CP - SEMLS Flashcards Preview

Paediatric Interventions > CP - SEMLS > Flashcards

Flashcards in CP - SEMLS Deck (22)
Loading flashcards...
1
Q

What are the different types of orthopaedic surgery in CP?

A
  • Contracture release (e.g. hip flexion, hip adductors, hamstrings, calf)
  • Tendon transfers (e.g. split tib post, rectus femoris)
  • Bony (e.g. proximal/distal femoral derotation, tibial supramalleolar derotation osteotomies)
  • Subtalar fusion or calcaneal lengthening
  • Epiphyseodesis
2
Q

When is hip adductor release performed?

A

Early in response to hip surveillance findings to prevent hip subluxation

3
Q

When is calf lengthening performed?

A
  • Due to fixed contracture that no longer responds to BTx , serial casting & orthotics
  • Recommended surgery is a Strayer procedure rather than tendo-Achilles lengthening (TAL)
4
Q

What is a precaution for calf lengthening?

A
  • Care must be taken not to over lengthen as this results in crouch gait
  • Need to leave soleus intact where possible
5
Q

What is SEMLS?

A
  • Single event multilevel surgery
  • Directed at type III & IV hemiplegics &
    diplegics who have predominantly spastic movements (not
    athetoid)
6
Q

What are the aims of SEMLS?

A
  • Correct deformity
  • Improve “lever arm dysfunction”
  • Improve gait pattern
  • Reduce the energy cost of walking
7
Q

What are the characteristics of the ideal candidate for SEMLS?

A
  • Independent walker
  • Compliant
  • Well motivated
  • Supported
  • Prior to pre-pubertal growth spurt
8
Q

What is the duration of SEMLS?

A
  • Up to 16 combined soft tissue & bony surgeries in a single operation
  • 4-6hrs duration with 2 surgeons
9
Q

What typically happens post-op SEMLS?

A
  • Hospitalised for 1 week
  • Rehab for 6-12 months post operative
  • Family need to be aware of post-op requirements & therapy services organised
10
Q

What may be involved pre-op SEMLS?

A
  • Preoperative planning 3DGA + physical Ax

- May also assess oxygen consumption

11
Q

What are the surgery principles of SEMLS?

A
  • To give a solid base (foot/ankle) that is directed straight ahead (tibial & femoral torsion) with effective joint ROM
  • Bony surgery must have sufficient fixation to allow for early mobilisation
12
Q

What equipment is used for immobilisation post SEMLS?

A
  • Hip spica
  • Broomstick casts
  • Zimmer splints
  • SL Plasters
13
Q

What are the rehab principles for SEMLS?

A
  • Adequate pain management acutely
  • Monitoring of plasters & positioning
  • Early & regular stretches/joint ROM
  • Hydrotherapy important ASAP
  • Appropriate & timely orthotic use
  • Intensive and prolonged physio (significantly
    weakened by surgery)
14
Q

What information should be communicated to families when setting goals for surgery in CP?

A
  • Goals of surgery and its limitations
  • Child still has cerebral palsy
  • Soft tissue surgery 6 month recovery time
  • Bony surgery 12 month recovery time
  • Recovery time refers to child returning to pre GMFCS level and mobility (FMS)
15
Q

What is involved in rehabilitation after surgery?

A
  • Period of NWB depending on surgery and surgeon, designed to be as short as possible
  • Positioning & plaster care
  • Skin care and pressure areas
  • Chest check
  • Medical review & removal of casts
  • Intensive inpatient rehab for approx 2 weeks.
  • Intensive physio for the following 3 months for soft tissue surgery & 9 months for bony surgery
  • Surgical review 12 months post op
  • Removal of internal fixators and further minor
    surgery planned
16
Q

How can equipment needs change after surgery?

A

High equipment needs for short time post surgery which may not have been previously required (need OT referral)

17
Q

What are the physio rehab aims post surgery?

A
  • Maintain muscle length (prone lying, long sitting, avoid side lying, long term monitor hip abductor length)
  • Strengthening program (quads, gluteals, hamstrings)
  • Increase knee ROM, early knee flexion to prevent adhesions (should be 90deg prior to discharge)
  • Standing (ensure good alignment especially hip
    & knee extension)
  • Transfer practice
  • Gait retraining
18
Q

What are the orthotics that may be used post surgery?

A
  • GRAFO
  • Static AFO
  • Hinged AFO
  • Assess need for ongoing orthotics – surgeon or when reaches skeletal maturity
19
Q

What are the gait aids that may be used post surgery?

A
  • Posterior walker
  • Quad sticks
  • Canadian crutches
20
Q

What are the goals 6-12 months after SEMLS?

A
  • Maintain compliance & motivation by incorporating other activities into the program e.g. bike riding
  • Prevention of burn out by integration into recreational and social exercise activities, or return to sports
21
Q

What are the potential complications of orthopaedic surgery?

A
  • Under/over correction of long bone torsion
  • Over lengthening of muscles
  • Nerve traction injuries has the biggest effect on rehab due to pain, hypersensitivity and inability to weight bear
  • Pressure sores from plasters and zimmer splints
22
Q

What are some of the other issues associated with orthopaedic surgery?

A
  • Equipment provision from local service or tertiary hospital
  • Little or no pre-op contact with patient, family or therapists
  • Limited understanding of family of what is required post-op
  • Locating local therapy services