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Which Spastic Hemiplegia(Hemiparesis) Treatment Is Best For My Child?

BOTOX®? Tendon Transfer? Serial Casting? FirstFlex™?


Treatment of spastic hemiplegia (hemiparesis) of the upper extremity generally follows a conservative to aggressive continuum that starts with DT, PNF, other PT/OT maneuvers and may progress to such treatments as serial casting, BOTOX®, and tendon lengthening or transfer.

1
The new FirstFlex
treatment protocol combines custom bracing and neuromuscular electrical stimulation (NMES). It offers
a conservative treatment

option throughout a patient's growth and development.
Individual patient treatment for children with spastic hemiplegia attempts to take into consideration:
  • developmental milestones,
  • growth spurts, and
  • the severity and topography of involvement.

This discussion does not pertain to predominantly athetoid or ataxic populations.

Continuum Of Spastic Hemiplegia
Treatment For Children

Beginning with the most conservative, this progression moves to the more aggressive treatments for spasticity:

  • NDT, PNF and other PT/OT maneuvers
  • Inhibitory and support bracing to control musculo-skeletal alignment and prevent deformity
  • Serial casting to lengthen spastic musculature
  • BOTOX® injections to temporarily paralyze spastic musculature
  • TES, NMES, FES - electrical stimulation to build, facilitate and functionally fire musculature (listed respectively)
  • Selective neurectomy to create a partial state of hypotonia in
    spastic musculature
  • Tendon/muscle transfer for upper extremity to surgically balance spasticity

Conservative Treatment Options

1Conservative treatments such as PT/OT maneuvers or support bracing should begin as soon as spasticity is diagnosed. This will typically mean stretching and developmental patterning.

Electrical modalities have shown some promise in building weak antagonist musculature (TES), facilitating antagonist musculature or fatiguing spastic musculature (NMES) and for functional augmentation/training during movement (FES), although use remains limited.

Serial Casting And BOTOX®

If spasticity is moderate to severe and begins to present both static muscle shortening and patho-mechanical reach, grasp and pinch; serial casting and BOTOX® are commonly used to stretch out the spastic musculature.

Selective Neurectomy And Tendon Transfer

Selective neurectomy is used in spastic hemiplegia to reduce pronator flexor dominated global upper extremity function. It is often accompanied by facilitation and strengthening of extensors to equate improved function.

A tendon transfer is a surgical procedure that sometimes helps to release and lengthen tendons. They often improve resting posture, may reduce muscle grade and must be followed by extensive physical therapy to maintain (if not improve) those patients that have functional reach, grasp and pinch. Tendon transfers attempt to aid function by relocating spastic musculature to aid balance and movement.

Where Is FirstFlex In The Continuum?

FirstFlex™ is a conservative treatment option because it combines custom bracing and neuromuscular electrical stimulation (NMES) for a "safe and effective" treatment for spasticity in children (according to a study by researchers at the Kleinert Institute).

It does not rely on pharmacological injections or surgical procedures to achieve patient improvement.

In summary, there are many other viable treatment options for addressing Cerebral Palsy induced spastic hemiplegia. We believe, however, that the FirstFlex™ treatment protocol is particularly suited to improve global hand function for spastic hemiplegia (hemiparesis).

Therefore, FirstFlex is a conservative option that should be considered prior to the more invasive alternatives.

Discover more about the studies conducted by the Kleinert Institute and promising results in the reduction of deformity and spasticity.

You can contact us for videos, research studies, or for more information.

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