The treatment of infantile spastic paralysis / by Robert Jones.

  • Robert Jones
Date:
[1902?]
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile spastic paralysis / by Robert Jones. Source: Wellcome Collection.

    4/18 page 348
    From the first, the reflexes are exaggerated and the arm and limb are powerless. Deformities soon follow. The foot is arched and adducted; the knee is bent; the hip is internally rotated, somewhat adducted, and the femur is bent on the trunk. The arm is huddled to the body, the elbow is flexed to a right angle, the wrist is dropped, the hand pronated and deviates towards the ulnar side, and the fingers generally grasp the thumb, which lies very forcibly adducted. As in the case of adults, rigidity of the affected muscles comes on in the generality of cases. This rigidity becomes more marked if the limb be moyed either passively or by the child, and disappears under an anesthetic. The aphasia so often present is motor in character, and may accompany either left or right hemiplegia. Then follows an inequality of growth. This is more marked in the arm than in the leg; a fact probably accounted for by the difference in nutrition, due to the more frequent exercise of the leg. I have seen the affected arm three inches or more shortened ; it is rare to find the leg over an inch shorter than its fellow. Of chief interest to us from the point of view of treatment are the following facts :— (a) The upper limb is more severely affected than the lower. (6) The lesion of the upper limb is more permanent. (c) The power of dorsiflexion of the hand, with simultaneous extension of the fingers, is lost. (d) That movements are performed without precision, spas- modically and slowly. (e) That the power of adduction of the thumb is often lost. The disabilities of the lower limb are generally :— (a) Contraction of the knee. (b) Extension of the foot. (c) Internal rotation of the femur with adduction. (d) General rigidity. The cerebral diplegic group is by far the most serious, as we have here to deal with both arms and feet. Unless the hands can be used, the surgeon is sorely handicapped in any
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