Cerebral Palsy

Foreword
Preface
Acknowledgments
	Acknowledgments from the First Edition
Contents
About the Editors
Contributors
Part I: Diagnosis and Pathology
	1 The Child, the Parent, and the Goal in Treating Cerebral Palsy
		Introduction
		How Different Is the Child with CP?
		Family Impacts of the Child with CP
		Care-Providing Community
		Cerebral Palsy Clinic
		Family Care Provider and Professional Care Provider Relationship
		Family Response Patterns
		Dealing with Blame
		Giving and Dealing with Prognosis
		Giving the Diagnosis
		Medical Therapeutic Relationship to Child and Family
		The Physical Therapist Relationship
		When the Doctor-Family Relationship Is Not Working
		When the Family Chooses Medical Treatment Against the Physician´s Advice
		Recommending Surgery
		A Plan for Managing Complications
		When Complications Occur
		The Final Goal
		Cases
		References
Part II: Etiology of Cerebral Palsy
	2 Cerebral Palsy and the Relationship to Prematurity
		Introduction
		Natural History
			Prevalence of Cerebral Palsy in Premature Infant
			Etiologies of Cerebral Palsy Related to Prematurity
				Intraventricular Hemorrhage (IVH)
				Periventricular Leukomalacia (PVL)
				Chorioamnionitis
				Postnatal Glucocorticoid Therapy
				Bronchopulmonary Dysplasia
				Apnea of Prematurity
				Neonatal Sepsis
				Patent Ductus Arteriosus
				Hypoxic-Ischemic Encephalopathy
				Necrotizing Enterocolitis
				Hypocarbia
				Hyperbilirubinemia
		Treatment
			Perinatal and Postnatal Interventions to Reduce the Risk of Cerebral Palsy in Preterm Infants
				Antenatal Glucocorticoids
				Magnesium for Neuroprotection
				Caffeine for Apnea of Prematurity
				Delayed Cord Clamping
				Follow-Up of the Premature Infant
		Conclusion
		References
	3 Genetic Abnormalities and Congenital Malformations as a Cause of Cerebral Palsy
		Introduction
			Evolving Evidence in the Genetics of Cerebral Palsy
		Natural History
			Congenital Anomalies and Coexisting Conditions
			Other Contributing Causes of Cerebral Palsy
				Intrauterine Growth Restriction
				Multiple Pregnancy
				Intrauterine Infection
				Thrombophilia
				Hypoxia-Ischemia
				Prematurity
			Single-Gene Causes of Cerebral Palsy
			Copy Number Variants
		Recommendation for Treatment/Assessments
		Cross-References
		References
	4 Infectious Etiologies of Cerebral Palsy
		Introduction
		Natural History
			Epidemiology and Pathophysiology
		Etiologies
			Cytomegalovirus (CMV)
				Testing, Treatment, and Outcomes
			Herpes Simplex Virus (HSV) and Other Human Herpes Viruses
				Testing, Treatment, and Outcomes
			Enteroviruses and Parechoviruses
				Testing, Treatment, and Outcomes
			Emerging Viruses: Chikungunya Virus and Zika Virus
				Testing, Treatment, and Outcomes
			Neonatal Bacterial Pathogens
				Testing, Treatment, and Outcomes
			Other Pathogens to Consider
				Testing, Treatment, and Outcomes
		References
	5 Perinatal Stroke as an Etiology of Cerebral Palsy
		Introduction
		Natural History
			Epidemiology
			Risk Factors
			Pathophysiology
			Diagnosis
		Treatment
			Acute Treatment
			Chronic Treatment
			Prevention
		Complications of Stroke and Treatment
		Conclusions
		Cross-References
		References
	6 Problems During Delivery as an Etiology of Cerebral Palsy in Full-Term Infants
		Introduction
		Natural History
			Problems During Birth as an Etiology of CP
				Prematurity
				Hypoxic-Ischemic Injury
				Low Apgar Scores
				Abnormal FHR Tracing
				Meconium-Stained Amniotic Fluid
				Intracranial Hemorrhage
				Perinatal Stroke
				Abnormal Labor
				Umbilical Cord Complications
				Placental Complications
					Placental Abruption
					Placental Infarction
					Uterine Rupture
				Instrumentation at Delivery
				Fetal Presentation
				Multiple Births
				Chorioamnionitis
		Treatment
			Perinatal and Postnatal Interventions to Reduce the Risk of Cerebral Palsy
		Complications
		Cross-References
		References
	7 Postnatal Causes of Cerebral Palsy
		Introduction
		Natural History
			Infectious Causes
				Neonatal Sepsis
				Viral Infections
			Trauma
				Congenital Heart Defects
			Stroke
			Neoplasms
		Summary
		Cross-References
		References
			Further Reading
	8 Animal Models of Cerebral Palsy: What Can We Learn About Cerebral Palsy in Humans
		Introduction
		Studies in Mice
			Infection/Inflammation model
			Hypoxic/Ischemic Model
		Studies in Rats
			Hypoxic/Ischemic Model
			Infection/Inflammation Model
			Studies on the Effectiveness of Treatment Methods
		Studies in Rabbits
			Hypoxic/Ischemic Model
			Infection/Inflammation Model
		Studies in Sheep
			Hypoxic/Ischemic Model
			Infection/Inflammation Model
			Studies on the Effectiveness of Treatment Methods
		Studies in Nonhuman Primates
			Hypoxic/Ischemic Model
			Infection/Inflammation Model
			Studies on the Effectiveness of Treatment Methods
		Studies in Other Animals
		Conclusion
		Cross-References
		References
	9 The Effects of Umbilical Cord Blood and Cord Tissue Cell Therapies in Animal and Human Models of Cerebral Palsy
		Introduction
		Natural History
		Treatment
			Animal Studies of Cell Therapy in Brain Injuries
				Animal Studies in Stroke
				Animal Studies in Hypoxic/Ischemic Brain Injury
				Animal Studies in Intraventricular Hemorrhage (IVH) and Periventricular Leukomalacia (PVL)
				Summary of Animal Studies
			Human Studies of Cell Therapy in Brain Injuries
				Clinical Trials of Autologous Umbilical Cord Blood in CP
				Clinical Trials of Allogeneic Umbilical Cord Blood in CP
				Clinical Trials of MSCs in CP
				Clinical Trials of CB in Babies with Hypoxic/Ischemic Encephalopathy (HIE)
		Complications
		Summary
		Cross-References
		References
	10 Risk Factors for Developing Cerebral Palsy
		Introduction
		Gestational Age and Birth Weight
			Prematurity as a Risk Factor for Cerebral Palsy
			Prevention of CP in Preterm Infants
		Birth Weight as Related to Gestational Age
			Prevention of CP in Infants with Deviations from Optimal Intrauterine Growth
		Twin or Multiple Birth
		Assisted Reproductive Technology and the Risk for CP
			Prevention of CP in Twins or Multiple Births
		Maternal Risk Factors
			Prevention of CP Related to Maternal Factors
		Congenital Infections
			Prevention of CP Related to Congenital Infections
		Congenital Malformations
			Prevention of CP Related to Congenital Malformations
		Coagulopathies
			Prevention of CP Related to Coagulopathies
		Genetic Variants and CP
			Prevention of CP Related to Genetic Causes
		Perinatal Risk Factors
			Prevention of CP Related to Perinatal Causes
		Neonatal Risk Factors
			Prevention of CP Related to Neonatal Causes
		Post-neonatally Acquired CP
			Prevention of CP Related to Postnatal Causes
		Epilogue
		Cross-References
		References
Part III: Epidemiology
	11 Epidemiology of Cerebral Palsy
		Introduction
		Definition and Classification of CP
		Frequency and Patterns of Occurrence
			Birth Prevalence: Overall Trends
			Trends by Birth Weight and Gestational Age
			Trends in Motor Severity and CP Subtypes
			Accompanying Impairments
		Survival in CP
		Major Risk Factors
			Multiple Birth
			Congenital Anomalies
			Congenital Cytomegalovirus
		Prevention of CP
		References
	12 Health and Healthcare Disparities in Children with Cerebral Palsy
		Introduction
			The Disabled Population as a Population with Health and Healthcare Disparities
				Health and Healthcare Disparities in Children with Special Healthcare Needs
				Health and Healthcare Disparities in Children with Special Healthcare Needs With and Without Disability and/or Medical Complex...
				Health and Healthcare Disparities in Children with Cerebral Palsy
				Racial Variance Within Cerebral Palsy Prevalence
				Socioeconomic Impact on Cerebral Palsy Prevalence
			Identifying Vulnerability Causing Health and Healthcare Disparities in the Cerebral Palsy Population
				The Measurement of Healthcare Disparities in Cerebral Palsy
			Strategies to Resolve Healthcare Disparities in the Cerebral Palsy Population
				Predisposing and Enabling Factor Disparity Interventions
				Need Factor Interventions Within the CP Population
					The Medical Home and Care Coordination
					Disparities in the Transition into Adult Healthcare
					Transition of Orthopedic Services in the CP Population
			Quality, Cost, and Value: Their Impact and Importance on Disparities in Children with Disabilities
			Value for CSHCN, CMC, and Children with CP: The Patient and Family Perspective
				Value of CSHCN, CMC, and Children with CP: The Provider and Payor Perspectives
				Value and Healthcare Delivery Models in CSHCN, CMC, and Children with CP
				Value and Alternative Payment Models in CSHCN, CMC, and Children with Cerebral Palsy
				A High-Value Musculoskeletal Model of Care Delivery for the CP Child
			Health Policy to Prevent Health and Healthcare Disparities in CSHCN
		Cases
			Case 1 (Pre-care Coordination) (Fig. 7)
			Case 2  (Fig. 8)
		References
Part IV: Pathology
	13 Neuroimaging Pathology in Cerebral Palsy
		Introduction
		Fetal Neuroimaging Techniques
		Hypoxic-Ischemic Brain Injury
			Preterm
				White Matter Injury of Prematurity or Periventricular Leukomalacia (Mild to Moderate Hypoperfusion)
				Profound Hypotension in Preterm Infants
				Germinal Matrix and Intraventricular Hemorrhage
				Porencephalic Cyst
			Term Infants
				Watershed Predominant Pattern of Injury
				Basal Ganglia/Thalamus Pattern
				Perinatal Stroke
		Congenital Infections of the Central Nervous System
			Cytomegalovirus
			Toxoplasmosis
			Lymphocytic Choriomeningitis Virus
		Congenital Malformations
			Lissencephaly (The Agyria-Pachygyria Complex)
			Microcephaly with Simplified Gyral Pattern (MSG)
			Schizencephaly
			Megalencephaly-Postaxial Polydactyly-Polymicrogyria-Hydrocephalus Syndrome (MPPH)
			Septo-Optic Dysplasia
			18q-Syndrome
			Syntelencephaly
			Joubert Syndrome and Related Disorders (Molar Tooth Malformations)
			Rhombencephalosynapsis
			Aicardi Syndrome
			Hydranencephaly
		Miscellaneous
			Kernicterus
		Conclusion
		Cross-References
		References
	14 Current Imaging: PET Scan Use in Cerebral Palsy
		Introduction
		Cranial Ultrasonogram
		Magnetic Resonance Imaging
		Positron Emission Tomography
		Diffusion Tensor Imaging
		Conclusion
		Cross-References
		References
	15 Neuromuscular Junction Changes in Spastic Cerebral Palsy
		Introduction
		Structure and Action of the NMJ
		NMJ Formation during Development
			Postsynaptic Maturation
			Presynaptic Maturation
		NMJ Microanatomic Organization in CP
		NMJ Ultrastructure in CP
		NMJ Gene Expression in CP
		Medications That Target NMJs
		Conclusion
		Cross-References
		References
	16 Muscle Changes at the Cellular-Fiber Level in Cerebral Palsy
		Introduction
		Muscle Growth
			Longitudinal Growth and Sarcomere Addition
			Postnatal Development
			Sarcomere Adaptation
			Sarcomeres in Children with CP
		Extracellular Matrix
			Changes in ECM Content
			Passive Mechanical Properties of Muscle Fibers and Bundles
		Muscle Stem Cells, Postnatal Development, and Contractures
			Satellite Cells (Muscle Stem Cells)
			Function of Satellite Cells
			Satellite Cells in Children with Cerebral Palsy
		Summary
		References
	17 Muscle Size, Composition, and Architecture in Cerebral Palsy
		Introduction
		Natural History
			Muscle Anatomy and Typical Muscle Growth and Development
			Skeletal Muscle Size and Architecture in Typically Developing Children
			Skeletal Muscle Size, Composition, and Architecture in Children with CP
		Assessing Muscle in Children with CP
		Factors Contributing to Atypical Muscle Growth and Development in Children with CP
			Physical Activity
			Muscle Spasticity
			Medications
			Surgery
		Treatment
		Summary
		Cross-References
		References
	18 Bone Size, Architecture, and Strength Deficits in Cerebral Palsy
		Introduction
		Natural History
			Bone Anatomy and Typical Bone Growth and Development
			Bone Growth and Development in Children with CP
		High Rate of Fragility Fractures in Children with CP
		Assessing Bone in Children with CP
		Factors Contributing to Atypical Bone Growth and Development in Children with CP
			Gross Motor Function and Physical Activity
			Muscle
			Nutrition
			Medications
		Bone Health in Adults with CP
		Treatment
		Summary
		Cross-References
		References
Part V: Diagnosis
	19 When and How to Evaluate the Child with Possible Cerebral Palsy
		Introduction
		Etiology and Pathology
			Congenital (Antenatal) Etiologies
			Neonatal and Perinatal Etiologies
			Postnatal Etiologies
		Classification of Cerebral Palsy
			Diagnosis of Cerebral Palsy
			Clinical Diagnosis
			Neuroimaging
			Metabolic and Genetic Testing
			Coagulopathies
			Diagnostic Evaluations for Associated Conditions
		Conclusion
		Cross-References
		References
	20 Cerebral Palsy Prognosis Based on the Physical and Neurologic Examination
		Introduction
		Making the Diagnosis
			Early Diagnostic Uncertainty Complicates Early Prognosis
		Developing a Prognosis
			Prognosis: Comorbidities and Life Expectancy
			The Challenge of Masqueraders
		Early Neurologic Examination Predicting Specific CP Syndromes
			Specific Syndromes
		Conclusion
		Cross-References
		References
	21 Classification Terminology in Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			Type and Topography of Neuromotor Impairment
				Spasticity
				Dyskinesia
				Ataxia
				Hypotonia
			Neuroanatomical Classifications
			Gait Pattern Classifications
			Functional Classification Systems
				Gross Motor Function
				Manual Ability
				Communication
		Evidence of Effectiveness
		Cross-Reference
		References
	22 Measuring Outcomes in Children with Cerebral Palsy
		Introduction
		Generic Versus Disease-Specific Measures
		Self-Report Versus Parent Proxy Reporting
		International Classification of Functioning
		Functional Outcome Measures
			Pediatric Outcomes Data Collection Instrument (PODCI)
			Gillette Functional Assessment Questionnaire (FAQ)
			Shriner´s Hospital Upper Extremity Evaluation (SHUEE)
			Pediatric Evaluation of Disability Inventory (PEDI) and Pediatric Evaluation of Disability Inventory Computer-Adaptive Test (P...
		Quality of Life/Health-Related Quality of Life Measures
			Cerebral Palsy Quality of Life Questionnaire (CP-QOL-Child)
			Cerebral Palsy Quality of Life Questionnaire (CP-QOL-Teen)
			Caregivers Priorities and Child Health Index of Life with Disabilities (CPCHILD)
			Pediatric Quality of Life Inventory (PedsQL) 3.0 Cerebral Palsy (CP) Module
			DISABKIDS-CP Module (CPM)
		Conclusion
		Cross-References
		References
	23 Biomarker Blood Tests for Cerebral Palsy
		Introduction
		Types and Classes of Biomarkers
		Basics of Diagnostic Biomarker Test Performance
		Circulating Biomarkers in the Blood
		Epigenetic Biomarkers and DNA Methylation in Blood Cells
		Conclusion
		Cross-References
		References
Part VI: General Medical Concerns
	24 General Nutrition for Children with Cerebral Palsy
		Introduction
		Natural History
			Etiology of Impaired Growth in Children with Cerebral Palsy
			Evaluating Growth in the Child with Non-ambulatory Cerebral Palsy
			Evaluating for Nutritional Deficiencies in the Child with Cerebral Palsy
			Role of Diet in Bone Health
		Treatment
			Nutritional Requirements
			Nutrition Interventions
			Oral Nutrition
			Enteral Nutrition
			Bone Health
			Follow-Up
		Complications of the Treatment and Disease Process
			Complications of Calorie Boosting
			Complications of Enteral Tube Feedings
			Complications of Mineral Supplementation for Bone Health
		Cross-References
		References
	25 Managing the Child with Cerebral Palsy Who Has Medical Complexity
		Introduction
		Role of Primary Care
		Care Coordination
		Practice Transformation
		Models of Care
			Medical Care
		Transition
		Payments
		Cases
			Case 1: Agitation
			Case 2: Fever
		Cross-References
		References
	26 Managing Bone Fragility in the Child with Cerebral Palsy
		Introduction
		Natural History
			Cerebral Palsy
			Medical Effects of CP
				Primary Effects
				Secondary Medical Problems
		Bone Basics
		Gross Motor Function Classification System
		Relationship of BMD and Fracture
		Pathophysiology/Etiology of Compromised Bone Health
			Malnutrition/Suboptimal Nutrition
			Puberty
			Weight Bearing
			Medications
		Treatment and Complications: Identification and Prevention
			Identification of Risk Factors and Prevention
			Review Medical Risk Factors
			Medication Selection/Consideration
				Nutrition Assessment
				Laboratory Evaluation
			Weight Bearing
				Standing
				Vibration
			Assessment of Bone Density
			Handling/Mechanics
			Education of Care Providers (School, Nurses/Aides, Families)
		Pharmacologic Treatment
			Bisphosphonates
			Other
		Summary/Wrap Up
		Case Studies
		Cross-References
		References
	27 Managing Irritability and Nonoperative Pain in the Noncommunicative Child with Cerebral Palsy
		Introduction
		Natural History
		Assessment of Pain
		Treatment and Complications
		Gastrointestinal Etiologies of Pain
		Constipation
		Gastroesophageal Reflux
		Feeding Intolerance
		Visceral Hyperalgesia
		Musculoskeletal
			Spasticity
				Treatment and Complications
			Dystonia
				Treatment and Complications
		CNS Shunt Malfunction
			Complications
			Surgical Complications
		Muscle Overuse Injuries
		Occult Fractures
			Treatment and Complications
		Kidney Stones
			Treatment and Complications
		Paroxysmal Sympathetic Hyperactivity
			Treatment and Complications
		Conclusion
		Cases
		Cross-References
		References
	28 Palliative Care for Individuals with Cerebral Palsy
		Introduction
		Natural History
			Advance Care Planning
			Decision-Making Support
				Assessing Medical Understanding
				Goals of Care
				End of Life Care
				Case Discussion
				Case Discussion
			Pain and Symptom Management
			Care Coordination
			Anticipatory Grief/Bereavement
			Family Support
		Treatment
			Case Discussion
		Complications
		Cross-References
		References
	29 Aging with Cerebral Palsy: Adult Musculoskeletal Issues
		Introduction
		Spine
		Hip
		Lower Extremity, Knee, and Foot
		Rehabilitation Issues
		Health Care System Issues for the Adult
		Conclusion
		Cross-References
		References
	30 Life Care Planning for the Child with Cerebral Palsy
		Introduction
			Definition of a Life Care Plan
			Purpose of a Life Care Plan
		Goals and Environment
			Healthcare Providers
			Treatment Interventions
				Common Nonsurgical Interventions
				Common Orthopedic Surgical Interventions
			Diagnostics
			Medications
				Medication for Spasticity
				Antiepileptic Medication
				Cognitive and Behavioral Medication
				Medication for Incontinence
				Medication for Acid Reflux
				Medication for Depression/Anxiety
			Laboratory
			Therapy
				Traditional Therapy
				Nontraditional Therapy
				Mental Health Therapy
			Education
				School
				Educational Advocate
				Educational Therapist/Tutor
				Vocational Rehabilitation Program
				Day Program
			Assistive Technology
				Activities of Daily Living Equipment
				Mobility Equipment
				Assistive Technology for Cognition
				Orthotic Devices
			Nursing/Attendant Care
				Care Attendant
				Respite Care
				Life Skills Coach
				Care Facility
			Professional Services
				Fiduciary/Trustee
				Attorney
				Conservatorship/Guardianship
			Benefits/Resources
				Federal and State Benefit Programs
					Social Security Benefits (All States) and Supplemental Security Income (SSI)
					Social Security Disability Insurance (SSDI)
					Medi-Cal (California)/Medicaid (All Other States)
				Developmental Disability Services
				Department of Social Services
				Department of Rehabilitation
			Recreation
				Camps
			Organizations
			Home Modifications
			Transportation
		Technique
		Case History
		Cross-References
		References
			Resources
Part VII: Central Neurologic Problems
	31 Epilepsy in the Child with Cerebral Palsy
		Introduction
		Natural History
			Seizures and Epileptogenesis
			Clinical Features of Seizures and Epilepsy in a Child with Cerebral Palsy
		Treatment Considerations
			The Diagnosis of Epilepsy in the Cerebral Palsies and the Role of EEG
			Treatment of Epilepsy Syndromes and Seizure Categories in Cerebral Palsy
			Specific Epilepsy Considerations and Syndromes in Cerebral Palsy
		Epilepsy Remission in Cerebral Palsy
		Complications of Epilepsy and Its Treatment in Cerebral Palsy
		Summary
		Cross-References
		References
	32 Epilepsy Surgery for the Child with Cerebral Palsy
		Introduction
		Impact
		When Should Surgery Be Considered?
		Evaluation for Epilepsy Surgery
			Studies
				Invasive or Intracranial EEG Monitoring
			Epilepsy Surgery Conference
		Types of Epilepsy Surgery
			Resective Surgeries
				Hemispherectomy
				Selection
				Infancy
				Outcome
				Complications
				Other Resective Surgical Techniques Including Lesionectomy and Multilobar and Lobar Resection
			Corpus Callosotomy
				Indication
				Adverse Effect
			Neurostimulation
				VNS
			Minimally Invasive Epilepsy Surgery
		Conclusion
		Cross-References
		Bibliography
	33 Hydrocephalus in the Child with Cerebral Palsy
		Hydrocephalus in Cerebral Palsy
			Introduction
			Natural History
				Anatomy and Physiology
				Physical Findings
				Causes
			Treatment
			Complications
		Cross-References
		References
Part VIII: Psychologic and Psychiatric Problems
	34 Psychiatric Disorders in Children with Cerebral Palsy
		Introduction
		Natural History
		Identification
			Incidence/Prevalence
			Evaluation
		Treatment/Remediation
		Illustrative Case Study
			Recognition by IEP Regarding Motor Issues/Condition
		Conclusion/Areas for Future Studies
		Cross-References
		References
	35 Autism Spectrum Disorder in the Child with Cerebral Palsy
		Introduction
			Definition of CP and ASD
			Epidemiology
			Diagnosis
			Challenges in ASD Diagnosis for Children with CP
		Natural History
			Comorbidities and Common Risk Factors
				Preterm Birth/Low Birth Weight
				Maternal Infection and Inflammation
				Perinatal Hypoxia/Ischemia
				Genetic Factors
				Epilepsy
				Intellectual Disability
				Motor Coordination Abnormalities
		Treatment
			Medical Testing
			Medical Treatments
				Pharmacotherapy
				Rehabilitative Therapies
				Early Intensive Behavioral Interventions (ABA, Developmental Models)
				Complementary and Alternative Medicine
		Conclusion
		Cross-References
		References
	36 Family Stress Associated with Cerebral Palsy
		Introduction
		Parent Stress
		Psychological Well-Being
		Physical Health Outcomes
		Disability Severity
		Family Adaptation
		Parent Personal Resources: Social Support and Self-Efficacy
		Assessment Tools and Interventions
		The Role of Respite Care Services
		Financial Resources and Socioeconomic Status
		Psychosocial Interventions and Parent Stress
		Conclusions
		Cross-References
		References
	37 The Impact of Cerebral Palsy on Siblings
		Introduction
			Children: Playmates, Mentors, and Friends
				Challenges
				Benefits
			Adults: Caregivers, Supports, and Friends
				Caregiving
				Benefits
				Challenges
			Advice to Healthcare Professionals
		Conclusion
		Cross-References
		References
Part IX: Neuromotor Function
	38 Motor Control and Muscle Tone Problems in Cerebral Palsy
		Introduction
		Pathophysiology
			Anatomic Motor Control Structure
				Central Motor System
				Peripheral Motor Control
			Development of the Anatomic Structure
				Central Nervous System
				Peripheral Motor System
			Controller Mechanisms and Theory
				Sensory System Feedback Versus Feed-Forward Control
				Controller Options: Maturation Theory
				Controller Options: Dynamic Systems Theory
				The Cause of Chaotic Attractors
				A Unified Theory of Motor Control
		Pathology Treatments
			Disorders of Muscle Tone
				Motor Tone
				Measuring Muscle Tone
			Spasticity
				Effects of Spasticity on Nerves
				Effects of Spasticity on Muscles and Tendons
				Effects of Spasticity on Bones
				Functional Effects of Spasticity on Sitting, Gait, and Activities of Daily Living
			Hypotonia
			The Effects of Hypotonia
				Functional Problems
			Treatments of Tone
			Movement Disorders
			Motor Control: Movement Disorders
				Dystonia
				Secondary Effects of Dystonia
				Athetosis
				Sensory Motor Effects of Athetosis
				Treatment
				Treatment: Therapy
			Chorea and Ballismus
			Summary of Motor Control Treatments
			Disorders of Balance (Ataxia)
				Treatment of Ataxia
				Orthotics
				Summary of Treatment: Ataxia
		Cases
		Cross-References
		References
	39 Spasticity Assessment in Cerebral Palsy
		Introduction
			Joint-Level Assessments to Infer About Muscle Function
			Definitions
		Measurement Methods
			Measurement Errors
			Qualitative Assessment Methods
			Quantitative Assessment Methods
				Passive Muscle Assessments
				Active Muscle Assessments
		Clinical Interpretation of Instrumented Assessments
		Conclusion
		Cross-References
		References
	40 Medical Management of Spasticity in Children with Cerebral Palsy
		Introduction
		Pathophysiology
		Assessment
		Treating Spasticity
		Therapy Services
		Bracing and Positioning
		Chemodenervation
		Oral Medications
		Intrathecal Baclofen
		Neurosurgery
		Orthopedic Surgery
		Summary Discussion
		Conclusion
		Cross-References
		References
	41 Focal Management of Spasticity in Cerebral Palsy
		Introduction
		Natural History
			Effects of Spasticity on Nerves
			Effects of Spasticity on Muscles and Tendons
			Effects of Spasticity on Bones
			Functional Effects of Spasticity on Sitting, Gait, and Activities of Daily Living
		Treatments
			Peripheral Nervous System
			Neuromotor Junction and the Muscle
				Botulinum Toxin (Botox)
				Complications of Botulinum Toxin
			Alcohol and Phenol
			Direct Surgical Treatment of the Musculotendinous Unit
			Orthotics
			Therapy
			A Global Approach to Managing Spasticity
		Cases
		Cross-References
		References
	42 Intrathecal Baclofen Therapy: Assessment and Medical Management
		Introduction
		History
		Pharmacology of Baclofen
		Criteria
		Screening Trial
		Pump Implantation
		Pump Management
		Complications
		Outcomes
		Summary
		References
	43 Intrathecal Medication Administration in Cerebral Palsy
		Introduction
		Natural History
		Treatment
		Complications
		Cross-References
		References
	44 Dorsal Rhizotomy for Spasticity Management in Cerebral Palsy
		Introduction
		Some History
		Treatment
			Patient Selection
				Decision Procedure
				General Selection Criteria for SDR
				Individual Selection Criteria for SDR
				Timing of SDR Surgery
				Surgical Procedure
				Neurophysiologic Intraoperative Monitoring
			Postoperative Rehabilitation Program
			Expected Outcome
		Complications
		Conclusions
		References
	45 Dystonia and Movement Disorders in Children with Cerebral Palsy
		Introduction
		Pathophysiology
			Dystonia
			Athetosis, Chorea, and Choreoathetosis
		Natural History
		Treatment
			Dystonia
			Medications
			Global Treatment
			Focal Dystonia Treatment
			Secondary Effects of Dystonia
			Athetosis and Choreoathetosis
			Treatment
			Treating Secondary Effects of Athetosis
			Chorea and Ballismus
		Conclusion
		Cases
		Cross-References
		References
	46 Deep Brain Stimulation for Pediatric Dystonia
		Introduction
		Epidemiology
		Preliminary Management
		History of Surgical Interventions for Dystonia
		Theoretical Mechanism of DBS
		Preoperative Planning and Lead Implantation
		Implantable Pulse Generators
		Complications
		Functional Outcome
		Future Directions
		Cross-References
		References
	47 Ataxia and Disorders of Balance in Children with Cerebral Palsy
		Introduction
		Balance Components
			Ataxia
			Vestibular System
			Common Vestibular Disorders
		Conclusion
		Cross-References
		References
	48 Assessing Dynamic Balance in Children with Cerebral Palsy
		Introduction
		Natural History
		Treatment
			Testing
				Task-Oriented Assessment of Dynamic Balance
				Timed or Distance-Based Walking Tests of Dynamic Balance
				Marker-Based Assessment of Dynamic Balance
				Other Instrumented Assessment of Dynamic Balance
			Treatment
				Exercise/Therapy
				Vestibular Stimulation
				Taijiquan
				Body Weight-Supported Treadmill Training
				Virtual Reality and Interactive Gaming
				Hippotherapy
				Vibrational Therapies
				Electrical Stimulation Therapies
				Surgical Interventions
		Complications
		Cross-References
		References
Part X: Gastrointestinal
	49 Overview of Feeding and Growth in the Child with Cerebral Palsy
		Introduction
		Natural History
			Prevalence and Pathophysiology
			Etiology of Feeding and Growth Problems
				Oral-Motor Dysfunction
				Inappropriate Dietary Intake
				Caregiver Dependency
				Abnormal Energy Expenditure
		Evaluations/Assessments
			Ability to Take in Adequate Nutrition
			Growth and Anthropometric Measurements
			Physical Examination
			Swallow Study
			Adequacy of Intake and Energy Needs
			Laboratory Evaluation
			GI Concerns
			Social History
		Treatment/Management of Problems
			Intake of Nutrition/Feeding Interventions
			Nutritional Adequacy
			Other Medical Management
		Conclusion
		Cross-References
		References
	50 Gastrostomy and Jejunostomy Feedings in Children with Cerebral Palsy
		Introduction
		Oropharyngeal Dysphagia
			Evaluation
		Gastroesophageal Reflux
			Evaluation
		Management
			Gastrostomy Tube
			Gastrojejunostomy
		Complications of Gastrostomy and Gastrojejunostomy Tubes
			During Placement
			Post-placement Complications
		Conclusion
		Cases
		Cross-References
		References
	51 Gastroesophageal Reflux in the Child with Cerebral Palsy
		Introduction
		Natural History
			Pathophysiology and Etiology
			Clinical Presentation and Symptoms
		Treatment
			Diagnosis and Testing
				Esophagogastroduodenoscopy (EGD) and Biopsy
				Esophageal pH Monitoring (EpHM)
				Combined Multiple Intraluminal Impedance and pH Monitoring (CMII)
				Barium Contrast Radiography/Upper GI (UGI) Series
				Nuclear Scintigraphy/Gastric Emptying Scan (GES)
			Management
				Conservative Management
				Pharmacologic Management
				Surgical Management
		Complications
			Reflux Esophagitis and Peptic Strictures
			Barrett Esophagus and Adenocarcinoma
		Conclusion
		Cross-References
		References
	52 Medical and Surgical Therapy for Constipation in Patients with Cerebral Palsy
		Introduction
		Natural History
			Physiopathology
		Treatment
			History and Physical Exam
			Abdominal Radiography
			Sitz Marker Study
			Motility Studies
			Rectal Biopsies
			Medical Therapy
			Retrograde Enemas and Fecal Disimpaction
			Antegrade Enteral Cleanout at Home
			Admission for Bowel Cleanout
			Maintenance Therapy
			Diet
			Medications that Induce Constipation
		Complications
			Surgical Therapy and Interventions
			Medically Refractory Constipation
			Volvulus
			Perforation
		Summary
		Case Example
		References
Part XI: Ear, Nose, and Throat
	53 Medical Management of Sialorrhea in the Child with Cerebral Palsy
		Introduction
		Natural History
			Physiology
			Pathophysiology
			Clinical Assessment of Drooling
		Treatment
			Non-pharmacologic Management of Drooling
			Pharmacologic Interventions for Drooling
			Botulinum Toxin Injections
		Outcomes
			Technique
			Adverse Effects
			Surgery
		Future Directions
		Cross-Reference
		References
	54 Surgical Options for Sialorrhea Management in Children with Cerebral Palsy
		Introduction
		Noninvasive Therapies
		Pharmaceutical Therapies
		Botulinum Toxin Injections
		Surgical Management
		Conclusion
		Cross-References
		References
	55 Auditory Rehabilitation in Children with Cerebral Palsy
		Introduction
		Diagnosis of Hearing Loss
		Treatment
			Conventional Amplification
			Cochlear Implantation
				Candidacy Assessment with Audiology
				Candidacy Assessment with Speech and Language Pathology
				Candidacy Assessment with Otolaryngology
				Candidacy Assessment with Social Work
				Preoperative Counseling
				Intraoperative Considerations
				Complications
				Postoperative Rehabilitation
		Conclusion
		Cross-References
		References
	56 Upper Airway Obstruction in the Child with Cerebral Palsy: Indication for Adenotonsillectomy
		Introduction
		Prevalence
		Etiology
			Impact on Quality of Life
		Diagnostic Considerations
		Treatment of OSA in CP
			Tonsillectomy
			Additional Surgical Interventions
			The Role of Tracheostomy
		Postoperative Management and Complications
		Cross-References
		References
	57 Surgical Management of Tracheostomies and Tracheal Diversion in Children with Cerebral Palsy
		Introduction
		History
		Natural History and Pathophysiology
			Indications
		Treatment
			Tracheostomy Technique
			Diversion Techniques
		Complications
			Complications After Tracheostomy
			Immediate Complications
				Early Complications
				Late Complications
			Complications of Tracheal Diversion
		Conclusions
		Cross-References
		References
Part XII: Genitourinary
	58 Toilet Training and Bladder Control in Children with Cerebral Palsy
		Introduction
		Natural History
			Normal Toilet Training and Voiding Review
			Voiding Issues in Upper Motor Neuron Versus Lower Motor Neuron Lesions
			Factors Influencing Toilet Training in Children with CP
			Effect of Constipation on Voiding
			Summary of Toilet Training
		Treatment
			Urologic Evaluation
			Noninvasive Testing
			Invasive Testing: Urodynamic Studies
			Treatment Options
			Environmental Modification and Communication
			Bowel Management
			Medications
				Anticholinergic Medications
				Desmopressin
			Bladder Catheterization
			Selective Dorsal Rhizotomy
		Complications
			Upper Urinary Tract Deterioration
			Changes in Adulthood
		Cross-References
		References
	59 Neurogenic Bladder in Cerebral Palsy: Upper Motor Neuron
		Introduction
		Natural History
			Normal Bladder Function
			Lower Urinary Tract Dysfunction in Cerebral Palsy
			Pathogenesis of Urinary Tract Symptoms in Cerebral Palsy
		Diagnostic Work Up and Treatment
			Work Up of Urological Symptoms in Children with Cerebral Palsy
			Treatment of Lower Urinary Tract Symptoms in Children with Cerebral Palsy
		Complications
		Cross-References
		References
	60 Kidney Stones: Risks, Prevention, and Management in Cerebral Palsy
		Introduction
		Immobilization and Hypercalciuria
		The Ketogenic Diet and Kidney Stone Risk
			Antiepileptic Medications
				Topiramate
				Zonisamide
		Treatment
			Medical Management of Acute Renal Colic
			Surgical Management of Kidney Stones
			Imaging
			Surgical Modalities for the Treatment of Kidney Stones
			Extracorporeal Shock Wave Lithotripsy (ESWL)
			Endoscopic Lithotripsy
			Percutaneous Nephrolithotomy (PCNL)
		Prevention of Recurrent Kidney Stones
			Adequate Fluid Intake
			Sodium
			Calcium
			Protein
			Alkali Therapy/Potassium Citrate
			Diuretics
		Cross-References
		References
	61 Undescended Testis in Boys with Cerebral Palsy
		Introduction
		Natural History
			Prevalence
			Associated Risk Factors
		Treatment and Complications
		References
	62 Gynecological Issues in Girls and Young Women with Cerebral Palsy
		Introduction
		Natural History
			Puberty and Menstruation
			Sexuality in Young Women
			The Office Visit
				History
				Physical Examination
		Treatment
			Menstrual Suppression
				Nonhormonal Treatment
				Hormonal Treatment
				Surgical Treatment
			Contraception
			Preventative Health and Screening
		Complications
			Pregnancy
		Cross-References
		References
Part XIII: Pulmonary
	63 Bronchopulmonary Dysplasia and Cerebral Palsy
		Introduction
		Natural History
			Definition
			Incidence
			Pathology of BPD
				Radiology
		Treatment
			Prevention of BPD
				Antenatal
			Postnatal
				Surfactant Therapy
				Caffeine
				Vitamin A
				Oxygen Therapy
				Corticosteroids
			Treatment of Established BPD
				Diuretics
				Bronchodilators
				Nutrition
			Immunizations and RSV Prophylaxis
		Outcome/Prognosis
			Respiratory Outcomes
			Neurodevelopmental Outcomes
		Conclusion
		Cross-References
		References
	64 Asthma in a Child with Cerebral Palsy
		Introduction
		Natural History
			Pathophysiology for Asthma
			Natural History of Risk Factors for Respiratory Illness
			Diagnostic Observations and Dynamic Imaging Studies
			Role of Historical Information to Treat Asthma
		Treatment for Asthma
		Complications of Treatment for Asthma
		Measurable Parameters for Asthma Symptoms
			Validated Surveys as a Diagnostic Tool for Asthma
			Laboratory Studies
			Limitations of Functional Respiratory Studies
		Summary
		Cross-References
		References
	65 Aspiration in the Child with Cerebral Palsy
		Introduction
		Definitions
		Natural History
			Aspiration from Above
			Aspiration from Below
			Screening and Diagnostic Testing
		Complications
			Aspiration Syndromes
			Tracheobronchitis
			Aspiration Pneumonitis
			Aspiration Pneumonia
		Treatment
		Summary
		Cross-References
		References
	66 Medical Management of Tracheostomy in the Child with Cerebral Palsy
		Introduction: What Is a Tracheostomy?
		Natural History of Respiratory Issues in Patients with Cerebral Palsy
		Treatment: Indications for Tracheostomy Tube Placement in Patients with CP
			Evaluation for Tracheostomy Placement
		Complications: Potential Risks of Trach Placement
		Care Following Trach Placement
			Decannulation of the Tracheostomy Tube
		Summary
		Cross-References
		References
	67 Obstructive Sleep Apnea in Children with Cerebral Palsy
		Introduction
		Prevalence
		Normal Breathing During Sleep
		Sleep-Disordered Breathing and OSA in Children with Cerebral Palsy
		Clinical History
		Diagnosis
		Treatment Options
		Cross-References
		References
Part XIV: Endocrine
	68 Short Stature in Children with Cerebral Palsy
		Introduction
		Natural History
			Overview of Normal Growth
			Measurements of Growth
			Growth Charts
		Diagnosis and Treatment
			Maturational Assessments of Growth
				Bone Age
				Body Composition: Overview
				Body Composition: Skinfold Thickness
				Body Composition: DXA Technique
		Complications (Non-nutritive Factors Affecting Growth)
			Growth Hormone-IGF-1 Axis: Normal
			Growth Hormone Axis: Assessment in Cerebral Palsy
			Growth Hormone Deficiency Treatment in Cerebral Palsy
			Other Non-nutritive Factors in Growth Disorders
			Functional Changes with Growth
		Approach to Growth Problems in Children with Cerebral Palsy
		Cross-References
		References
	69 Growth Attenuation for the Child with Cerebral Palsy
		Introduction
		Natural History
		Treatment
		Complications
		Ethical Considerations
			Autonomy and Family Preferences
			Beneficence, Nonmaleficence, and the Best Interest Principle
			Justice and Contextual Features
			Perspective of Stakeholders
		Conclusion
		Cross-References
		References
	70 Premature and Delayed Sexual Maturation in Children with Cerebral Palsy
		Introduction
			Normal Pubertal Maturation
				Phase of Fetus and Infant Puberty Development
				Phase of Childhood Hormonal Suppression
				Phase of Adolescent Puberty
			Physical Assessment of Puberty
			Adrenal Role in Puberty
		Natural History
			Precocious Puberty
				Incomplete Precocious Puberty
					Benign Variants
					Pathological Variants
				Complete Precocious Puberty
				Delayed Puberty
		Diagnosis and Treatment
			Diagnosis of Central Precocious Puberty
			Treatment of Central Precocious Puberty
			Diagnosis of Delayed Puberty
			Treatment of Delayed Puberty
		Complications
			Studies of Pubertal Milestones in Children with Cerebral Palsy
			Studies of Pubertal Hormonal and Metabolic Changes in Children with Cerebral Palsy
			Studies of Mechanisms of Pubertal Disruption in Cerebral Palsy
		Conclusion
		Cross-References
		References
	71 Endocrine Dysfunction in Children with Cerebral Palsy
		Introduction
		Natural History
			Pituitary Gland
			Thyroid Gland
			Adrenal Gland
		Treatment
			Pituitary Gland
			Thyroid Gland
			Adrenal Gland
		Complications
		Cross-References
		References
Part XV: Eyes
	72 Testing Visual Function and Visual Evaluation Outcomes in the Child with Cerebral Palsy
		Introduction
		Natural History
			Vision Disorders Commonly Associated with Cerebral Palsy
		Evaluation and Treatment of Ocular and Vision Disorders Associated with Cerebral Palsy
			Preparation for the Vision Evaluation
				Preliminary Information from Caregiver
				Information from Educators and Rehabilitation Therapists
				Clinical History
				Ocular Health Examination
		Visual Skills Evaluation
			What Are the Primary Visual Skills that Can Be Helpful for Professionals Working with Children with CP to Be Aware of?
		Color Vision
		Glare Sensitivity and Dark Adaptation
		Vision Evaluation Outcomes
		Complications of the Disease Process and Treatment
		Treatment and Management of Identified Vision Disorders
		Integration of Recommendations into Education and Rehabilitation Plans
		Cross-References
		References
			Further Readings
	73 Strabismus Management in the Child with Cerebral Palsy
		Introduction
		Natural History
		Treatment
			Nonsurgical Treatment
			Surgical Treatment
		Complications
			Binocular Vision
			Amblyopia and Visual Acuity
			Strabismus Surgery Failure
			Psychosocial Complications
		Cross-References
		References
	74 Cortical Visual Impairment in the Child with Cerebral Palsy
		Introduction
		Natural History
			Case History
			Pathophysiology
			Etiology
			Characteristics
			Visual Acuity
			Visual Field
			Higher Order Deficits
		Treatment
			Diagnosis
			Interventions
			Prognosis
			Multidisciplinary Team
		Complications
		Cross-References
		References
Part XVI: Dental
	75 Dental Hygiene for Children with Cerebral Palsy
		Introduction
		Goals and Environment
			Body Function and Structure
			Impact on Oral Hygiene
			Environmental Factors
			Personal (Family) Factors
				Early Intervention and Counseling by Pediatric Services
		Technique
			Early Establishment of Dental Home
			Oral Hygiene
			Non-cariogenic Diet
			Anticipatory Guidance
			Conditioning
			Regular Dental Care Management
			New Strategies
		Evidence of Effectiveness
		Conclusion
		Cross-References
		References
	76 General Dentistry for Children with Cerebral Palsy
		Introduction
		Common Issues
			Similarities and Differences to Other Mental and Physical Challenges
			Risk Factors
			Quality of Life
			Dental Awareness and Oral Hygiene Education for Parents and Caregivers
		Clinical Concerns
			Lip Biting
			Bruxism, Clenching, and Grinding
			Drooling
			Incompetent Lip Seal
			Dental Trauma
			Caries
			Periodontal Disease (Gingivitis, Periodontitis)
			GERD, Erosion, and Wear
			Malocclusion
			Temporomandibular Joint (TMJ) Dysfunction
		Dental Treatment for Children with CP
			Before Treatment
				Oral Drugs
				Caregiver in Room
				Special Operatory Chairs
				Safety Restraint
				Nitrous Oxide
				Opening the Mouth
				Keeping the Mouth Open
			Treatment: Oral Exam and Cleaning
				Illuminating the Oral Field
				Illuminating Inside the Oral Cavity
				Intraoral Photos and Video
				X-Ray Imaging
				Magnification
				Isolation
			Treatment: Complex Dental Procedures
			When Office Efforts Don´t Succeed
				IV Sedation
				General Anesthesia
				OR (Operating Room) Follow-Up in the Office
		Oral Hygiene at Home or Institution
		Training for Dentist and Dental Staff
		Access to Care
		Conclusion
		Case Studies
		Cross-References
		References
	77 Management of Skeletal Facial Deformation and Malocclusion in Cerebral Palsy
		Introduction
		Etiology
		Functional Deficits and Impact
		Assessment
		Treatment
		Summary
		Cross-References
		Glossary of Terms
		References
Part XVII: Anesthesia Management
	78 Medical Evaluation for Preoperative Surgical Planning in the Child with Cerebral Palsy
		Introduction
		Medical Evaluation/Optimization
			General
			Musculoskeletal
			Neuro/Developmental
			Respiratory
			Gastroenterology/Nutrition
			Cardiovascular
			Renal/Urologic/Genitourinary
			Endocrinology
			Hematology
			Psychiatric
		Medications
		Laboratory Evaluation
		Miscellaneous
		Summary
		Case Histories
		Cross-References
		References
	79 Anesthesia in the Child with Cerebral Palsy
		Introduction
		Surgical Epidemiology
		Perioperative Concerns
			Neurologic
			Respiratory
			Cardiovascular
			Gastrointestinal
			Fluids and Electrolytes
			Musculoskeletal
			Thermoregulatory
			Pharmacologic
			Positioning
		Management
			Preoperative
			Intraoperative
			Postoperative
		Conclusion
		Cross-References
		References
	80 Postoperative Pain and Spasticity Management in the Child with Cerebral Palsy
		Introduction
		Epidemiology of Pain
		Pathophysiology of Pain
		Special Challenges Relating to Pain Management
		Chronic Systemic Sources of Pain
		Pain Assessment
		Multimodal Approach to Pain
		Approaches to Pain Management
			Opioids
			Nonopioid Drugs
			Antispasmodics
		Regional Approaches
		Postoperative Spasticity Management
		Monitoring
		Pain Management for Specific Procedures
		Summary
		Cross-References
		References
	81 Regional Anesthesia in Patients with Cerebral Palsy
		Introduction
		Caudal Anatomy and Analgesia
		Epidural Anatomy/Analgesia
		Epidural Placement in Patients with a Baclofen Catheter
		Neuraxial Blockade in Patients after Spinal Instrumentation
		Peripheral Nerve Blocks
		Surgical Site and Type of Regional Blocks
			Hip and Thigh Surgeries
			Lumbar Plexus Block
			Fascia Iliaca Compartment Block
			Thigh Surgery and Femur Fracture
				Femoral Nerve Block
				Lateral Femoral Cutaneous Nerve Block
			Knee Surgery
			Sciatic Nerve Block
			Adductor Canal Block
			Foot and Ankle Surgeries
		Regional Blocks for the Upper Extremity
			Shoulder Surgery
				Interscalene Block
			Upper Arm, Elbow, Forearm, Wrist, and Hand Surgery
				Supraclavicular Block
				Infraclavicular Block
				Axillary Block
		Cross-References
		References
	82 Anesthetic Management of Spine Fusion
		Introduction
		Anesthetic Management
		Preoperative Care and Workup
		Intraoperative Care
		Total Intravenous Anesthesia (TIVA)
		Procoagulants and Management of Blood Loss
		Neuromonitoring and Its Influence on the Anesthetic Management
		Anesthetic Choices to Facilitate Neuromonitoring
		Postoperative Management
		Conclusion
		References
	83 Postoperative Care of the Cerebral Palsy Patient
		Introduction
		Respiratory Considerations
			Patients at Respiratory Baseline
			The Intubated Patient
			Upper Airway Obstruction and Respiratory Effort
			Impaired Mucociliary Function and Secretion Clearance
			Postoperative Respiratory Complications
			Liberation from the ICU or Stepdown Unit
		Cardiovascular Considerations
			Background
			Modalities of Monitoring Hemodynamics
			Fluid Resuscitation
			Vasopressor Support
				Norepinephrine
				Dopamine
				Hydrocortisone
		Gastrointestinal Considerations
			Nutrition
			Nausea and Vomiting
			Constipation
			Pancreatitis
		Genitourinary and Renal
			Fluid Management
			Electrolyte Abnormalities
			Urinary Retention
		Hematology
			Bleeding/Anemia
			Venous Thromboembolism
			VTE Prevention
			VTE Treatment
		Fever and Infectious Disease
			Introduction
			Fever Timing
			Noninfectious Etiologies of Postoperative Fever
			Diagnostic Testing
			Antibiotics
		Neurology
			Spasticity
			Seizures
			Sleep
			Mood
		Early Mobilization/Postoperative Rehabilitation
		Cross-References
		References
Part XVIII: Complementary Medical Treatments
	84 Complementary and Alternative Medicine in Cerebral Palsy
		Introduction
		Selected CAM Therapies Utilized in Cerebral Palsy
			Acupuncture
				Description
				Evidence
			Myofascial Structural Integration/Rolfing
				Description
				Evidence
			Adeli Suit (TheraSuit) Treatment
				Description
				Evidence
			Craniosacral Therapy
				Description
				Evidence
			Hyperbaric Oxygen Therapy
				Description
				Evidence
			Electrical Stimulation (e-Stim)
				Description
				Evidence
			Cannabinoids
				Description
				Evidence
			Stem-Cell Therapy
				Description
				Evidence
		Summary
		References
	85 Hyperbaric Oxygen Therapy for Cerebral Palsy: Definition and Principles
		Introduction
		History of the Development of HBOT
		Adverse Effects of HBOT
		Current Policy and Regulation of HBOT
		Cost
		Rationale for Use of HBOT in Cerebral Palsy
		Goals and Environment
		Technique
		Evidence of Effectiveness
		Summary and Conclusions
		References
	86 Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy
		Introduction
		Treatment
			Acupuncture and Moxibustion
				Scalp Acupuncture Therapy
				Electrical Acupuncture Therapy
				Acupuncture Point Injection Therapy
			Tui Na Therapy (Massage Therapy)
				Supine Position
				Prone Position
				Alternative Treatment
					Triceps Surae Spasticity
					Knee Hyperextension
					Adductor Muscle Spasticity
			Traditional Chinese Medication for Topical Use
			Comprehensive Chinese Medicine Therapy and Intervention
		Complications
			Pain
			Infection
			Acupuncture Syncope
			Allergy
			Curved or Fixed Needles
		Case 1
		Conclusion
		Cross-References
		References
	87 Osteopathic Manipulative Treatment and Acupuncture in Cerebral Palsy
		Introduction
		Natural History
		Treatment
		Outlook
		Cross-References
		References
Part XIX: Gait in Cerebral Palsy
	88 Musculoskeletal Physiology Impacting Cerebral Palsy Gait
		Introduction
		Natural History and Pathophysiology
			Central Nervous System
			Biomechanics
		Muscle Mechanics
			Force Production
			Muscle Fiber Types
			Muscle Anatomy
			Muscle Length-Tension Relationship (Blix Curve)
			Muscle Control
			Muscle Force-Generating Capacity
			Muscle Excursion
			Increasing Muscle Excursion
			Connective Tissue Mechanics
			Growth of the Muscle-Tendon Unit
			Bone Mechanics
			Joint Mechanics
			Joint Motor Mechanics
			Single-Joint Muscles
			Multiple-Joint Muscles
				Treatment
		Cross-References
		References
	89 Normal Human Gait
		Introduction
		Natural History and Pathophysiology
			Gait Cycle
			Stance Phase
			Swing Phase
			Body Segments Important in the Gait Cycle
			Ankle
			Foot Segment
			Knee
			Hip
			Pelvis
			HAT Segment
		Treatment
			Simplified Joint Functions
			Simplified Cycle Functions
			Global Body Mechanics of Human Gait
			Cognitive Subsystem
			Balance Subsystem (Chap. 47, ``Ataxia and Disorders of Balance in Children with Cerebral Palsy´´)
			Energy Production
			Motor Control
			Structural Stability
		Cases
		Cross-References
		References
	90 Cerebral Palsy Gait Pathology
		Introduction
		Natural History and Pathology
		Balance
			The Impact of Growth and Development
			Interventions
		Motor Control
			The Impact of Growth and Development
			Interventions
		Motor Power
			Impact of Growth and Development
			Interventions
		Musculoskeletal Subsystem
		Cross-References
		References
	91 History and Physical Examination Components of Gait Analysis
		Introduction
		History Related to Current Disability
		Physical Examination
			Global Function Measures
			Interrater and Intrarater Reliability
			Motor Control
			Muscle Strength
			Muscle Tone
			Passive Range-of-Motion Assessment
			Reliability
		Cross-References
		References
	92 Diagnostic Gait Analysis Technique for Cerebral Palsy
		Introduction
		Components of Gait Analysis Assessment
			History
			Physical Examination
				Global Function Measures
				Motor Control (Chap. 91, ``History and Physical Examination Components of Gait Analysis´´)
				Muscle Strength (Chap. 91, ``History and Physical Examination Components of Gait Analysis´´)
				Muscle Tone
				Passive Range-of-Motion Assessment
			Video Recording
			Kinematics (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
				Measurement System
				Data Reduction Algorithms (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
				Measurement Accuracy
			Kinetics (Chap. 93, ``Kinematics and Kinetics: Technique and Mechanical Models´´)
				Measurement Accuracy
			Electromyography
			Pedobarograph (Chap. 95, ``Pedobarograph Foot Evaluations in Children with Cerebral Palsy´´)
			Oxygen Consumption (Chap. 97, ``Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy´´)
			Activity Monitoring (Chap. 97, ``Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy´´)
		Summary of Gait Analysis
		Cross-References
		References
	93 Kinematics and Kinetics: Technique and Mechanical Models
		Introduction
		Goals and Environment
		Technique
			Gait Evaluation
			Marker Sets and Models
			Calculating Kinematics
			Clinical Implications of Kinematics
			Calculating Kinetics
			Clinical Implications of Kinetics
		Evidence of Effectiveness
		References
	94 Foot Kinematics: Models Used to Study Feet in Children with Cerebral Palsy
		Introduction
		Measurement Other than Motion Analysis
		Motion Analysis: Single-Segment Foot Model
		Motion Analysis: Multisegment Foot Model
		Normal Multisegment Foot Model Kinematics
		Clinical Examples
		Summary
		Cross-References
		References
	95 Pedobarograph Foot Evaluations in Children with Cerebral Palsy
		Introduction
		Natural History
		Therapeutic Use of the Pedobarograph
		Evaluations Complimentary to Pedobarograph
		Complications
		Cross-References
		References
	96 Measuring Femoral and Tibial Torsion in Children with Cerebral Palsy
		Introduction
		Natural History and Methods
			Natural History
			Methods
		Natural Pathophysiology: Measuring Tibial Torsion
			Physical Examination
				Trans-Malleolar Axis (TMA)
				Thigh-Foot Angle (TFA)
			Imaging Technology
				Radiography
					Plane Radiograph (X-ray)
					Fluoroscopy
				Computed Tomography, Magnetic Resonance Imaging, and EOS System
					CT and MRI
					EOS System
				Ultrasonography
			Three-Dimensional Motion Analysis
		Natural Pathophysiology: Measuring Femoral Torsion
			Physical Examination
			Imaging Technology
				Radiography
				Computed Tomography, Magnetic Resonance Imaging, and EOS System
				Ultrasonography
			Three-Dimensional Motion Analysis
		Conclusion
		References
	97 Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy
		Introduction
		Pathophysiology and Measurement Techniques
			Oxygen Consumption and Cost
			Cardiovascular Conditioning
		Activity Monitors
		Treatment Implications
			Data Interpretation
			Treatment Recommendations
		Complications
		Cross-References
		References
	98 Gait Analysis Interpretation in Cerebral Palsy Gait: Developing a Treatment Plan
		Introduction
		History and Pathophysiology
			Outpatient Clinical Assessment
			When Is Gait Analysis Needed to Develop Treatment Plan?
			How Should Gait Analysis Be Applied?
		Treatment Plan Development
			Foot Contact-Weight Acceptance
			Midstance
			Late Stance Phase
			Early Swing Phase
			Late Swing Phase
		Complications
		Cross-References
		References
	99 Gait Treatment Outcome Assessments in Cerebral Palsy
		Introduction
		Evaluating Individual Domains
			Body Function and Structure
			Health Condition-Related Quality of Life
			Personal Factors
			Participation
			Environment Factors
		Conclusions
		Cross-References
		References
	100 Hemiplegic or Unilateral Cerebral Palsy Gait
		Introduction
		Natural History and Pathophysiology
			Etiology
		Treatment
			Hemiplegia Type 0
			Hemiplegia Type 1
			Hemiplegia Type 2
			Outcome of Plantar Flexor Tendon Lengthening
			Rotational Deformities
			Hemiplegia Type 3
			Stiff Knee Gait
			Rotational Deformities
			Hemiplegia Type 4
			Rotational Deformities
			Limb Length Discrepancy
		Complications
		Cases
		Cross-References
		References
	101 Diplegic Gait Pattern in Children with Cerebral Palsy
		Introduction
		Natural History and Treatment
			Diplegia in Young Children (The Prancing Toe Walker) (True Equinus)
				Mild Involvement
				Moderate Degree of Involvement
				Severe Involvement
				Surgical Treatment of the Prancing Toe Walker (True Equinus)
				Middle Childhood, Early Crouch, and Recurvatum of the Knee
				Adolescent Severe Crouch
				Knee Recurvatum (Back-Kneeing)
			Complications
		Cases
		Cross-References
		References
	102 Hip and Pelvic Kinematic Pathology in Cerebral Palsy Gait
		Introduction
		Natural History and Pathophysiology
			Hip Joint
				Sagittal Plane
				Coronal Plane Hip Pathology
				Transverse Plane Deformity
			Pelvis
				Pelvic Rotation
				Pelvic Tilt
				Pelvic Obliquity
			HAT Segment
		Treatment and Outcome Summary
		Cases
		Cross-References
		References
	103 Crouch Gait in Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
			Pathophysiology
		Treatment
			Performing the Crouched Gait Surgery
			Spasticity Reduction in Adolescents and Young Adults
		Complications
		Cases
		Cross-References
		References
	104 Knee Deformities Impact on Cerebral Palsy Gait
		Introduction
		Natural History and Pathophysiology
			Knee Position at Weight Acceptance
			Midstance Knee
			Terminal Stance Knee Position
			Early Swing Phase
			Terminal Swing Phase
			Treatment Summary
		Cases
		Cross-References
		References
	105 Foot Deformities Impact on Cerebral Palsy Gait
		Introduction
		Natural History and Pathophysiology
			Secondary Adaptations
				Treatment
			The Foot as a Functional Moment Arm in Contact with the Ground Reaction Force
			Secondary Adaptations
				Treatment
			The Ankle as a Power Output Joint
			Ankle Dorsiflexion in Swing Phase
		Treatment Summary and Outcome Expectations
		Cases
		Cross-References
		References
	106 Complications from Gait Treatment in Children with Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
		Treatment
			Complications of Gait Analysis
			Complications of Surgery Planning
			Interrelated Effect of Multiple Procedures
			Complications of Surgical Execution
			Complications of Rehabilitation
			Monitoring the Outcome of Gait Development and Treatment
			Energy Use Measurement
		Cases
		Cross-References
		References
	107 The Evolution of Knee Flexion During Gait in Patients with Cerebral Palsy
		Introduction
		Current Knowledge
		Assumptions
		The Concept of the Development of Knee Flexion Gait
			Starting with the Foot
			Starting with the Knee
			Starting with the Hip
		Conclusions
			Limitations
		Cross-References
		References
Part XX: Upper Extremity
	108 The Upper Extremity in Cerebral Palsy: An Overview
		Introduction
		Natural History
			Normal Development of Function of Children´s Upper Extremities
			Classifying Upper Extremity Function
		Treatment
		Specific Treatments
		Complications
		Conclusion
		Cross-References
		References
	109 Upper Extremity Assessment and Outcome Evaluation in Cerebral Palsy
		Introduction
		Mode of Administration
		Classifications Versus Tests
		Norm-Referenced Versus Criterion-Referenced Tests
		Assessing Hand Use in Infants
		The ICF Framework
			Capacity Versus Performance
		Psychometric Properties
		Clinical Utility
		Final Points
		Upper Extremity Evaluation: Examples of Commonly Used Tools
		Body Function Assessments
			Classifications
			Body Function Assessments
		Activity and Participation Assessments
			Classifications
			Questionnaires
		Observation Based
			Speed and Dexterity
			Quality of Movements
			Bimanual Performance
			Functional Activity Performance
			Development of Hand Skills
			Individualized Measures
		Cross-References
		References
	110 Physical Examination and Kinematic Assessment of the Upper Extremity in Cerebral Palsy
		Introduction
			Natural History: Evaluation of Patients
				Guidelines for Setting Goals
				Early Childhood: Ages 0-6 Years
				Middle Childhood: Ages 6-12 Years
				Adolescence: Ages 12 Years and Older
		Treatment: Assessment to Develop a Plan
			Pretreatment Evaluation
				Classification of Upper Extremity Involvement
				Assessment of Specific Impairment
					Physical Examination
					Sensation
					Selective Motor Control
					Muscle Strength
				Kinematic Assessment
					Electromyography (EMG)
		Developing a Treatment Plan
		Cross-References
		References
	111 Spasticity, Dystonia, and Athetosis Management in the Upper Extremity in Cerebral Palsy
		Introduction
		Natural History of Spasticity and Movement Disorder
			Measuring Spasticity and Movement Disorder
			Treatment
				Spasticity
			Movement Disorder: Dystonia, Athetosis, and Chorea
		Conclusion
		Cross-References
		References
	112 Single-Event Multilevel Surgery for the Upper Extremity in Cerebral Palsy
		Introduction
		Natural History: Pathophysiology
		Treatment
			Patient Age
			Neurologic Type
			Voluntary Control
			Sensibility
			Intelligence
			Patient Motivation
			Developing the SEMLS Plan
		Outcome and Complications of SEMLS
		Cross-References
		References
	113 Shoulder and Elbow Problems in Cerebral Palsy
		Introduction
		Shoulder
			Shoulder Contractures
				Natural History
				Treatment
				Outcome of Treatment
				Other Treatment
				Complications of Treatment
			Shoulder Instability
				Natural History
				Treatment
		Elbow
			Elbow Flexion Contracture
				Natural History
				Treatment
				Complications of Treatment
			Radial Head Dislocation
				Natural History
				Treatment
				Complications of Treatment
		Cases
		Cross-References
		References
	114 Forearm, Thumb, and Finger Deformities in Cerebral Palsy
		Introduction
		Natural History (Pathophysiology and Symptoms)
		Regional Treatment
			Forearm Pronation
				Natural History
				Treatment
				Outcome of Treatment
				Complications of Treatment
			Wrist Flexion Deformity
				Natural History
				Diagnostic Evaluations
					Mild Wrist Flexion Deformity
					Moderate Wrist Flexion Deformity
					Severe Wrist Flexion Deformity
					Very Severe Wrist Flexion Deformity
					Wrist Extension Contracture
				Treatment
				Outcome of Treatment
				Other Treatment
				Complications of Treatment
			Thumb
				Natural History
				Diagnostic Evaluations
				Treatment
				House Classification
					Type 1
					Type 2
					Type 3
					Type 4
				Outcome of Treatment
				Other Treatment
				Complications of Treatment
			Finger Flexion
				Treatment
				Outcome of Treatment
				Other Treatment
				Complications of Treatment
			Finger Swan Neck
				Treatment
				Outcome of Treatment
		Conclusion
		Cases
		Cross-References
		References
	115 Upper Extremity Operative Procedures in Cerebral Palsy
		Introduction
		Individual Procedures
			Shoulder Adductor, Extension, and External Rotator Lengthening
				Indication
				Procedure
				Postoperative Care
		Humeral Derotation Osteotomy
			Indication
			Procedure
			Postoperative Care
		Elbow Flexion Contracture Release
			Indication
			Procedure
			Postoperative Care
		Pronator Release or Transfer
			Indication
			Procedure
			Postoperative Care
		Flexor Carpi Ulnaris (FCU) Transfer for Wrist Flexion Deformity
			Indication
			Procedure
			Postoperative Care
		Carpectomy and Wrist Fusion
			Indication
			Procedure
			Postoperative Care
		Thumb Adductor Lengthening
			Indication
			Procedure
			Postoperative Care
		Webspace Lengthening and Z-Plasty
			Indication
			Procedure
			Postoperative Care
		Metacarpal Phalangeal Joint Fusion of the Thumb
			Indication
			Procedure
			Postoperative Care
		Extensor Pollicis Longus Rerouting
			Indication
			Procedure
			Postoperative Care
		Palmaris Longus or Brachioradialis Transfer to the Abductor Pollicis
			Indication
			Procedure
			Postoperative Care
		Volar Plate Advancement and Sublimis Slip Reinforcement for Swan Neck Deformity
			Indication
			Procedure
			Postoperative Care
		Central Extensor Slip Release for Swan Neck Deformity
			Indication
			Procedure
		Cross-References
		References
Part XXI: Spine
	116 Spinal Deformity in Children with Cerebral Palsy: An Overview
		Introduction
		Natural History and Treatment
			Scoliosis
			Kyphosis and Lordosis
			Early Onset Scoliosis
		Complications
			Problems Related to Spinal Deformity
		Conclusion
		Cross-References
		References
	117 Cerebral Palsy Spinal Deformity: Etiology, Natural History, and Nonoperative Management
		Introduction
		Natural History, Incidence, and Etiology
			Natural History
		Treatment: Nonoperative
			Conservative Treatment
			Orthotics
			Seating
			Therapy
			Electrical Stimulation
			Botulinum Toxin
		Conclusion
		Cases
		Cross-References
		References
	118 Surgical Treatment of Scoliosis Due to Cerebral Palsy
		Introduction
			Etiology
			Incidence and Natural History
			Indications for Scoliosis Surgery
				Preoperative Orthopedic Evaluation
				Preoperative Management and Preparation
					Preparing for Intraoperative Bleeding
				Soft Bone
					Maintaining Spinal Cord Integrity
					Prophylaxis to Prevent Deep Wound Infection
			Operative Treatment
			Evolution of Instrumentation for Neuromuscular Scoliosis Correction
				Unit Rod
				Current Methods of Pelvic Fixation, Pre-contoured Rods with Pelvic Screw, and Segmental Spine Fixation
				Sublaminar Wires vs. Pedicle Screws
				Rigid Scoliosis in the Cerebral Palsy Child
			Surgical Outcomes
			Functional Outcomes and Quality of Life
		Cross-References
		References
	119 Surgical Management of Kyphosis and Hyperlordosis in Children with Cerebral Palsy
		Introduction
		Etiology/Pathogenesis/Natural History
		Patient Assessment and Preoperative Considerations
		Nonoperative Treatment
		Surgical Treatment
			Medical/Anesthesia Considerations (Anesthesia for Cerebral Palsy Spine Fusion Surgery)
			Operative Principles
			Preoperative Planning
		Current Preferred Surgical Treatment Methods (Spinal Procedure Atlas for Cerebral Palsy Deformities)
			Intraoperative Positioning
			Instrumentation
			Fusion to the Pelvis
		Kyphosis Correction
			Lumbar and Thoracolumbar Kyphosis
			Thoracic Kyphosis
			Hyperlordosis
			Rigid Kyphotic and Hyperlordotic Deformities
		Evidence-Based Outcomes
		Summary
		Cross-References
		References
	120 Early-Onset Scoliosis in Cerebral Palsy
		Introduction
		Natural History and Etiology
		Treatment Options for Early-Onset Scoliosis
			Early Short Fusion as an Option
			Growing Rod Constructs
			Spinal Deformity in Very Small Children Who Are Older
		Recommendation for Early-Onset Spine Fusion in Children with CP
		Long-Term Outcome of Early Spine Fusion
		Conclusion
		Cases
		Cross-References
		References
	121 Complications of Spine Surgery in Cerebral Palsy
		Introduction
		Natural History
			Overall Risk Factors
			Death: Mortality
				Transition Time
				Immediate Postoperative Period
			Preoperative Problems
				Poor Nutrition
			Intraoperative Complications
				Respiratory Problems
					Bleeding Problems (Chapter ``Anesthetic Management of Spine Fusion´´)
				Epidural Bleeding
				Bone Bleeding
				Dural Leak
				Perforation of the Pelvis with Unit Rod
				Medial Pelvic Perforation
				Lateral Pelvic Perforation
				Acetabular Perforation
				Wires Pulling Through Laminae
				Rod Either Too Long or Too Short
			Spinal Cord Monitoring: Loss of Motor Evoked Potentials
		Postoperative Complications
			Hypotension
			Thrombophlebitis and Pulmonary Embolism
			Coagulopathy
			Respiratory Failure
			Pneumothorax or Hemothorax and Pleural Effusion
			Reflux and Aspiration
			Pancreatitis
			Colicystitis
			Duodenal Obstruction
			Constipation
			Poor Feeding
			Seating Adjustments
			Hair Loss
		Doing Posterior Spinal Fusion When Families Refuse Blood Transfusions
			Dealing with Families Who Refuse Spinal Fusion
		Handling Families and Children When a No Resuscitation Status Is Requested
		Cases
		Cross-References
		References
	122 Neuromonitoring and Anesthesia for Spinal Fusion in Cerebral Palsy
		Introduction
		Personnel and Practical Aspects of Neuromonitoring
		Technical Aspects and Interpretation of IONM
			Somatosensory Evoked Potentials (SSEP)
			Motor Evoked Potentials (MEP)
			Electromyography (EMG)
		Stagnara Wake Up Test
		Physiological Application and Risk of Neuromonioring
			Blood Supply to the Spinal Cord
			Risk of Neuromonitoring
		Anesthesia
			Inhaled Anesthetics
			Intravenous Anesthetics
		Nonanesthetic Intraoperative Influences
		Clinical Application
		References
	123 Cervical Spine in Children with Cerebral Palsy
		Introduction
		Treatment: Cervical Spine Problems
			Extensor Posturing
			Occipital Subluxation, Posturing
			Atlantoaxial Instability and Subluxation with or without Os Odontoideum
			Congenital Atlantoaxial Displacement with Os Odontiodeum
			Cervical Spine Spondylosis
			Inability to Hold up the Head
			Severe Upper Thoracic Kyphosis with Lower Cervical Lordosis
		Complications of Cervical Spinal Deformity
			Cervicothoracic Junction Kyphosis
		Cross-References
		References
	124 Pelvic Alignment and Spondylolisthesis in Children with Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
			Pelvic Malalignment
			Pelvic Obliquity
				Etiology
				Natural History
				Treatment
				Seating Adjustment
				Surgical Correction of Pelvic Obliquity
			Anterior Pelvic Tilt
				Etiology
				Natural History
				Treatment
			Pelvis Rotational Malalignment
			Spondylolisthesis
				Natural History
				Treatment
		Conclusion
		Cases
		Cross-References
		References
	125 Infections and Late Complications of Spine Surgery in Cerebral Palsy
		Introduction
		Pathology of Long-Term Complication
			Postoperative Infections
				Persistent Fevers
				Superficial Wound Infections
				Acute Deep Wound Infection
				Treatment
			Mechanical Problems
				Pain in the Spine
				Proximal End Prominence or Wire Prominence
				Nonunion-Pelvic Leg Halos-Rod Fracture
				Crankshaft
				Neck Stiffness
				Decreased Floor or Bed Mobility
		Special Problems with Spinal Surgery
			Doing Revision Spinal Surgery in Children with Cerebral Palsy
				Fall-Off from a Short Fusion
				Torsional Collapse
				Pseudarthrosis
				Hardware Failure
				Correcting Deformity Posterior Dorsal Rhizotomy
				Correcting Spinal Deformity in Ambulatory Children
			Mortality
		Conclusion
		Cases
		Cross-References
		References
	126 Spinal Procedure Atlas for Cerebral Palsy Deformities
		Introduction
		Posterior Spinal Fusion with Single Unit Rod or Modular Unit Rod Using Cantilever Correction
			Indication
			Procedure
			Postoperative Care
		Special Consideration for Correction of Kyphosis and Lordosis
		Anterior Spinal Release
			Indication
			Procedure
			Postoperative Care
		Cross-References
		References
Part XXII: Hip
	127 Hip Problems in Children with Cerebral Palsy: An Overview
		Introduction
		Natural History, Etiology, and Pathophysiology
		Treatment
			Typical Posterior Lateral Dislocations in Children with Spasticity
			Other Hip Deformities
			Femoral Torsional
		Complications in CP Hip Management
			Surgical Procedures
		Conclusion
		Cross-References
		References
	128 Etiology of Hip Displacement in Children with Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
		Posterior-Superior Hip Subluxation
			Etiology
			Secondary Pathology
			Tertiary Changes
		Treatment and Outcomes
		Conclusion
		References
	129 Natural History and Surveillance of Hip Dysplasia in Cerebral Palsy
		Introduction
		Natural History
			Childhood
			Adolescence
			Adult
		Diagnostic Evaluations
			Hip Radiograph
			Computed Tomography Scans
			Ultrasound
			Bone Scan
			Arthrography
		Treatment
			Surveillance Algorithm
			Surveillance Results
		Conclusion
		References
	130 Prophylactic Treatment of Hip Subluxation in Children with Cerebral Palsy
		Introduction
		Treatment
			Specific Prophylactic Treatment
				Operative Procedures
		The Outcome of Preventative Treatment
			Other Treatment
			Iliopsoas Transfer
			Adductor Transfer
			Botulinum Toxin Injection
			Intrathecal Baclofen
			Dorsal Rhizotomy
			Abduction Orthosis
		Complications of Preventative Treatment
			Pain
			Infections
			Hyperabduction
		Cases
		References
	131 Hip Reconstruction in Children with Cerebral Palsy
		Introduction
		Natural History
		Treatment
			Indications for Reconstructive Treatment
			Recommended Surgical Reconstruction Approach
			Outcome of Reconstruction Treatment
			Other Reconstructive Treatment Options: Varus Osteotomy Without Acetabular Osteotomy
			Other Pelvic Osteotomies
			Indication for Doing Bilateral Femoral Varus Osteotomy
		Complications of Reconstruction
			Loss of Fixation
			Repeat Early Dislocation
			Heterotopic Ossification
			Sleep Problems
			Prolonged Hip Pain
			Avascular Necrosis
			Intraarticular Extension of Pelvic Osteotomy
			Other
		References
	132 Palliative or Salvage Hip Management in Children with Cerebral Palsy
		Introduction
		Natural History
		Treatment
			Recommended Treatment
			Total Hip Replacement
			Interposition Arthroplasty
			Resection Arthroplasty (Castle Procedure)
			Proximal Femoral Valgus Osteotomy (McHale Procedure)
			Subtrochanteric Valgus Osteotomy Without Femoral Head Resection (Schanz Osteotomy)
			Femoral Head Resection (Girdlestone Procedure)
			Hip Fusion
		Complications of Palliative Treatment
			Chronic Pain Syndrome
			Persistent Pain
		Conclusion
		Cases
		References
	133 Anterior Dislocation of the Hip in Cerebral Palsy
		Introduction
		Natural History, Pathophysiology, and Etiology
		Treatment
			Type I Anterior Hip Dislocation
				Treatment
			Type II Anterior Hip Dislocation
				Treatment
				Other Treatment Recommendations
				Complications
			Type III Anterior Hip Dislocation: Present in Hypotonic and Hypermobile Hips
				Treatment
				Complications
			Inferior Hip Dislocation
		Conclusion
		References
	134 Hypotonic and Special Hip Problems in Cerebral Palsy
		Introduction
		Natural History and Etiology
			Hypotonic Hip Subluxation
			The Natural History of Hypotonic Hip Disease
			Treatment: Hypotonic Hip
		Complications
			Hip Dislocation in Children with Down Syndrome and Cerebral Palsy
			Developmental Hip Dysplasia (DDH) in Children with Cerebral Palsy
				Established Developmental Dislocation
			Slipped Capital Femoral Epiphysis
			Perthes Disease in Children with Spasticity
		Cases
		References
	135 Femoral Anteversion in Children with Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
			Internal Rotation Posture
			Anteversion or Internal Femoral Torsion
				Measuring Anteversion and Coxa Valga
				Physical Examination
				Radiographic Measurement
				CT Scan
				Ultrasound
				Fluoroscopy
				Magnetic Resonance Imaging Scan
				Femoral Torsion Measurement Summary
				Measuring Coxa Valga
			Etiology of Femoral Anteversion and Coxa Valga
				Muscle Contractures
				Etiology of Coxa Valga
		Natural History
		Treatment
			Femoral Anteversion
				Methods for Correcting Anteversion
				Proximal Femoral Derotation
				Midshaft and Distal Femoral Osteotomy
				Orthotic Treatment
				Muscle Lengthening
		Conclusion
		Cases
		Cross-References
		References
	136 Windblown Hip Deformity and Hip Contractures in Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
		Treatment
			Hyperabducted Hip Deformity
				Postoperative Management
			Hip Flexion Contracture
				Assessment and Measurement of Hip Flexion Contracture
				Etiology
				Natural History
				Treatment
				Osteotomy
				Windblown Hips
				Etiology
				Asymmetric Neurologic Involvement
				Symmetric Neurologic Involvement
				Natural History
				Treatment (Table 1)
				Indications for Specific Treatment
				Middle Childhood
				Adolescence
				Adult
			Other Treatment Options for Windblown Hips
				Orthotic Management
				Tone Reduction
				Hip Pain After Correction of Windblown Hip
				Windblown Hip Deformity and Pelvic Obliquity (Hip Problems in Children with Cerebral Palsy: An Overview)
				Anteversion, Coxa Valga, and Internal Rotation Contracture
				Anteversion and Coxa Valga Relationship
				Coxa Valga
		Cases
		References
	137 Complications of Hip Treatment in Children with Cerebral Palsy
		Introduction
		Natural History and Symptoms
			Delayed Treatment
			Recurrent Contracture and Dislocation
			Hip Wound Infections
				Adductor Wound Infections
				Femoral Osteotomy Infections
			Femoral Osteotomy Nonunions
			Fractures of the Femur
				Fixation Failure
				Trochanteric Fracture
				Distal End of Plate Fractures
			Leg Length Discrepancy
				Caused by Adductor Contracture
				Secondary to Varus Osteotomy
				Dislocated Hip
				Pelvic Obliquity
			Heterotopic Ossification
				After Adductor Lengthening
				Prophylactic Treatment of Heterotopic Ossification
				Treatment
			Postoperative Hip Pain
				Plate Bursitis
				Medial Plate Protrusion
				Degenerative Arthritis
				Sudden Pain in Therapy
			Avascular Necrosis
			Thrombophlebitis and Pulmonary Embolism
			Hip Joint Stiffness
		Cases
		Cross-References
		References
	138 Surgical Atlas of Cerebral Palsy Hip Procedures
		Introduction
		Procedures
			Adductor and Iliopsoas Lengthening with Proximal Hamstring Lengthening
				Indication
				Procedure
				Postoperative Care
			Iliopsoas Lengthening: Over the Pelvic Brim Approach
				Indication
				Procedure
				Postoperative Care
			Proximal Femoral Osteotomy
				Indication
				Procedure
				Postoperative Care
			Peri-Ilial Pelvic Osteotomy (Dega Osteotomy)
				Indication
				Procedure
				Postoperative Care
			Pemberton-Type Pelvic Osteotomy for Anterior Dislocation
				Indication
				Procedure
				Postoperative Care
			Abductor Lengthening
				Indication
				Procedure
				Postoperative Care
			Resection Arthroplasty (Castle Procedure)
				Indication
				Procedure
				Postoperative Care
			Interposition Arthroplasty
				Indication
				Procedure
				Postoperative Care
			Femoral Derotation with an Intramedullary Nail
				Indication
				Procedure
				Postoperative Care
			Revision Adductor Lengthening
				Indication
				Procedure
				Postoperative Care
		Conclusion
		References
Part XXIII: Knee
	139 Overview of Knee Problems in Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
		Treatment
			Knee Flexion Deformity
			Patellar Femoral Instability
			Knee Extension Pathology (Chap. 148, ``Ankle Equinus in Cerebral Palsy´´)
			Knee Varus-Valgus and Tibial Torsion (Chap. 149, ``Equinovarus Foot Deformity in Cerebral Palsy´´)
		Complications
		Cross-References
		References
	140 Anterior Knee Pain and Patellar Subluxation in Cerebral Palsy
		Introduction
		Natural History
			Treatment (Chap. 103, ``Crouch Gait in Cerebral Palsy´´)
				Anterior Knee Pain and Extensor Mechanism Insufficiency
				Extensor Mechanism Stress
					Outcome of Treatment: Anterior Knee Pain
				Patellar Subluxation and Dislocation
					Outcome of Patellar Dislocation Treatment
			Complications
		Cases
		Cross-References
		References
	141 Knee Flexion Deformity in Cerebral Palsy
		Introduction
		Natural History and Etiology
			Natural History
			Etiology
				Secondary Pathology
				Tertiary Changes
		Treatment
			Hamstring Contractures
				Indications
				Specific Treatments (Atlas of Knee Operative Procedures In Cerebral Palsy)
				Outcome of Treatment
				Other Treatment
			Moderate Knee Flexion Contracture
				Indications and Treatments
				Outcome of Moderate Knee Flexion Contracture
			Severe Knee Flexion Contracture
				Indications and Treatments
				Outcome of Treatment
				Other Treatment
		Complications
		Cases
		Cross-References
		References
	142 Stiff Knee and Knee Extension Deformities in Cerebral Palsy
		Introduction
		Natural History and Pathology
			Pathology
				Inadequate Knee Flexion
				Stiff Knee Gait
				Knee Extension Contractures
			Secondary Pathology
			Tertiary Changes
		Treatment and Outcome
			Diagnostic Studies
				Treatment of Dynamic Knee Stiffness
			Other Treatment
			Outcome of Treatment
				Treatment of Fixed Knee Extension Contractures
			Outcome of Treatment
			Other Treatment
		Complications
		Cases
		Cross-Reference
		References
	143 Tibial Torsion and Knee Instability in Cerebral Palsy
		Introduction
		Natural History and Etiology
			Knee Mechanical Instability
			Intraarticular Pathology
			Varus and Valgus Deformity
			Tibial Torsion
				Natural History
				Etiology
				Diagnostic Evaluations
		Treatment
			Ligament Instability
			Varus and Valgus Deformity
			Tibial Torsion
			Outcome of Tibial Osteotomy
			Other Treatments
		Complications
		Cases
		Cross-References
		References
	144 Atlas of Knee Operative Procedures in Cerebral Palsy
		Introduction
		Treatment
			Hamstring Lengthening
				Indication
				Procedure
				Postoperative Care
			Rectus Transfer
				Indication
				Procedure
				Postoperative Care
			Posterior Knee Capsulotomy
				Indication
				Procedure
				Postoperative Care
			Repair of Dislocation of the Patella
				Indication
				Procedure
				Postoperative Care
			Tibial Osteotomy with Cast
				Indication
				Procedure
				Postoperative Care
			Tibial Osteotomy with Intramuscular Nail
				Indication
				Procedure
				Postoperative Care
			Patellar Advancement
			Distal Femoral Osteotomy
				Indication
				Procedure
				Postoperative Care
		Cross-References
		References
Part XXIV: Ankle, Foot, and Toes
	145 Foot Deformities in Children with Cerebral Palsy: An Overview
		Introduction
		Natural History and Pathophysiology (Chap. 146, ``Natural History of Foot Deformities in Children with Cerebral Palsy´´)
			Equinus
			Equinovarus
			Planovalgus
			Hallux Valgus with Bunion
		Treatment
			Equinus Treatment (Chap. 148, ``Ankle Equinus in Cerebral Palsy´´)
			Equinovarus (Chap. 149, ``Equinovarus Foot Deformity in Cerebral Palsy´´)
			Planovalgus (Chap. 150, ``Planovalgus Foot Deformity in Cerebral Palsy´´)
			Hallux Valgus with Bunion (Chap. 151, ``Forefoot and Toe Deformities in Cerebral Palsy´´)
		Conclusion
		Cross-References
		References
	146 Natural History of Foot Deformities in Children with Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
		Treatment
		Complications
		Cases
		Cross-References
		References
	147 Ankle Valgus in Cerebral Palsy
		Introduction
			Natural History
		Treatment
			Diagnostic Evaluations
			Indications for Intervention
			Outcome of Treatment
		Complications of Treatment
		Conclusion
		Cases
		Cross-References
		References
	148 Ankle Equinus in Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
			Etiology
			Secondary Pathology
			Tertiary Changes
		Treatment
			Diagnostic Evaluations
			Treatment
			Cavus and Equinus
			Outcome of Treatment
			Other Treatment
		Complications of Treatment
		Cases
		Cross-References
		References
	149 Equinovarus Foot Deformity in Cerebral Palsy
		Introduction
		Natural History and Pathophysiology
			Secondary Pathology
			Tertiary Changes
		Treatment
			Indications and Treatment
				Adolescents
			Fixed Heel Varus
			Severe Fixed Spastic Clubfeet
			Outcome of Treatment
			Other Treatments
		Complications of Treatment
		Conclusion
		Cases
		Cross-References
		References
	150 Planovalgus Foot Deformity in Cerebral Palsy
		Introduction
		Natural History (Chap. 146, ``Natural History of Foot Deformities in Children with Cerebral Palsy´´)
			Etiology
			Pathologic Deformity in Ambulators
				Primary Pathology
				Secondary Pathology
				Tertiary Pathology
				Midfoot Break with Rocker Bottom Foot
			Pathologic Deformity in Nonambulators
		Treatment
			Diagnostic Evaluations
			Indications
			Reconstruction
				Lateral Column Lengthening
				Subtalar Fusion
				Calcaneocuboid Lengthening Fusion
				Isolated Talonavicular fusion
				Multiple Arthrodesis
			Outcome of Treatment
			Other Treatments
		Complications of Treatment
			Surgical Procedures (Chap. 152, ``Atlas of Foot and Ankle Procedures in Cerebral Palsy´´)
			Midfoot Supination and Dorsal Bunion
				Indications and Treatment
		Complications
		Cases
		Cross-References
		References
	151 Forefoot and Toe Deformities in Cerebral Palsy
		Introduction
		Natural History
			Dorsal Bunion
			Hallux Valgus with Bunion
				Pathology
				Natural History
				Diagnostic Evaluations
			Extended Hallux
			Minor Toes
			Ingrown Toenails
		Treatment and Outcome
			Dorsal Bunion
			Hallux Valgus with Bunion
				Outcome of Treatment Hallux Valgus
				Extended Hallux Treatment
				Minor Toes Treatment
				Ingrown Toe Nails (Onychocryptosis) Treatment
			Blue Feet: Sympathetic Vascular Dysfunction
				Treatment
		Complications
			Complications of Dorsal Bunion
			Complications of Hallux Valgus
		Cases
		Cross-References
		References
	152 Atlas of Foot and Ankle Procedures in Cerebral Palsy
		Introduction
		Ankle Epiphysiodesis Screw
			Indication
			Procedure
			Postoperative Care
		Subtalar Fusion
			Indication
			Procedure
			Postoperative Care
		Lateral Column Lengthening Through the Calcaneus
			Indication
			Procedure
			Postoperative Care
		Lateral Column Lengthening Through the Calcaneocuboid Joint
			Indication
			Procedure
			Postoperative Care
		Medial Column Correction: Forefoot Supination and First Ray Elevation
			Indication
			Procedure
			Postoperative Care
		Triple Arthrodesis
			Indication
			Procedure
			Postoperative Care
		Gastrocnemius Lengthening
			Indication
			Procedure
			Postoperative Care
		Achilles Tendon Lengthening
			Indication
			Procedure
			Postoperative Care
		Tibialis Posterior Lengthening or Split Transfer
			Indication
			Procedure
			Postoperative Care
		Split Tibialis Anterior Transfer
			Indication
			Procedure
			Postoperative Care
		Lengthening of the Tibialis Anterior
			Indication
			Procedure
			Postoperative Care
		Bunion Correction
			Indication
			Procedure
		Fusion of the First Metatarsal Phalangeal Joint
			Indication
			Procedure
			Postoperative Care
		Correction of Clawed Toes
			Indication
			Procedure
			Postoperative Care
		Medial Border Great Toenail Resection
			Indication
			Procedure
			Postoperative Care
		References
Part XXV: Therapy Management in Cerebral Palsy: Introduction
	153 Therapy Management of the Child with Cerebral Palsy: An Overview
		Introduction
		The Second Edition of Dr. Freeman Miller´s Medical Text: Cerebral Palsy
		Therapy Management in the Child with Cerebral Palsy
			Introduction: Expert Opinion
			Life Span Approaches and Environmental Settings
			Body Structure and Functions
			Activity and Participation
			Adaptive Technology and Supports
			Complementary Therapy Approaches
		Cross-References
		References
	154 Physical Therapy Elements in the Management of the Child with Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
		Key Points
			Adaptations in the Movement System Require Repetition and Repeated Exposure to Stimuli to Induce the Desired Change
			PT Interventions Must Address Goals and Outcomes That Are Meaningful to the Child and Family
			Motor Learning Is an Active Process: Practice with Variable, Graded Sensory and Task Constraints Should Be Balanced for Engage...
			PT Interventions Should Not Only Emphasize the Learning of the Skill but Also the ``Retrieval´´ and Actual Use of the Skill in...
			The Timing of Interventions Affects Intervention Outcomes
			The Sum of Impairments Does Not Equal the Limits on Activities or Restrictions in Participation
			Address the Need for Adherence and Behavior Change Directly with Evidence-Based Approaches
		Evidence of Effectiveness
		Conclusion
		Cross-References
		References
	155 Occupational Therapy Elements in the Management of the Child with Cerebral Palsy
		Introduction
		Goals and Environment
		Techniques
			Body Function and Structure Impact on Activity
				Occupational Therapy Intervention Strategies Body Function and Structure Impact on Activity
					Upper Limb Strengthening and Orthotics
					Tactile and Sensory Integration Interventions for Children with Unilateral Cerebral Palsy
					Constraint-Induced Movement Therapy and Hand-Arm Bimanual Training
			Occupational Therapy Interventions to Improve Participation in Activity
				Specific Occupational Therapy Strategies
				Interventions for Feeding, Eating, and Drinking
				Approaches to Self-Care Activities
			Family Considerations in Occupational Therapy
		Evidence of Effectiveness
		Cross-References
		References
	156 Speech, Language, and Hearing Practice Elements in the Management of the Child with Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			Communication Activity and Participation
			The Role of Communication in a Child´s Participation in Life Situations
			Speech Practice Elements
			Language Practice Elements
			Hearing Practice Elements
			Elements of Environmental and Personal Factors
		Evidence of Effectiveness
		References
Part XXVI: Lifespan Approaches and Environmental Settings
	157 Therapies in Newborn and Pediatric Intensive Care Units for the Neurologic At-Risk Infants
		Introduction
		Goals and Environment
		Technique
			Examination
				NICU
					Positioning
					Range of Motion/Active Movement
					Developmental Skills
				PICU
					Positioning
					Range of Motion/Splinting and Casting
						Mobility
		Evidence of Effectiveness
		Case Studies
			Case 1: NICU
			Case 2: PICU
		Cross-References
		References
	158 Early Intervention Services for Young Children with Cerebral Palsy
		Introduction
		Goals and Environment
			Body Function and Structure, Impact on Activity, and Participation in Activity
			Personal Factors
			Environment Factors
		Technique
			Evaluation
			Interventions
			Teaming Models
		Evidence of Effectiveness
		Cases
		Cross-References
		References
	159 Innovative Approaches to Promote Mobility in Children with Cerebral Palsy in the Community
		Introduction
			Introduction: Community Mobility Is a Human Right
			Mobility Goals and Environments
			Community Mobility Approaches Are Built upon a Comprehensive Scientific Foundation
		Technique
			Assistive and Rehabilitative Tech Approaches to Community Mobility
		Evidence of Effectiveness
			Modified Ride-On Cars (ROCs): Hybrid Technology for Clinic and Community
				General Features of ROCs
			Real-World Body Weight Support Systems: Hybrid Technology for Impairments, Functional Activities, and Participation Within EE
		Conclusion: Creating the High-Impact Community Mobility Professional
		Cross-References
		References
	160 Outpatient-Based Therapy Services for Children and Youth with Cerebral Palsy
		Introduction
		The Setting
		Accessing Services
		Episodic Care
		Frequency of Outpatient Therapy Services
		Evolving Care
		Cross-References
		Appendix A
		References
	161 School-Based Therapy Services for Youth with Cerebral Palsy
		Introduction
			Educationally Relevant Services Provided by Medical Professionals
			Related Service Provision Under IDEA
			Section 504 and IDEA
		Goals and Environment
			IEP as the Structure for School-Based Practice
			Educational Environment as a Practice Setting
		Technique
		Evidence of Effectiveness
		Conclusion
		Case Study: Christian
		Cross-References
		References
	162 Community Resources: Sports and Active Recreation for Individuals with Cerebral Palsy
		Introduction: Promoting Participation in Sports and Active Recreation
		Goals and Environment
		Techniques
		Case Example
		Evidence of Effectiveness
		Cross-References
		References
	163 Clinical Therapy Services for Adults with Cerebral Palsy
		Introduction
		Health Needs
		Rehabilitation Needs and Environment
			Assessing Rehabilitation Needs
		Goals
		Techniques
		Conclusion
		Cross-References
		References
	164 Community Engagement for Adults with Cerebral Palsy
		Introduction
		Goals and Environment
		Techniques and Evidence of Effectiveness
			Transportation
			Home Health and Support Services
				Assistive Technology and Home and Workplace Accessibility Accommodations
					Assistive Technology
					Home Modifications and Accessibility Adaptations
					Other Assistive Technology Devices
					Workplace Modifications
				Postsecondary Education, Work, and Vocational Services
					Postsecondary Education
					Work and Vocational Services
				Clinical Case Example
		References
Part XXVII: Body Structure and Functions
	165 Postural Control in Children and Youth with Cerebral Palsy
		Introduction
			Systems Underlying Posture
			Development and Theory
			Categorizing and Testing Posture
			Deficits in Posture in Cerebral Palsy
		Goals and Environment
		Technique
			Assessments
			Principles of Motor Learning
			Interventions
				Biomechanical
				Strength or Muscle Facilitation
				Massed Practice
				Enhanced Feedback
				Perturbation Training
		Evidence of Effectiveness
			Evaluation of Research
				Improvement
				Adaptability
				Retention
				Consistency
			Theoretical Concepts
		Professional Practice Reflections with Respect to Device Modifications
		Cross-References
		References
	166 Selective Voluntary Motor Control in Children and Youth with Spastic Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			Evaluation of SVMC
			Treatment Approaches
		Evidence of Effectiveness
		Cross-References
		References
	167 Using Hippotherapy Strategies for Children and Youth with Cerebral Palsy
		Introduction
		Goals and the Environment
			Environment
		Technique
			Examination/Evaluation
			Plan of Care
			Hippotherapy Principles
		Evidence of Effectiveness
		Cross-References
		References
	168 Muscle Performance in Children and Youth with Cerebral Palsy: Implications for Resistance Training
		Introduction
			Central and Peripheral Contributions to Impairments in Muscle Performance
		Goals and Environment
		Technique: Dosing Guidelines for Resistance Training
			Application: What Is the Goal of the Intervention?
		Evidence of Effectiveness
		Cross-References
		References
	169 Aquatic Therapy for Individuals with Cerebral Palsy Across the Lifespan
		Introduction
		Goals and Environment
			Body Function and Structure
			Impact on Activity
			Impact on Participation
			Environmental Factors Personal (Family) Factors
			Aquatic Properties
				Refraction
				Hydrostatic Pressure
				Density/Specific Gravity
				Buoyancy (Archimedes´ Principle)
				Drag/Turbulence
			Physiological Effects
			Assessment and Evaluation
			Specialized Aquatic Techniques
				Halliwick Concept
				Bad Ragaz Ring Method
				WATSU/Water Shiatsu
			Transitioning to Land-Based Therapy
		Evidence of Effectiveness
		Case Studies
			Case 1 (Longitudinal)
				Birth History
				7 Years of Age
				12 Years Old
				14-22 Years of Age
			Case 2
				Birth History
		Cross-References
		Bibliography
	170 Functional Electrical Stimulation Interventions for Children and Youth with Cerebral Palsy
		Introduction
			History of Electrical Stimulation
			Types of Electrical Stimulation
		Goals and Environment
		Technique
			FES Background
			Neuroprosthetic and Neurotherapeutic Mechanisms of FES
			Rationale for FES Use in CP
			FES Precautions
				Risks Associated with External Electrical Stimulation of Muscles
				Risks Associated with Exercise
			Commercially Available FES Devices
				FES for Hand Function
				FES-Assisted Walking Devices
				FES Cycling Devices
		Evidence of Effectiveness
			FES for the Upper Extremities and Trunk
			FES-Assisted Walking
				FES Application to the Ankle Dorsiflexor Muscles
				Ankle Dorsiflexor Neuroprosthetic Effects
				Ankle Dorsiflexor Neurotherapeutic Effects
				FES as an Alternative to Ankle-Foot Orthoses
				FES Application to the Ankle Plantar Flexors (APFs)
			FES Cycling
		FES Tolerance and Acceptability
		Conclusion
		Limitations and Future Direction
		References
	171 Aerobic and Anaerobic Fitness in Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			International Classification of Functioning, Disability, and Health (ICF-CY)
			Energy Demands
			Physical Strain
			Physical Fitness
				Aerobic Capacity
				Aerobic Performance
				Anaerobic Performance
		Technique
			Physical Fitness Testing
				Testing Aerobic Fitness
				Testing Energy Demands of Walking and Physical Strain
				Testing Anaerobic Fitness
		Evidence of Effectiveness
			Fitness Training
				Effect on the Aerobic Capacity
					VO2peak
					Anaerobic Threshold
				Effect on Aerobic Performance
				Effect on Anaerobic Performance
			The Role of Exercise Testing and Advices on an Individual Basis
		References
	172 Flexibility in Children and Youth with Cerebral Palsy
		Introduction
			Neural Contributions to Reduced Flexibility
			Nonneural Contributions to Reduced Flexibility
		Goals and Environment
			Body Function and Structure
			Activity
			Participation
			Environmental Factors
			Personal Factors
		Measurement Techniques
			Measuring Flexibility
			Measuring Flexibility: Spasticity
			Measuring Flexibility: Increased Passive Muscle Stiffness
			Measuring Flexibility: Contracture
		Interventions
			Interventions to Improve Flexibility in Children and Youth with CP
			Interventions to Address Spasticity
			Interventions to Address Increased Passive Muscle Stiffness
			Interventions to Address Lower Extremity Contracture
			Interventions to Address Upper Extremity Contracture
		Evidence of Effectiveness
			Measuring Flexibility: Spasticity
			Measuring Flexibility: Increased Passive Muscle Stiffness
			Measuring Flexibility: Contracture
			Interventions to Address Spasticity and Their Impact on Spasticity
			Interventions to Address Spasticity and Their Impact on Impairments, Activity, and Participation
			Interventions to Address Increased Passive Muscle Stiffness and Their Impact on Passive Muscle Stiffness
			Interventions to Address Contracture and Their Impact on Contracture
			Interventions to Address Contracture and Their Impact on Impairments, Activity, and Participation
			Summary of Evidence Effectiveness
		References
	173 Postsurgical Therapy for the Individual with Cerebral Palsy
		Introduction
		Goals and Environment: Service Delivery
			Preoperative Evaluation and Planning
				Postoperative Inpatient Acute Hospital Therapy Model
				Home-Based Therapy Model
				Rehabilitation Program Therapy Service Model
				Outpatient Therapy Service Model
				School-Based Therapy
			Recovery Expectations
				Single Event Multilevel Surgery (SEMLS) for the Individual with Cerebral Palsy
				Special Considerations for the Progression of Weight Bearing after Orthopedic Surgeries
		Technique
			Hip
			Knee
			Lower Leg & Foot
			Spine
			Intrathecal Baclofen Pump
			Upper Extremity
		Summary/Evidence of Effectiveness
		Cross-References
		References
Part XXVIII: Activity and Participation
	174 Fine Motor Skill Development in Children and Youth with Unilateral Cerebral Palsy
		Introduction
		Goals and Environment
			Neural Integrity
			Classification of Grip/Pinch, Prehension, and Upper Extremity Function
			Atypical Prehension and Upper Extremity Function
				Muscle Activation
				Prehension Patterns
				Sensibility
				Anticipatory Control
				Selective Motor Control
		Technique: Strengthening of Prehension and Upper Extremity Function
			Assessment/Outcome Measures
				Classification of Functional Hand Use
			Effective Intervention Strategies
		Evidence of Effectiveness
		References
	175 Functional Mobility and Gait in Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			Classification
				The International Classification of Functioning, Disability, and Health ICF
				Gross Motor Function Classification System
				Sagittal Gait Patterns: Spastic Hemiplegic Cerebral Palsy
				Sagittal Gait Patterns: Spastic Diplegic Cerebral Palsy
			Assessment
				Instrumented Gait Analysis (IGA)
				Video Gait Analysis
				Functional Mobility Scale
				Functional Assessment Questionnaire
				Gross Motor Function Measure
				The Pediatric Evaluation of Disability Inventory (PEDI)
				Timed Walking Measures
				Timed Up and Go Test (TUG)
				The Functional Independence Measure for Children (WeeFIM)
				Goal Attainment Scale (GAS)
				Activity Monitoring
				The Canadian Occupational Performance Measure
				The Children´s Assessment of Participation and Enjoyment
				Gait Outcomes Assessment List
			Evidence of Effectiveness
				Intramuscular Injections of Botulinum Toxin A
				Selective Dorsal Rhizotomy
				Single Event Multilevel Surgery
				Muscle Strength Interventions
				Functional Electrical Stimulation
				Robotic-Assisted Gait Training
		Summary
		Cross-References
		References
	176 Robot-Assisted Gait Training for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Positioning RAGT Within the ICF
			Goals of Robotic Assisted Gait Training
		Technique
			Equipment
			Control Modes
			Exergames
			Indications, Contra-Indications, Possible Complications
				Dosage of RAGT
		Evidence of Effectiveness
		Cases
		References
	177 Treadmill Training for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Body Functions and Structures
			Activity
			Participation
			Contextual Factors
		Technique
			Treadmill Training for Children with Hemiplegic CP or Unilateral Impairment
			Treadmill Training for Children with Diplegic (Bilateral) CP and GMFCS Levels I-II
			Treadmill Training for Children with Diplegic or Quadriplegic CP (Bilateral) and GMFCS Levels III and IV
		Evidence of Effectiveness
		Cross-References
		References
	178 Functional ADL Training for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Technique
				Mental Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
				Sensory Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
				Neuromusculoskeletal and Movement-Related Functions as They Relate to Functional Skill Acquisition Within the ICF Framework
			Evidence of Effectiveness
		Cross-References
		References
	179 Constraint-Induced Movement Therapy for Children and Youth with Hemiplegic/Unilateral Cerebral Palsy
		Introduction
			The Problem to Be Addressed
			What Is CIMT: The Theoretical Concepts
			Principles for Training
		Goals and ICF
		Technique and Environment
			Intensive Group Models/Day-Camps
			Distributed Individual-Based Models Home/Preschool Models
			Combined Models CIMT/Bimanual Training/GOAL
			Distributed Internet/Phone Models
		Evidence of Efficacy
			Natural History of the Development of Hand Function
			Early Plasticity and Early Training
			Strength, Limitation, and Cost Effectiveness
		In Summary: CIMT in a Life Perspective
		Cross-References
		References
	180 Assessment and Treatment of Feeding in Children and Youth with Cerebral Palsy
		Introduction
		Natural History
			Assessment
		Examples of How the Health Condition (CP) May Impact Feeding
			Diet History and Bowel/Bladder Elimination
			Feeding History/Caregiver Interview
			Clinical Assessment
		Oral Motor Assessment
			Feeding Observation
			Self-Feeding
			Trial Therapy
			Cervical Auscultation
				Instrumental Assessments
		Intervention
			Caregivers and the Child
			Physicians, Dentists, and Physician Assistants
			Psychologist
			Dietitian
			Speech and Language Pathologist (SLP)
			Occupational Therapist (OT)
			Physical Therapist (PT)
			Social Worker
			Educational/Support Staff
				Elements of Treatment
				Tube Feeding
				Goals of Treatment
		Conclusion
		References
	181 Communication in Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Speech Intelligibility
			Language
			Literacy
		Technique
			Assessment
				Assessment of Speech
				Connection Between Speech and Language
				Assessment of Language
					Assessment of Early Language
					Assessment of Conventional Language
				Assessment of Emergent and Conventional Literacy
			Intervention
				Speech Intervention
				Language Intervention
					Language Modeling
					Partner-Focused Intervention Approaches
				Intervention for Emergent and Conventional Literacy
					Modifications
		Evidence of Effectiveness
		Cross-References
		References
	182 Mobility Supports in Educational Curriculum for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
		Techniques to Determine Services, Dosing, and Transition/Discontinuation
		Interventions and Evidence of Effectiveness
			Positioning
			MOVE Program
			Mobility Training
			Fitness Interventions (Strengthening, Stretching, and Aerobic Conditioning)
			CMT
			Consultation
		Case Studies
		Cross-References
		References
	183 Gaming Technologies for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Body Function and Structure Goals
			Activity Goals
			Participation Goals
		Technique
			Technology and Equipment
				Fine Motor Function and Activity Protocol Parameters
				Gross Motor Function and Activity Protocol Parameters
				Postural Control and Balance Protocol Parameters
				Fitness Protocol Parameters
			Participation
		Summary of Evidence of Effectiveness and Future Applications
			VR/AVG as a Supplement to Rehabilitation Interventions
			VR/AVG Systems in Development
			VR/AVGs in Clinical Practice
		Case Examples
		Conclusion
		Cross-References
		References
Part XXIX: Adaptive Technology and Supports
	184 Wheeled Mobility Options and Indications for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
			Overview of Current Issues
		Technique
			Wheeled Mobility Examination and Evaluation
			Wheeled Mobility Options
			Wheeled Mobility Training
				Transfer of Behavior
				Practice
				Feedback
		Evidence of Effectiveness
		Case Scenarios
		Cross-References
		References
	185 Ambulatory Assistive Devices for Children and Youth with Cerebral Palsy
		Introduction
		Standing Devices
			Ambulatory Devices
		Types of Ambulatory Devices
			Gait Trainer
			Walkers
			Crutches
			Canes
				Therapeutic Ambulation Devices
		Cross-References
		References
	186 Seating and Positioning Approaches for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
		Technique: Seating and Positioning Components - Definition of Terms (Fig 1)
		Evidence of Effectiveness
		Cross-References
		References
	187 Activities of Daily Living Supports for Persons with Cerebral Palsy
		Introduction
		Technique: ADLs
		Evidence of Effectiveness
		Cross-References
		References
	188 Lower Extremity Orthoses for Children and Youth with Cerebral Palsy
		Introduction
		History and Terminology
		Treatment and Expected Outcome
			Hip Frontal Plane
			Hip Transverse Plane
				Twister Cables
				Derotation Elastic Wraps
			Hip Multiplane
				SWASH Brace
			Knee Orthoses
				Knee Sagittal Plane
					Recurvatum: Back-Kneeing
				Knee Flexion Contracture
			Ankle-Foot Orthoses
				Equinus in Stance and Swing Phase
				Ankle Hyper-Dorsiflexion with Stance Knee Flexion (Crouch)
				Swing Phase Ankle Equinus with Normal Stance Ankle Posture
				Foot Deformities
			Specific Orthotic Design Considerations by Age and Special Conditions
				Preambulatory Stage
				Articulated Ground Reaction AFO
				Wraparound AFO Design
				Anterior Ankle Strap
				Foot Plate
				Off-The-Shelf (Ready-To-Fit) Shoe Inlays and Arch Supports
		Complications, Risks, and Benefits of Lower Extremity Orthotic
		Cross-References
		References
	189 Upper Extremity Orthotics for Children and Youth with Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			General Principles of Splinting
			Postoperative Orthotic Intervention
			Contracture Management
			Functional
			Motor Reeducation and Exercise Orthoses
		Evidence of Effectiveness
		References
	190 Augmentative and Alternative Communication for Cerebral Palsy
		Introduction
		Goals and Environment
		Technique
			AAC Evaluation
				Identifying Communication Needs to Increase Participation
				Determining AAC System Including Symbols, Aids, Techniques, and Strategies
			AAC Intervention
				Being Able to Carry Out One´s Communication Rights
				Interventions Using the WHO ICF Framework
				Communication Competencies
				For Beginning Communicators
		Evidence of Effectiveness
		Conclusion
		Cross-References
		References
Part XXX: Complementary Therapy Approaches
	191 Neurodevelopmental Treatment Clinical Practice Model´s Role in the Management of Children with Cerebral Palsy
		Introduction
		Goal and Environment
			Body Function and Structure
			Activity and Participation
			Contextual Factors in the ICF
		Technique
			Information Gathering
			Examination
			Evaluation
			Intervention
				Pretest
				Set Up
				Handling
				Preparation
				Simulation
				Posttest
				Home Program and Carryover
				Important Factors
					Frequency
					Indications, Contraindications, and Possible Complications
		Evidence of Effectiveness
		Cross-References
		References
	192 Complementary Therapy Approaches for Children and Youth with Cerebral Palsy
		Introduction
		Therapeutic Suits and Garments
			Therapeutic Suits: Goals and Environment
			Therapeutic Suits: Technique
			Therapeutic Suits: Evidence of Effectiveness
			Therapeutic Garments: Goals and Environment
			Therapeutic Garments: Techniques
			Therapeutic Garments: Evidence of Effectiveness
		Therapeutic Taping
			Goals and Environment
			Techniques
			Evidence of Effectiveness
		Yoga
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Pilates
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Myofascial Release
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Craniosacral Therapy
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Conductive Education
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Patterning
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Feldenkrais
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Vojta Therapy
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Medical Marijuana
			Goals and Environment
			Technique
			Evidence of Effectiveness
		Cross-References
		References
Index