The Spastic Forms of Cerebral Palsy: A Guide to the Assessment of Adaptive Functions

368 Pages·2010·9.77 MB·English

by  Adriano Ferrari

The Spastic Forms of Cerebral Palsy
Adriano Ferrari Giovanni Cioni
•
The Spastic Forms
of Cerebral Palsy
A Guide to the Assessment
of Adaptive Functions
Forewords by
Alain Berthoz
Pietro Pfanner
Adriano Ferrari
Child Rehabilitation Unit
S. Maria Nuova Hospital
Department of Neuroscience
University of Modena and Reggio Emilia
Reggio Emilia, Italy
Giovanni Cioni
Department of Developmental Neuroscience
Stella Maris Scientific Institute
Division of Child Neurology and Psychiatry
University of Pisa
Pisa, Italy
This is a revised, enlarged and completely updated version of the Italian Edition published under the title
“Le forme spastiche della paralisi cerebrale infantile.Guida all’esplorazione delle funzioni adattive”
edited by A. Ferrari, G. Cioni
© Springer-Verlag Italia 2005
All rights reserved
Translation: Maurizio Boni and Vincent Corsentino, Italy
ISBN 978-88-470-1477-0 e-ISBN 978-88-470-1478-7
DOI 10.1007/978-88-470-1478-7
Springer Dordrecht Heidelberg London Milan New York
Library of Congress Control Number: 2009936779
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Foreword
by A. Berthoz
The publication of this volume, edited by Adriano Ferrari and Giovanni Cioni, is a major
event for several reasons. Most importantly, it concerns an area of child pathology that has
yet to be fully explored. In this context, the authors’ efforts to compile their observations
as well as those of other clinicians and to elaborate their theories have resulted in an essen-
tial step in the field of cerebral palsy (CP).
The originality of the book is its very clear focus, while at the same time the authors
have encouraged the book’s contributors to express their ideas and personal opinions. This
leads sometimes to redundancy, but this is precisely one of the benefits of the book be-
cause the same problems are then exposed from different points of views. The reader is
thus spared the normative attempts of many other pathology books, in which the complex-
ity of a given disease is hidden by the authors’ or editors’ desire to impose a rigid taxono-
my or epidemiology.
The chapters in the book offer a lively, up to date discussion about the mechanisms of
CP as well as the possible approaches to the child with CP. This will be fruitful to the read-
er, whether he or she is involved in practical training and rehabilitation or in clinical prac-
tice. Furthermore, the book is a rich source of information for designers of rehabilitation
equipments, basic research scientists, and those who are interested in the social conse-
quences of this pathology (education, transportation, etc.).
A special feature of this book is that, in accordance with the originality of the Stella
Maris Institute and its departments of Child Neurology and Psychiatry, it also includes
chapters in which the psychiatric and psychosocial dimensions of CP are discussed.
This book is of interest not only because of the diversity of its approaches to CP, but al-
so because it contains a number of extremely new ideas concerning the mechanisms of this
condition. For instance, the possible involvement of top-down, cognitive, and perceptive
factors in so-called motor deficits is extensively discussed. This is crucial because too of-
ten motor pathology is attributed only to low-level or muscular deficits. However, as fre-
quently stated in the book, an understanding the relationship between cognitive, percep-
tive, and bottom-up sensory-motor factors still requires extensive research.
The consequences of this and related research will be important for the design of new
rehabilitation methods; but they will also lead to “remediation” procedures, i.e., activities
v
vi Foreword by A Berthoz
that allow the brain to discover and put into action as-yet-unexploited resources, alterna-
tive sensory-motor strategies, and new combinations of the elements of the motor reper-
toire – the brain is, after all, a clever and creative machine. This will also require that each
individual with CP is given free rein to find his or her way to recuperation, or to a substi-
tution of function.
The wide range of knowledge offered in this book will enable readers to consider the
problem of “generalization”. Today we see a rapidly developing market of training devices
some of which are deceiving as the CP patient’s capacities improve on the machine, but the
improvements are not transferred to the many unexpected situations of daily life.
We owe the authors of this book our gratitude for inviting us to join in their efforts to
better the life of so many bright and promising children.
Paris, September 2009 Alain Berthoz
Professor at the College de France
Member French Academy of Sciences
Associate member of American Academy of Arts and Sciences
and Royal Belgium and Bulgarian Academies of Medicine
Foreword
by P. Pfanner
It is with great pleasure that I present this book devoted to cerebral palsy, in which Adri-
ano Ferrari and Giovanni Cioni have collected from their experiences and reflections the
results of over a decade of productive collaboration in this field.
Its layout and contents mirror the expertise and background of the authors and their co-
workers, and their original scientific approach.
Besides being a university professor in Child Neuropsychiatry, Giovanni Cioni is the
director of the clinical department of an Italian scientific biomedical research institute,
dedicated to child neurology, psychiatry, and rehabilitation, in which the research and
clinical aspects of neurological and psychiatric disorders in childhood are treated.
Adriano Ferrari is the founder and director of an important specialized hospital center
operating on a national level, that carries out multifaceted and innovative child rehabilita-
tion program.
Progress in the rehabilitation field, a recent science that still needs to construct a frame-
work in order to consolidate knowledge and experience, has to appropriately develop from
the collaboration between clinics and rehabilitation, between purely neurobiological as-
pects of functioning and orthopedic ones of the locomotor apparatus, namely anatomy and
pathology. However it must go further to also include important psychological aspects re-
lated to the motivation of the motor act and its emotional components, both of which in-
evitably play a crucial role in learning under pathological conditions.
In my opinion, the great medical and scientific contribution of Giovanni Cioni and
Adriano Ferrari, expressed in this book, lies in their ability to integrate all these aspects in
theoretical models and clinical procedures on cerebral palsy.
A look through the table of contents of this book will confirm my statements. The first
part summarizes the history of cerebral palsy and describes how the understanding of this
pathology has been modified over the years up to its present interpretation, which states
palsy is a disorder that involves not only strictly motor functions, but also perceptual, cog-
nitive, and emotional ones. This part also points out the recent contribution of neuroimag-
ing, especially ultrasound and magnetic resonance, in visualizing and identifying brain le-
sions that cause cerebral palsy. Imaging, but also and especially careful observations of
neonate’s and young infant’s movements, enables us to make diagnoses and prognoses
vii
viii Foreword by P. Pfanner
starting from the first weeks of life, thus doing away with the ancient concept of the silent
period.
The second, more extensive part of this book analyzes the adaptive functions of cerebral
palsy patients, offering an extremely complete and integrated examination of the clinical
aspects of these special children. This is followed by a section dealing with the classifica-
tion of spastic forms of cerebral palsy. Here, the taxonomic proposal, which the authors
have been working on for several years, is presented in an analytic format enhanced with
designs and diagrams taken from the files of the Motion Analysis Laboratory in Pisa.
This classification proposal is innovative because it utilizes not only kinematic, but al-
so multiple parameters in order to classify the various forms of cerebral palsy, and because
it also gives suitable indications for prognosis and treatment. As with all proposals, also in
this book, it is the intention of the authors to submit their model to the contributions and
criticisms of the readers.
The book also comes with an interactive DVD on the different forms of cerebral palsy,
prepared by the physiotherapists of Reggio Emilia and Pisa. It is particularly useful be-
cause it also contains exercises to assess learning.
This book therefore is full of the information and ideas of Giovanni Cioni and Adriano
Ferrari and their co-workers, who have collaborated in drafting several chapters. Howev-
er, as indicated by the authors themselves in their introduction, this is not a textbook in the
classical sense, that is to say a comprehensive review of the literature and state of the art of
the studied topic. The book instead reflects on the cultural and methodological approach
and the original and very often provocative interpretation by the authors and their collab-
orators. It presents working hypotheses that in part must be confirmed through further re-
search of evidence and verified by other groups, and one of the purposes of this text is to
stimulate and promote additional useful and necessary scientific contributions.
I welcome and agree with the choice of the authors to search for the neurophysiopatho-
logical connection in every aspect of cerebral palsy, to more than merely present their
quantitative data and clinical series collected over many years of work.
Springer has superbly edited and printed this work, praiseworthy of this well-known
publishing house.
I would like to express once again my warmest congratulations to the authors. I am cer-
tain this book will be a great success among doctors, child neuropsychiatrists and physia-
trists, therapists, and students specializing in these related fields.
Pisa, September 2009 Pietro Pfanner
Former Professor of Child Neurology and Psychiatry
University of Pisa
Preface
This book is the result of studies and reflections on cerebral palsy (CP) in children that the
authors and their collaborators (medical doctors and therapists) from the Pisa and Reggio
Emilia specialised centers have carried out in recent years. It addresses the main topics as-
sociated with the evaluation of adaptive functions in the spastic forms of CP (accepted def-
inition and its modifications over the most recent decades, new taxonomic orientations,
etiopathogenesis, semiotics, and the so-called associated impairments: visual, cognitive
and behavioral).
The main goal of this book is not to relate or update the state of art of these topics, but
to offer readily accessible information on the explored themes in order to encourage con-
siderations and comparisons with the readers’ experiences.
The topics are treated from a pathophysiological point of view that guides the authors’
interpretations of the nature of the disease (functional diagnosis), the problems correlated
with prognosis (such as the hypothesis of its natural history) and with rehabilitation (such
as modification of the architecture of functions in adaptive terms). The text comes with a
DVD of clinical cases which are subdivided according to classification criteria elaborated
by the authors. These cases enhance the teaching usefulness of this book for people already
working in this field (medical doctors, child neuropsychiatrists and physiatrists, rehabilita-
tion therapists), for university students of physical and occupational therapy, and for resi-
dents in rehabilitation medicine, child neurology, and orthopedics. The reader, student, or
professional interested in CP will find innovative ideas, proposals, remarks, and correla-
tions resulting from the collective expertise of our two groups, to which the reader can
compare his own personal ideas. For this reason, the book maintains the structure of per-
sonal notes, like a travel journal, offering the authors’ interpretations and reflections, while
referring to other scientific publications for detailed analyses of related clinical cases and
comparisons with the viewpoints of other specialists. In this sense, every chapter represents
an autonomous unit that can be studied separately. The statements presented in each chap-
ter are frequently full of repercussions and, we hope, this will lead the reader to further re-
flections, comparisons, and, obviously, doubts and disagreements based on his own expe-
riences. Also for this reason some concepts and references to the scientific literature and to
primary authors are quoted in several chapters, as a common basis for specific topics.
ix
x Preface
The publication of this book would not have been possible without the effort and con-
tribution of all the colleagues, medical doctors and therapists, of our specialised centres,
and the collaboration of children and their parents. We would like to thank everyone for
their cooperation.
Reggio Emilia and Pisa, September 2009 Adriano Ferrari
Giovanni Cioni