Spasticity Management for Preventing Muscle Contractures in Cerebral Palsy
Wednesday, February 26, 2025
2:30 PM-4:00 PM
BIOMED Seminar
Title:
Spasticity Management for Preventing Muscle Contractures in Cerebral Palsy: How Basic Science Is Challenging the Traditional View
Speaker:
Jason J. Howard, MD, GCert (Biodesign), FRCSC, FRCS (Glasg), FAAOS
Senior Attending Pediatric Orthopedic Surgeon, Division of Cerebral Palsy
Director of Orthopedic Research
Alfred I. duPont Campus, Nemours Children’s Health, Wilmington, DE
Associate Professor of Orthopedics and Pediatrics
Sidney Kimmell Medical College
Thomas Jefferson University
Details:
In cerebral palsy (CP), the spastic motor type is most common, associated with a velocity-dependent increase in muscle stiffness that precedes the development of fixed muscle contracture. In ambulatory CP, the reduction of spasticity has been a cornerstone of management, the ‘traditional view’ purporting that this approach will result in the prevention of fixed muscle contracture and bony deformities, and thus the need for subsequent orthopedic surgery. Emerging clinical evidence, recently synthesized in high quality systematic reviews, has suggested that the reduction of spasticity has little effect on the prevention of static contracture or the need for subsequent orthopedic surgery.
In addition, the most commonly used treatment modalities – including botulinum toxin (BoNT-A) and selective dorsal rhizotomy – have not improved functional outcomes. In the case of BoNT-A, animal studies have identified a persistent loss of contractile material post injection, replaced with fibrofatty tissue. Recent basic science work has provided new insights into the development of muscle contracture in CP, challenging previously held beliefs with implications for future treatment strategies and the goals/indications for spasticity reduction. For this talk, Dr. Howard will present latest evidence regarding clinical and basic science data relating to the pathophysiology, functional outcomes, contracture prevention, and need for orthopedic surgery, associated with the treatment of spastic muscle in CP.
Biosketch:
Dr. Jason J. Howard is a board certified academic Pediatric Orthopedic Surgeon at Nemours Children’s Hospital–Alfred I. duPont Campus in Wilmington, Delaware, and is the Director of Orthopedic Research for the Department of Orthopedic Surgery. He completed his medical training in Canada at Memorial University in 1998 and residency training in Orthopedic Surgery at the University of Calgary in 2003. His Fellowship training in Pediatric Orthopedic Surgery was at the Royal Children's Hospital, Melbourne, followed by a Fellowship in Pediatric Spine Surgery at Starship Children's Hospital in Auckland, New Zealand. He became a member of the Royal College of Physicians and Surgeons of Canada in 2003. In 2017, Dr. Howard completed a sabbatical at Inselspital, Bern, Switzerland where he trained in Pediatric Hip Preservation. In addition to his medical training, Dr. Howard also holds a bachelor’s degree in electrical engineering (Memorial) and graduate studies in Biodesign at Stanford University.
Dr. Howard is an active member of numerous societies including Pediatric Orthopaedic Society of North America (POSNA, Research Committee Member), American Academy of Orthopaedic Surgeons (AAOS), American Academy of Cerebral Palsy and Developmental Medicine (AACPDM, Awards Committee Member), Australian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM), European Academy of Childhood Disability (EACD), Muscular Dystrophy Association (MDA), the Hip Hope Network [Rare Disease Lead (SMA)], and the Canadian Orthopaedic Association (COA). His clinical interests include cerebral palsy, muscular dystrophies, spinal muscular atrophy, peripheral neuropathies, and other neuromuscular conditions (including spine). His research interests are focused on muscle basic science and epidemiological studies in cerebral palsy and other neuromuscular disorders, specifically spinal muscular atrophy. Prior to joining the Department of Orthopedic Surgery at Nemours in 2019, Dr. Howard spent 5+ years as the Chief of Orthopedic Surgery at Sidra Medicine, a greenfield Women and Children’s Hospital in Doha, Qatar, partnered with Weill Cornell Medical College. He played an integral role in planning and activating the hospital and served on many of its operational committees during his tenure.
Contact Information
Carolyn Riley
cr63@drexel.edu