement of my hip, the last time I saw her I was really really tight but not this time, in fact she was shocked at the difference it was moving freely which is something that has never happened.
So much so that she went to get one of the other Physio's who has also seen me for one session to see if they could feel the difference and wow was the remark that's amazing what's happened? I said nothing I have done nothing different other than use the new frame. Well that was it I had dumb struck them both.We all then went into the gym, and as you know from the rest of my blog I enjoy using the gym. I virtually ran to the bars it was unreal. Then the fun started, my Physio presented me with 2 walking sticks, but rather than stand them on the floor to walk with they were put out in front of me like having the bars either side of me and then I had to walk towards her. I set off a bit hard at first then had a few more goes and seemed to go ok. Then we decided ok that's it time to try the crutches, I smiled and waited, this is what I have wanted to do for a long time.
Well that was it my Physio supported me from behind and the other Physio that was with us give slight support from the side, but nevertheless we were off it was if I was walking again holding nothing at all, didn't even feel like I was putting any weight through the crutches, before I knew it I had walked to the end of the gym and turned around and was heading for the stairs.My next task I wanted to try was the stairs, you may recall reading an earlier entry about how I have been able to step up and down on a step, this time I wanted to try the actual stairs. With the help of both Physios’ I started off managed the first step that was not too bad then before I knew it I had got to the top and had turned and was coming down.
Then I took off again with the crutches across the gym to the bed.My Physio then went off in search for my Orthopaedic Surgeon, who I have know from many many years, to let him see me in action, and he was so pleased.My Physio could not believe what was happening, "I can't work it out, I don't have an answer for it yet, but I'm going to post to the Chartered Society of Physiotherapy website to see if anyone had experienced the same" "It must have something to do with the nueropathways connecting because you are walking in a more normal gait pattern it is opening up new pathways allowing the messages to get through" "It is also surprising because you have the metal rod in your spine so therefore you don't have as much rotation, if any, therefore it should have been difficult for you to walk with this type of frame, although obviously its not" I replied I bet my sitting ability on the ball will of improved, it will be interesting to see can we try it next timeI am going back next week for some treatment to help strengthen my quad muscles and improve my walking ability.
So much so that she went to get one of the other Physio's who has also seen me for one session to see if they could feel the difference and wow was the remark that's amazing what's happened? I said nothing I have done nothing different other than use the new frame. Well that was it I had dumb struck them both.We all then went into the gym, and as you know from the rest of my blog I enjoy using the gym. I virtually ran to the bars it was unreal. Then the fun started, my Physio presented me with 2 walking sticks, but rather than stand them on the floor to walk with they were put out in front of me like having the bars either side of me and then I had to walk towards her. I set off a bit hard at first then had a few more goes and seemed to go ok. Then we decided ok that's it time to try the crutches, I smiled and waited, this is what I have wanted to do for a long time.
Well that was it my Physio supported me from behind and the other Physio that was with us give slight support from the side, but nevertheless we were off it was if I was walking again holding nothing at all, didn't even feel like I was putting any weight through the crutches, before I knew it I had walked to the end of the gym and turned around and was heading for the stairs.My next task I wanted to try was the stairs, you may recall reading an earlier entry about how I have been able to step up and down on a step, this time I wanted to try the actual stairs. With the help of both Physios’ I started off managed the first step that was not too bad then before I knew it I had got to the top and had turned and was coming down.
Then I took off again with the crutches across the gym to the bed.My Physio then went off in search for my Orthopaedic Surgeon, who I have know from many many years, to let him see me in action, and he was so pleased.My Physio could not believe what was happening, "I can't work it out, I don't have an answer for it yet, but I'm going to post to the Chartered Society of Physiotherapy website to see if anyone had experienced the same" "It must have something to do with the nueropathways connecting because you are walking in a more normal gait pattern it is opening up new pathways allowing the messages to get through" "It is also surprising because you have the metal rod in your spine so therefore you don't have as much rotation, if any, therefore it should have been difficult for you to walk with this type of frame, although obviously its not" I replied I bet my sitting ability on the ball will of improved, it will be interesting to see can we try it next timeI am going back next week for some treatment to help strengthen my quad muscles and improve my walking ability.
18 February 2002
Cerebral Palsy
There are different types of Cerebral Palsy and they are:
Spastic Diplegia This type of cp primarily affects the legs.Hemiplegia This is a form of cerebral palsy that affects one arm and leg on the same side of the body
Double Hemiplegia This is used to describe people who have a weakness in all four limbs, with more involvement on one side of the body than the other.Quadriplegiathis is a form of cp that affects all limbs.
Athetoid This type of CP is characterised by tremors, unsteadiness, lack of coordination, and constant movement. People with Athetoid Cerebral Palsy often have speech difficulties as well.Ataxicthis type of CP is the least common form of cerebral palsy. Ataxia means having a lack of balance. People with ataxic CP have a disturbed sense of balance and depth perception. They usually have low muscle tone, a staggering walk and unsteady hands.I have Spastic Diplegia, which means I have tight muscles and this can make it difficult at times to move about. I take muscle relaxants daily to help reduce the high tone allowing me to move a little easier. I walk with the help of a frame and I use a wheelchair.
Spastic diplegia refers to a type of cerebral palsy that is a neuromuscular condition of hypertonia and spasticity in the muscles of the lower extremities, usually those of the legs, hips and pelvis. It results from brain damage at birth that prevents proper development of the pyramidal tract, meaning that certain nerve receptors in the spine are in turn unable to properly absorb the gamma amino butyric acid which would otherwise properly regulate tone in the affected areas.
Without GABA, affected nerves perpetually fire the message for their corresponding muscles to contract and tighten up. Doctor William John Little's first recorded encounter with cerebral palsy is reported to have been among paediatric patients who displayed signs of spastic diplegia. Above the hips, persons with spastic diplegia typically retain normal or near-normal muscle tone and range of motion, though some lesser spasticity may also affect the upper body, such as the trunk and arms, depending on the severity of the condition in the individual; additionally, because the leg tightness often leads to instability in ambulation, some extra muscle tension usually develops in the upper body, shoulders, and arms regardless of the fact that the upper body is not directly affected by the condition. Spasticity in the legs is rarely so great as to totally prevent ambulation; i.e., most people with spastic diplegia can walk. However, spastic diplegia does result in the signature "scissor gait" that some able-bodied people might tend to confuse with the effects of drunkenness.Spastic diplegia typically results from damage to the motor cortex or corticospinal tract sustained before, during, or shortly after birth. This damage is usually caused by asphyxia, hypoxia of the brain, premature birth, birth trauma, haematoma in the brain, or the presence of certain maternal infections during pregnancy. Genetic susceptibility may also play a part. Known post-birth causes of spastic diplegia may include exposure to toxins, traumatic brain injury, encephalitis, meningitis, other brain infections, and drowning or suffocation.
Major treatments for spastic diplegia include:baclofen (and its derivatives), a gamma amino butyric acid substitute injected into the spine or administered via an intrathecal pump; phenol, injected selectively into the over-firing nerves in the legs to reduce spasticity in their corresponding muscles; botox, injected directly into the spastic muscles; orthopaedic surgery to release the spastic muscles from their hypertonic state (these results are usually temporary because of the source of the spasticity being in the nerves, not in the muscles); Rhizotomy, a neurosurgery directly targeting and eliminating (cutting) the over-firing nerve rootlets and leaving the properly-firing ones intact. The term "spastic" describes the attribute of spasticity in spastic cerebral palsy, but has since been used extensively as a general insult to disabled people and/or as an insult to able-bodied people when they seem overly anxious or unskilled in sports (spazz). In 1952 a UK charity called The Spastics Society was formed; the charity changed its name to Scope in 1994.
Spastic Diplegia This type of cp primarily affects the legs.Hemiplegia This is a form of cerebral palsy that affects one arm and leg on the same side of the body
Double Hemiplegia This is used to describe people who have a weakness in all four limbs, with more involvement on one side of the body than the other.Quadriplegiathis is a form of cp that affects all limbs.
Athetoid This type of CP is characterised by tremors, unsteadiness, lack of coordination, and constant movement. People with Athetoid Cerebral Palsy often have speech difficulties as well.Ataxicthis type of CP is the least common form of cerebral palsy. Ataxia means having a lack of balance. People with ataxic CP have a disturbed sense of balance and depth perception. They usually have low muscle tone, a staggering walk and unsteady hands.I have Spastic Diplegia, which means I have tight muscles and this can make it difficult at times to move about. I take muscle relaxants daily to help reduce the high tone allowing me to move a little easier. I walk with the help of a frame and I use a wheelchair.
Spastic diplegia refers to a type of cerebral palsy that is a neuromuscular condition of hypertonia and spasticity in the muscles of the lower extremities, usually those of the legs, hips and pelvis. It results from brain damage at birth that prevents proper development of the pyramidal tract, meaning that certain nerve receptors in the spine are in turn unable to properly absorb the gamma amino butyric acid which would otherwise properly regulate tone in the affected areas.
Without GABA, affected nerves perpetually fire the message for their corresponding muscles to contract and tighten up. Doctor William John Little's first recorded encounter with cerebral palsy is reported to have been among paediatric patients who displayed signs of spastic diplegia. Above the hips, persons with spastic diplegia typically retain normal or near-normal muscle tone and range of motion, though some lesser spasticity may also affect the upper body, such as the trunk and arms, depending on the severity of the condition in the individual; additionally, because the leg tightness often leads to instability in ambulation, some extra muscle tension usually develops in the upper body, shoulders, and arms regardless of the fact that the upper body is not directly affected by the condition. Spasticity in the legs is rarely so great as to totally prevent ambulation; i.e., most people with spastic diplegia can walk. However, spastic diplegia does result in the signature "scissor gait" that some able-bodied people might tend to confuse with the effects of drunkenness.Spastic diplegia typically results from damage to the motor cortex or corticospinal tract sustained before, during, or shortly after birth. This damage is usually caused by asphyxia, hypoxia of the brain, premature birth, birth trauma, haematoma in the brain, or the presence of certain maternal infections during pregnancy. Genetic susceptibility may also play a part. Known post-birth causes of spastic diplegia may include exposure to toxins, traumatic brain injury, encephalitis, meningitis, other brain infections, and drowning or suffocation.
Major treatments for spastic diplegia include:baclofen (and its derivatives), a gamma amino butyric acid substitute injected into the spine or administered via an intrathecal pump; phenol, injected selectively into the over-firing nerves in the legs to reduce spasticity in their corresponding muscles; botox, injected directly into the spastic muscles; orthopaedic surgery to release the spastic muscles from their hypertonic state (these results are usually temporary because of the source of the spasticity being in the nerves, not in the muscles); Rhizotomy, a neurosurgery directly targeting and eliminating (cutting) the over-firing nerve rootlets and leaving the properly-firing ones intact. The term "spastic" describes the attribute of spasticity in spastic cerebral palsy, but has since been used extensively as a general insult to disabled people and/or as an insult to able-bodied people when they seem overly anxious or unskilled in sports (spazz). In 1952 a UK charity called The Spastics Society was formed; the charity changed its name to Scope in 1994.
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