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Cerebral Palsy & Spasticity

Cerebral palsy occurs when a child sustains a brain injury very early on in life. Although the brain injury is static, its effects change continuously in the growing child. The commonest cause is premature birth. This causes damage to some of the bundles of nerve fibres in the brain, particularly the motor nerves that control leg movement. These nerve fibres run down from the brain to the spinal cord and control contraction of the limb muscles. If these fibres are damaged, the limb muscles contract too much and become stiff. This stiffness, or spasticity, interferes with children's ability to move and to learn to walk. Spasticity also causes pain, and, over time, shortening of muscles and tendons, joint contractures and severe deformities.

One of the patterns of muscle stiffness in cerebral palsy is spastic diplegia. This predominantly involves the muscles of the thighs, legs and feet. Nerve fibres running from the muscles back to the spinal cord play a major role in maintaining this excessive muscle stiffness. This is why dividing some of these fibres tends to reduce stiffness and spasticity. This is the basis of selective dorsal rhizotomy (SDR).