Treatment of Pediatric Movement Disorders

Surgery: Orthopedic Procedures

Orthopedic procedures may be very helpful at fixing particular mechanical impairments associated with movement disorders. Tendon lengthening procedures, rotation of bone segments, or cutting tendons or muscles may reduce the mechanical effects of severe contracture and lead to significantly improved performance. When surgery is used for spasticity, it is important to assess whether the spasticity is the cause of the child's functional problems or whether it is in fact helping to compensate for muscle weakness. Gait analysis may be particularly helpful in determining whether an orthopedic procedure is likely to be helpful or worsen the child's function. Before or as an adjunct to surgery, many orthopedic surgeons attempt serial casting. During casting, sequences of casts are applied to progressively lengthen a particular muscle by providing increasing stretch. These procedures tend to be most helpful when there is a fixed mechanical reason for difficulty moving, such as a shortened tendon or muscle or a joint contracture. If the difficulty is due to weakness, dystonia, or another movement disorder, then the results of surgery are more difficult to predict and may not be as helpful.

	Dorsal Rhizotomy