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Physical therapeutic and surgical management in spastic diplegia. A Japanese experience.

With the development of intensive neonatal care, spastic diplegia associated with prematurity has become the most common type of cerebral palsy. The principles of the present authors' treatment for children with the disease are physical therapy (involving neurodevelopmental treatment) and surgical treatment for contractures and deformities. The authors studied the long-term results of physical therapy and its effect on the necessity for surgery and the improvement of locomotor function. From 1973 to 1988, 355 children with spastic diplegia were treated at the authors' facility. From this group, the authors selected and studied 71 children who received systematic treatment for a minimum of one year and who could be followed at the age of six years or older. At the follow-up examination, 41 of these children were free ambulators, 28 were crutch ambulators, and two were not ambulatory. Of the 41 freely ambulatory children, four achieved free ambulation after the age of seven years. Of the 28 crutch ambulators, relatively small hip-flexion contractures were found in 11 children who had received the early developmental treatment program.