By W. Chenor. Northwestern College, Iowa. 2017.
Therefore purchase 400 mg levitra plus visa, the final goal is to encourage the devel- opment of individual adults who are as competent as possible to make their own decisions cheap levitra plus 400 mg, who develop the confidence to make those decisions, and are then willing to make decisions and live with the consequences. Always in the context of this final goal, we as orthopaedic physicians want the individual’s physical impairments minimized as much as technically possible. The lesion may occur as a developmental defect, such as lissencephaly; as an infarction, such as a middle cerebral artery occlusion in a neonate; or as trauma during or after delivery. Because brain pathology in all these etiologies is static, it is consid- ered CP. Many minor static lesions leave no motor impairment and do not cause CP. Many pathologies, such as Rett syndrome, are progressive in child- hood, but then become static at or after adolescence. These conditions are not part of the CP group, but after they become static, they have problems very similar to those of CP from the motor perspective. Other problems, such as progressive encephalopathy, have very different considerations from the motor perspective. Saying a child has CP only means the child has a motor impairment from a static brain lesion, but says nothing about the etiology of this impairment. Some authors advocate using a plural term of “cerebral palsies” to imply that there are many kinds of CP. Although applying this concept to CP is appealing from the perspective of determining etiologies and under- standing the epidemiology, it provides very little help in actually managing the motor impairment. From the cancer analogy, for example, the specific cellular type and stage of breast cancer are important to know to prescribe the correct treatment. With CP, knowing the cause does not help treat a child who has a dislocated hip. The treatment is based on the diagnosis of CP, as opposed to a muscle disease, spinal paralysis, or a progressive encephalo- pathy.
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