8:30 // Introduction
• Spasticity: an update / J.M Gracies (France)
• Discussion
9:00 // Evaluation: what does the surgeon need?
• International Classification of Functioning, Disability and Health (ICF) / C. Colborne (UK)
• SHUUE / D. Weigl (Israel)
• MUUL / C. Colborne (UK)
• AHA / E. Chaleat-Valayer (France), R. Bard (France)
• MACS / H. Gong (Korea)
• GAS / F. Coroian, I. Laffont (France)
• COPM / M. Lewis (Australia)
• Sensory deficit / A. Van Heest (USA)
• The role of video / EMG analysis / A. Van Heest (USA)
• Functional assessment in children with hemiplegia: a surgical perspective / C. Parot (Chile)
• Pre-operative assessment in the brain-injury patient: detecting «hidden functions» / D. Gasq, C. Villepinte (France)
• Debate // The ideal surgical assessment / E. Chaleat-Valayer (France), C. Colborne (UK), B. Coulet (France), I. Laffont (France), C. Parot (Chile), A. Van Heest (USA)
10:10 // Clinical examination
• Key points of clinical examination / C. Vuillermin (USA)
• Patient examination / M. Tonkin (Australia)
• Attempted surgical classification of spastic upper limbs / B. Coulet (France)
• Discussion
10:40-11:10 // Break
11:10 // Non-surgical treatments
• Botulinum toxin and surgery
- Botulinum toxin and surgery / S. Kocer (Switzerland)
- Complications and so-called “failures” / E. Cosentino (Italy)
11:30 // Decision making: Goals, strategy and timing -
When to refer the patient to the surgeon?
• In children: C. Colborne (UK) / Discussor M. Ezaki (USA)
• In adult: I. Laffont (France) / Discussor C. Gschwind (Australia), F. Lapierre (France)
• Contra-indications to surgery / M. Ezaki (USA)
• Discussion
12:30 // Neurosurgical treatment
Moderator: P. Mertens (France)
• Intrathecal baclofen and dorsal selective radicotomy / C. d’Hardemare (France)
• Intrathecal baclofen therapy in children: special considerations / C. Hagemann (Germany)
13:00-14h:00 // Break
14:00 // Invited lecture
• Fifty years’ experience of surgery of the spastic upper limb: evolution of my practice / Y. Allieu (France)
14:20 // Surgical techniques
• “Multiple Fasciotomies: the shark attack”
- Technique and indications / M. Poschmann (Germany)
• Comment / M. Kreulen (Netherlands)
• Discussion
14:40 // Partial neurectomies
Moderator : F. Lapierre (France)
• Mechanism of action and evolution / P. Mertens (France), J. Maarravi (Lebanon)
• Technique of selective neurectomy and results / P. Mertens (France)
• Hyperselective neurectomy
- Anatomical basis / A. Cambon-Binder (France), C. Parot (Chile), R. Paulos (Brazil)
- Technique video / M. Gras (France)
- Results / C. Leclercq (France)
• Discussion
15:30 // Tendon transfers
Moderator : S. Kozin (USA)
• Tendon transfer surgery Vs Botox Vs regular ongoing therapy / A. Van Heest (USA)
• Characteristics of the spastic muscle and biomechanics of tendon transfers in the spastic patient /M. Kreulen (Netherlands)
• Choice of donor muscle / A. Lovic (Spain)
• Why tendon transfers in the growing child are unpredictable / E. Ponten (Sweden)
• Discussion
16:20-16:50 // Break
16:50 // Invited lecture
• Movement disorders / M. Ezaki (USA)
• Discussion
17:05 // Indications and Results
• Shoulder lengthening / P. Zerbinati (Italy)
• Shoulder neurectomy / F. Fitoussi (France)
• Articular procedures: suspension, arthroplasty / B. Coulet (France)
• Influence of shoulder surgery on distal function / B. Coulet (France)
• Clinical cases // M. Ezaki (USA)
• Discussion
18:00 // End of scientific programme
8:00 // Elbow
• Technique of elbow release / S. Kozin (USA)
• The role of the biceps / S. Pickard (UK)
• Partial release: fractional lengthening of the biceps / H. Gong (Korea)
• Lengthening and neurectomies / P. Panciera (Italy)
• Anterior release and self-esteem / F. Soldado (Spain)
• Clinical case // Elbow dislocation due to movement disorders / W. Girsch (Austria)
8:50 // Pro-supination
Moderator: M. Kreulen (Netherlands)
• The forearm: the forgotten joint / S. Kozin (USA)
• Classifciation and indications / C. Gschwind (Australia)
• Release of pronation / T. Ozkan (Turkey)
• Pronator rerouting / A. Van Heest (USA)
• Augmenting supination: the brachioradialis transfer / T. Ozkan (Turkey)
• One bone forearm for fixed supination contracture: An easy solution / S. Kozin (USA)
• Debate // how to avoid hypercorrection? A. Van Heest (USA), M. Kreulen (Netherlands), C. Gschwind (Australia), S. Kozin (USA)
// Wrist and fingers
9:40 // Lengthening
• Medial epicondylar release and Scaglietti-Page / B. Coulet (France)
• Flexor - pronator aponeurectomy / M. Tonkin (Australia), C. Leclercq (France)
• Fractional lengthening: anatomical basis / A. Arnaout (France)
• Fractional lengthening: surgical technique / M. Kreulen (Netherlands)
• Debate // Scaglietti- Page / B. Coulet (France)
vs Fractional lengthening / M. Kreulen (Netherlands)
• STP transfer: technique, indications and complications / B. Coulet (France)
• Alternative to STP: tenotomy-lengthening / A. Geffrier, P. Denormandie (France)
• Discussion
10:45-11:15 // Break
11:15 // Restoring the balance: tendon transfers
• Assessment of FCU function for tendon transfer surgery / M. Kreulen (Netherlands)
• Analysis of the FCU firing pattern before and after tendon transfer surgery / A. Van Heest (USA)
• Why I no longer transfer the spastic FCU / S. Kozin (USA)
• ECU to ECRB - preferred approach / S. Kozin (USA)
• What to do when tendon transfers don’t turn out the way you expected ? / E. Ponten (Sweden)
• Debate // Transfer or not transfer ? Which donor muscle? / M. Ezaki (USA), S. Kozin (USA), M. Kreulen (Netherlands), A. Lovic (Spain), A. Van Heest (USA)
11:50 // Wrist arthrodesis
Moderator : S. Hovius (Netherlands)
• Technique / S. Kozin (USA)
• Indications and results / A. Van Heest (USA)
• Wrist arthrodesis in adolescents / F. Fitoussi (France)
• Partial wrist arthrodesis / C. Parot (Chile)
• Impact of wrist arthrodesis on proximal function / B. Coulet (France)
• Kienbock and Spasticity / W. Girsch, G. Weigel (Austria)
• Discussion // Arguments against wrist arthrodesis - comment / M. Kreulen (Netherlands)
12:35 // Clinical cases
13:00-14:00 // Break
14:00 // Thumb
• Classification of thumb deformities / C. Gschwind (Australia)
• First web release: techniques / M. Kreulen (Netherlands)
• Alternative technique 1st web approach / M. Gras (France)
• Hyperselective neurectomy of the first web muscles: preliminary results / N. Bini (Italy)
• EPL rerouting / M. Kreulen (Netherlands)
• Thumb MPj instability: capsulodesis / M. Kreulen (Netherlands)
vs sesamoido-metacarpal arthrodesis ?
• Thumb in palm: get rid of a joint! / S. Kozin (USA)
• Dynamic thumb-in-palm. Temporary transarticular pinning to assess definitive joint fusion / F. Soldado (Spain)
• Discussion
14:50 // Fingers
• Anatomy of the interosseous muscles / C. Fontaine, N. Nachef (France)
• How do we assess the intrinsic muscles? / C. Gschwind (Australia)
• Intrinsic release: technique and postoperative management / L. Gatin, P. Denormandie (France)
• Feasibility of percutaneous release of the interosseous muscles / N. Nachef, C. Fontaine (France)
• Swan-neck: lateral band rerouting: technique / M. Kreulen (Netherlands)
: central slip tenotomy ?
• Boutonnière deformities ?
• Debate // Clinical cases
15:30 // Tetraplegia and spasticity
• Classification / Y. Allieu (France)
• Treatment / C. Reinhold (Sweden)
15:40-16:00 // Break
16:20 // Severe spasticity
• The Mini-Hand-Score / S. Facca (France)
• Management of severe deformities: finger flexor tenotomies at the bedside / A. Geffrier, L. Gatin, P. Denormandie (France)
• Hopeless cases: beyond surgery? / S. Hovius (Netherlands)
• Improvement in the career burden score after surgery for severe spasticity / C. Gschwind (Australia)
• Discussion
17:00 // Misc
• The hand in Parkinson’s disease / N. Nachef (France)
• Spastic missions in developing countries: interview / S. Kozin (USA), S. Gallego (Columbia)
17:20 // The future
• Brain stimulation / S. James (France)
• Nerve transfers ? /
17:45 // End of the Symposium
