Cerebral Palsy 1st ed.2005.pdf

Cerebral Palsy

Freeman Miller, MD

Co-Director, Cerebral Palsy Program

Alfred I. duPont Hospital for Children

Nemours Foundation

Wilmington, Delaware

Cerebral Palsy

With CD-ROM

With 1116 Illustrations, 777 in Full Color

Illustrations by Erin Browne, CMI

Springer

Freeman Miller, MD

Co-Director, Cerebral Palsy Program

Alfred I. duPont Hospital for Children

Nemours Foundation

Wilmington, DE 19899

USA

Library of Congress Cataloging-in-Publication Data

Miller, Freeman.

Cerebral palsy / Freeman Miller.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-387-20437-7 (hc. : alk. paper)

1. Cerebral palsied children—Rehabilitation. 2. Movement disorders in children. 3.

Cerebral palsy. I. Title.

[DNLM: 1. Cerebral Palsy—rehabilitation—Child. 2. Cerebal Palsy—surgery—Child.

3. Disabled children—rehabilitation. WS 342 M647ca 2004]

RJ496.C4M535 2004

618.92

836—dc22

2003065734

ISBN 0-387-20437-7

Printed on acid-free paper.

written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street,

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of going to press, neither the authors nor the editors nor the publisher can accept any legal re-

sponsibility for any errors or omissions that may be made. The publisher makes no warranty,

express or implied, with respect to the material contained herein.

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Preface

Cerebral palsy is a lifelong condition that affects the individual, family, and

immediate community. Therefore, the goal of allowing the individual with

cerebral palsy to live life with the least impact of the disability requires com-

plex attention to the individual and the family. Furthermore, society needs

to be sensitive and to accommodate individuals with disabilities by limiting

architectural impediments and providing accessible public transportation

and communication. The educational system provides the key means for

helping the individual prepare to function in society to his or her maximum

ability. In many ways, the medical care system probably has the least signif-

icant role in preparing the child with cerebral palsy to function optimally in

society. However, the medical care system is the place where parents first

learn that their child has developmental issues outside the expected norm. It

is almost universally the place where parents also expect the child to be made

normal in our modern society. In earlier times, the parents would expect

healing to possibly come from the doctor, but also they would place hope for

healing in religion. As this belief in spiritual or miraculous healing has de-

creased, a significant font of hope has decreased for parents of young chil-

dren with disabilities.

The text aims to help the child with cerebral palsy to develop into an

adult in whom the effects of the disability are managed so that they have the

least impact possible on adult function. This intention is in the context of the

fact that the magnitude of improvement in the disability that occurs with

ideal management of the musculoskeletal system during growth may be only

a small improvement. Probably the more significant aspect of good muscu-

loskeletal management through childhood is helping the child and family to

maintain realistic hope for the successful adult life of the growing child. This

aim requires the medical practitioner to get to know the child and family and

to communicate in a compassionate way realistic expectations of the child’s

function. For many reasons, the greatest difficulty in providing this kind of

care is the limited time practitioners have to spend with the individual pa-

tient. There is also the sense, especially among orthopedic physicians, that

cerebral palsy cannot be cured (cannot make the child function normally),

and thus it is a frustrating condition with which to work. The physician must

maintain a balance between communicating hopelessness to the patient and

family; and feeling the need to do something, usually a heel cord lengthening,

because the parents are frustrated that the child is not progressing. All med-

ical decisions, including a surgical option, should always consider both the

short- and long-term impact. With every decision the medical practitioner

should ask, “What will be the impact of this recommendation by the time

the child is a mature adult?” This is the most difficult perspective, especially

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