title: Management of the upper limb in cerebral palsy.
abstract: The management of the upper limb in cerebral palsy is often complex and challenging. Effective treatment requires a multidisciplinary approach involving paediatricians, occupational therapists, physiotherapists, orthotists and upper extremity surgeons. Interventions are generally aimed at improving function and cosmesis by spasticity management, preventing contractures and correcting established deformities. Treatment objectives vary according to each child and range from static correction of deformities to ease nursing care, to improvements in dynamic muscle balance to augment hand function. Botulinum toxin A therapy has been shown to relieve spasticity and improve function in the short term. Surgery is also effective but requires careful patient selection, as many children with cerebral palsy are not candidates for surgery. Occupational therapy and physiotherapy have small treatment effects alone but are essential adjuncts to medical and surgical management.
authors.affiliation: Department of Orthopaedics, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Terence Y P
authors.initials: TY
authors.lastname: Chin
authors.forename: Josie A
authors.initials: JA
authors.lastname: Duncan
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Johnstone
authors.forename: H Kerr
authors.initials: HK
authors.lastname: Graham
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D034941:Upper Extremity / Q000503:physiopathology / Q000601:surgery
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A