Getting dressed, putting on socks, eating alone: for Giovanni, 14 years old, childhood cerebral palsy made many daily activities difficult. Following an innovative hyper-selective neurectomy procedure performed at the Regina Margherita children's hospital in Turin and a rehabilitation programme, the boy achieved a significant improvement in the use of his upper limb and, above all, in his personal independence.
Childhood cerebral palsy represents the most common cause of motor disability in paediatric age, with an estimated frequency of approximately two to three cases per 1,000 live births, and can lead to, among other manifestations, spasticity of the upper limb. Over time, the excessive contraction of certain muscles can make movement control more difficult and encourage the appearance of abnormal postures and deformities, limiting essential gestures of daily life. In Piedmont, between 800 and 1,000 children are estimated to be affected by neuromotor conditions.
The procedure integrated specific expertise in upper limb surgery in paediatric patients from Regina Margherita and in peripheral nerve microsurgery from the CTO hospital in Turin. To understand the technique used, one can imagine the nerve that transmits the command to contract to the muscle as a cable made up of many small wires. In spasticity, certain muscles receive an excessive and persistent contraction command. Hyper-selective neurectomy acts on the small nerve branches directed at the affected muscles: the surgeon removes a portion of the nerve fibres that transmit the contraction command in order to reduce excessive muscle tension.
The choice of treatment stems from a multidisciplinary assessment of the child, which takes into account not only the spasticity and any deformities present, but above all the functional abilities, difficulties in daily activities and the objectives shared with the patient and family.
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