Management
Sensory
loss
If the sensory loss is likely to he temporary (such as caused by
transected sensory nerve) then the limb should be carefully protected to avoid
injuries such as burns. Splints and plaster should also be applied with great
caution as the patient will be unaware when they are developing sores at
pressure points.
Temporary
flaccid paralysis
This can be managed with splints to prevent overloading of ligaments and
to maintain function of joints. Physiotherapy will be needed to maintain joint
mobility, and to build up muscle power as the nerve supply returns. Lively
splints are fitted with springs so that the weak muscle does not have to
function but nevertheless the limb can be kept moving by the opposing muscle
whose function remains normal.
Spastic
paralysis
This is much more difficult to manage and requires regular gentle
physiotherapy to try and put joints through a full range of movement without
creating spasm. Regular physiotherapy should prevent the development of
contractures which may make the deformity very difficult to manage. As a general
rule, splints do not work well in spastic paralysis as they can stimulate spasm.
The result is then either stress or a broken splint. Deformity as a result of
spasticity
(b) the tendinous insertion of the muscle can be lengthened;
(c) the insertion of the muscle into bone can be released and allowed to
slide along the bone reducing the mechanical lever arm;
(d) the muscle can be injected with either a temporary or permanent
paralytic agent such as botulin toxin;
(e) the nerve supply to the muscle can be divided.
In
children many of these actions causing defunction of the muscle are reversed by
the natural healing powers of a child. Transected muscles heal. Divided nerves
regenerate. The procedures may therefore need repeating.
In
athetosis, paralysis of the muscle with botulin or by transection of the nerve
is a possibility but there is usually considerable function available despite
the irregular movements of the limb and this loss of function must be balanced
against the improvement in abnormal movements.
Trick
manoeuvres
Patients with paralysed muscles develop a set of trick manoeuvres aimed
to overcome their disability. For example, paralysis of the quadriceps muscle
makes it difficult to lock the knee when walking. Patients with this problem
frequently walk with their hand in the trouser pocket pressing firmly on the
front of the knee and heel strike. This serves to lock the knee for normal
locomotion. Patients with paralysis of the shoulder girdle may develop trick
manoeuvres with their trunk which enable them to throw their arm high above
their head.