Kids

Not every child with cerebral palsy requires surgery, but for many, surgical intervention becomes an important part of their treatment journey. Cerebral palsy surgery is typically considered when muscle tightness, bone deformities, or joint problems significantly impact a child’s mobility, comfort, or quality of life.

The decision to pursue surgery isn’t made lightly. It’s a collaborative process involving parents, the child (when appropriate), therapists, and specialized surgeons who understand the unique needs of children with cerebral palsy. The goal is always the same: to improve function, reduce pain, and help children participate more fully in daily activities.

Soft Tissue Surgery for Cerebral Palsy

Soft tissue procedures address the muscles, tendons, and ligaments that have become tight or shortened due to cerebral palsy. These surgeries can dramatically improve a child’s ability to move more naturally and comfortably.

Muscle Lengthening Procedures

When muscles remain contracted for extended periods, they can become permanently shortened, limiting movement and causing discomfort. Muscle lengthening procedures carefully extend these tight muscles to improve range of motion. Common areas treated include the hamstrings, hip adductors, and calf muscles.

These procedures allow children to straighten their legs more fully, improve their walking pattern, and reduce the scissoring gait that many children with spastic cerebral palsy experience. The surgery is typically performed through small incisions, and recovery involves a period of casting followed by intensive physical therapy to maintain the gains achieved.

Tendon Transfer Surgery

Sometimes, muscles pull in the wrong direction due to cerebral palsy, creating movement problems that therapy can’t fully address. Tendon transfer surgery repositions tendons to restore more balanced muscle function. This approach is particularly effective for foot and ankle deformities, wrist positioning problems, and certain shoulder issues.

By rerouting a tendon to a new attachment point, surgeons can improve the mechanical advantage of functioning muscles and reduce the pull of overactive ones. The result is often better control, improved positioning, and enhanced function for everyday activities.

Orthopedic Surgery for Cerebral Palsy

As children with cerebral palsy grow, the persistent pull of tight muscles and abnormal movement patterns can cause bones to develop improperly or joints to dislocate. Orthopedic bone surgery addresses these skeletal problems to improve alignment, stability, and function.

Hip Surgery and Hip Reconstruction

Hip problems are common in children with cerebral palsy, ranging from hip dysplasia to complete hip dislocation. These issues can cause significant pain and limit sitting, standing, and walking abilities. Hip surgery for cerebral palsy may involve several components:

• Femoral Osteotomy: This procedure reshapes the thighbone (femur) to improve how it fits into the hip socket, promoting better alignment and stability.
• Pelvic Osteotomy: Sometimes the hip socket itself needs to be repositioned or reshaped to better accommodate the femoral head and prevent future dislocation.
• Soft Tissue Releases: Often combined with bone surgery, these releases address tight muscles around the hip that contribute to dislocation.

Hip reconstruction surgery can be extensive, but the results often include reduced pain, improved sitting balance, better hygiene care, and in some cases, improved walking ability.

Femoral Derotation Osteotomy

Many children with cerebral palsy develop excessive inward rotation of the thighbone, causing the knees and feet to turn inward during walking. Femoral derotation osteotomy corrects this rotation by cutting the femur, rotating it to a more normal position, and securing it with plates and screws.

This procedure significantly improves walking appearance and efficiency, reduces the risk of tripping, and can prevent future joint problems caused by abnormal alignment. The surgery is often performed on both legs during the same operation when rotation affects both sides.

Foot and Ankle Surgery

Foot deformities in cerebral palsy can range from mild toe-walking to severe equinovarus (clubfoot-like) positions. Surgical options for the foot and ankle include:

• Achilles Tendon Lengthening: Addresses a tight calf muscle that prevents the heel from touching the ground, allowing for more normal foot positioning during walking.
• Foot Osteotomies: Reshapes bones in the foot to correct deformities and improve weight-bearing alignment.
• Arthrodesis (Fusion): In severe cases, fusing certain joints in the foot or ankle can provide stability and reduce pain, though this limits motion in the fused area.

These procedures help children achieve a more stable, plantigrade foot position (flat on the ground), which is essential for comfortable walking and standing.

The Motion Analysis Lab Advantage

Dr. Siambanes utilizes Motion Analysis Lab technology to make precise surgical decisions. This sophisticated system captures how your child walks, analyzes muscle activity, and identifies exactly which muscles and bones are causing movement problems.

This objective data ensures that cerebral palsy surgery is targeted to address the specific issues affecting your child, avoiding unnecessary procedures and maximizing functional gains. The Motion Analysis Lab evaluation is a crucial part of surgical planning that sets specialized cerebral palsy centers apart from general orthopedic practices.

Expert Cerebral Palsy Surgery in Tampa, Florida

Dr. David Siambanes brings specialized expertise in cerebral palsy surgery to the Tampa Bay area and serves families throughout Florida. As a board-certified orthopedic surgeon with fellowship training in pediatric orthopedics and spinal deformities, he has dedicated his career to improving outcomes for children with cerebral palsy.

His work as director of the Motion Analysis Lab ensures that surgical decisions are based on objective data rather than guesswork. Additionally, as director of The Scoliosis Center at St. Joseph’s Children’s Hospital, Dr. Siambanes offers comprehensive care for children with spinal deformities related to cerebral palsy.

Schedule a Consultation for Cerebral Palsy Care

If your child might benefit from cerebral palsy surgery, or if you’re simply exploring options for improving their mobility and quality of life, Children’s Cerebral Palsy offers comprehensive evaluations to help you understand your choices.

Schedule a consultation with Dr. Siambanes today.

Ataxic cerebral palsy affects balance, coordination, and precise movements in children, presenting unique challenges that require specialized therapeutic approaches. As one of the less common forms of cerebral palsy, ataxic cerebral palsy demands a comprehensive understanding of its characteristics and targeted treatment strategies to help children achieve their maximum potential.

What Is Ataxic Cerebral Palsy?

Ataxic cerebral palsy is a movement disorder that primarily affects the cerebellum, the part of the brain responsible for balance, coordination, and fine motor control. Children with ataxic cerebral palsy typically experience difficulties with depth perception, balance, and coordinated movements. This form represents approximately 3.8% of all cerebral palsy cases, making it the least common type.

The condition results from damage to the cerebellum during brain development, whether before, during, or shortly after birth. Unlike other forms of cerebral palsy that may cause muscle stiffness or involuntary movements, ataxic cerebral palsy primarily manifests as unsteady, shaky movements and poor coordination.

Signs and Symptoms of Ataxic Cerebral Palsy

Children with ataxic cerebral palsy display several characteristic symptoms that distinguish this condition from other forms of cerebral palsy:

Motor Function Challenges:

• Unsteady walking with a wide-based gait
• Difficulty with balance and frequent falls
• Tremors, particularly during purposeful movements
• Poor hand-eye coordination
• Challenges with precise movements like writing or buttoning clothes

Developmental Challenges:

• Delayed motor milestones such as sitting, crawling, and walking
• Difficulty with activities requiring fine motor skills
• Problems with spatial awareness and depth perception
• Inconsistent muscle tone that may appear normal at rest

Functional Challenges:

• Challenges with activities of daily living
• Difficulty participating in sports or playground activities
• Academic challenges related to handwriting and motor tasks
• Potential speech difficulties due to coordination issues

Physical Therapy for Ataxic Cerebral Palsy

Physical therapy serves as the cornerstone of treatment for children with ataxic cerebral palsy, focusing on improving balance, coordination, and functional mobility. A comprehensive physical therapy program addresses the specific needs of each child through targeted interventions.

Balance Training Techniques

Physical therapists employ various balance training methods, including standing on different surfaces, using balance boards, and practicing weight-shifting exercises. These activities help children develop better proprioceptive awareness and improve their ability to maintain stability during daily activities.

Coordination Exercises

Specialized exercises target hand-eye coordination, bilateral coordination, and motor planning skills. Activities might include ball games, obstacle courses, and repetitive movement patterns that help establish better motor control pathways in the brain.

Gait Training

Walking training focuses on improving the child’s gait pattern, reducing the characteristic wide-based stance, and promoting more efficient movement patterns. This may include treadmill training, parallel bar exercises, and over-ground walking practice.

Occupational Therapy Interventions

Occupational therapy plays a crucial role in helping children with ataxic cerebral palsy develop independence in daily living activities and improve fine motor coordination.

Fine Motor Skill Development

Occupational therapists work on improving hand strength, dexterity, and coordination through activities like playing with small objects, drawing, cutting with scissors, and practicing handwriting skills. These interventions help children develop the precision needed for academic and self-care tasks.

Adaptive Strategies and Equipment

When standard approaches aren’t sufficient, occupational therapists introduce adaptive equipment and strategies. This might include weighted utensils to reduce tremors, special writing tools, or computer keyboards designed for children with coordination difficulties.

Sensory Integration

Many children with ataxic cerebral palsy benefit from sensory integration techniques that help improve their body awareness and motor planning abilities. These interventions address underlying sensory processing issues that may contribute to coordination difficulties.

Speech and Language Therapy

Children with ataxic cerebral palsy may experience speech difficulties related to coordination problems affecting the muscles used for speaking. Speech and language therapy addresses these challenges through:

Articulation Training

Speech therapists work on improving the clarity and precision of speech sounds, often using exercises that strengthen oral motor muscles and improve coordination between breathing, speaking, and swallowing.

Communication Alternatives

For children with significant speech challenges, therapists may introduce alternative communication methods, including sign language, communication devices, or picture exchange systems, to ensure effective communication.

Assistive Technology and Adaptive Equipment

Modern assistive technology offers numerous solutions to help children with ataxic cerebral palsy overcome coordination and balance challenges:

Mobility Aids

Depending on the severity of balance issues, children may benefit from mobility aids such as walkers, canes, or ankle-foot orthoses (AFOs) to improve stability and prevent falls.

Computer and Learning Aids

Specialized keyboards, voice recognition software, and adaptive mouse options can help children with fine motor coordination difficulties access computers and complete academic work more effectively.

Daily Living Equipment

Adaptive tools for eating, dressing, and personal care can promote independence and reduce frustration for children struggling with coordination tasks.

Creating a Comprehensive Treatment Plan

The most effective approach to treating ataxic cerebral palsy involves a multidisciplinary team that may include physical therapists, occupational therapists, speech therapists, and specialized physicians like Dr. Siambanes. This collaborative approach ensures that all aspects of the child’s development and function are addressed.

Individualized Goal Setting

Each child’s treatment plan should be tailored to their specific needs, abilities, and family goals. Regular assessments help track progress and adjust interventions as the child grows and develops.

Family Involvement

Successful therapy outcomes depend heavily on family participation and continuation of therapeutic activities at home. Therapists work closely with families to teach strategies and exercises that can be incorporated into daily routines.

The Role of Surgical Intervention

While therapy forms the foundation of treatment for ataxic cerebral palsy, some children may benefit from surgical interventions to address specific complications or improve function. Dr. Siambanes evaluates each child individually to determine if surgical options might enhance their mobility or reduce secondary complications.

Children with ataxic cerebral palsy may develop orthopedic issues over time, including scoliosis or hip problems, which may require surgical intervention to maintain function and prevent further complications.

Long-term Outcomes for Ataxic Cerebral Palsy

With appropriate therapeutic interventions and family support, children with ataxic cerebral palsy can achieve significant improvements in balance, coordination, and independence. While the underlying brain damage cannot be reversed, the brain’s plasticity allows for the development of compensatory strategies and improved function over time.

Early intervention and consistent therapy provide the best opportunities for children to develop their maximum potential. Many children with ataxic cerebral palsy go on to participate in regular school activities, sports, and lead fulfilling, independent lives.

Expert Care for Cerebral Palsy in Tampa, Florida

At Children’s Cerebral Palsy, Dr. Siambanes understands the unique challenges faced by children with ataxic cerebral palsy and their families. Through comprehensive evaluation and collaborative treatment planning, he works to help each child achieve their highest level of function and independence.

If your child has been diagnosed with ataxic cerebral palsy or you have concerns about balance and coordination issues, contact us to schedule a consultation and learn more about treatment options available to help your child thrive.

Parents of children with cerebral palsy (CP) often hear unfamiliar medical terms during the diagnosis process. One of the less common types is athetoid cerebral palsy, a condition that can affect a child’s ability to control their movements and hold their posture. Unlike spastic or hypotonic types of CP, athetoid CP presents unique challenges that may change how a child interacts with their environment.

What Is Athetoid Cerebral Palsy?

Athetoid cerebral palsy, also called dyskinetic CP, is a type of cerebral palsy marked by involuntary movements. These movements can be writhing, twisting, or jerky, and they often interfere with a child’s ability to sit still, maintain balance, or perform intentional actions like grasping a toy or feeding themselves.

Unlike spastic CP, which involves tight, stiff muscles, athetoid CP often includes a mix of fluctuating muscle tone, sometimes too tight (hypertonia) and sometimes too loose (hypotonia).

This type of cerebral palsy is linked to damage in the basal ganglia, the part of the brain responsible for regulating voluntary movement. That’s why the symptoms are so centered on motion control and coordination.

What Causes Athetoid Cerebral Palsy?

Athetoid CP usually results from brain damage that occurs before, during, or shortly after birth. This damage often involves:

• Lack of oxygen (hypoxia) to the baby’s brain
• Birth complications such as prolonged labor or emergency C-sections
• Severe cases of neonatal jaundice that lead to a condition called kernicterus
• Infections during pregnancy that affect fetal brain development
• Premature birth, which increases the risk of brain injury

This type of cerebral palsy accounts for about 10–15% of all CP cases, making it less common than the spastic form, but still important for families to understand and identify early.

Signs and Symptoms of Athetoid Cerebral Palsy

Children with athetoid CP may show a wide range of symptoms depending on which areas of the body are affected. Common signs include:

• Involuntary movements in the arms, legs, hands, or face
• Muscle tone that constantly changes from tight to loose
• Difficulty with fine motor skills (grasping, writing, holding utensils)
• Problems with balance and coordination
• Difficulty speaking or forming words (due to facial muscle involvement)
• Challenges with eating or swallowing

Many children with athetoid CP have normal intelligence, but the physical movements can affect communication and daily tasks, which sometimes leads others to underestimate their cognitive abilities.

How Athetoid Cerebral Palsy Affects Daily Life

Daily life with athetoid CP can be unpredictable. Because muscle tone and movement are constantly changing, kids may be able to do something one day but struggle with it the next. Tasks that require precision, like writing or tying shoes, may be particularly frustrating.

Children may also experience:

• Social challenges if facial expressions or speech are affected
• Fatigue from the constant effort of controlling their movements
• Increased risk of falls or injury due to poor balance

However, with the right support, many children with athetoid CP can learn to adapt and thrive.

Treatment Options for Athetoid Cerebral Palsy

There is no one-size-fits-all treatment, but a multidisciplinary care plan can significantly improve a child’s independence, comfort, and ability to engage in everyday activities. At Children’s Cerebral Palsy, Dr. Siambanes leads a collaborative approach to care that may include:

Physical Therapy

This is the cornerstone of treatment for athetoid CP. PT helps improve strength, coordination, posture, and balance through guided movement exercises and stretching.

Occupational Therapy

OT focuses on building skills for everyday tasks, like dressing, eating, and using assistive devices. Therapists may also work on hand control, adaptive techniques, and motor planning.

Speech and Language Therapy

If your child’s facial muscles or vocal cords are affected, speech therapy can help improve communication. Therapists may also introduce alternative communication methods, such as speech-generating devices.

Medication

While no medication can cure CP, certain drugs may help manage symptoms like excessive movements or muscle tightness. These may include muscle relaxants or medications that reduce involuntary movement.

Orthopedic Support

Some children may benefit from braces, orthotics, or other mobility aids to help stabilize posture and reduce strain on joints.

Advanced Interventions

In select cases, botulinum toxin injections may be explored to manage severe movement challenges. Surgery is a less common treatment in children with athetoid CP compared to other forms of CP, but it may be appropriate in some cases. 

Dr. Siambanes works closely with families to evaluate whether these options are suitable and what benefits they may bring.

Expert Cerebral Palsy Care in Tampa, Florida 

Dr. Siambanes is a board-certified orthopedic surgeon who is fellowship trained in both pediatric orthopedics and spinal deformities. He brings years of experience in pediatric orthopedic care, working hand-in-hand with therapists, specialists, and families to support children with all types of CP, including athetoid cerebral palsy. 

He has performed countless procedures to improve walking and sitting tolerance, which have resolved pain and corrected deformities in children with Cerebral Palsy. His personalized care plans focus not just on movement, but on empowering your child at home, in school, and beyond.

Whether your child needs help with walking, using their hands, improving communication, or simply gaining confidence in their body, our goal is to make sure they receive comprehensive, compassionate care every step of the way.

Get the Support You Need

If your child has been diagnosed with athetoid cerebral palsy, or you’re noticing signs that something may be off, early intervention is key. The sooner we start working together, the more progress your child can make with mobility, independence, and quality of life.

Contact us today to schedule a consultation with Dr. Siambanes and start building your child’s personalized treatment plan.

Spastic hemiplegia is a type of cerebral palsy that affects movement and muscle tone on one side of the body. For parents, learning how spastic hemiplegia impacts your child’s development and exploring the treatments available can make a huge difference in building confidence and independence.

At Children’s Cerebral Palsy, Dr. David Siambanes, a board-certified orthopedic surgeon with fellowship training in pediatric orthopedics and spinal deformities, works with families to create personalized care plans for children with spastic hemiplegia. His expertise, combined with a compassionate, family-centered approach, helps children gain greater mobility, reduce pain, and thrive in daily life.

What is Spastic Hemiplegia?

The term spastic refers to the increased muscle tone or stiffness that makes movement difficult, while hemiplegia means that the condition affects just one side of the body, typically the arm and leg on the same side.

Children with spastic hemiplegia often walk with an uneven gait, have difficulty using one hand or arm, or experience stiffness that makes movements jerky or awkward. While some children have mild symptoms and walk independently, others require therapy, braces, or surgery to improve mobility. Scoliosis also isn’t uncommon in these children.

Signs and Symptoms of Spastic Hemiplegia

The signs of spastic hemiplegia can appear early in life, sometimes as soon as a baby begins reaching for toys or crawling. Common symptoms include:

• Stiffness or tightness in one side of the body (arm, hand, or leg)
• Difficulty with fine motor skills (grasping small objects, buttoning clothes)
• Walking on toes on the affected side
• Uneven gait or posture
• Weakness or smaller muscle mass on the affected side
• Limited range of motion in joints such as the ankle or wrist

Some children may also experience challenges with balance, coordination, or fatigue, as their unaffected side compensates for the weaker side.

How Spastic Hemiplegia Affects Movement

The increased muscle tone in spastic hemiplegia can cause muscles to contract involuntarily, making certain movements harder. For example, the arm may remain bent, or the foot may point downward (toe walking) due to tight calf muscles. Over time, these patterns can lead to muscle shortening, joint stiffness, and difficulty with functional tasks like walking or climbing stairs.

The good news is that with early intervention, most children with spastic hemiplegia can significantly improve their movement and develop strategies to stay active and independent.

Treatment Options for Spastic Hemiplegia

A comprehensive treatment plan for spastic hemiplegia may include physical therapy, bracing, medications, or surgical interventions. Dr. Siambanes works closely with families to identify which treatments will best support their child’s needs and goals.

Physical and Occupational Therapy

Therapy is essential for improving strength, flexibility, and coordination in children with spastic hemiplegia.

Physical therapy focuses on stretching tight muscles, improving gait, and enhancing balance.

Occupational therapy helps children develop fine motor skills and adapt to everyday activities such as writing or dressing.

Bracing and Orthotic Support

Ankle-foot orthoses (AFOs) or hand splints may be prescribed to maintain proper alignment and prevent contractures. Braces can also help children walk more efficiently by keeping the foot flat and improving balance.

Medications and Botox

Botulinum toxin (Botox) injections are often used to relax overly tight muscles on the affected side. When combined with therapy, Botox can make stretching and functional activities easier.

Casting or Serial Casting

Casting may be used to gradually stretch tight muscles, particularly in the ankle, to reduce toe walking and improve range of motion.

Surgical Options

When spasticity leads to significant muscle contractures or joint deformities, surgery may be recommended. Dr. Siambanes specializes in orthopedic procedures that can lengthen tendons, improve hip and leg alignment, and enhance walking ability.

How Dr. Siambanes Helps Children with Spastic Hemiplegia

Dr. Siambanes combines advanced orthopedic care with state-of-the-art motion analysis to pinpoint the unique challenges each child faces. As director of the Motion Analysis Center at St. Joseph’s Children’s Hospital, he uses 3-D gait assessments to evaluate walking patterns and identify the specific muscle imbalances or joint issues that contribute to difficulty with movement.

With his extensive experience in both non-surgical and surgical treatments, Dr. Siambanes has helped countless children improve their walking, sitting tolerance, and overall quality of life. His personalized approach ensures that every family receives guidance tailored to their child’s needs.

Supporting Your Child’s Independence

Living with spastic hemiplegia presents challenges, but with the right care, children can thrive. Early intervention is key. Starting therapy, bracing, or other treatments as soon as possible can prevent complications and support healthy growth and development.

Parents can also play a vital role by encouraging their child’s independence and celebrating milestones, no matter how small. Adaptive sports, recreational activities, and assistive technologies can all help children build confidence and engage fully with their peers.

If you’re seeking support for your child with spastic hemiplegia or any form of cerebral palsy, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes.

Spastic diplegia is one of the most common types of cerebral palsy (CP), and it primarily affects movement and muscle tone in the legs. For parents, understanding how spastic diplegia impacts their child’s daily life and what can be done to improve mobility can make a significant difference in navigating care and support.

Dr. David Siambanes provides specialized orthopedic care for children with spastic diplegia in Tampa Bay and the surrounding areas. His expertise in pediatric orthopedics, spinal deformities, and motion analysis helps families explore the most effective treatments for improving movement, comfort, and independence.

What is Spastic Diplegia?

Spastic diplegia is a form of cerebral palsy that results from damage to the part of the brain responsible for controlling movement. In spastic diplegia, this damage leads to increased muscle tone (spasticity) in the legs, while the arms may be only mildly affected or not at all.

The term spastic refers to muscle stiffness or tightness that makes it harder to move certain parts of the body. Diplegia means that the condition affects both sides, primarily both legs.

How Spastic Diplegia Affects Movement

Children with spastic diplegia often have tight muscles in the hips, thighs, and calves. This muscle stiffness can make walking, standing, and balance more difficult. Common signs of spastic diplegia include:

• Toe walking due to tight calf muscles pulling the heels off the ground
• Scissoring gait, where the legs cross at the knees when walking
• Stiffness in the hips and knees, limiting the range of motion
• Difficulty with balance and coordination, leading to frequent falls or trouble with activities like running
• Weak core muscles, making posture and stability harder to maintain

While many children with spastic diplegia can walk, their walking may be slow, awkward, or energy-consuming. Some children may need walkers, crutches, or wheelchairs for longer distances.

How Muscle Tone is Affected in Spastic Diplegia

In spastic diplegia, the increased muscle tone means that certain muscles are always “on.” They are tighter than they should be, even when the child is at rest. This ongoing tightness:

• Makes stretching and straightening the legs difficult
• Can lead to joint contractures (permanent tightening of muscles and tendons) over time
• Contributes to discomfort or pain, especially as the child grows

The uneven pull of tight muscles can also cause joint deformities, such as hip dislocation or curvature of the spine (scoliosis), if not properly managed.

Available Treatments to Improve Mobility

While there is no cure for spastic diplegia, there are many treatments that can help improve mobility, reduce discomfort, and prevent complications. The goal is to create a personalized plan that meets your child’s unique needs.

Physical Therapy

Physical therapy is one of the most important treatments for spastic diplegia. Therapists work with children to:

• Stretch tight muscles
• Strengthen weaker muscles (especially in the core)
• Improve balance and coordination
• Practice walking and other functional movements

Consistent therapy helps reduce stiffness and supports better posture and mobility over time.

Bracing and Orthotic Devices

Ankle-foot orthoses (AFOs) and other braces are often used to:

• Support the feet and ankles
• Prevent toe walking
• Encourage better alignment during standing and walking

Braces are custom-made to fit your child and may be worn during the day, at night, or both, depending on their needs.

Medications and Injections

For children with significant muscle tightness, medications may help:

• Oral medications can relax muscles, though they often affect the whole body and may cause side effects.
• Botox injections can be used to target specific tight muscles, temporarily reducing spasticity and improving range of motion.

Botox is often combined with therapy and bracing to maximize benefits.

Serial Casting

Serial casting involves placing a series of casts on the legs to gently stretch tight muscles over time. This non-surgical approach can help improve ankle flexibility and reduce toe walking.

Surgical Options

When other treatments are not enough, surgery may be recommended. Dr. Siambanes specializes in orthopedic surgeries that can:

• Lengthen tight muscles or tendons (such as the hamstrings or Achilles tendon)
• Correct bone or joint deformities
• Improve hip stability and reduce the risk of dislocation

These procedures can significantly enhance walking ability, comfort, and overall quality of life.

How Dr. Siambanes Can Help Children with Spastic Diplegia

Dr. David Siambanes is a board-certified orthopedic surgeon with fellowship training in pediatric orthopedics and spinal deformities. His passion for caring for children with disabilities has led him to become a leader in cerebral palsy treatment.

At Children’s Cerebral Palsy, Dr. Siambanes combines surgical expertise with advanced technology. As director of the Motion Analysis Center at St. Joseph’s Children Hospital, he uses 3-D gait analysis to assess your child’s walking patterns and pinpoint the specific barriers to better movement. This allows for a highly personalized approach to treatment, whether that means therapy, bracing, injections, or surgery.

Dr. Siambanes has helped countless children with cerebral palsy and spastic diplegia achieve greater independence, reduce pain, and improve their ability to participate in daily life.

Help Your Child Regain Mobility

Spastic diplegia presents unique challenges, but with the right care, children can make remarkable progress. Dr. Siambanes is dedicated to working alongside families to provide comprehensive, compassionate care every step of the way.

If you have questions about your child’s movement or muscle tone, or if you’re exploring treatment options for spastic diplegia, contact us today to schedule a consultation with Dr. Siambanes. Together, we can help your child take meaningful steps toward improved mobility and confidence.

Cerebral palsy (CP) is a neurological condition that affects movement, posture, and muscle tone. For many years, CP was believed to be caused almost exclusively by birth complications or injury to the developing brain. However, recent research, including new insights from whole-genome sequencing, is changing how we understand this condition, raising the question many parents are now asking: is cerebral palsy genetic?

What Causes Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage to the developing brain, typically before, during, or shortly after birth. Common known risk factors include:

• Lack of oxygen during birth (asphyxia)
• Premature birth or low birth weight
• Infections during pregnancy
• Traumatic brain injury in infancy
• Stroke or bleeding in the brain before or shortly after birth

However, despite these known causes, many cases of cerebral palsy cannot be explained by birth trauma or medical complications alone. This has led researchers to explore whether genetic factors may also play a role.

Can Cerebral Palsy Be Genetic?

Recent studies suggest that genetics may contribute to the development of cerebral palsy in a significant number of cases. A Canadian-led study published in Nature Genetics in 2024 found that more than one in ten children with CP had a gene variant associated with their condition. An additional 17% of children had variants of unknown significance that may be linked to CP after further research.

These findings suggest that for some children, genetic mutations affecting brain development may be a contributing factor to CP or increase vulnerability to brain injury before or during birth.

What Does This Mean for Families?

The discovery of a genetic link does not mean that CP is always inherited or passed down through families. In fact, many of the gene changes identified in recent studies are de novo mutations (spontaneous changes that occur for the first time in the child and are not present in either parent)

However, in some families, especially those with multiple children affected by neurological disorders, inherited genetic patterns may play a role.

At this stage, we can say that while cerebral palsy is not typically a genetic disorder, it can have genetic contributions in some cases, and these may be more common than previously understood.

The Value of Genetic Testing

As more is learned about the connection between genetics and cerebral palsy, genetic testing is becoming an increasingly valuable tool in diagnosing and managing the condition. Testing can:

• Help explain the underlying cause of CP in certain children
• Identify associated conditions (such as autism or epilepsy) that may share a genetic basis
• Guide more personalized treatment and care plans
• Provide clarity for families who may be planning future pregnancies

Dr. Siambanes’ Role in Advanced Cerebral Palsy Care

Dr. Siambanes is a board-certified orthopedic surgeon, fellowship-trained in pediatric orthopedics and spinal deformities. As director of the Motion Analysis Lab at St. Joseph’s Children’s Hospital, he helps families understand how neuromuscular challenges affect a child’s movement and function and how interventions such as bracing, physical therapy, or surgery can improve quality of life.

Although he does not perform genetic testing himself, Dr. Siambanes is deeply involved in guiding the comprehensive treatment of children with cerebral palsy, regardless of its cause. Whether a child’s CP is linked to a birth injury, genetic factor, or unknown cause, his goal remains the same: improve mobility, reduce pain, and support independence.

Click here to request a consultation with Dr. Siambanes today.

Toe walking is a common issue seen in children with cerebral palsy, especially those with spasticity affecting the lower legs. While many toddlers briefly go through a phase of walking on their toes, persistent toe walking — particularly in children with cerebral palsy — often indicates an underlying muscular or neurological cause.

If your child is frequently walking on their toes, it’s important to understand why it’s happening and what treatment options are available. At Children’s Cerebral Palsy, Dr. David Siambanes offers expert orthopedic care to help address the causes of toe walking and guide families toward the most effective solutions.

What is Toe Walking?

Toe walking refers to a walking pattern where the heel does not touch the ground. Instead, the child walks on the balls of their feet or their toes. In cerebral palsy, this walking pattern is typically due to muscle tightness or imbalances that limit flexibility in the lower leg and foot.

Persistent toe walking can cause pain, instability, and long-term changes in foot and joint structure if left untreated. It can also affect balance, coordination, and energy levels during walking, making daily activities more difficult for your child.

Why Does Toe Walking Happen in Children with Cerebral Palsy?

Toe walking in cerebral palsy is most commonly caused by spasticity, which is the involuntary tightening or stiffness of muscles. Children with spastic cerebral palsy often have increased tone in the calf muscles (gastrocnemius and soleus), which prevents the heel from touching the ground during walking.

Other contributing factors include:

• Shortened Achilles tendon or calf muscles
• Poor muscle coordination
• Weakness in opposing muscle groups
• Balance or sensory challenges
• Delayed motor development

Over time, untreated toe walking can lead to joint contractures (permanent tightening of the muscles and tendons), abnormal gait patterns, and even pain in the feet, knees, or hips.

When to Seek Help for Toe Walking

If your child consistently walks on their toes, especially past the toddler years, it’s worth getting an evaluation, particularly if they have cerebral palsy or other neuromuscular conditions. Early intervention can help prevent complications and support better long-term outcomes.

Signs it may be time to seek help include:

• Toe walking that persists beyond age 2 or 3
• Your child avoids putting their heels down entirely
• Toe walking is accompanied by pain, falls, or poor balance
• Tightness in the calves or reduced range of motion in the ankle
• Toe walking that worsens over time

Treatments for Toe Walking in Cerebral Palsy

The goal of treatment is to address the root cause of toe walking — usually muscle tightness or imbalance — and help your child develop a more natural, functional walking pattern. Dr. Siambanes, a fellowship-trained pediatric orthopedic surgeon, takes a personalized approach to care based on your child’s specific needs and mobility goals.

1. Physical Therapy

Targeted stretching and strengthening exercises can help lengthen tight calf muscles and improve ankle flexibility. Physical therapists may also work on balance, posture, and walking mechanics.

2. Orthotic Devices and Bracing

Ankle-foot orthoses (AFOs) are commonly used to support proper foot alignment and prevent toe walking. Rigid or hinged AFOs can hold the foot in a more neutral position and reduce the strain on tight muscles.

3. Botox Injections

Botulinum toxin (Botox) can be injected into overly tight muscles to temporarily reduce spasticity and allow for improved range of motion. This is often paired with physical therapy or bracing to maximize results.

4. Serial Casting

In some cases, a series of casts may be applied over several weeks to gradually stretch and lengthen tight calf muscles. This non-surgical approach is especially useful when the goal is to improve flexibility without permanent intervention.

5. Surgical Intervention

If conservative treatments are not successful, surgery may be necessary. Dr. Siambanes specializes in procedures such as tendon lengthening, which can release tight calf muscles or adjust foot alignment. Surgical correction is often recommended when toe walking causes pain, impairs function, or leads to contractures.

Advanced Care with Dr. Siambanes

As the director of the Motion Analysis Center at St. Joseph’s Children’s Hospital, Dr. Siambanes uses 3D gait analysis to precisely assess walking patterns and identify the physical barriers contributing to toe walking. This advanced tool allows him to develop highly targeted treatment plans and ensure your child is receiving the most effective care.

Dr. Siambanes has performed countless procedures to help children walk more comfortably and confidently. His experience in managing cerebral palsy-related deformities, combined with his compassionate approach to care, makes him a trusted partner for families navigating complex mobility challenges.

Improving Mobility, One Step at a Time

Toe walking may seem like a small issue, but it can have a big impact on a child’s comfort, confidence, and ability to participate in daily life. With early intervention and expert care, most children with cerebral palsy can make significant improvements in their gait and overall mobility.

If your child is toe walking, don’t wait to seek support. Click here to contact Children’s Cerebral Palsy to schedule an evaluation with Dr. Siambanes and take the first step toward better movement, improved function, and greater independence.

Children with cerebral palsy often face a range of orthopedic challenges, and one of the most common complications is hip dysplasia. This condition occurs when the hip joint does not develop properly, leading to instability, misalignment, and in some cases, severe pain.

In children with cerebral palsy, especially those with spastic quadriplegia, muscle imbalances can pull the hip out of its socket over time, increasing the risk of dislocation. Early recognition of hip dysplasia is essential to prevent pain, improve mobility, and avoid long-term complications.

Dr. David Siambanes, a board-certified orthopedic surgeon specializing in pediatric orthopedics and spinal deformities, has extensive experience diagnosing and treating hip dysplasia in children with cerebral palsy. His expertise helps children maintain comfort, improve sitting tolerance, and reduce the risk of future mobility issues.

What is Hip Dysplasia?

The hip is a ball-and-socket joint, where the top of the thigh bone (femoral head) fits into the curved part of the pelvis (acetabulum). In children with hip dysplasia, this joint doesn’t form correctly. The ball may sit loosely in the socket or move partially — or completely — out of place.

For children with cerebral palsy, muscle tightness and imbalances can pull the hip out of alignment, gradually leading to hip subluxation (partial dislocation) or hip dislocation (complete separation of the ball from the socket). Without treatment, hip dysplasia can cause chronic pain, reduced mobility, and difficulties with sitting or standing.

Why Children with Cerebral Palsy Are at Higher Risk

Cerebral palsy affects muscle tone and control, often leading to spasticity (increased muscle stiffness) or hypotonia (decreased muscle tone). In children with spastic cerebral palsy, tight muscles can pull unevenly on the hip joint, gradually leading to misalignment.

Children who are non-ambulatory or spend much of their time in a seated position, such as those with spastic quadriplegia, are especially at risk. The lack of weight-bearing activities, like walking, can limit proper hip development, making dislocation more likely over time.

Common Symptoms of Hip Dysplasia in Children with Cerebral Palsy

Hip dysplasia symptoms can sometimes be difficult to detect, especially in non-verbal children who cannot express their discomfort. However, there are signs that parents and caregivers can watch for:

1. Pain and Discomfort

Pain is often the most noticeable symptom of hip dysplasia. Children may experience:

• Discomfort during diaper changes or when legs are moved
• Pain when sitting, especially for extended periods
• Crying or irritability when the hip is manipulated or under pressure
• Pain even while at rest in severe cases

Non-verbal children may express pain through agitation, crying, or changes in behavior.

2. Limited Range of Motion

Hip dysplasia can cause stiffness in the hip joint, making it difficult to:

• Spread the legs apart during diaper changes
• Move the hips into different positions
• Sit comfortably without leaning to one side

Parents may notice that one leg appears stiffer or harder to move than the other.

3. Asymmetrical Leg Positioning

Children with hip dysplasia often have one leg that appears longer or shorter due to the misalignment of the hip. Other signs of asymmetry include:

• One hip or buttock appearing higher than the other
• Uneven skin folds on the thighs or buttocks
• A noticeable tilt in the pelvis when sitting

4. Difficulty Sitting or Standing

When the hip is out of alignment, children may struggle to sit upright or balance evenly while standing. In wheelchair-dependent children, poor hip positioning can make it harder to maintain an upright seated posture, increasing the risk of pressure sores and spinal curvature.

5. Audible Clicking or Popping Sounds

In some cases, the hip may make clicking or popping sounds during movement. While not always painful, these sounds can indicate that the hip is unstable or partially dislocated.

The Importance of Early Detection

If left untreated, hip dysplasia can progress to a full dislocation, leading to severe pain and further limitations in mobility. Early detection allows for less invasive treatment options and can prevent long-term complications.

Dr. Siambanes emphasizes the importance of routine orthopedic evaluations for children with cerebral palsy. Using advanced imaging techniques and the Motion Analysis Lab, he can assess your child’s gait, posture, and joint health to catch early signs of hip dysplasia before it becomes more severe.

Treatment Options for Hip Dysplasia Symptoms in Children with Cerebral Palsy

The goal of treatment is to restore proper hip alignment, reduce pain, and improve function. Treatment plans vary based on the severity of the misalignment and the child’s overall mobility.

1. Non-surgical Interventions

• Physical Therapy can help strengthen surrounding muscles and improve hip positioning.
• Bracing or Orthotic Devices may be used to support the hip and prevent further misalignment.
• Botox Injections can reduce muscle spasticity around the hip, making it easier to maintain proper alignment.

2. Surgical Options

For children with significant misalignment or pain, surgery may be necessary. Dr. Siambanes specializes in procedures that relocate the hip joint and stabilize it within the socket. These surgeries are often performed between ages 7 and 12, allowing for optimal hip development as the child grows.

Surgical intervention can dramatically improve a child’s sitting balance, mobility, and overall comfort, especially for those who rely on wheelchairs or spend extended time in seated positions.

Supporting Your Child’s Comfort and Mobility

Recognizing the signs of hip dysplasia early is crucial in helping your child avoid pain and maintain as much independence as possible. If you notice any of the symptoms listed above or have concerns about your child’s hip development, don’t hesitate to reach out to a specialist.

Dr. Siambanes is committed to helping children achieve better mobility, improved sitting tolerance, and a higher quality of life. With expertise in both non-surgical and surgical treatments, Dr. Siambanes provides comprehensive care tailored to your child’s unique needs.

Schedule a Consultation Today

If you’re concerned about your child’s hip health, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes. Early intervention can make all the difference in preventing pain and supporting your child’s mobility as they grow.

While cerebral palsy is often associated with high muscle tone, muscle stiffness and spasticity, some children experience the opposite — low muscle tone, known as hypotonia. Hypotonic cerebral palsy affects a child’s strength, posture, and movement, making everyday activities more challenging. 

What is Hypotonic Cerebral Palsy?

Hypotonic cerebral palsy is a less common form of cerebral palsy characterized by decreased muscle tone, which makes muscles feel floppy or weak. Unlike spastic cerebral palsy, where muscles are stiff and tight, children with hypotonia have difficulty maintaining muscle control and posture due to reduced muscle tension.

This condition results from damage to the parts of the brain responsible for muscle coordination, often occurring before, during, or shortly after birth. Because muscle tone plays a key role in movement, balance, and strength, children with hypotonic cerebral palsy may experience delays in reaching developmental milestones such as sitting, crawling, or walking.

Signs and Symptoms of Hypotonic Cerebral Palsy

Children with hypotonic cerebral palsy may show symptoms early in life, often appearing “floppy” when held. Some common signs include

• Delayed motor development: Difficulty lifting the head, rolling over, or sitting up without support.
• Poor posture: A tendency to slump forward or struggle to maintain an upright position.
• Weak muscle control: Arms and legs may appear limp, making movements uncoordinated.
• Difficulty swallowing or feeding: Weakened oral muscles can make eating and speaking challenging.
• Loose joints and hypermobility: The child may have excessive flexibility due to a lack of muscle resistance.
• Fatigue and endurance issues: Low muscle tone can make even simple activities tiring.

How Hypotonic Cerebral Palsy Affects Daily Life

Children with hypotonic cerebral palsy often require additional support in daily activities. Weak muscle control can make standing, walking, and even holding objects more difficult. Tasks that require sustained effort, like sitting upright for long periods, may be exhausting. Some children may also experience breathing difficulties due to reduced muscle tone in the chest.

Despite these challenges, many children with hypotonic cerebral palsy can make significant progress with the right treatment and support. Early intervention is key to helping them develop strength, coordination, and independence.

Treatment Options for Low Muscle Tone in Children

1. Physical and Occupational Therapy

Therapy plays a crucial role in managing hypotonic cerebral palsy.

• Physical therapy focuses on building strength, balance, and coordination through targeted exercises.
• Occupational therapy helps children develop fine motor skills needed for daily activities like dressing, eating, and writing.

2. Bracing and Orthotic Support

Children with weak muscle tone often benefit from orthotic devices such as ankle-foot orthoses (AFOs) to provide stability and improve posture. These supports help prevent joint misalignment and make walking easier.

3. Speech and Feeding Therapy

If low muscle tone affects the face, mouth, or throat muscles, speech therapy can help improve swallowing, speech clarity, and oral motor function. Specialized exercises and feeding techniques may also be introduced to ensure safe and effective eating.

4. Strengthening Exercises

Engaging in activities that encourage movement, such as swimming or adapted sports, can help build muscle endurance and improve coordination. Therapy programs are often designed to make exercise fun and engaging for children.

5. Surgical Interventions

For children with severe joint instability or posture-related issues, surgical intervention may be necessary. Dr. David Siambanes is a board-certified orthopedic surgeon and fellowship trained in both pediatric orthopedics and spinal deformities. He specializes in procedures that enhance mobility and sitting tolerance, helping children maintain better posture and reduce pain. As the director of the Motion Analysis Center, he uses advanced gait analysis technology to assess movement challenges and determine the best treatment options.

The Importance of Early Intervention

Early diagnosis and treatment of hypotonic cerebral palsy can significantly improve a child’s ability to move, engage in daily activities, and build independence. With the right combination of therapy, bracing, and medical interventions, many children can achieve greater mobility and quality of life.

Dr. Siambanes is dedicated to providing specialized care for children with hypotonic cerebral palsy. Whether through therapy, orthotic support, or surgical solutions, his goal is to help every child reach their full potential.

How Dr. Siambanes Can Help

Hypotonic cerebral palsy presents unique challenges, but with the right support, children can make remarkable progress. Through expert medical care, therapy, and adaptive strategies, families can help their children build strength and confidence in their abilities.

If you have concerns about your child’s muscle tone or mobility, click here to request a consultation with Dr. Siambanes. Together, we can create a personalized plan to support your child’s development and well-being.