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Post Impairment Syndrome

Dr. Silberman has successfully treated Cerebral Palsy Post Impairment Syndrome with platelet rich plasma therapy (PRP) injections.  We are taught in medical school that patients teach doctors if we listen to them. So when an adult with cerebral palsy came to New Jersey Sports Medicine after researching platelet rich plasma (PRP), he asked me if I was familiar with Post Impairment Syndrome?  He had multiple muscle and tendon complaints and was fearful he would one day lose his mobility and independence.  Ask any adult with Cerebral Palsy what their biggest fear is and they will tell you the same.  There was very little in the scientific literature on Post Impairment Syndrome, in fact zero articles came up in my search described below and what is written online is largely a plagiarized non-scientific description with no reference source to who even coined "Post Impairment Syndrome".  My patient would teach me about Post Impairment Syndrome and I discovered using diagnostic ultrasound that one of the cardinal features of Post Impairment Syndrome is not arthritis and bone damage but musculoskeletal deterioration evidenced by tendonopathy, tendonosis, tenosynovitis, tendon tears, and muscle tears. And so I began my research....


Adults with cerebral palsy have largely been forgotten by the medical profession. A Pubmed search using the keywords 'cerebral palsy post impairment syndrome' yielded a paltry 22 results none of which contained the term "Post Impairment Syndrome" in the title or in the descriptive search result. Zero articles on "Post-Impairment Syndrome" were found in the search. The first result 'Cerebral Palsy' by Colver et al in the Lancet in 2014 in it's first descriptive sentence in the search list erroneously states, "The syndrome of cerebral palsy encompasses a large group of childhood movement and posture disorders...", forgetting in the definition that children become adults; it is a lifelong movement and posture disorder. Cerebral Palsy is also erroneously defined repeatedly in the literature and by Google as a "non-progressive disorder of motor function". The CDC erroneously writes on the CDC Cerebral Palsy home page entitled "What is Cerebral Palsy" that "CP does not get worse over time".  The CDC reports on the same page that "CP is the most common motor disabiltiy in childhoood" and then too ignores that children with CP become adults, failing to even reference adults with CP or use the word 'adult' once on the page.


There are four type of cerebral palsy: 1. Spastic cerebral palsy (most common affecting 75%) 2. Dyskinetic cerebral palsy 3. Ataxic cerebral palsy 4. Mixed. And there is a wide spectrum of disability.  Repeated chronic and persistent loading of tendons, far greater than an athlete who practices and participates in sport but then gets to rest, occurs over and over again without respite in those with cerebral palsy, greater in spastic CP, but occurring in all forms, and over time tendons will deteriorate.


One of the cardinal features of Post Impairment Syndrome in Cerebral Palsy discovered by Dr. Silberman is musculoskeletal deterioration evidenced by diagnostic ultrasound as tendon damage, tendonopathy, tendonosis, tenosynovitis, and tendon tears.  Gangliano et al in 2013 were the first to document tendon damage and tendonosis histologically in cerebral palsy patients undergoing tendon lengthening procedures. Mathewson et al in 2015 documented altered muscle, extracellular matrix, and connective tissue at a structural level in patients with cerebral palsy.  Dr. Silberman using in office, in-expensive, diagnostic ultrasound can document in Post Impairment Syndrome tendon and muscle tears, tendonosis, and tenosynovitis for accurate ultrasound guided platelet rich plasma (PRP) injections which have been successfully used to improve function and lessen pain in those suffering from Post Impairment Syndrome.


Long term studies are needed to see if PRP can slow, reverse, or prevent permanent damage.  Ultrasound images and article coming soon documenting Cerebral Palsy Post Impairment Syndrome tendon disorders with diagnostic ultrasound.


References:Gagliano N, Menon A, Martinelli C, et al. Tendon structure and extracellular matrix components are affected by spasticity in cerebral palsy patients. Muscles Ligaments Tendons J. 2013;3(1):42-50. Published 2013 May 21. doi:10.11138/mltj/2013.3.1.042Mathewson MA, Lieber RL. Pathophysiology of muscle contractures in cerebral palsy. Phys Med Rehabil Clin N Am. 2015;26(1):57-67. doi:10.1016/j.pmr.2014.09.005

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