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Congenital Hemiplegia
  1. J Gibbs

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If you believe that congenital hemiplegia is a straightforward, unilateral motor disability then you need to read this informative book. On the other hand, if you appreciate the variety of motor difficulties and additional problems experienced by children with congenital hemiplegia, then you will value the practical guidance offered in this comprehensive review of a deceptively challenging disorder.

About 30% of children with cerebral palsy have a congenital hemiplegia. In around 40%, the hemiplegia results from periventricular haemorrhage or leucomalacia, whilst malformations or cortical infarcts each account for 15% of cases. Progressive refinements in brain imaging are proving increasingly helpful in determining aetiology although in almost 40% of those with congenital hemiplegia the aetiology remains unknown.

Gait analysis contributes invaluably to the planning and monitoring of surgery. Many abnormal movement patterns may be encountered. The range of abnormalities and, consequently, the numerous surgical options to be considered may appear daunting those less familiar with such a detailed analysis of gait. Yet, this is precisely the point; abnormalities of gait in hemiplegia are complex and even experienced clinicians cannot fully interpret gait from simple observation. Without formal gait analysis, inappropriate surgical options may be chosen resulting in deleterious, and occasionally disastrous, functional outcomes.

The mistaken view that a hemiplegia represents a straightforward motor disorder is not uncommon. A national hemiplegia support group has evolved rapidly because many parents struggle to understand their children's difficulties, having been reassured that the child merely had a simple, limited motor impairment. After establishing that the motor disability in congenital hemiplegia is often far from straightforward, the remainder of this book considers the additional problems that those with hemiplegia may encounter.

Around 20% of children with congenital hemiplegia have epilepsy which is intractable in about 25% of cases. Although epilepsy surgery may not be feasible, this option should be considered in any child with intractable seizures as surgical resection, including hemispherectomy, can be remarkably effective. The psychosocial impact of congenital hemiplegia is also reviewed. Psychological problems are managed using standard child mental health approaches, although the attitude of the child and family towards the hemiplegia, and the presence of intractable epilepsy, influence treatment. Children with hemiplegia may experience learning difficulties, particularly with respect to language and visuospatial skills. Left hemisphere lesions are more likely to result in educational difficulties, but the most powerful determining factors are the presence of epilepsy and overall cognitive ability.

Amongst the many thorough and thoughtful contributions, Scrutton's chapter on physical treatment stands out for its sensitive, patient orientated approach. Scrutton cautions that treatment, no matter how well intentioned, is unlikely to be successful if it is not considered to be entirely appropriate by the patient. This book increases the likelihood of appropriate, well informed and successful management being offered to those with congenital hemiplegia.