Hand & Arm Spasticity Surgeon

During our CE professional carrier we often expected to share our “conductive “opinion on surgical solution of different physical difficulties. Parents are asking our view on specific operation possibilities when something seems to be stuck or developing very slow. This is understandable. During my student years in the early 90’s at the Peto Institute, Budapest, there was no such a module, training where we could study the main ideas of CP related surgical methods. I learnt however that some of the experienced conductors knew about such solutions and they were really confident to suggest… also, we saw many children who have already had different operations or were going to have one. Top of that, I learnt that Dr. Tibor Vizkeleti, a Hungarian orthopaedic surgeon had a great professional relationship with the Institute. I understood that surgery was a medical way of approaching physical problems and as such it was not the main focus of the training of CE but we all missed that bit…or maybe we did not realize when we were there but soon after leaving the alma mater it become obvious to me personally that a little knowledge of that subject could have helped my everyday life as a conductor. Since, I learnt through experience a lot and I developed my own idea of many types of surgeries as I work with children and adults on an everyday basis but it took some good years to do so. I have learnt that different countries have different general thinking of approaches and those could be very different. Just recently, Susie M. was asking if we could suggest anything on Dorsal Tenotomy. This fact made me to think that it could be so great to share “results” in terms of seeing those through conductors’ eyes…
Just only some days later one of our kids’ mother was asking if we knew Waseem Rias Saeed’s Hand & Arm spasticity surgical method - actually we, I did not.
So, I thought to share this (see below) maybe some others can say something about it or learn about it and use it.

The following text is from his www.waseemsaed.com website.

Hand & Arm Spasticity

Hand and arm spasticity develops as a result of damage to that part of the brain that controls the limb. This may be apparent at or shortly after birth as in cerebral palsy, or be the devastating consequence of a severe head injury, brain mass or stroke. Despite these conditions being common, the provision of integrated surgical care for these patients has not been widely available. It was disturbing to me that many patients had been actively discouraged from surgical intervention or told, frequently by specialists, that there was none. Many of these patients suffered and continue to suffer from avoidable disability throughout their lives. The United Kingdom did not have a dedicated treatment centre for the surgical treatment of spasticity in the upper limb despite an increasing and weighty body of evidence supporting its benefits. This was in contrast to established units in the USA, Europe and Australia. I had gained experience in the treatment of such patients in Louisville in the United States and had made an in depth survey of the current literature on surgical techniques and the results of these techniques. My conclusions were that certain surgical techniques had been shown clearly to be beneficial in these patients. In 2000 I set up a multidisciplinary team with senior occupational and physiotherapists to treat patients afflicted with spasticity of the arms. This is called the CP Clinic although all causes of upper limb spasticity are treated. Colleagues in paediatric and adult neurology, rehabilitation medicine and paediatric orthopaedics to are also available to provide an overall strategy of care.

A NEW APPROACH

My approach to patients suffering from spasticity preventing hand use – whether an infant born with cerebral palsy or an elderly stroke-victim, challenges some of the preconceived ideas that have lead to patients being denied surgical intervention over the years. I have introduced surgical modifications based on biomechanical studies that exist in the peer-reviewed, hand surgery literature and simply do not accept the (unsupported) view that the brain cannot adapt and learn new ways of using the hand into adulthood. Some of my own patients have clearly demonstrated this adaptation. It was clear to me from my work on tendons that the traditional view of immobilising patients following surgery for cerebral palsy had little scientific support. In contrast the advantages of early movement in terms of less scarring and stronger tendons was established. As a result I incorporated early movement into the post-operative protocol for the patients that I treat. This has been successful and at the time of writing is a unique post-operative protocol for this condition.I have carefully recorded all aspects of patient's’ function in a multidisciplinary clinic, using validated assessment and outcome measures prior to surgery and at intervals after surgery. In 2003, I presented my early results at the annual meeting of The Federation of European Societies for Surgery of the Hand in Lisbon – a meeting attended by hand specialists from around the world. The work was received well (appendix 2).3 years later the extended work was presented at the International Federation of Societies for Surgery of the Hand Meeting in Sidney 2007.I have started to train the next generation of hand surgeons in the techniques involved and increased awareness through presentations to primary and secondary care physicians, trainees and therapists. The work continues at currently the only unit in the UK dedicated to the treatment of upper limb spasticity in a multi-disciplinary setting. Patients are referred on a national and regional level.