title: [Principles of treatment of spastic palsy in children: a critical review].
abstract: BACKGROUND
  In patients with cerebral palsy who are able to walk the source of the problem of spasticity must first be correctly determined. The weakness appears to be the main problem and the first line treatment must concentrate on improvement of strength and bodily control.
  
  
  METHODS
  Spasticity can also compensate for weaknesses. The indications for weakening measures for correction of muscle tonus must therefore be carefully appraised but are part of the repertoire. Orthoses result in stability and correction of deformities. Night braces are in our experience of doubtful value. Biomechanical objectives are a right-angle between the sole of the shoe and lower leg axis (leading edge of the tibia) and full passive and active extension in the knees and hips.
  
  
  CONCLUSIONS
  Severely handicapped patients often suffer from hip luxation and scoliosis. Regular control of the hips and spine under loading are necessary. Early interventions, conservative and operative, have a better prognosis than a late correction. In general patients who have a risk for deformities and dysfunction of the musculoskeletal system due to the underlying disease should undergo early orthopedic control.
authors.affiliation: Abt. Neuroorthopädie, Univ.-Kinderspital beider Basel, Spitalstraße 33, 4005, Basel, Schweiz, reinaldbrunner@sunrise.ch.
authors.forename: R
authors.initials: R
authors.lastname: Brunner
mesh_terms: D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D004185:Disability Evaluation; D061345:Early Medical Intervention; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D053580:Muscle Strength / Q000502:physiology; D009129:Muscle Tonus / Q000502:physiology; D019637:Orthopedic Procedures; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012600:Scoliosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery