Sample records for quadriplegia

  1. A new magnetic device for quadriplegia (United States)

    Veneziano, F; Tirone, D; Masuccio, FG; Actis, MV; Massazza, G


    Study design: Case report. Objectives: The objective of this study was to evaluate whether a new custom-made magnetic device might enable a patient affected with quadriplegia to self-feed. Setting: Day Hospital of the Unipolar Spinal Unit, CTO Hospital, Turin, Italy. Methods: Three magnets were affixed to a custom-made device and to a specially modified cutlery and a bottle of water. Results: The magnetic device permitted the patient to feed himself autonomously, using both a knife and a fork to eat and a bottle of water to drink. Conclusion: Such a magnetic device might be useful for self-feeding in a patient with quadriplegia. PMID:28053717

  2. Ischemic stroke of the pyramidal decussation causing quadriplegia and anarthria. (United States)

    Wilkins, Emilia G; Kamel, Hooman; Johnson, Eric C B; Shalev, Sarah M; Josephson, S Andrew


    A 52-year-old man with a history of hypertension and previously irradiated head and neck cancer presented with quadriplegia and anarthria sparing the face and sensory functions. Brain magnetic resonance imaging (MRI) demonstrated acute infarction of the pyramidal decussation. We describe the clinical and radiological characteristics of infarction at the pyramidal decussation and review the arterial supply to this region in the lower brainstem. Although rare, infarction of the pyramidal decussation should be considered in the differential diagnosis when patients present with atraumatic pure motor quadriplegia.

  3. An Odontoid Fracture Causing Apnea, Cardiac Instability, and Quadriplegia

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    Christian A. Bowers


    Full Text Available Odontoid fractures are typically associated with low rates of acute neurologic deficit and morbidity/mortality in nonelderly patients. In the patient in this case, traumatic injury triggered by a syncopal event led to a combined C1-C2 fracture and a fatal spinal cord injury with apnea, quadriplegia, and cardiovascular instability. We briefly review the anatomical basis for the pathophysiology of cardiac dysfunction following high-cervical spine injury and present an example of a worst-case scenario.

  4. Quadriplegia due to lead-contaminated opium: a case report

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    Baigmohammadi MT


    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Lead poisoning could be associated with gastrointestinal renal, hematologic complications and neurologic deficit."n"n Case report: The patient was an opium addict, forty one years old male, to hospital admitted with gastrointestinal signs, constipation, abdominal pain, severe weakness of upper and lower limbs without any sensory impairment and with anemia, leukocytosis, and slightly increased liver function tests. Serum level of lead was more than 200µg/dl. After treatment with dimercaprol (BAL, CaNa2EDTA for two five days sessions that followed with oral succimer for three days, signs and symptoms relieved, all laboratory tests became normal and blood level of lead reduced but the patient was discharged with quadriplegia. There was no fecal or urinary incontinence."n"n Conclusions: Because of irreversibility and severity of lead related neuronal injury, we should suspect to lead poisoning in each patient with neuronal involvement and concurrent GI and hematologic signs."n"n Keywords: Lead poisoning, motor palsy, opium, neuropathy, quadriplegia.

  5. Thematic analysis of the experience of group music therapy for people with chronic quadriplegia

    National Research Council Canada - National Science Library

    Tamplin, Jeanette; Baker, Felicity A; Grocke, Denise; Berlowitz, David J


    People living with quadriplegia are at risk for social isolation and depression. Research with other marginalized groups has indicated that music therapy can have a positive effect on mood and social interaction...

  6. Effect of nutritional support in children with spastic quadriplegia. (United States)

    Soylu, Ozlem Bekem; Unalp, Aycan; Uran, Nedret; Dizdarer, Gülsen; Ozgonul, Figen Oksel; Conku, Aliye; Ataman, Hamide; Ozturk, Aysel Aydogan


    Malnutrition is a common problem in patients with cerebral palsy. We evaluated the effect of nutritional support on clinical findings in children with spastic quadriplegia. Feeding history, numbers of lower respiratory tract infections, and gastrointestinal and neurologic findings were evaluated via questionnaire. Weight, height, head circumference, midarm circumference, and triceps skinfold thickness were measured. Height for age, weight for age, weight for height, body mass index, and weight and height z-scores were calculated. Clinical findings and anthropometric parameters were re-evaluated after nutritional support for 6 months. Forty-five patients were enrolled. No difference was evident between the first and the last height z-scores of 31 patients who completed the follow-up. Weight, height, weight z-scores, weight for age, weight for height, body mass index, midarm circumference, and triceps skinfold thickness exhibited improvement. Moreover, a significant decrease in number of infections was evident. Frequency of seizures and Gross Motor Function Classification System status did not change. Constipation decreased significantly. Nutritional therapy revealed improvements in some anthropometric findings and a decrease in number of infections. Although there was no difference regarding motor development or seizure frequency, further studies with a longer follow-up are required.

  7. Biofeedback to facilitate unassisted ventilation in individuals with high-level quadriplegia. A case report. (United States)

    Morrison, S A


    The purpose of this case report is to discuss the effectiveness of electromyographic biofeedback in reeducating and strengthening the accessory breathing muscles in an individual with high-level (C1) complete quadriplegia. Six unassisted breathing sessions were performed with EMG biofeedback intervention. Six unassisted breathing sessions without EMG biofeedback intervention were also performed. In both conditions, the subject's vital capacity and the amount of time of unassisted ventilation were recorded. The study results indicated that EMG biofeedback may be a helpful modality in training accessory breathing muscles to enable an individual with high-level quadriplegia to become independent of mechanical ventilation for varying amounts of time.

  8. The effect of singing training on voice quality for people with quadriplegia. (United States)

    Tamplin, Jeanette; Baker, Felicity A; Buttifant, Mary; Berlowitz, David J


    Despite anecdotal reports of voice impairment in quadriplegia, the exact nature of these impairments is not well described in the literature. This article details objective and subjective voice assessments for people with quadriplegia at baseline and after a respiratory-targeted singing intervention. Randomized controlled trial. Twenty-four participants with quadriplegia were randomly assigned to a 12-week program of either a singing intervention or active music therapy control. Recordings of singing and speech were made at baseline, 6 weeks, 12 weeks, and 6 months postintervention. These deidentified recordings were used to measure sound pressure levels and assess voice quality using the Multidimensional Voice Profile and the Perceptual Voice Profile. Baseline voice quality data indicated deviation from normality in the areas of breathiness, strain, and roughness. A greater percentage of intervention participants moved toward more normal voice quality in terms of jitter, shimmer, and noise-to-harmonic ratio; however, the improvements failed to achieve statistical significance. Subjective and objective assessments of voice quality indicate that quadriplegia may have a detrimental effect on voice quality; in particular, causing a perception of roughness and breathiness in the voice. The results of this study suggest that singing training may have a role in ameliorating these voice impairments. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.



    Meher Kumar; Rakesh


    Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero - Renal Scopy (URS) and double ‘J’ (DJ) stenting for right ureteric calculus under spinal ...

  10. Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. (United States)

    Tamplin, Jeanette; Baker, Felicity A; Grocke, Denise; Brazzale, Danny J; Pretto, Jeffrey J; Ruehland, Warren R; Buttifant, Mary; Brown, Douglas J; Berlowitz, David J


    To explore the effects of singing training on respiratory function, voice, mood, and quality of life for people with quadriplegia. Randomized controlled trial. Large, university-affiliated public hospital, Victoria, Australia. Participants (N=24) with chronic quadriplegia (C4-8, American Spinal Injury Association grades A and B). The experimental group (n=13) received group singing training 3 times weekly for 12 weeks. The control group (n=11) received group music appreciation and relaxation for 12 weeks. Assessments were conducted pre, mid-, immediately post-, and 6-months postintervention. Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, assessments of voice quality (Perceptual Voice Profile, Multidimensional Voice Profile), and Voice Handicap Index, Profile of Mood States, and Assessment of Quality of Life instruments. The singing group increased projected speech intensity (P=.028) and maximum phonation length (P=.007) significantly more than the control group. Trends for improvements in respiratory function, muscle strength, and recruitment were also evident for the singing group. These effects were limited by small sample sizes with large intersubject variability. Both groups demonstrated an improvement in mood (P=.002), which was maintained in the music appreciation and relaxation group after 6 months (P=.017). Group music therapy can have a positive effect on not only physical outcomes, but also can improve mood, energy, social participation, and quality of life for an at-risk population, such as those with quadriplegia. Specific singing therapy can augment these general improvements by improving vocal intensity. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Correlations between risk factors and functional evolution in patients with spastic quadriplegia. (United States)

    Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, L; Trăistaru, M R


    Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.

  12. Treinamento de músculos inspiratórios em pacientes com quadriplegia


    Silveira,Janne Marques; Gastaldi, Ada Clarice [UNIFESP; Boaventura,Cristina de Matos; Souza,Hugo Celso


    OBJETIVO: Determinar se o treinamento de músculos inspiratórios pode aumentar a força e endurance desses músculos em pacientes com quadriplegia. MÉTODOS: Oito pacientes quadriplégicos (7 homens e 1 mulher) com lesão medular cervical entre C4 e C7 foram submetidos ao treinamento de músculos inspiratórios utilizando-se um resistor de carga linear ajustado em 30% da PImáx. As sessões de treinamento foram realizadas com os pacientes sentados 5 vezes por semana por 8 semanas. Tempo de endurance, P...

  13. Upper limb functions regained in quadriplegia: a hybrid computerized neuromuscular stimulation system. (United States)

    Nathan, R H; Ohry, A


    A new, computerized neuromuscular stimulation system was applied to the upper limbs of two patients with complete quadriplegia below the C4 level. The stimulation-generated movements were integrated and augmented by residual, voluntary shoulder girdle movements and mechanical splinting. Up to 12 muscles were stimulated individually with high-resolution surface electrodes; coordination and control of the stimulation was effected by microcomputer. Simple vocal commands to the computer triggered preprogrammed hand prehensions, arm motion, and other functions, giving the patient complete control over the system. In pilot clinical trials of six weeks, writing, eating, and drinking, including picking up and replacing the pen or cup, were achieved.

  14. Chest tubes, lung entrapment, and failure to wean from the ventilator. Report of three patients with quadriplegia. (United States)

    Peterson, W P; Whiteneck, G G; Gerhart, K A


    The cases of three patients with traumatic quadriplegia who had been treated with chest tubes are described. Each had been injured at a neurologic level that typically allows weaning from the ventilator, yet none was able to clear refractory atelectasis or become ventilator free. Each underwent surgery during which lung adhesions, entrapment, or deformation at the former chest tube site were identified and corrected. Subsequently, each patient cleared his atelectasis and weaned from the ventilator. These cases suggest the importance of ruling out lung deformity in individuals with ventilator-dependent quadriplegia who have had chest tubes and unexpectedly fail to wean.


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    Meher Kumar


    Full Text Available Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero - Renal Scopy (URS and double ‘J’ (DJ stenting for right ureteric calculus under spinal anaesthesia. The patient was on nonsteroidal anti - inflammatory agents (NSAIDS and oral Prednisolone for sero - negative rheumatoid arthritis. The preoperative investigations were normal. About four hours after surgery, the patient developed paraesthesia of lower limbs, a little later paraplegia and gradually quadriplegia within 12 to 15 hours of surgery. Magnetic Resonance Imaging (MRI revealed an extensive spinal epidural haematoma and cord oedema extending from C2 to L5 vertebrae. In consultation with neuro - surgeon, the patient was treated conservatively, while awaiting for the results of coagulation profile, which proved to be Haemophilia. By the end of 2nd and 3rd postoperative day, the upper limbs showed signs of recovery and within a week’s time, both the upper limbs regained normal power and tone. The lower limbs showed sensory as well as motor recovery by 3 rd week and about total recovery to normalcy by 6 weeks. Residual paresis remained in left lower limb. The patient was sent for physiotherapy and he recovered completely by 9 months

  16. Complications corner: Quadriplegia after a minor hyperextension injury with severe OPLL teaching case and illustrative images

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    Daniel Spitzer


    Full Text Available Background: A previously healthy and asymptomatic male surviving well into his ninth decade (86 years of age was rendered immediately and completely quadriplegic after a minor fall associated with cervical hyperextension. Methods: Since he was unable to undergo a magnetic resonance (MR scan due to the presence of a cardiac pacemaker, a non-contrast computed tomography (CT was performed. This study demonstrated extremely severe cervical spinal canal stenosis secondary to previously undiagnosed ossification of the posterior longitudinal ligament (OPLL resulting in marked spinal cord compression between C5 and C6. Results: Secondary to his severe and irreversible quadriplegia, the patient elected not to undergo any intervention; he expired 4 days later. Had his deficit not been so severe, and had he been diagnosed earlier and undergone prophylactic/preventive posterior decompression (e.g. laminectomy C4-C7 sufficient to allow his cord to migrate dorsally, his irreversible quadriplegic deficit might have been avoided. Conclusions: Older patients with symptoms of progressive myelopathy should undergo early cervical MR (or CT if they have a pacemaker screening looking for "silent" cord compression due to stenosis, spondyloarthrosis, and/or OPLL. This case highlights the devastating consequences of even a mild hyperextension injury in a patient harboring extremely severe but previously undiagnosed OPLL. Devastating life-threatening or life-ending injuries may be avoided by maintaining a low threshold for performing "screening" cervical studies in elderly patients with vague complaints that might signal the onset of myelopathy.

  17. Restoring cortical control of functional movement in a human with quadriplegia. (United States)

    Bouton, Chad E; Shaikhouni, Ammar; Annetta, Nicholas V; Bockbrader, Marcia A; Friedenberg, David A; Nielson, Dylan M; Sharma, Gaurav; Sederberg, Per B; Glenn, Bradley C; Mysiw, W Jerry; Morgan, Austin G; Deogaonkar, Milind; Rezai, Ali R


    Millions of people worldwide suffer from diseases that lead to paralysis through disruption of signal pathways between the brain and the muscles. Neuroprosthetic devices are designed to restore lost function and could be used to form an electronic 'neural bypass' to circumvent disconnected pathways in the nervous system. It has previously been shown that intracortically recorded signals can be decoded to extract information related to motion, allowing non-human primates and paralysed humans to control computers and robotic arms through imagined movements. In non-human primates, these types of signal have also been used to drive activation of chemically paralysed arm muscles. Here we show that intracortically recorded signals can be linked in real-time to muscle activation to restore movement in a paralysed human. We used a chronically implanted intracortical microelectrode array to record multiunit activity from the motor cortex in a study participant with quadriplegia from cervical spinal cord injury. We applied machine-learning algorithms to decode the neuronal activity and control activation of the participant's forearm muscles through a custom-built high-resolution neuromuscular electrical stimulation system. The system provided isolated finger movements and the participant achieved continuous cortical control of six different wrist and hand motions. Furthermore, he was able to use the system to complete functional tasks relevant to daily living. Clinical assessment showed that, when using the system, his motor impairment improved from the fifth to the sixth cervical (C5-C6) to the seventh cervical to first thoracic (C7-T1) level unilaterally, conferring on him the critical abilities to grasp, manipulate, and release objects. This is the first demonstration to our knowledge of successful control of muscle activation using intracortically recorded signals in a paralysed human. These results have significant implications in advancing neuroprosthetic technology

  18. Treinamento de músculos inspiratórios em pacientes com quadriplegia Inspiratory muscle training in quadriplegic patients


    Janne Marques Silveira; Ada Clarice Gastaldi; Cristina de Matos Boaventura; Hugo Celso Souza


    OBJETIVO: Determinar se o treinamento de músculos inspiratórios pode aumentar a força e endurance desses músculos em pacientes com quadriplegia. MÉTODOS: Oito pacientes quadriplégicos (7 homens e 1 mulher) com lesão medular cervical entre C4 e C7 foram submetidos ao treinamento de músculos inspiratórios utilizando-se um resistor de carga linear ajustado em 30% da PImáx. As sessões de treinamento foram realizadas com os pacientes sentados 5 vezes por semana por 8 semanas. Tempo de endurance, P...

  19. Treinamento de músculos inspiratórios em pacientes com quadriplegia Inspiratory muscle training in quadriplegic patients

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    Janne Marques Silveira


    Full Text Available OBJETIVO: Determinar se o treinamento de músculos inspiratórios pode aumentar a força e endurance desses músculos em pacientes com quadriplegia. MÉTODOS: Oito pacientes quadriplégicos (7 homens e 1 mulher com lesão medular cervical entre C4 e C7 foram submetidos ao treinamento de músculos inspiratórios utilizando-se um resistor de carga linear ajustado em 30% da PImáx. As sessões de treinamento foram realizadas com os pacientes sentados 5 vezes por semana por 8 semanas. Tempo de endurance, PImáx, PEmáx e CVF foram medidos antes do treinamento e nas semanas 4 e 8. RESULTADOS: Em comparação ao valor basal médio, houve um aumento da PImáx, mensurada na posição sentada, nas semanas 4 e 8 (-83,0 ± 18,9 cmH2O vs. -104,0 ± 19,4 e -111,3 ± 22,7 cmH2O. Houve aumento da PEmáx, também na posição sentada, na semana 4 (de 36,8 ± 8,1 a 42,6 ± 8,8 cmH2O. Houve uma melhora na FVC na 4ª semana (de 2,1 ± 0,8 a 2,5 ± 0,6 L, representando um incremento de 24 ± 22%. O tempo de endurance (sentado não apresentou um aumento significativo entre o momento basal e a semana 8 (29,8 ± 21,0 min vs. 35,9 ± 15,5 min; aumento de 173 ± 233%. CONCLUSÕES: Pacientes com quadriplegia podem se beneficiar com o treinamento com baixas cargas (30% da PImáx, com melhora da força dos músculos inspiratórios, CVF e efetividade dos músculos expiratórios.OBJECTIVE: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. METHODS: Eight quadriplegic patients (7 males and 1 female with injury to the lower cervical spine (segments C4-C7 were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30% of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. RESULTS: In comparison with the mean baseline value

  20. Delayed Transient Post-Traumatic Quadriplegia

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    Khaloud Al-Shaaibi


    Full Text Available Transient neurological deficit following cervical trauma have been reported following sports injuries, and has been referred to as cervical cord neurapraxia. The so-called "whiplash injuries" following minor motor vehicle collisions usually do not produce any neurological deficit. Here we report the case of a whiplash type of injury presenting with a delayed onset neurological deficit, which was followed by rapid and complete recovery. The patient, an otherwise healthy 34-year-old male, attended the emergency department of Sultan Qaboos University Hospital following a rear-end motor vehicle collision. We present images showing degenerative disc disease causing spinal canal narrowing and mild cord compression in the patient, but no spinal instability. Differential diagnoses are also discussed.

  1. Neuroplasticity of prehensile neural networks after quadriplegia. (United States)

    Di Rienzo, F; Guillot, A; Mateo, S; Daligault, S; Delpuech, C; Rode, G; Collet, C


    Targeting cortical neuroplasticity through rehabilitation-based practice is believed to enhance functional recovery after spinal cord injury (SCI). While prehensile performance is severely disturbed after C6-C7 SCI, subjects with tetraplegia can learn a compensatory passive prehension using the tenodesis effect. During tenodesis, an active wrist extension triggers a passive flexion of the fingers allowing grasping. We investigated whether motor imagery training could promote activity-dependent neuroplasticity and improve prehensile tenodesis performance. SCI participants (n=6) and healthy participants (HP, n=6) took part in a repeated measurement design. After an extended baseline period of 3 weeks including repeated magnetoencephalography (MEG) measurements, MI training was embedded within the classical course of physiotherapy for 5 additional weeks (three sessions per week). An immediate MEG post-test and a follow-up at 2 months were performed. Before MI training, compensatory activations and recruitment of deafferented cortical regions characterized the cortical activity during actual and imagined prehension in SCI participants. After MI training, MEG data yielded reduced compensatory activations. Cortical recruitment became similar to that in HP. Behavioral analysis evidenced decreased movement variability suggesting motor learning of tenodesis. Data suggest that MI training participated to reverse compensatory neuroplasticity in SCI participants, and promoted the integration of new upper limb prehensile coordination in the neural networks functionally dedicated to the control of healthy prehension before injury.

  2. The social isolation of young men with quadriplegia. (United States)

    Blake, K


    This article describes the results of a study undertaken to identify perceptions of possible social isolation among individuals who become quadriplegic as young adults. Two focus group sessions were held with 4 male participants in each group. All the young men were between the ages of 19 years and 35 years, and all had been disabled for more than 3 years. The results showed that the participants felt challenged by the environment and their resources but did not experience the feelings associated with social isolation as defined by Goffman (1963). The participants, however, identified important socially isolating stressors based on the human needs described by Maslow (1970) as existing in a hierarchy. The results of the study suggest that people with disabilities need interpersonal techniques that enable them to feel a sense of security and control of their time; rehabilitation nurses are ideally suited to assist clients in developing such techniques.

  3. Tratamento da luxação paralítica do quadril na paralisia cerebral tetraparética espástica com osteotomia do fêmur e do ilíaco sem abertura da cápsula articular (capsuloplastia Hip dislocation treatment in cerebral palsy patients with spastic quadriplegia with femoral and pelvic osteotomies, without opening of the joint capsule (capsuloplasty

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    Fernando Farcetta Junior


    ten hips in eight patients with cerebral palsy with spastic quadriplegia treated with surgery from 2003 to 2005, by the same surgical technique. Were assessed clinical and radiological outcomes before and after surgery, as well as the preoperative planning with the use of fluoroscope. The clinical parameters analyzed were: pain, difficulty performing personal hygiene, and sitting balance. The radiological parameters were Reimer's index, acetabular index and neck-shaft angle. These results were submitted to statistical analysis. RESULTS: We obtained good results with this technique. After an average follow-up of three years, all hips were stable in the last assessment, and there was a high level of satisfaction among the families in relation to the treatment. We also show that preoperative planning with fluoroscopy enables the reduction and stabilization of the hips without the need for capsuloplasty. CONCLUSION: The authors conclude that in the treatment of hip dislocation in patients with Cerebral Palsy with spastic quadriplegia, it is not necessary to open the joint capsule to stabilize the coxofemoral joint.

  4. Quantas medidas de pressões respiratórias são necessárias para se obterem medidas máximas em pacientes com tetraplegia? ¿Cuántas maniobras son necesarias para llegar a las presiones máximas en pacientes con tetraplejía? How many maneuvers of respiratory pressures are required to obtain maximal values in patients with quadriplegia?

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    Ada Clarice Gastaldi


    Full Text Available INTRODUÇÃO: pressões inspiratórias (PImax ou expiratórias (PEmax máximas constituem um método simples e não-invasivo para avaliação da força de músculos respiratórios e auxiliam na identificação de fraqueza dos músculos respiratórios, presente em diversas doenças e situações clínicas, como a tetraplegia. OBJETIVO: avaliar o número de manobras necessárias para atingir as pressões máximas em pacientes com tetraplegia. MÉTODOS: oito pacientes com tetraplegia (sete homens, média de idade de 37,8±11,96 anos, com diagnóstico de lesão raquimedular cervical completa realizaram 10 medidas de PImax e PEmax nas posições sentada e deitada, totalizando 320 medidas. Os dados foram comparados pelo teste de Wilcoxon (pINTRODUCCIÓN: las presiones inspiratorias (PImax y espiratorias (PEmax máximas constituyen un método simple y no invasivo para evaluar la fuerza de los músculos respiratorios, y ayudan a identificar la debilidad de los músculos respiratorios presente en diferentes enfermedades y situaciones clínicas, como la tetraplejía. OBJETIVO: evaluar el número de maniobras necesarias para llegar a las presiones máximas en pacientes con tetraplejía. MÉTODOS: fueron incluidos ocho pacientes con tetraplejía (siete hombres, con edad media de 37,8±11,96 años y diagnóstico de lesión cervical raquis medular completa, a lo que se le realizaron 10 mediciones de PImax y PEmax en posición sentado y acostado, totalizando 320 mediciones. Los datos fueron comparados por el test de Wilcoxon (pINTRODUCTION: maximum inspiratory (IPmax and expiratory (EPmax pressures constitute a simple noninvasive method for evaluation of respiratory muscle strength which helps in the identification of muscle weakness usually present in several diseases and clinical situations, such as quadriplegia. OBJECTIVE: to assess the number of maneuvers needed to achieve maximum pressures in patients with quadriplegia. METHODS: eight quadriplegic

  5. Quantas medidas de pressões respiratórias são necessárias para se obterem medidas máximas em pacientes com tetraplegia? ¿Cuántas medidas de presiones respiratorias son necesarias para obtener mediciones máximas en pacientes con tetraplejia? How many maneuvers of respiratory pressures are required to obtain maximal values in patients with quadriplegia?

    Directory of Open Access Journals (Sweden)

    Ada Clarice Gastaldi


    Full Text Available INTRODUÇÃO: pressões inspiratórias (PImax ou expiratórias (PEmax máximas constituem um método simples e não-invasivo para avaliação da força de músculos respiratórios e auxiliam a identificação de fraqueza dos músculos respiratórios, presente em diversas doenças e situações clínicas, como a tetraplegia. OBJETIVO: avaliar o número de manobras necessárias para atingir as pressões máximas em pacientes com tetraplegia. MÉTODOS: oito pacientes com tetraplegia (sete homens, média de idade de 37,8±11,96 anos, com diagnóstico de lesão raquimedular cervical completa realizaram 10 medidas de PImax e PEmax nas posições sentada e deitada, totalizando 320 medidas. Os dados foram comparados pelo teste de Wilcoxon (pINTRODUCCIÓN: las presiones inspiratorias (PImáx y espiratorias (PEmáx máximas constituyen un método simple y no invasivo para evaluar la fuerza de los músculos respiratorios, y ayudan a identificar la debilidad de los músculos respiratorios presente en diferentes enfermedades y situaciones clínicas, como la tetraplejía. Objetivo: evaluar el número de maniobras necesarias para llegar a las presiones máximas en pacientes con tetraplejía. MÉTODOS: fueron incluidos ocho pacientes con tetraplejía (siete hombres, con edad media de 37,8±11,96 años y diagnóstico de lesión cervical raquis medular completa, a lo que se le realizo diez mediciones de PImáx y PEmáx en posición sentado y acostado, totalizando 320 mediciones. Los datos fueron comparados por el test de Wilcoxon (pINTRODUCTION: maximum inspiratory (PImax and expiratory (PEmax pressures are a simple non-invasive method for evaluation of respiratory muscle strength that helps in the identification of muscle weakness, usually present in several diseases and clinical situations, such as quadriplegia. Objective: to assess the number of maneuvers needed to achieve maximum pressures in patients with quadriplegia. METHODS: eight quadriplegic patients

  6. Neonatal infectious spondylitis of the cervical spine presenting with quadriplegia - A case report

    NARCIS (Netherlands)

    van Dalen, [No Value; Heeg, M


    Study Design. A case report. Objective. To highlight the evaluation and treatment of neonatal infectious spondylitis of the cervical spinel Summary of Background Data. Most authors advise intravenous antibiotics as first-choice treatment. The place of aspiration or operative drainage is debated, as

  7. Using an Artificial Neural Bypass to Restore Cortical Control of Rhythmic Movements in a Human with Quadriplegia (United States)

    Sharma, Gaurav; Friedenberg, David A.; Annetta, Nicholas; Glenn, Bradley; Bockbrader, Marcie; Majstorovic, Connor; Domas, Stephanie; Mysiw, W. Jerry; Rezai, Ali; Bouton, Chad


    Neuroprosthetic technology has been used to restore cortical control of discrete (non-rhythmic) hand movements in a paralyzed person. However, cortical control of rhythmic movements which originate in the brain but are coordinated by Central Pattern Generator (CPG) neural networks in the spinal cord has not been demonstrated previously. Here we show a demonstration of an artificial neural bypass technology that decodes cortical activity and emulates spinal cord CPG function allowing volitional rhythmic hand movement. The technology uses a combination of signals recorded from the brain, machine-learning algorithms to decode the signals, a numerical model of CPG network, and a neuromuscular electrical stimulation system to evoke rhythmic movements. Using the neural bypass, a quadriplegic participant was able to initiate, sustain, and switch between rhythmic and discrete finger movements, using his thoughts alone. These results have implications in advancing neuroprosthetic technology to restore complex movements in people living with paralysis.

  8. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Abilash KAK


    Full Text Available Ankylosing spinal disorders (ASD tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.

  9. Plasma Tumor Necrosis Factor-alpha (TNF-α) Levels Correlate with Disease Severity in Spastic Diplegia, Triplegia, and Quadriplegia in Children with Cerebral Palsy. (United States)

    Wu, Jianxian; Li, Xueming


    BACKGROUND Inflammatory responses in utero and in neonates have been involved in the development of white matter lesions. This study aimed to investigate the role of tumor necrosis factor-alpha (TNF-α) in spastic cerebral palsy. MATERIAL AND METHODS Plasma TNF-α was measured by ELISA in 54 children with spastic cerebral palsy and 28 aged-matched controls. Both groups were split into age subgroups (1-3 vs. 4-12). Gross motor function and activities of daily living were assessed on enrollment and after 6 months of rehabilitation. RESULTS TNF-α was higher in patients with cerebral palsy than in controls in young (Pcerebral palsy had significantly higher TNF-α levels compared with older ones (Pcerebral palsy showed higher plasma levels of TNF-α than controls. In addition, pre-treatment TNF-α levels were correlated with the improvements after rehabilitation therapy.

  10. 16 CFR 1207.1 - Scope, purpose, and findings. (United States)


    ...) quadriplegia and paraplegia resulting from users (primarily adults using the swimming pool slide for the first... address the risk of quadriplegia and paraplegia (except insofar as the standard specifies a low angle...

  11. 颈髓损伤并四肢瘫患者的早期康复训练效果观察%Effect observation of the early rehabilitation for patients with cervical spine injury and quadriplegia

    Institute of Scientific and Technical Information of China (English)



    目的 探讨对颈髓损伤患者进行早期康复训练,能否使患者生活自理能力明显提高.方法 采用早期综合性训练方法治疗颈髓损伤并四肢瘫患者58例,对患者进行床上正确体位及体位变换、呼吸功能训练、关节活动度训练、肌力训练、膀胱功能的训练、肛门排便功能的训练,并配合针灸、物理、心理等综合治疗.结果 C5损伤患者生活部分自理,可操纵电动轮椅,平地上可用手动轮椅.C6损伤患者生活大部分自理,可使用轮椅及多种自助具.C7损伤患者生活基本自理,可使用轮椅和残废人专用汽车.所有患者均可借助Parapodium站立行走架在室内行走.结论 早期综合训练可以改善颈髓损伤并四肢瘫患者的功能状态,提高生活质量.

  12. 38 CFR 17.44 - Hospital care for certain retirees with chronic disability (Executive Orders 10122, 10400 and... (United States)


    ... quadriplegia, hemiplegia and paraplegia, tuberculosis, blindness and deafness requiring definitive rehabilitation, disability from major amputation, and other diseases as may be agreed upon from time to time by...

  13. Cerebral palsy (United States)

    Spastic paralysis; Paralysis - spastic; Spastic hemiplegia; Spastic diplegia; Spastic quadriplegia ... and speech therapists Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist Treatment is based on ...

  14. Effective Structured Query Formulation for Session Search (United States)


    with top frequency are “type of paralysi”, “quadriplegia paraplegia ”, “ paraplegia ”, “spinal cord injury”, and “quadriplegic tetraplegic”, so the final...quadriplegia paraplegia ) 0.004819 paraplegia 0.004819 #combine(spinal cord injury) 0.00241 #combine(quadriplegic tetraplegic) )”, where the

  15. Cuidar de pessoas com tetraplegia no ambiente domiciliário: intervenções de enfermagem na dependência de longo prazo Cuidar de personas con tetraplégia en el ambiente domiciliario: intervenciones de enfermería en la dependencia de largo plazo Take care of people with quadriplegia at home environment: long-term nursing interventions

    Directory of Open Access Journals (Sweden)

    Ana Paula Scramin


    Full Text Available O crescente índice de acidentes de trânsito e a violência urbana contribuem para o aumento de pessoas com seqüelas neurológicas graves na coluna vertebral, fenômeno com reflexos diretos na relação de dependência de suas vítimas com cuidados sistemáticos de enfermagem. O presente estudo tem como objetivo chamar a atenção para conhecimentos do âmbito da reabilitação que interessam à Enfermagem, de maneira a contribuir para a promoção do cuidado domiciliário de pessoas com lesão medular em nível cervical, envolvendo seus familiares e cuidadores. A coleta de dados fez-se por meio de um levantamento bibliográfico dos últimos 10 anos, mediante pesquisa nos bancos de dados Lilacs (1996-2006; Mediline (1996-2006, além de terem sido consideradas referências do estudo de origem. Efetuada a análise dos dados, conclui-se que é preciso ampliar nosso conhecimento sobre cuidado de longo prazo no contexto da reabilitação do cliente com lesão medular alta, para atender à demanda social, em especial compartilhando experiências cotidianas com cuidadores domiciliares.El creciente índice de accidentes de automóviles y la violencia urbana contribuyen para el aumento en el número de personas con graves lesiones neurológicas en la médula espinal, un fenómeno que exige cuidados sistemáticos de enfermería para estas personas. Este estudio tiene como objetivo llamar la atención sobre los conocimientos de rehabilitación que interesan a la Enfermería para la provisión de cuidados domiciliarios para personas con lesión medular, involucrando sus familiares y cuidadores domiciliarios. Las informaciones fueron cosechadas a través de una búsqueda en las publicaciones de los últimos 10 años, accesando las bases de datos Lilacs (1996-2006 y Mediline (1996-2006, bien así las referencias de un estudio que ha originado este artículo. Después de analizar los datos, se llegó a la conclusión de que es necesario ampliar nuestro conocimiento sobre intervenciones de largo plazo en el proceso de rehabilitación del cliente con lesión medular alta, para atender a la demanda social, especialmente compartiendo nuestra experiencia diaria con los cuidadores domiciliarios.The increasing rate of automobile accidents and the urban violence contribute to the growth in the number of persons with serious neurological injuries in the spinal cord, a phenomenon demanding systematic nursing care for these people. This study aims to focus attention on the rehabilitation acquirements that are of particular interest for the nursing professionals to provide homecare services to persons with spinal cord injuries, involving their families and homecare attendants. Data were collected by surveying publications of the last 10 years, found through data banks such as the Lilacs (1996-2006 and the Mediline (1996-2006, as well as through references of a study that has originated this article. Data analysis led to the conclusion that it is necessary to increase our knowledge on long-term nursing interventions in the rehabilitation process of a client with high-level spinal cord injuries, in order to attend to social demand, especially by sharing our daily experiences with domiciliary caregivers.

  16. Trauma death in a resource constrained setting: Mechanisms and ...

    African Journals Online (AJOL)


    Nov 20, 2013 ... interpretation of symptoms and signs by specialized and experienced ... imaging facilities such as magnetic resonance imaging (MRI) and computerized ... cervical spinal cord injury with quadriplegia 5 (3.4%), blunt chest ...

  17. Quantas medidas de pressões respiratórias são necessárias para se obterem medidas máximas em pacientes com tetraplegia? ¿Cuántas maniobras son necesarias para llegar a las presiones máximas en pacientes con tetraplejía? How many maneuvers of respiratory pressures are required to obtain maximal values in patients with quadriplegia?


    Ada Clarice Gastaldi; Getúlio Antonio de Freitas Filho; Ana Paula Manfio Pereira; Janne Marques Silveira


    INTRODUÇÃO: pressões inspiratórias (PImax) ou expiratórias (PEmax) máximas constituem um método simples e não-invasivo para avaliação da força de músculos respiratórios e auxiliam na identificação de fraqueza dos músculos respiratórios, presente em diversas doenças e situações clínicas, como a tetraplegia. OBJETIVO: avaliar o número de manobras necessárias para atingir as pressões máximas em pacientes com tetraplegia. MÉTODOS: oito pacientes com tetraplegia (sete homens), média de idade de 37...

  18. Analysis of cranial CT-scan findings in cerebral palsy

    Energy Technology Data Exchange (ETDEWEB)

    Wada, F.; Andoh, T.; Une, K.; Takamatsu, T. (Kitakyushu Municipal Sogo-Ryoiku Center (Japan))


    CT-scan findings of 87 cerebral palsied children were studied. They consist of 23 cases of spastic quadriplegia, 9 cases of diplegia, 12 cases of paraplegia, 24 cases of athetosis and mixed type, and 19 cases of hemiplegia. In the former four types, ventricular dilatation and cortical atrophy were measured and abnormal changes in cerebral substance and cerebellar atrophy were observed. Spastic quadriplegia showed most intense changes in every aspect of the abnormalities, while paraplegia had almost normal appearance. Athetosis and mixed type had moderate changes. Hemiplegia always showed asymmetrical view on CT-scan, dilatation of lateral ventricle or atrophy of hemisphere in contralateral side being observed.

  19. The epidemiology of catastrophic spine injuries in high school and college football. (United States)

    Gill, Sanjitpal S; Boden, Barry P


    Athletic events have long been identified as a source of catastrophic spinal injuries. One of the most notorious sports has been American football. At both the amateur and professional level, this collision sport is associated with the highest number of direct catastrophic injuries including cervical spine trauma and quadriplegia. Although modifications in the rules of play and education of players and coaches have significantly diminished the rate of quadriplegia, there remains a need to decrease the number of catastrophic spine injuries in football. Further research related to the prevention and management of athletic cervical spine trauma is necessary.

  20. Sjögren-Larsson syndrome: importance of early diagnosis and aggressive physiotherapy. (United States)

    Kathuria, Sushruta; Arora, Shikha; Ramesh, V


    Sjögren-Larsson syndrome (SLS) is a congenital ichthyotic disorder with spasticity. We describe a case of a 5-year-old boy with SLS diagnosed clinically based on congenital ichythosis, quadriplegia, and mental retardation. The child responded well to emollients and antihistamines. His quadriplegia was managed by aggressive physiotherapy and mental retardation by stimulation techniques. After a 3-year follow up, significant improvement was seen in his motor and mental disability. This case highlights the importance of clinical diagnosis and early intervention for such a disabling disorder.

  1. Million Dollar Baby (2004 and Palliative Care

    Directory of Open Access Journals (Sweden)

    José Elías García Sánchez


    Full Text Available The worst misfortune that can befall an old, tormented and fearful boxing trainer is that the pupil he is training and of whom he is very fond should have a lesion as serious as a quadriplegia. This is the crux of the plot in Million Dollar Baby. A person who suffers a quadriplegia sees how most of her physical and sensorial abilities disappear and habitually suffers psychological disturbances requiring palliative medical care. Relatives are subjected to great stress and suffering. All these aspects are reflected, in general accurately, in the film.

  2. Programmed management of acute cervical cord trauma. (United States)

    White, R J; Bryk, J P; Yashon, D; Albin, M S; Demian, Y K

    Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.

  3. University Teaching with a Disability: Student Learnings beyond the Curriculum (United States)

    Sheridan, Lynnaire; Kotevski, Suzanne


    This research examines the learning experience of university students who were tutored by a teacher with quadriplegia mixed type cerebral palsy. It was inspired by Pritchard's [2010. "Disabled People as Culturally Relevant Teachers." "Journal of Social Inclusion" 1 (1): 43-51] argument that the presence of people with a…

  4. Central Cardiovascular Responses of Quadriplegic Subjects to Arm Exercise at Varying Levels of Oxygen Uptake. (United States)

    Figoni, Stephen F.

    The purpose of this study was to assess selected central cardiovascular functions of spinal cord injured, quadriplegic subjects at varying levels of oxygen uptake (VO sub 2). Subjects included 11 untrained, male college students with C5, C6, or C7 complete quadriplegia and 11 able-bodied reference subjects. Exercise was performed on a Monark cycle…

  5. Communicating in and through "Murderball": Masculinity and Disability in Wheelchair Rugby (United States)

    Lindemann, Kurt; Cherney, James L.


    This article investigates communicative practices surrounding wheelchair rugby, a growing sport played worldwide by people with quadriplegia. Researchers have studied extensively the practice of using sport for rehabilitation, but the role of communication in this process has been overlooked. We argue that participating in this sport is itself a…

  6. Communicating in and through "Murderball": Masculinity and Disability in Wheelchair Rugby (United States)

    Lindemann, Kurt; Cherney, James L.


    This article investigates communicative practices surrounding wheelchair rugby, a growing sport played worldwide by people with quadriplegia. Researchers have studied extensively the practice of using sport for rehabilitation, but the role of communication in this process has been overlooked. We argue that participating in this sport is itself a…

  7. 78 FR 12264 - Criteria for a Catastrophically Disabled Determination for Purposes of Enrollment (United States)


    ..., 344.03, 344.04, 3.44.09), paraplegia (ICD-9-CM Code 344.1), blindness (ICD-9-CM Code 369.4... quadriparesis, paraplegia, and persistent vegetative state would be unchanged. For this same reason, we would...) * * * (1) Quadriplegia and quadriparesis; paraplegia; legal blindness defined as visual impairment of...

  8. Sjogren's syndrome presenting with hypokalemic periodic paralysis. (United States)

    Agrawal, Sumita; Bharti, Vishrant; Jain, Mayur N; Purkar, Prashant D; Verma, Avinash; Deshpande, Alaka K


    We report a rare case of a 38-year-old female who presented with sudden onset flaccid quadriplegia and respiratory arrest with no significant past clinical history. She was later found to have hypokalemia due to distal renal tubular acidosis and further diagnosed as case of Sjogrens Syndrome.

  9. A peritoneal dialysis patient with osmotic demyelination syndrome

    Directory of Open Access Journals (Sweden)

    Hing Ming Cheng


    Full Text Available A peritoneal dialysis patient with cirrhosis presented with drowsiness, vomiting, and mild hyponatremia. Despite no active correction of hyponatremia, she developed convulsion and quadriplegia. Magnetic resonance imaging of the brain showed changes of osmotic demyelination syndrome. This case illustrates that osmotic demyelination syndrome may occur in peritoneal dialysis without rapid correction of hyponatremia.

  10. Hypokalaemic paralysis and normocalcaemic tetany--a rare presentation of Sjogren's syndrome. (United States)

    Selvaganesh, M; Murali, A; Mookambik, R V; Jayachandran, K


    38 year old woman was admitted with acute onset of quadriplegia. Biochemical investigation revealed severe hypokalaemia with hyperchloraemic metabolic acidosis, alkaline urine, and positive urinary anion gap which are the hallmark of distal tubular acidosis. In addition she also had hypophosphataemia, normoglycaemic glycosuria, aminoaciduria, and hyperphosphaturia suggestive of proximal tubular dysfunction. Further evaluation confirmed the diagnosis of Sjogren's syndrome. Interestingly our patient also had carpopedal spasm despite normal calcium and magnesium level. Quadriplegia and carpopedal spasm improved with correction of hypokalaemia and acidosis. Proximal tubular abnormalities (except albuminuria) were normalised at the time of discharge. Distal tubular acidosis is a well known renal manifestation of Sjogren's syndrome. But this type of transient proximal tubular dysfunction with distal tubular acidosis in Sjogren's syndrome is very rare and hypokalaemic tetany also deserves mention.

  11. [Factors affecting prognosis in childhood Guillain Barré syndrome]. (United States)

    Ortiz Corredor, F

    Guillain Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis in children. The factors that come to bear on its prognosis have not been properly determined in Latin America. Our aim was to establish the clinical and electrophysiological indicators of GBS in a group of paediatric patients attended in a tertiary care hospital. Patients and methods. We conducted a prospective study involving 67 patients who were hospitalised in the Instituto de Ortopedia Infantil Roosevelt between 1999 and 2002 after having been diagnosed as suffering from GBS. The clinical and electrophysiological characteristics were evaluated during the first month of illness and a clinical follow up was carried out until the patients reached stage III on Hughes' functional disability scale. Initially, it was observed that the protracted plateau time, the quadriplegia on day 10 of the disease and the electrical non excitability demonstrated by means of neuroconduction studies were variables linked to a protracted recovery time. Patients with a protracted recovery time required respiratory assistance more often, but this association was not statistically significant. In the Kaplan Meier survival analysis and the Cox analysis employed to determine the effects of covariance, the presence of quadriplegia associated to electrical non excitability were identified as significant variables in nine patients who required a longer time to reach Hughes stage III (mean: 172.7 days, 95% confidence intervals: 143.51 202.05). Patients with excitable motor nerves (EMN) and without quadriplegia reached functional stage III more quickly (mean: 39.51 days, 95% confidence intervals: 25.79 53.24). Children with GBS who display EMN and quadriplegia on day 10 of the illness are the group with the poorest prognosis and have a very long motor recovery time.

  12. A Rare case of Guillain-Barré syndrome in pregnancy treated with plasma exchange

    Directory of Open Access Journals (Sweden)

    Rahul Vasudev


    Full Text Available Guillain-Barre syndromé (GBS is an autoimmune disorder. It is rare in pregnancy as there is a decrease in cell-mediated immunity. A case of 28-year-old pregnant woman who presented with acute flaccid quadriplegia suffering from GBS is discussed in this study. She was treated with plasma exchange in her immediate post-partum period. The management of GBS in pregnancy has been discussed.

  13. Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury


    Lauren Surdyke; Jennifer Fernandez; Hannah Foster; Pamela Spigel


    Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following tr...

  14. Roxarsone (3-nitro-4-hydroxyphenylarsonic acid) poisoning in pigs



    Young pigs, six to ten weeks of age, from two unrelated swine operations were fed a grower ration obtained from a common commercial supplier. Following ingestion of the feed for approximately two weeks, pigs in both groups developed neurological disturbances characterized by blindness, ataxia, incoordination, muscle tremors, posterior paralysis, and quadriplegia. Vocalization described as “screaming” was also observed in several animals. Necropsy findings and tissue arsenic concentrations wer...

  15. Locked-in syndrome in a patient with acute obstructive hydrocephalus, caused by large unruptured aneurysm of the basilar artery (BA). (United States)

    Kolić, Zlatko; Kukuljan, Melita; Vukas, Duje; Bonifačić, David; Vrbanec, Kristina; Franić, Ivana Karla


    We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ventriculoperitoneal shunt (VPS), we encountered the "locked-in syndrome" clinical condition. "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.

  16. Locked-in syndrome. (United States)

    Sepcić, J; Sepić-Grahovac, D; Strenja-Grubesić, J; Antonelli, L; Andrasević, D


    A patient, young fisherman, with a locked-in syndrome is reported, in whom intact consciousness, quadriplegia of spastic type, voluntary eye blinking, (de)sursumvergence and anarthria were observed. Thrombosis of the basilar artery and slightly disturbed bioelectrogenesis of the cerebral cortex were proved by clinical examination. The patient died after 41 days. At the autopsy thrombosis a. basilaris and ventrobasal pontine infarction were confirmed. Differential diagnosis of this and similar syndromes has been discussed.

  17. Effects of a Static Bicycling Programme on the Functional Ability of Young People with Cerebral Palsy Who Are Non-Ambulant (United States)

    Williams, Heather; Pountney, Teresa


    This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…

  18. Central pontine myelinolysis (CPM and extrapontine myelinolysis (EPM following concurrent chemoradiotherapy for nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Chen-Hui Chong


    Full Text Available Central pontine myelinolysis (CPM is a disease that may present with coma, quadriplegia, or no symptoms at all. It is an iatrogenic demyelinating disease caused most frequently by overzealous correction of chronic hyponatremia and excessive swings in serum osmolality. Lesions can also occur outside the pons as extrapontine myelinolysis (EPM. Herein we have reported a case of CPM and EPM in a patient after chemoradiotherapy for recurrent nasopharyngeal carcinoma.

  19. Pontine hemorrhage in a patient with pheochromocytoma. (United States)

    Scardigli, K; Biller, J; Brooks, M H; Cespedes, L E; Posniak, H V


    A 24-year-old woman with a two-year history of hypertension was hospitalized for coma and quadriplegia secondary to pontine hemorrhage. A seven-year history of intermittent severe headaches, diaphoresis, and anxiety together with persistent severe hypertension led to the diagnosis of pheochromocytoma. This unusual but devastating manifestation of pheochromocytoma illustrates the importance of excluding remedial forms of hypertension in young patients before initiating antihypertensive therapy.

  20. High cervical spine spondylodiscitis management and literature review

    Directory of Open Access Journals (Sweden)

    André Luis Sebben

    Full Text Available Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

  1. Acute rehabilitation of spinal cord injury


    KIDRIČ-SIVEC, Urška; SEDEJ, Bogdana; MAROLT, Melita


    Traumatic spinal cord injury presents with loss of function of neuromuscular and other systems below the level of injury. Patients may suffer from minor loss of strength to complete quadriplegia with respiratory distress. All the patients with traumatic spinal cord injury who are admitted and treated in University Medical Centre Ljubljana are evaluated after admission and individualized plan of rehabilitation is made. The neurological level of injury is documented with international standa...

  2. Complications with use of the Stryker frame. (United States)

    Slabaugh, P B; Nickel, V L


    Roentgenograms were made of two patients with acute dislocations of the cervical spine who were undergoing treatment on Stryker frames with cervical traction. Losses of reduction were evident when the patients were turned from the supine to the prone position. The pulmonary vital capacity of patients with complete traumatic quadriplegia consistently decreased when they were turned to the prone position. Prolonged supine positioning of patients on the Stryker frame also caused occipital decubitus ulcers.

  3. Krabbe病患者の全身麻酔経験



    We present a 5-year-old boy with late infantile form of Krabbe disease who required general anesthesia for dental treatment. He was diagnosed with Krabbe disease at 1 year and 6 months old, and bone marrow transplantation was performed to prevent the neurological deterioration at 2 years old. He presented severe neurodegeneration and quadriplegia, and could not move actively except for tossing about from laterel to supine position. A diazepam syrup (2 mg) was administered 90 minutes before th...

  4. Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Andrea A. García-Contreras


    Full Text Available Objective: To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia Methods: Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used. Results: During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01. The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%. Conclusion: Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia.

  5. Motor recovery after Guillain-Barré syndrome in childhood. (United States)

    Ortiz-Corredor, Fernando; Peña-Preciado, Marta; Díaz-Ruíz, Jorge

    To determine the clinical factors that modify the recovery time for gait after Guillain-Barré syndrome (GBS) in childhood. Medical records of patients admitted to Instituto de Ortopedia Infantil Roosevelt (IOIR) between years 1991 and 2001, were reviewed. Age, sex, cranial nerve impairment, requirement of assisted ventilation, number of days of assisted ventilation, muscular strength at day 10 of the disease, presence of quadriplegia, intravenous infusion of human gamma globulins (IVIG), were taken as independent variables. The number of needed days to reach Hughes State III was taken as the major outcome. First, univariate analysis was performed and with the factors that showed a statistically significant association with recovery time, multiple linear regression analysis and Cox regression were also performed. Data of 332 children under 15 years old was collected. (Mean age: 7.1 years). A sample of 215 children was gathered for the study, all of them were regarded as functional states IV or V. Acute Motor Axonal Neuropathy (AMAN) was found in 30% of all cases. In the univariate analysis Cranial nerve impairment, requirement of assisted ventilation, presence of quadriplegia and presence of non-excitable motor nerves were associated with delayed motor recovery time. Patients who received IVIG reached Hughes state III faster than those who received only support treatment. This finding, that was more important in the presence of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), lost its value in the Cox regression analysis. In the multivariate analysis, muscular strength, assessed at day 10 of the disease was the most important predictor to determine motor recovery. The presence of quadriplegia was strongly associated with a delayed recovery time. Relative risk: 3.3 (95% Confidence Interval 2.1 - 5.2). Muscular strength at day 10 of the disease is the most useful clinical factor to determine prognosis of motor recovery in children who have suffered

  6. Alcohol based surgical prep solution and the risk of fire in the operating room: a case report

    Directory of Open Access Journals (Sweden)

    Gupta Rajiv


    Full Text Available Abstract A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.

  7. Health insurance for the "uninsurable". (United States)

    Schneck, L H


    State-sponsored health insurance plans for people labeled "uninsurable" by commercial carriers provide financial lifelines for those who qualify. In 28 states, individuals suffering from cancer, AIDS, multiple sclerosis, emotional disorders, cystic fibrosis, para- or quadriplegia and other chronic or recurrent health problems receive benefits--for reasonable premiums--from innovative programs that can literally make the difference between life and death, solvency or indigence. Medical practices and other health care facilities can play a pivotal role in informing patients of these coverage options--and by doing so, increase their revenue, as well.

  8. A rare case of Sjogren-Larsson syndrome with recurrent pneumonia and asthma


    Tavasoli, Azita; Sayyahfar, Shirin; Behnam, Babak


    Sjogren-Larsson syndrome (SLS) is a rare autosomal recessive neurocutaneous disorder with worldwide incidence of 0.4 per 100,000 people. It is characterized by the triad of congenital ichthyosis, spastic diplegia or quadriplegia, and mental retardation. Herein we report a 2-year-old male child with SLS, asthma, and recurrent pneumonia. SLS was confirmed by a molecular genetics study that revealed a deletion mutation in the ALDH3A2 gene. An ALDH3A2 gene mutation results in dysfunction of the m...

  9. Successful treatment of paroxysmal tonic spasms with topiramate in a patient with neuromyelitis optica. (United States)

    Iida, Shin; Nakamura, Masataka; Wate, Reika; Kaneko, Satoshi; Kusaka, Hirofumi


    A 49-year-old woman with neuromyelitis optica (NMO) developed severe quadriplegia and frequent paroxysmal tonic spasms (PTS). Carbamazepine, although initially effective against PTS, caused drug eruption and she was unable to continue. PTS re-emerged after discontinuation of carbamazepine and hindered rehabilitation. Then topiramate was started, and PTS promptly disappeared. The patient became able to resume rehabilitation and her activity of daily life improved significantly. Carbamazepine and topiramate have a common pharmacological action to block voltage-gated sodium channels. The action may have contributed to inhibition of ephaptic transmission in the demyelinating lesions by NMO and eventually improved PTS.

  10. Craniocervical mycetoma caused bu Streptomyces somaliensis

    Energy Technology Data Exchange (ETDEWEB)

    Ramboer, J.H.; De Graaf, A.S. (Tygerberg Hospital, Bellville (South Africa). Dept. of Internal Medicine); Hewlett, R.H. (Tygerberg Hospital, Bellville (South Africa). Dept. of Radiology); Kirby, P.A. (Tygerberg Hospital, Cape Town (South Africa). Department of Anatomical Pathology); Robson, R.A. (Tygerberg Hospital, Capetown (South Africa). Department of Microbiology)

    Magnetic resonance (MR) imaging, computerized tomography (CT) and clinical-pathological findings are described in a case of craniocervical mycetoma caused by the actinomycete Streptomyces somaliensis. Clinical features includes epilepsy, visual and hearing disturbance, quadriplegia and incontinence. CT revealed a hyperdense, diffusely enhancing intra-extracranial mass, further defined by MR to involve the oropharyngeal region, skull base, cranial-cervical peridural spaces and brain. On treatment with Dapsone, the lesion decreased in size, with recovery of spinal cord function. The combined plain film, CT and MR images are considered to be diagnostic of this form of mycetoma. (author). 10 refs.; 4 figs.

  11. Traumatic posterior atlantooccipital dislocation with Jefferson fracture and fracture-dislocation of C6-C7: a case report with survival


    Park, Jong-Beom; Ha, Kee-Yong; Chang, Han


    Atlantooccipital dislocation (AOD) is a rare and usually fatal injury. In the current study, the authors reported an extremely rare case of posterior AOD with Jefferson fracture and fracture-dislocation of C6-C7. The patient survived the injury and had only incomplete quadriplegia below the C7 segment with anterior cord syndrome. He was successfully managed with in situ occipitocervical fusion using the Cotrel-Dubousset rod system, corpectomy of C6, and anterior interbody fusion of C5–C7 with...

  12. Bispectral index monitoring in the management of sedation in an intensive care unit patient with locked-in syndrome. (United States)

    Quraishi, Sadeq A; Blosser, Sandralee A; Cherry, Robert A


    Locked-in syndrome is an extremely rare neurological state caused by injury of the ventral pons. The syndrome is characterized by quadriplegia and anarthria with concomitant preservation of cortical function. When a reversible underlying pathological abnormality is identified and managed aggressively, meaningful recovery is possible. Because patients retain consciousness throughout their illness, a dependable method for titrating sedation may improve their quality of life. The case presented suggests that bispectral index monitoring may be a cost-effective and reliable method for managing sedation in patients with locked-in syndrome.

  13. Correlation Analysis of Gross Motor Function Classification and Core Strength of Children with Cerebral Palsy%脑瘫患儿粗大运动功能分级与核心肌力的相关性分析

    Institute of Scientific and Technical Information of China (English)

    王刚; 李莉; 支世保


    目的:探讨痉挛型四肢瘫患儿核心肌力状况及其与粗大运动功能的关系.方法:选取痉挛型四肢瘫患儿70例,采用徒手肌力检查法(manual muscle test,MMT)对其核心肌群进行肌力评估,采用粗大运动功能分级系统(Gross Motor Function Classification System,GMFCS)对其粗大运动功能进行评估,并探讨两者相关性.结果:MMT测试结果显示,受试70例痉挛型四肢瘫患儿的核心肌群肌力均减低;GMFCS测试显示,I级10例,II级28例,III级18例,IV级2例,V级12例;Pearson相关分析结果显示,受试患儿GMFCS与核心肌群肌力均呈显著负相关(P<0.01).结论:痉挛型四肢瘫患儿核心肌力减低,核心肌力与粗大运动功能分级相关.%Objective:To investigate the relationship between core strength and gross motor function of children with spastic quadriplegia. Methods:70 cases of children with spastic quadriplegia were selected, whose myodynamia of core muscles was evaluated with manual muscle test (MMT), and gross motor function was evaluated with gross motor function classification system (GMFCS), as well as the correlation between them. Results:MMT showed that core muscle strength of 70 children with spastic quadriplegia decreased;according to GMFCS there were 10 cases of grade I, 28 cases of grade II, 18 cases of grade III, 2 cases of grade IV and 12 cases of grade V;Pearson correlation analysis showed that there was significantly negative correlation between GMFCS and core muscle strength (P<0.01). Conclusion:core muscle strength of children with spastic quadriplegia de-creases, core muscle strength and gross motor function classification are relative.

  14. Síndrome de Guillain-Barrè após varicela: relato de caso

    Directory of Open Access Journals (Sweden)

    Walter Oleschko Arruda


    Full Text Available Os autores relatam caso grave de síndrome de Guillain-Barré após quadro inicial de varicela em rapaz de 13 anos. Como complicações este paciente desenvolveu quadriplegia flácida com insuficiência respiratória, hipertensão arterial, taquicardia e importante neuropatía sensitiva periférica (disestesia dolorosa. Comenta-se a relação entre quadros virais benignos e o desenvolvimento de polirradiculoneurite aguda, assim como o possível mecanismo imunopatogênico envolvendo fatores humorais e celulares.

  15. Autopsy report of acute necrotizing opticomyelopathy associated with thyroid cancer. (United States)

    Kuroda, Y; Miyahara, M; Sakemi, T; Matsui, M; Ryu, T; Yamaguchi, M; Sasadomi, E; Sugihara, H


    We report an autopsied case of paraneoplastic necrotizing myelopathy. The patient had bilateral blindness, quadriplegia, and dyspnea of acute onset and died without remission 7 weeks later. The severe tissue necrosis and demyelination were found in the optic chiasm and from the medulla oblongata throughout the whole length of spinal cord. A papillary carcinoma was found in the thyroid gland at autopsy. In the present case IgG, myelin basic protein and activated helper T cells were increased in the CSF at onset, suggesting a mechanism of autoimmune demyelination for the condition.

  16. Clinical Presentation of Inadvertent Intrathecal Vincristine Masquerading Guillain-Barre Syndrome. (United States)

    Saha, Agni Sekhar; Islam, Md Fekarul; Bhattacharya, Sukanta; Giri, Prabhas Prasun


    Vincristine, a potent chemotherapeutic agent, is highly neurotoxic. If given intrathecally by accident it is almost always fatal. We are reporting a 6 year old girl with acute lymphoblastic leukaemia in complete remission, who was given inadvertent intrathecal Vincristine instead of Methotrexate. She developed gradually progressive quadriplegia and respiratory paralysis requiring prolonged mechanical ventilation, initially mimicking Guillain-Barre Syndrome, both clinically and electro-physiologically. She also developed progressive encephalopathy. The clinical deterioration subsequently plateaued without any significant improvement and after more than 5 months, she finally expired.

  17. A Neuroprosthesis System Utilizing Optical Spatial Feedback Control (United States)


    Spinal Cord Injury. CRC Press Inc., pp 123-138, 1989 Lathem, P.A., Gregorio, T.L., Garber, S.L. High Level Quadriplegia: The Occupational Therapy ...Challenge. American Journal of Occupational Therapy . 39(11). 705-714, 1985. Lauer R, P. Peckham, and K. Kilgore. EEG-based control of a hand grasp...cylindrical and one Lego block set Objects avoided Trial 3 One cylindrical object, one gray cup, and one Lego block set Gray cup not recognized and knocked

  18. Novel mutation in Sjogren-Larsson syndrome is associated with divergent neurologic phenotypes. (United States)

    Davis, Kathleen; Holden, Kenton R; S'Aulis, Dana; Amador, Claudia; Matheus, M Gisele; Rizzo, William B


    Sjögren-Larsson syndrome is an inherited disorder of lipid metabolism caused by mutations in the ALDH3A2 gene that codes for fatty aldehyde dehydrogenase, which results in accumulation of fatty aldehydes and alcohols and is characterized by ichthyosis, intellectual disability, and spastic diplegia/quadriplegia. The authors describe 2 unrelated Honduran patients who carried the same novel homozygous nonsense mutation (c.1309A>T, p.K437X) and ALDH3A2 DNA haplotype, but widely differed in disease severity. One patient exhibited spastic quadriplegia with unusual neuroregression, whereas the other patient had the usual static form of spastic diplegia with neurodevelopmental disabilities. Biochemical analyses showed a similar profound deficiency of fatty aldehyde dehydrogenase activity and impaired fatty alcohol metabolism in both patients' cultured fibroblasts. These results indicate that variation in the neurologic phenotype of Sjögren-Larsson syndrome is not strictly determined by the ALDH3A2 mutation or the biochemical defect as expressed in cultured fibroblasts, but by unidentified epigenetic/environmental factors, gene modifiers, or other mechanisms.

  19. Correlation between developmental disorders and MRI findings in very low birth weight infants

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Kuniaki; Endo, Shoichi; Goda, Tomoko; Ota, Akira; Akita, Yuji; Furukawa, Seikyo (Kagawa Children' s National Sanatorium, Zentsuji (Japan))


    We investigated the prevalence of developmental disorders in very low birth weight infants, their risk factors during the neonatal period, and the correlation between their neurological symptoms and their MRI findings. Seventy-three infants, who were followed up for more than 5 years in the developmental clinic, were enrolled. The developmental disorders included 6 patients with cerebral palsy (CP) and 6 patients with mental retardation (MR). The types of CP were as follows: spastic diplegia (3), spastic quadriplegia (2), athetotic quadriplegia (1). Intraventricular hemorrhage (IVH) and mechanical ventilation (MV) were significant risk factors for CP and MR and retinopathy was also a significant risk factor for MR. Periventricular areas of bright signal intensity on T2 (TR 2000 msec/TE 120 mse) weighted images, compatible with old, small white matter infarcts, gliosis or demyelination, were observed in only three of the seven patients. We measured the width of anterior horns, the maximum diameter of cerebrum, and the minimum thickness of white matter in occipital lobe on T1 (TR 500 msec/TE 20 msec) weighted transaxial images in eight patients (five patients with CP, three patients with MR). The maximum diameters of cerebrums and the minimum thickness of white matters were significantly smaller in patients with CP or MR than those in controls, respectively. The DQ of patients significantly correlated with the maximum diameters of cerebrums and the minimum thickness of white matters in left occipital lobe significantly correlated with DQ. (author).

  20. Morphological brain damage, functional disorders and the possibilities of their treatment in children with infantile cerebral palsy. (United States)

    Popko, J; Sobaniec, W; Król, E; Sendrowski, K; Kossakowski, D; Olszewski, S


    Twenty-four children with infantile cerebral palsy (6 girls and 18 boys aged 3-17 years), surgically treated in the years 1993-1997, were involved in the study. Neurological-orthopaedic examinations and computer tomography (CT) of the head allowed precise diagnosis and understanding of its pathology. The group consisted of 10 patients with hemiplegia, 10 with diplegia and 4 with severe quadriplegia. In 18 children changes in the brain were largely dependent on the clinical type of paresis. In hemiparesis, unilateral changes, such as cerebral cortex atrophy with enlarged ventricles, were predominant. Diplegia cases frequently showed periventricular damage to the white matter. Brain tomography in severe quadriplegia did not always correspond to the clinical condition. CT examinations revealed no abnormalities in the brain in 6 out of 24 cases. Since the results of rehabilitation were not satisfactory, 29 surgical procedures were performed in the presented group of patients, with improved the course of therapeutic rehabilitation or nursing care in all the children.

  1. Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Lauren Surdyke


    Full Text Available Locked-in syndrome (LIS is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

  2. Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury. (United States)

    Surdyke, Lauren; Fernandez, Jennifer; Foster, Hannah; Spigel, Pamela


    Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

  3. MR imaging of cerebral palsy

    Energy Technology Data Exchange (ETDEWEB)

    Saginoya, Toshiyuki [Urasoe General Hospital, Okinawa (Japan); Yamaguchi, Keiichiro; Kuniyoshi, Kazuhide [and others


    We evaluated 35 patients with cerebral palsy on the basis of MR imaging findings in the brain. The types of palsy were spastic quadriplegia (n=11), spastic diplegia (n=9), spastic hemiplegia (n=2), double hemiplegia (n=1), athetosis (n=10) and mixed (n=2). Of all patients, 28 (80%) generated abnormal findings. In spastic quadriplegia, although eight cases revealed severe brain damage, two cases showed no abnormal findings in the brain. One of the three had cervical cord compression caused by atlanto-axial subluxation. In spastic diplegia, the findings were divided according to whether the patient was born at term or preterm. If the patient had been born prematurely, the findings showed periventricular leukomalacia and abnormally high intensity in the posterior limbs of the internal capsule on T2-weighted images. MR imaging in spastic hemiplegia revealed cerebral infarction. In the athetoid type, half of all cases showed either no abnormal findings or slight widening of the lateral ventricle. Three cases showed abnormal signals of the basal ganglia. The reason why athetoid-type palsy did not show severe abnormality is unknown. We believe that MR imaging is a useful diagnostic modality to detect damage in the brain in cerebral palsy and plays an important role in the differentiation of cerebral palsy from the spastic palsy disease. (author)

  4. Characteristics and Evaluation of Oral Dyskinesia and Dysarthria in Children with Cerebral Palsy%脑性瘫痪患儿口运动与构音障碍特征及其临床评定

    Institute of Scientific and Technical Information of China (English)

    纪静丽; 李欣; 侯梅; 李淑秋; 乔卫卫


    Objective To observe the efficacy of Complex Oral Motor Scoring (COMS) and diadochokinetic rate (DR) on evaluation of oral motor dysfunction and speech disorders in children with cerebral palsy. Methods 107 children with cerebral palsy were tested with Chi-nese-version Articulation Test, Simple Oral Motor Scoring (SOMS), COMS and DR. The correlation among SOMS, COMS and DR was analysesd. Results 85 children were abnormal in SOMS and 94 in COMS. Oral dyskinesia was found in all the children with spastic quadri-plegia, dyskinetic, ataxia and mixed type of cerebral palsy, and less in the type of spastic diplegia and hemiplegia. DR was the least in spas-tic quadriplegia, dyskinetic, mixed type of cerebral palsy, more in the type of ataxia and spastic diplegia, and the most in hemiplegia. The co-efficient of correlation among the SOMS, COMS, the longest pronunciation and DR were more than 0.8 (P0.8(P<0.01)。结论脑瘫患儿口运动障碍及构音障碍的发生率和严重程度与脑瘫类型有关。SOMS、COMS与DR、最长发音评估相关性良好。

  5. Acute-onset chronic inflammatory demyelinating polyneuropathy in hantavirus and hepatitis B virus coinfection (United States)

    Lim, Jong Youb; Lim, Young-Ho; Choi, Eun-Hi


    Abstract Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disorder with progressive weakness. Acute-onset CIDP resembles Guillain-Barre syndrome (GBS), a rapidly progressive disorder, and follows a chronic course. To our knowledge, no case of acute-onset CIDP in hantavirus and hepatitis B virus (HBV) coinfection has been reported previously. Clinical findings: We report a case of acute-onset CIDP that was initially diagnosed as GBS. Diagnoses: A 44-year-old male logger complained of acute quadriplegia and dyspnea. Mechanical ventilation was initiated. He was an HBV carrier with mild elevation of hepatic enzyme, and positive for hantavirus antibody. He was diagnosed with GBS and immunoglobulin therapy was administered. Interventions: After 8 months, quadriplegia and hypesthesia recurred. Immunoglobulin therapy at this time had no effect, but steroid therapy had some effect. Outcomes: A diagnosis of CIDP was made. After 2 months, severe extremity pain and dyspnea developed again, and steroid pulse therapy was initiated. Conclusion: Besides GBS, acute-onset CIDP can occur with hantavirus and HBV coinfection. Patients with this coinfection in whom GBS has been initially diagnosed should be followed up for a long time, because of the possibility of relapse or deterioration, and acute-onset CIDP should always be considered. PMID:27930572

  6. Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study. (United States)

    Knox, Virginia; Evans, Andrew Lloyd


    This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.

  7. A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings

    Institute of Scientific and Technical Information of China (English)

    Katsuyoshi Tamaki; Ichiro Shimizu; Mari Urata; Nao Kohno; Hiroshi Fukuno; Susumu Ito; Nobuya Sano


    Although spinal tumors are uncommon, they may reduce survival or cause serious functional disorders in the extremities. Metastatic spinal tumors from malignant tumors can induce symptoms of spinal cord compression, such as paraplegia, quadriplegia, and vesicorectal disturbance, which are aggravated with progression of the diseases and time. We report a patient with hepatocellular carcinoma (HCC) who was suspected of having spinal lesions based on neurological findings, and a metastatic spinal tumor was found by imaging examination. Assuming that metastasis had occurred at the time lumbar pain developed, the patient reached the level of gAlt disturbance within only 4 mo, showing a rapid advancement of symptoms. If early diagnosis had been possible, treatment could be performed before acute myelopathy progressed to complete paralysis. We speculate that the terminal stage of HCC is not only liver fAllure associated with intrahepatic lesions but also metastasis to other regions, treatment for individual pathologies therefore, will be needed, which constitutes an important issue.

  8. Haemodynamic collapse in a patient with acute inferior myocardial infarction and concomitant traumatic acute spinal cord injury. (United States)

    Kumagai, Naoto; Dohi, Kaoru; Tanigawa, Takashi; Ito, Masaaki


    A 71-year-old man suddenly collapsed and went into cardiopulmonary arrest. The cardiopulmonary resuscitation attempt succeeded in restoration of spontaneous circulation. The initial 12-lead electrocardiogram showed inferior acute myocardial infarction (AMI). The patient was initially diagnosed as having cardiogenic shock associated with inferior AMI. In spite of early coronary revascularisation, bradycardia and hypotension were sustained. After termination of sedation and extubation, he was found to have a quadriplegia and diagnosed with a cervical spinal cord injury (SCI). Therefore, the patient was finally diagnosed with neurogenic shock caused by acute cervical SCI due to the traumatic injury preceded by loss of consciousness complicating inferior AMI. We should recognise that SCI has unique haemodynamic features that mimic those associated with inferior AMI, but requires very different treatment.

  9. Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As a Presentation of Coeliac Disease

    Directory of Open Access Journals (Sweden)

    Funda Sarı


    Full Text Available Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.

  10. Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients. (United States)

    Yarkony, G M; Roth, E J; Heinemann, A W; Wu, Y C; Katz, R T; Lovell, L


    The functional outcomes of 711 patients with traumatic spinal cord injuries who were admitted to a rehabilitation hospital during an eight-year period were studied. The modified Barthel index, a 100-point scale, was used to assess ability to perform self-care and mobility skills at rehabilitation admission and discharge. There were statistically significant improvements in self-care and mobility subscores of the modified Barthel index. Mean total modified Barthel index scores increased from 13.8 at admission to 46.1 at discharge for patients with quadriplegia, and from 37.7 to 74.4 for patients with paraplegia. Functional gains made by patients with incomplete spinal lesions were greater than those made by patients with complete lesions. This study documents improvement in ability to perform self-care and mobility skills among patients with spinal cord injuries who participate in comprehensive rehabilitation.

  11. Neurocutaneous melanocytosis presenting in a teenager: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    I Monica


    Full Text Available Neuro cutaneous melanocytosis (NCM is a non-familial, congenital disorder characterized by multiple congenital nevi and brain or leptomeningeal abnormal melanin deposits. Here, we present an adult onset NCM. A 17-year-old boy presented with headache and double vision for 1 month. Magnetic resonance imaging of the brain showed hydrocephalus and abnormal meningeal hyper intensities in supra and infratentorial regions predominantly in the posterior fossa. Para medullary region showed an 11 × 10 mm nodular contrast enhancing nodule. Resection of an intramedullary central nervous system lesion revealed melanoma while skin biopsy was benign melanocytic nevus. As per Kadonaga and Frieden criteria, a diagnosis of NCM was made. Planned for craniospinal irradiation by three-dimensional conformal radiotherapy with a dose of 36 Gy, in 18 fractions (2 Gy/fraction and 5 days in a week along with steroids however patient progressed and developed quadriplegia with intradural metastasis.

  12. A recurrence of Guillain-Barr and eacute; syndrome or a case of acute-onset chronic inflammatory demyelinating polyneuropathy in the course of chronic hepatitis B?

    Directory of Open Access Journals (Sweden)

    Guner Celik Koyuncu


    Full Text Available Chronic inflammatory demyelinating polyneuropathy is a demyelinating polyneuropathy characterized by distal/proximal weakness, which shows gradual progression over a period of 8 weeks or longer. Guillan-Barre Syndrome is a condition characterized by acute monophasic paralysis typically following an infectious assault, and it usually peaks in severity over 3-4 weeks at most. Although rare, there are acute-onset chronic inflammatory demyelinating polyneuropathy cases that show progression over a period shorter than 4 weeks, as is the case in Guillan-Barre Syndrome .This report discusses a case of chronic inflammatory demyelinating polyneuropathy in a HBsAg-positive patient, which started as Guillan-Barre Syndrome but showed 3 recurrences within 6 months, each with rapidly progressing quadriplegia, respiratory arrest, and elevated liver enzymes and HBV DNA. [Cukurova Med J 2016; 41(4.000: 782-786

  13. Spinal cord injury in Parkour sport (free running: a rare case report

    Directory of Open Access Journals (Sweden)

    Derakhshan Nima


    Full Text Available A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient’s muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome. Key words: Spinal cord injuries; Cervical vertebrae; Athletic injuries

  14. Spinal cord injury in Parkour sport (free running): a rare case report

    Institute of Scientific and Technical Information of China (English)

    Nima Derakhshan; Mohammad Reza Zarei; Zahed Malekmohammady; Vafa Rahimi-Movaghar


    A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport,which is also called double front flip.Neurological examination revealed that the patient's muscle power was 0/5 at all extremities.The patient did not show any sense of light touch or pain in his extremities.In radiological studies,cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury.The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.

  15. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

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    G S Umamaheswara Rao


    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  16. A case with basilar artery thrombosis resulted in Locked-in syndrome in spite of endovascular treatment

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    Yusuf İnanç


    Full Text Available Locked-in Sendrome is a clinical picture consist of quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement. Consciousness remains intact and the patient is able to communicate intentionally using eye blinking. The most common cause underlying the locked-in syndrome is thrombosis of the basilar artery. In this study, we reported a 49-years-old male with past medical history for cerebrovascular disease presented with acute basilar artery thrombosis, manifesting as reduced level of consciousness, weakness in all extremity dominated on the right side, speech impairment, horizontal gaze disorder and for reaching us of the last munite of endovascular intervention threshold, so it can perform only mechanical and intra-arterial thrombosis treatment method as an endovascular treatment modalities of acute stroke.

  17. Alternative input medium development for wheelchair user with severe spinal cord injury (United States)

    Ihsan, Izzat Aqmar; Tomari, Razali; Zakaria, Wan Nurshazwani Wan; Othman, Nurmiza


    Quadriplegia or tetraplegia patients have restricted four limbs as well as torso movement caused by severe spinal cord injury. Undoubtedly, these patients face difficulties when operating their powered electric wheelchair since they are unable to control the wheelchair by means of a standard joystick. Due to total loss of both sensory and motor function of the four limbs and torso, an alternative input medium for the wheelchair will be developed to assist the user in operating the wheelchair. In this framework, the direction of the wheelchair movement is determined by the user's conscious intent through a brain control interface (BCI) based on Electroencephalogram (EEG) signal. A laser range finder (LFR) is used to perceive environment information for determining a safety distance of the wheelchair's surrounding. Local path planning algorithm will be developed to provide navigation planner along with user's input to prevent collision during control operation.

  18. Reversible electrophysiological abnormalities in acute secondary hyperkalemic paralysis

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    Karkal R Naik


    Full Text Available Hyperkalemia manifests clinically with acute neuromuscular paralysis, which can simulate Guillain Barré syndrome (GBS and other causes of acute flaccid paralysis. Primary hyperkalemic paralysis occurs from genetic defects in the sodium channel, and secondary hyperkalemic paralysis (SHP from diverse causes including renal dysfunction, potassium retaining drugs, Addison′s disease, etc. Clinical characteristics of SHP have been addressed in a number of publications. However, electrophysiological evaluations of these patients during neuromuscular paralysis are infrequently reported and have demonstrated features of demyelination. The clinical features and electrophysiological abnormalities in secondary hyperkalemia mimic GBS, and pose diagnostic challenges. We report the findings of nerve conduction studies in a middle-aged man who was admitted with rapidly reversible acute quadriplegia resulting from secondary hyperkalemic paralysis.

  19. [Congenital toxoplasmosis with ocular involvment--case report]. (United States)

    Constantin, Farah; Denislam, Dogan


    Two thirds of the congenital toxoplasmosis cases describe minimal or inapparent symptoms present at birth, being diagnosed from a psychomotor retard. The forms of chorioretinitis may be described by repeated outbursts in the first years of life. Chorioretinitis or focal necrotizing retinitis usually develops in a bilateral way, being progressive and leading to blindness. Usually there is only one focal inflammatory beginning at the edge of a pigmented scar and the local inflammatory process may extend through successive spikes in other regions of the retina. Active chorioretinitis is expressed clinically by a blurred misty eyesight, with the advent of scotomas, photophobia, and if the macula is involved, the loss of the central eyesight may occur. In this paper I present the patient R.A., 6 years old from Constanta who is hospitalized in the Clinic of Infectious Diseases for investigations and treatment continuity because positive IgG Toxoplasma was previously found. The child has spastic quadriplegia and profound mental retardation.

  20. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

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    Halim Tariq


    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  1. The use of a neoprene "thumb-sock" to prevent trauma in a thumb-sucking child with intractable epilepsy. (United States)

    Dennison, P J; Walton-Jones, A


    A nine-year-old girl with spastic quadriplegia, mental retardation, poor vision, a gastrostomy, and intractable epilepsy was referred by her pediatrician for a dental assessment with a view to extracting her anterior teeth as a means of preventing repeated damage to the skin over the proximal phalanx of her left thumb, which she sucked at night. This was the time of day when the frequency of her epileptic seizures was highest. A simple solution to the problem was developed by a dentist and an occupational therapist in which nylon-coated 3-mm neoprene sheeting (wet-suit material) was formed into a "thumb-sock" with a simple Velcro fastening around the wrist. No trauma to the thumb from epileptic seizures has occurred since the "thumb-sock" was fitted 24 months ago.

  2. A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms

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    Kishi S


    Full Text Available Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma

  3. Midline and far lateral approaches to foramen magnum lesions.

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    Sharma B


    Full Text Available Twenty patients with foramen magnum lesions were operated upon in the last 5 years at Postgraduate Institute of Medical Education and Research, Chandigarh. The common presenting features were quadriparesis, quadriplegia, diminished sensations, neck pain and respiratory insufficiency. The lesions encountered were meningiomas, neurofibromas, posterior inferior cerebellar artery aneurysms, neurenteric cyst and chordoma. Patients with posterior or posterolaterally placed lesions were operated by the midline posterior approach while those with anterior or anterolateral lesions were managed by the far lateral approach. All mass lesions were excised completely and the aneurysms were clipped. Seventeen patients made good neurological recovery while three died. The latter three patients presented very late. The merits of various surgical approaches to the foramen magnum are discussed.

  4. Fatal rabies despite post-exposure prophylaxis

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    D G Deshmukh


    Full Text Available Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

  5. Virtual reality in rehabilitation: WIITM as an occupational therapy tool in patients with spinal cord injuries

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    Fundación del Lesionado Medular


    Full Text Available The use of virtual reality has gained importance in the rehabilitation sector over the last few years. The Wii™ console complements traditional treatment by exercising the motor skills in a motivating context, which is important in long-term interventions, such as spinal cord injury. Objectives: to describe our work with the Wii™ console and the different support products used in occupational therapy at the Fundación del Lesionado Medular, and to discuss advantages and disadvantages. Method: 63 patients with spinal cord injury (of whom 46 with quadriplegia and 17 with paraplegia, treated over the period of one year in weekly 30-minute sessions. Results: motor-skill improvements, more involvement of the patients in the treatment. Conclusion: the features of the console and the support products created by our department make the Wii™ accessible to patients, increase their motivation and enrich the treatment.

  6. Coma blisters with hypoxemic respiratory failure. (United States)

    Agarwal, Abhishek; Bansal, Meghana; Conner, Kelly


    A 24-year-old woman with quadriplegia was admitted with respiratory failure because of pneumonia. She was on multiple medications including diazepam, oxycodone, and amitriptyline, known to be associated with coma blisters, though she did not overdose on any of them. On hospital day 2, she developed multiple blisters on both sides of her right forearm and hand. Skin biopsy showed eccrine gland degeneration consistent with coma blisters. It was felt that hypoxemia from her pneumonia contributed to the development of these blisters, which occurred on both pressure and non-pressure bearing areas of the arm. Coma blisters are self-limited skin lesions that occur at sites of maximal pressure, mostly in the setting of drug overdose. However, coma blisters may occur with metabolic and neurological conditions resulting in coma.

  7. Isolated extra pontine myelinolysis – a rare imaging appearance of osmotic demyelination syndrome

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    D. Rajitha


    Full Text Available Rapid correction of hyponatraemia leads to serious neurological complications, like osmotic demyelination syndrome (ODS. In ODS, magnetic resonance imaging (MRI often reveals features of pontine myelinolysis, that may occur in isolation or may, sometimes be associated with extrapontine myelinolysis. Isolated extrapontine myelinolysis is rare. We report the case of a 53-year-old lady brought to the emergency service with vomitings, and altered sensorium. She was found to have profound hyponatraemia (serum sodium 110 meq/L. Correction of hyponatremia was done with slow intravenous infusion of 3% sodium chloride. However, inadvertant, concomitant oral administration of salt led to overcorrection with serum sodium going upto 150 meq/L. She developed quadriplegia, depressed level of consciousness and respiratory failure and required ventilatory support. MRI brain showed features of isolated extrapontine myelinolysis.

  8. Traumatic cervical cord transection without facet dislocations--a proposal of combined hyperflexion-hyperextension mechanism: a case report. (United States)

    Cha, Yoo-Hyun; Cho, Tai-Hyoung; Suh, Jung-Keun


    A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

  9. Medical image of the week: ascending cholangitis from biliary obstruction

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    Wong C


    Full Text Available A 79 year old man with a history of quadriplegia presented to an outside hospital in septic shock. He was found to have an elevated total bilirubin of 10 mg/dL, direct bilirubin of 7 mg/dL, alkaline phosphatase of 405 U/L, and lipase of 370 U/L. Imaging showed cholelithiasis with likely intra- and extrahepatic biliary duct dilatation. The patient underwent placement of a biliary drain with clinical improvement. Additional imaging was requested prior to endoscopic retrograde cholangiopancreatography (ERCP, but magnetic resonance cholangiopancreatography (MRCP was unavailable due to metallic implants. Interventional radiology performed a cholangiogram using the biliary drain which confirmed biliary obstruction. ERCP was then performed, with significant biliary sludge found and two stents placed.

  10. Hydrocephalus in an elderly man with systemic lupus erythematosus. (United States)

    Chen, Wei-Sheng; Wu, Tsai-Hung; Chou, Chung-Tei; Tsai, Chang-Youh


    A 71-year-old man presented with quadriplegia, seizures, dysarthria, motor aphasia and urinary incontinence lasting for several years. The development of proteinuria and increased susceptibility to infections brought the physician's attention to possible underlying autoimmune diseases. Laboratory investigations revealed evidence for systemic lupus erythematosus (SLE) and antiphospholipid syndrome. Imaging studies showed obstructive hydrocephalus. Several courses of methylprednisolone therapies followed by maintenance therapy with low-dose steroid, ventriculoperitoneal shunt, and antihypertensives improved the proteinuria and dysarthria but not the urinary incontinence or dementia. A thromboembolic event in the central nervous system secondary to phospholipid antibodies or lupus activity may represent a pathogenetic basis for hydrocephalus. When encountering a patient with hydrocephalus but without apparent predisposing factors, it is always important to include SLE as a differential diagnosis.

  11. Chronic subdural haematoma revealed by quadriparesis: A case report

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    Boulahroud Omar


    Discussion: CSDH is more common in the elderly. As reported here, clinical features may be delayed after the causal head injury (often weeks, and the trauma may even be forgotten. Cases manifesting bilateral haematomas are quite rare. The mechanism for quadriparesis is not fully understood. Motor deficit in the arms can be explained by direct compression or distortion of the cerebral hemispheres. This would not, however, account for motor weakness in the legs because the cortical areas responsible for the lower limbs would be relatively protected from the direct effect of compression. CSDH can present in many clinical scenarios, and may develop in the absence of a reported head injury. The diagnosis of CSDH should be considered in the differential when investigating cases of quadriplegia of uncertain aetiology, especially in the elderly population.

  12. Aculaser therapy: a comprehensive approach for the treatment of cerebral palsy (United States)

    Anwar, Shahzad; Nazir Khan, Malik Muhammed; Nadeem Khan, Malik Mohammad; Munir Qazi, Faiza; Ahmed, Imtiaz; Awan, Abid Hareef


    A single, open and non comparative study was conducted at Anwar Shah's First C.P. & Paralysis Clinic and Research Center in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (CP) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, quadriplegia, paraplegia, monoplegia, sensory-neural deafness and speech disorders. In all 100 childern were treated and the data was gathered during a period of 18 months from December 2003 till June 2005. This article shows results of the treatment with ACULASER THERAPY in CP childern who were treated for minimum 6 weeks and more or had minimum of 10 treatment sessions and more. This paper also shows that those childern who were given a break in the treatment for 4-12 weeks did not show any reversal of the symptoms. These children were classified according to the associated Neurological Disorders. Analysis of the data showed that out of 81 children with Spasticity and Stiffness 69 showed marked improvement showing 85% improvement rate, out of 54 children with Epileptic fits there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 34 children showing 63% success rate, out of 18 children with Cortical Blindness 13 children showed improvement accounting for 72% efficacy rate, out of 45 children with Hearing Difficulties, 31 showed marked improvement accounting for 69% improvement rate, out of 100 children with Speech Disorders 67 showed improvement reflecting 67 % improvement rate, out of 46 children with Hemiplegia 32 showed improvement in movement, tone and power accounting for 69% improvement rate, out of 36 children with Quadriplegia 25 showed improvement in gross and fine motor functions showing 69% success rate and out of 18 children with Paraplegia of lower limbs 12 showed improvement in weight bearing

  13. Treating cerebral palsy with aculaser therapy (United States)

    Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Dar, Irfan


    A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensory-neural deafness and speech disorders. In all 250 childern were treated and the data was gathered during a period of 3 years from December 2003 till December 2006. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for minimum 6 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 171 children with Spasticity and Stiffness 147 showed marked improvement showing 87% success rate, out of 126 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 91 children showing 72% success rate, out of 48 children with Cortical Blindness 30 children showed improvement accounting for 63% efficacy rate, out of 105 children with Hearing Difficulties, 63 showed marked improvement accounting for 60% improvement rate, out of 190 children with Speech Disorders 122 showed improvement reflecting 64% improvement rate, out of 96 children with Hemiplegia 71 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 76 children with Quadriplegia 52 showed improvement in gross and fine motor functions showing 69% success rate and out of 58 children with Paraplegia of

  14. Aculaser therapy for the treatment of cerebral palsy (United States)

    Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Ammad, Haseeb U.


    A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensoryneural deafness and speech disorders. In all 500 children were treated and the data was gathered during a period of 4 years from December 2006 till December 2010. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for a minimum of 08 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 342 children with Spasticity and Stiffness 294 showed marked improvement showing 87% success rate, out of 252 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 182 children showing 72% success rate, out of 96 children with Cortical Blindness 60 children showed improvement accounting for 63% efficacy rate, out of 210 children with Hearing Difficulties, 126 showed marked improvement accounting for 60% improvement rate, out of 380 children with Speech Disorders 244 showed improvement reflecting 64 % improvement rate, out of 192 children with Hemiplegia 142 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 152 children with Quadriplegia 104 showed improvement in gross and fine motor functions showing 69% success rate and out of 116 children with

  15. Cystic periventricular leukomalacia in the neonate: analysis of sequential sonographic findings and neurologic outcomes

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    Lee, Young Seok; Yoo, Dong Soo [Dankook University College of Medicine, Cheonan (Korea, Republic of)


    To analyse the sequential sonographic findings of cystic PVL and to evaluate relationship between sonographic grading of PVL and patterns of neurologic outcomes. Authors have retrospectively analysed the sequential sonographic findings of 36 cases of PVL in the preterm neonates. Initial sonographic features done within 3 days of life were divided into 3 patients such as normal, localized, and diffuse hyperechogenic flare. Grading of PVL confirmed by follow-up studies was classified as involvement of one lobe (grade 1), two lobes (grade 2) and more than extent of grade 2 (grade 3). The relationship between sonographic grading of leukomalacia and later neurologic outcomes were also analysed. Initial sonographic patterns according to grading of PVL were normal pattern in seven of nine (77.8%) of grade 1, diffuse hyperechogenic flares in five of eight cases of grade 2 and in 13 of 16 cases of grade 3. There was a significant difference between the grades and frequency of pattern of diffuse hyperechoic flare (p=0.021). Average detection timing of cystic PVL was 38.4{+-}18.9 days in grade 1, 29.8{+-}14 days in grade 2, and 19.1{+-}5.6 days in grade 3 with a significant statistical difference between the detection time and grades (p=0.037). Cerebral palsy has occurred in 62.5% of grade 1 and 100% of grade 2 and grade 3 (p=0.043). Frequency of spastic quadriplegia was higher in grade 3 (76.5%) than in grade 1 (25%) and grade 2 (12.5%) (p=0.001). Most of grade 1 cystic PVL revealed normal pattern of white matter echogenicity in initial ultrasonography and needed follow up examination over one month period. Spastic quadriplegia occured mainly in patients with grade 3 cystic PVL.

  16. Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases. (United States)

    Oppenlander, Mark E; Hsu, Forrest D; Bolton, Patrick; Theodore, Nicholas


    Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6-7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4-T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6-T1 decompression and fixation for a C6-7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6-7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.


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    Wadugodapitiya .S .I


    Full Text Available Background: Cerebral palsy (CP is one of the most common conditions in childhood causing severe physical disability. Spastic paresis is the most common form of CP. According to the topographic classification, CP is divided into spastic hemiplegia, diplegia and quadriplegia. Distribution of functional motor disability is varied in each type of CP. Aims: To describe functional motor disability in children with cerebral palsy using standard scales. Method: This cross-sectional descriptive study included 93 children with cerebral palsy (CP. Functional motor disability of each type of spastic CP was assessed using standard scales. Results: The dominant sub-type of cerebral palsy in the present study was spastic diplegia. Most affected muscle with spasticity was gastrocnemius-soleus group of muscles. Active range of motion of foot eversion and dorsiflexion were the most affected movements in all the types of CP. In the overall sample, only 35% were able to walk independently. Majority of subjects with quadriplegia were in levels III and IV of Gross Motor Functional Classification Scale representing severe disability. There was a significant relationship observed between the muscle tone and range of motion of their corresponding joints as well as between the muscle tone of gastrocnemius-soleus group of muscles and the ankle components of Observational Gait Analysis. Conclusions: Results of the present study confirms the clinical impression of disability levels in each type of CP and showed that the assessment of functional motor disability in children with different types of spastic CP is useful in planning and evaluation of treatment options.

  18. Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy. (United States)

    Bar-Haim, Simona; Harries, Netta; Belokopytov, Mark; Frank, Alexander; Copeliovitch, Leonel; Kaplanski, Jacob; Lahat, Eli


    This study compared the efficacy of Adeli suit treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). Twenty-four children with CP, Levels II to IV according to the Gross Motor Function Classification System (GMFCS), were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12; eight males, four females; mean age 8.3 y [SD 2.0]), six children had spastic/ataxic diplegia, one triplegia and five spastic/mixed quadriplegia. In the NDT group (n=12; nine males, three females; mean age 8.1 y [SD 2.2]), five children had spastic diplegia and seven had spastic/mixed quadriplegia. Both groups were treated for 4 weeks (2 hours daily, 5 days per week, 20 sessions). To compare treatments, the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EIHB) during stair-climbing were measured at baseline, immediately after 1 month of treatment, and 10 months after baseline. The small but significant time effects for GMFM-66 and EIHB that were noted after 1 month of both intensive physiotherapy courses were greater than expected from natural maturation of children with CP at this age. Improvements in motor skills and their retention 9 months after treatment were not significantly different between the two treatment modes. Post hoc analysis indicated a greater increase in EIHB after 1 month (p=0.16) and 10 months (p=0.004) in AST than that in NDT, predominantly in the children with higher motor function (GMFCS Levels II and III). The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function.

  19. Eight years of follow-up after laminectomy of calcium pyrophosphate crystal deposition in the cervical yellow ligament of patient with Coffin–Lowry syndrome (United States)

    Morino, Tadao; Ogata, Tadanori; Horiuchi, Hideki; Yamaoka, Shintaro; Fukuda, Mitsumasa; Miura, Hiromasa


    Abstract Background: We report 8 years of follow-up after decompression to treat cervical myelopathy in a patient with Coffin–Lowry syndrome (CLS). CLS is a rare X-linked semidominant syndrome associated with growth and psychomotor retardation, general hypotonia, and skeletal abnormalities. In this patient, the spinal cord was compressed by calcium pyrophosphate crystal deposition in the cervical yellow ligament (YL). To date, only 1 report has described clinical features after surgery for calcified cervical YL in CLS. Methods: A 15-year-old male with tetraplegia secondary to compression of the cervical spinal cord induced by a hypoplastic posterior arch of C1 and calcification of the YL from C2 to C7 was treated surgically with laminectomy from C1 to C7. The patient's history, clinical examination, imaging findings, and treatment are reported. The patient was incapable of speech because of mental retardation, so he could not describe his symptoms. Gait disturbance worsened over the 2 months before admission to our hospital. At admission, the patient could not move his extremities, and tendon reflexes of the upper and lower extremities were significantly increased. Computed tomography of the cervical spine showed YL calcification from C2 to C7. Magnetic resonance imaging showed consecutive compression of the cervical spinal cord. We diagnosed quadriplegia secondary to cervical cord damage and performed emergency surgery. Results: During C1–C7 laminectomy, YL calcification in C2–C7 was observed. The calcification was confirmed as calcium pyrophosphate by crystal analysis. Quadriplegia gradually resolved, and almost disappeared by 2 weeks after the operation. Cervical hyperlordosis was observed in radiographs starting from 1 month after the operation, but it has not progressed and is not associated with any symptoms. Conclusions: The efficacy of decompression continued, and no postoperative complications have occurred during at least 8 years of follow-up. PMID

  20. 双侧延髓内侧梗死的临床和影像学特征%Clinical and imaging features of bilateral medial medullary infarction

    Institute of Scientific and Technical Information of China (English)

    傅海扬; 孙建华; 陈璐; 夏晨; 王立


    目的:探讨双侧延髓内侧梗死( BMMI)的临床和影像学特征。方法对20例BMMI患者的临床资料进行回顾性分析。结果20例患者首发症状为头晕6例(30%),四肢无力6例(30%),单侧肢体无力4例(20%),吞咽困难3例(15%),双下肢无力1例(5%)。本组患者均为急性起病,16例进展性加重;20例患者均出现不同程度的四肢瘫痪,吞咽困难17例,构音障碍15例,头晕13例,舌瘫11例,水平眼震7例,呼吸困难8例,双侧深感觉障碍8例,双侧Babinski征阳性16例。20例颅脑MRI均示BMMI,18例DWI示双侧延髓内侧高信号,10例头颅MRI双延髓内侧见T1低信号、T2高信号。20例患者中有8例患者MRA、CTA或DSA见椎动脉的远端局限性的狭窄或闭塞。治疗后基本痊愈7例。结论 BMMI表现为急起四肢瘫痪,两侧基本对称,双侧锥体束征,常有迷走神经、舌下神经受累症状及双侧深感觉障碍。头颅MRI结合DWI成像检查有助于早期诊断,积极治疗多数患者预后良好。%Objective To Investigate the clinical and imaging features of bilateral medial medullary infarction ( BMMI) .Methods The clinical data of 20 BMMI patients were analyzed retrospectively.Results In 20 cases, the initial symptom was dizzy in 6 cases ( 30%) , quadriplegia in 6 cases ( 30%) , hemiplegic paralysis in 4 cases (20%), dysphagia in 3 cases (15%), weakness of lower limbs in 1 cases (5%).All 20 cases were acute onset, progressive in 16 cases.The main clinical features were shown that 20 cases demonstrated quadriplegia, 17 cases dysphagia, 15 cases dysarthria, 13 cases vertigo, 11 cases tongue atrophy, 7 cases horizontal nystagmus, 8 cases difficulty breathing, 8 cases deep sensory disturbance, 16 cases bilateral babinski sign positive.Twenty cases of brain MRI show bilateral medial medullary infarction, DWI found increased signal intensity in double inside of the medulla oblongata in

  1. Comorbidities in children with spastic cerebral palsy and their relationship to neurologic subtype and GMFCS level%痉挛型脑瘫儿童伴随症状与瘫痪类型及功能的关联研究

    Institute of Scientific and Technical Information of China (English)

    朱默; 史惟; 杨红; 吴毅


    [目的]研究痉挛型脑瘫儿童常见伴随症状与瘫痪类型及粗大运动功能分级的关系.[方法]研究对象均来自2008年2月-2010年9月间加入scpchild脑瘫登记与系统管理数据库的大于4岁痉挛型脑瘫儿童,共计172名,其中男109例,女63例,平均年龄8.0岁,分析瘫痪类型、粗大运动功能分级(Gross Motor Function Classification Sys-tem,GMFCS)与常见伴随症状(癫痫、视觉障碍、听觉障碍、言语障碍)的关系.[结果]偏瘫和四肢瘫儿童的癫痫发生率明显高于双瘫,双瘫、四肢瘫儿童的视觉障碍明显多于偏瘫,四肢瘫儿童的言语障碍明显多于偏瘫和双瘫.四肢瘫儿童伴发多重障碍明显多于双瘫和偏瘫,GMFCS分级越高伴发多重障碍的发生率也越高,GMFCS分级Ⅰ~Ⅲ级较Ⅳ~Ⅴ级的脑瘫儿童伴随症状明显发生较少.[结论]痉挛型脑瘫儿童伴随症状的发生率与脑瘫类型及粗大运动功能分级有关,在重症脑瘫儿童中伴发多重障碍的发生率明显增高.%[Objective]To evaluate the burden of comorbidities in a sample of children with spastic cerebral palsy and stratified according to both neurologic subtype and functional capability with respect to gross motor skills.[Methods]Scpchild registry and systematic management database was utilized to identify children over 4-year-old with Spastic cerebral palsy from Feb 2008 to Sep 2010.172 children (male 109 ,female 63) were involved.The average age was 8.0 years old.Information on neurologic subtype classified according to the qualitative nature and topographic distribution of the motor impairment on neurologic examination, Gross Motor Function Classification System (GMFCS) categorization of motor skills,and the presence of certain comorbidities(epilepsy, visual impairment, hearing impairment and speech disorder) was obtained.[Results]The incidence of epilepsy was higher in children with hemiplegia or quadriplegia than those with diplegia.The incidence

  2. 《关于国外渗透性脱髓鞘综合征部分文献之重新分析:反思》英文摘要与说明

    Institute of Scientific and Technical Information of China (English)

    张海鹏; 王荣明; 杨子军; 闫四梅; 陈萌; 崔松; 张力; 杜长生; 陈宗羡; 曾伏虎; 翟所鑫; 李玉清; 刘庆梅; 朱玉忠


    Objectives: To explore the main etiological factors of central pontine myelinolysis (CPM) and of the “osmotic demyelination syndrome(ODS)”that occurs after hepatic transplantation, to explore the differential diagnosing the manifestation consisting of dysarthria, dysphagia and quadriplegia presented after vomiting for a number of times, and to explore which fraction to be mainly involved by the “ODS”, what to be the pathological mechanism of the “ODS”, and how to prevent the “ODS”.Methods: Physiopathological principles are applied on the base of the clinical certificates, the diagnostic results differring from those in the case reports (that have been analyzed again by us).Results and Conclusions: It could be suggested that (1) CPM based mainly on alcoholism should result mainly from beriberi, as was mentioned by HUANG Ke-wei, the well-known Chinese neurologist, before or in 1960; (2) The coma secondary to hepatic transplantation could be often caused by Wernicke encephalopathy(WE, one of beriberi), which could be asscociated with the postoperative elevated corticosteroid or/and high-starch food for liver cirrhosis, which complicated by hepatic encephalopathy; (3)The case that was in 1995 reported by Kabeer et al, of possiblity of the earliest reported CPM due to cyclosporine, appeared to be the bilateral type of pontine lower paracentral hematal syndrome, a bilateral uncomplete Foville syndrome. It should be considerable whether an epileptic attack related to both cyclosporine and corticosteroid could result from reverible posterior leukoencephalopath syndrome with negative MRI owing to the effect of corticosteroid; (4) It is cerebral cortex that could be mainly involved by the “ODS” following a number of times of vomiting, of which one of evidences has been the 2 cases reported by Tomlinson et al in 1976.The kind of “ODS” following the encephalopathy of alkalosis yet without hypoxemic hypoxia, is possibly preventable not only if the

  3. Urinary tract stone in patients with spinal cord injury: a retrospective radiological study

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    Yun, Eun Joo; Lee, Jong Koo; Shin, Hyun Ja [Korea Veterans Hospital, Seoul (Korea, Republic of)


    To compare the incidence between author's first and current report on urinary tract stone in patient with spinal cord injury and to evaluate the effectiveness of recent developed in medical technology and care on in treating the patients. We reviewed urinary tract stone in 257 patients with paraplegia or quadriplegia after spinal cord injury. These patients were diagnosed retrospectively by KUB and intravenous urography at the Korea Veterans Hospital during 10 years from January, 1984 to December, 1993. We evaluated and compared the overall incidence, incidence of specific location of urinary tract, recurrent rate, incidence according to the level of spinal cord injury, and the duration of development in urinary tract stone. Total patients were 257 with 186 (72.4%) paraplegia and 71 (27.6%) quadriplegia. Overall incidence of the stone was 16.0% in this study and 38.1% in the first study. Incidence of the stone in individual organ; 5.5% in kidney, 1.2% in ureter, and 13.6% in urinary bladder. The recurrent rate was 29.3% in this study and 40.6% in the first study. Incidence of the stone according to the level of spinal cord injury was as follows; 15.6% in cervix, 17.1% in upper thorax, 17.9% in lower thorax and 13.9% in lumbar. The stone developed during the first 4 years and between 12 to 16 years following spinal cord injury was 28.3% each. Overall incidence and recurrent rate of urinary tract stone was obviously decreased since the first study. Highest incidence of the stone occurred in urinary bladder and in patient with lower thoracic spinal cord injury, which is similar to first report. Peak incidence of the stone was in the first 4 years, and another peak was in 12-16 years after spinal cord injury. The decreased overall incidence of urinary tract stone maybe attributable to the development in medical technology and care, and active rehabilitation.

  4. A rare case of Sjogren-Larsson syndrome with recurrent pneumonia and asthma. (United States)

    Tavasoli, Azita; Sayyahfar, Shirin; Behnam, Babak


    Sjogren-Larsson syndrome (SLS) is a rare autosomal recessive neurocutaneous disorder with worldwide incidence of 0.4 per 100,000 people. It is characterized by the triad of congenital ichthyosis, spastic diplegia or quadriplegia, and mental retardation. Herein we report a 2-year-old male child with SLS, asthma, and recurrent pneumonia. SLS was confirmed by a molecular genetics study that revealed a deletion mutation in the ALDH3A2 gene. An ALDH3A2 gene mutation results in dysfunction of the microsomal enzyme fatty aldehyde dehydrogenase and impaired metabolism and accumulation of leukotriene B4, which is a key molecule and a pro-inflammatory mediator in developing allergic diseases, especially asthma. An increased level of leukotriene B4 has been reported in SLS patients. As far as we are aware, this is the first report of SLS associated with asthma and recurrent pneumonia. In conclusion, pediatricians should be aware of and evaluate patients with SLS for possible associated asthma and allergic disorders.

  5. Avaliação do desempenho motor em indivíduos com paralisia cerebral após hipoterapia - doi: 10.5102/ucs.v10i2.1734

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    Marianne Lucena


    Full Text Available Este estudo teve como objetivo comparar escores de desempenho motor, antes e após sessões de hipoterapia através da escala de Medida da Função Motora Grossa (GMFM. Como método, foi realizado um estudo quantitativo descritivo de intervenção do tipo antes e depois, com 3 casos de paralisia cerebral (PC,de ambos os sexos, com idades entre 5 e 7 anos, escolhidos de forma não probabilista, com quadro motor de quadriplegia mista. Foi obtida, como resultado, FAB, RFC e BES apresentaram melhora de 88.35%, 96% e 31%, respectivamente na dimensão A deitar e rola e 16.65%, 31.66% e 33% na dimensão B: sentar. RFC e BES também apresentaram melhoras na dimensão C: engatinhar e ajoelhar de 2.38% e 40.47%, respectivamente. Este estudo conclui que indivíduos com PC melhoram controle de tronco e cervical, sendo que com os índices da escala GMFM foi possível quantificar os ganhos motores.

  6. Catastrophic rugby injuries of the spinal cord: changing patterns of injury. (United States)

    Scher, A T


    In reports from the UK and New Zealand, it is noted that the incidence of rugby injuries to the cervical spinal cord has dropped and that the percentage of players injured in the tackle has similarly decreased. In contrast, this does not appear to be the pattern in South Africa and an analysis has therefore been made of 40 rugby players sustaining injuries to the spinal cord during the period 1985 to 1989. The radiological appearances on admission have been correlated with the circumstances of injury, associated orthopaedic injuries and neurological deficits. The tackle was responsible for the majority of injuries, causing more than the scrum. Tackles were also responsible for more cases of complete, permanent quadriplegia than the scrum. The commonest cause of injury in players being tackled was the high tackle around the neck, while the commonest cause of injury in players making the tackle was the dive tackle. This survey has shown that the tackle is now the major cause of spinal cord injury in South African rugby, in contrast to earlier analyses in which the scrum was identified as the most common cause.

  7. Acute spinal cord injury and neurogenic shock in pregnancy. (United States)

    Gilson, G J; Miller, A C; Clevenger, F W; Curet, L B


    A case of a pregnant woman with a subluxation of C-6 on C-7 with acute quadriplegia and sensory loss to the T-10 dermatome is described. Hemodynamic and fetal monitoring during the 3-week period of neurogenic shock resulted in good maternal and fetal outcomes. Pulmonary complications and anesthetic issues are important aspects of the care of these critically ill patients. Major trauma is a common cause of death and disability in young adults and may contribute to as much as 15 percent of nonobstetric maternal deaths. Spinal cord injuries involve young women in 15 percent of cases. The literature is replete with information on the obstetric management of patients with preexisting spinal cord injury (1-4) but there is little on the management and special problems of the pregnant patient with acute spinal cord trauma. We report here the management of a case of acute cord transection accompanied by spinal shock and discuss the specific maternal as well as fetal considerations in this syndrome.

  8. Effects of training programs for spinal cord injury. (United States)

    Devillard, X; Rimaud, D; Roche, F; Calmels, P


    Endurance exercise training programs in patients with spinal cord injury (SCI) were largely studied to determine different types of adaptations. The aim of specific rehabilitation is to obtain maximal gains in quality-of-life (QoL) after SCI. To review the literature on the efficiency of training programs for SCI. We searched the MEDline database with the keywords SCI, paraplegia and quadriplegia and synonyms, then combined them with one of the following terms: rehabilitation, training, exercise conditioning, physical fitness, exercise prescription, adaptation, effect, or benefit. We found 65 articles related to the physiological and psychological effects of training programmes on patients with SCI. Training programs after SCI offer reconditioning cardiorespiratory, cardiovascular, cardiac, metabolic, bone, biomechanical, muscle adaptation, and QoL benefits. Reconditioning training increases VO2 max, reverses leg vascular resistance in the paralyzed legs and has possible cardiac and neural adaptations, favorable catecholamine responses and effects on platelet aggregation. Reconditioning can also modify lipid profile, reduce risk for cardiovascular diseases, prevent osteoporosis and increase maximal upper-extremity muscle strength, sprint power output and maximal power output. This effect allows for considerable improvement in mechanical efficiency and wheelchair propulsion technique. Reconditioning training programs after SCI have a direct impact on function and QoL, permitting participation in physical activities in addition to daily living activities in subjects with SCI.


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    Full Text Available ObjectiveThis study was planned to compare the effects of neurodevelopmental treatment and sensory integration therapy on gross motor function in children with cerebral palsyMaterials & MethodsTwenty two children with spastic CP were randomly divided into two groups. Sensory integrative therapy was given to the first group (n=11, and neurodevelopmental treatment was given to the second group (n=11. All children were evaluated with GMFM-88. Treatment was scheduled for three - one hour sessions per week for 3 months.ResultsTwenty two children with spastic CP (11 diplegia and 11 quadriplegia participated in this study. When two groups were compared, a significant difference was found in lying and rolling (P=0.003, sitting (0.009, crawling and kneeling (0.02 and standing ability (P=0.04. But there was no significant difference in walking, running, and jumping abilities between the two groups (0.417. Paired t-tests revealed a significant difference between pre and post test results, with increases in scores of lying and rolling, sitting, crawling and kneeling, standing in sensory integration therapy (SIT and neurodevelopmental treatment (NDT approaches.Conclusion Neurodevelopmental treatment and sensory integration therapy improved gross motor function in children with cerebral palsy in four dimensions (lying and rolling, sitting, crawling and kneeling, standing. However, walking, running and jumping did not significantly improve.

  10. Noncontact binocular eye-gaze tracking for point-of-gaze estimation in three dimensions. (United States)

    Hennessey, Craig; Lawrence, Peter


    Binocular eye-gaze tracking can be used to estimate the point-of-gaze (POG) of a subject in real-world 3-D space using the vergence of the eyes. In this paper, a novel noncontact model-based technique for 3-D POG estimation is presented. The noncontact system allows people to select real-world objects in 3-D physical space using their eyes, without the need for head-mounted equipment. Remote 3-D POG estimation may be especially useful for persons with quadriplegia or Amyotrophic Lateral Sclerosis. It would also enable a user to select 3-D points in space generated by 3-D volumetric displays, with potential applications to medical imaging and telesurgery. Using a model-based POG estimation algorithm allows for free head motion and a single stage of calibration. It is shown that an average accuracy of 3.93 cm was achieved over a workspace volume of 30 x 23 x 25 cm (W x H x D) with a maximum latency of 1.5 s due to the digital filtering employed. The users were free to naturally move and reorient their heads while operating the system, within an allowable headspace of 3 cm x 9 cm x 14 cm.

  11. Atlantoaxial instability after a header in an amateur soccer player. (United States)

    Werle, Stephan; Nahleh, Kais Abu; Boehm, Heinrich


    Case report and literature review. To report a unique case of atlantoaxial instability after a header in a 37-year-old amateur soccer player and to discuss the injury pattern in relation to the impact of heading. Although there is potential for cervical spine injuries, the rates in soccer are low compared with other contact or even noncontact sports. No cases of acute post-traumatic atlantoaxial instability after heading have ever been reported in a MEDLINE-listed article. A 37-year-old male soccer player experienced acute upper neck pain and transient quadriplegia after heading a long-distance ball on 2 occasions during a match. Imaging revealed atlantoaxial instability. Persistent neurological symptoms on conservative treatment led to his referral to our department. The considerable instability required surgical intervention. Transarticular C1-C2 fixation and posterior fusion with structural iliac crest grafting were performed. The procedure immediately led to complete relief of the neurological symptoms. After an uneventful postoperative recovery, follow-up at 9 months revealed solid fusion. The patient remained symptom free. Heading the ball in soccer can potentially lead to atlantoaxial instability. Ligamentous damage can theoretically be caused by anteriorly directed and rotational overload. However, the causative mechanism remains unclear. Diagnostic workup should consider dynamic imaging in players with transient neurological symptoms after minor trauma to the cervical spine. N/A.

  12. Corticalization of motor control in humans is a consequence of brain scaling in primate evolution. (United States)

    Herculano-Houzel, Suzana; Kaas, Jon H; de Oliveira-Souza, Ricardo


    Control over spinal and brainstem somatomotor neurons is exerted by two sets of descending fibers, corticospinal/pyramidal and extrapyramidal. Although in nonhuman primates the effect of bilateral pyramidal lesions is mostly limited to an impairment of the independent use of digits in skilled manual actions, similar injuries in humans result in the locked-in syndrome, a state of mutism and quadriplegia in which communication can be established only by residual vertical eye movements. This behavioral contrast makes humans appear to be outliers compared with other primates because of our almost total dependence on the corticospinal/pyramidal system for the effectuation of movement. Here we propose, instead, that an increasing preponderance of the corticospinal/pyramidal system over motor control is an expected consequence of increasing brain size in primates because of the faster scaling of the number of neurons in the primary motor cortex over the brainstem and spinal cord motor neuron pools, explaining the apparent uniqueness of the corticalization of motor control in humans. © 2015 Wiley Periodicals, Inc.

  13. [Scintigraphic imaging in the diagnosis of failed intrathecal baclofen therapy: a case report of a 7-year-old boy with ventriculoperitoneal shunt]. (United States)

    Shibata, Akiko; Yamamoto, Mariko; Watanabe, Yu; Terashima, Hiroshi; Kashii, Hirofumi; Kubota, Masaya; Morota, Nobuhito


    Intrathecal baclofen (ITB) therapy is popular for the management of intractable spasticity. In 2007, the indications of ITB therapy expanded to include spasticity of children in Japan. In this report, we assessed the utility of radioisotopic scintigraphy in the diagnosis of failed ITB therapy. A 7-year-old boy with schizencephaly, hydrocephalus, and spastic quadriplegia had an ITB pump implanted. In his infancy, he had undergone ventriculoperitoneal shunt implantation. One month after the ITB operation, the ITB therapeutic effect diminished. Several examinations confirmed that the pump function was normal and catheter failure had not occurred. However, radioisotopic scintigraphy revealed that the baclofen had been washed out to blood circulation more rapidly than is typically observed. We considered two possible causes for this; obstruction of the cerebrospinal space due to kyphosis and excessive washout of celebrospinal fluid through the ventriculoperitoneal shunt. The catheter was moved to a more caudal site surgically, and his spasticity improved. The use of radioisotopic scintigraphy to identify the distribution of baclofen is an effective technique for investigation of baclofen pump system malfunction.

  14. September 2012 critical care case of the month

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    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. History of Present IllnessA 45 year old man was transferred from another medical center. He was found unresponsive, with muscle spasticity. After arrival at the outside medical center his vital signs were temperature 106.4 degrees F, heart rate 160 beats/min, respiratory rate 44 breaths per minute, and BP of 70/45 mm Hg. He was orally intubated for respiratory distress with induced by vecuronium. His white blood cell count was 21,000 cells/μL. Chest x-ray showed bilateral consolidations and he was given fluids and gatifloxacin. His blood pressure improved to 130/94 and he was transferred. PMH, SH, FHHe has a past medical history of quadriplegia at the C6 level with a history of severe back pain because syringomyelia. He has a history of autonomic dysreflexia. Despite his disability he is quite functional working as a personal injury lawyer. He had been managed with a variety of medications including benzodiazepams, narcotics …

  15. Roxarsone (3-nitro-4-hydroxyphenylarsonic acid) poisoning in pigs. (United States)

    Blakley, B R; Clark, E G; Fairley, R


    Young pigs, six to ten weeks of age, from two unrelated swine operations were fed a grower ration obtained from a common commercial supplier. Following ingestion of the feed for approximately two weeks, pigs in both groups developed neurological disturbances characterized by blindness, ataxia, incoordination, muscle tremors, posterior paralysis, and quadriplegia. Vocalization described as "screaming" was also observed in several animals. Necropsy findings and tissue arsenic concentrations were consistent with a diagnosis of phenylarsonic acid poisoning. The liver and kidney contained an average arsenic content of 2.9 and 1.8 mg/kg (wet weight), respectively. The feed contained 38 mg of arsenic/kg corresponding to 133 mg roxarsone (3-nitro-4-hydroxyphenylarsonic acid)/kg. This level of roxarsone is approximately three to five times higher than the levels recommended for swine rations. The feed company had placed roxarsone in the ration at levels recommended for the less toxic arsanilic acid. It was assumed that the two organic arsenicals could be added to the rations interchangeably at the same level of formulation. The present investigation indicated that roxarsone is more toxic than arsanilic acid and the margin of safety in swine rations is low.

  16. A pilot study comparing mouse and mouse-emulating interface devices for graphic input. (United States)

    Kanny, E M; Anson, D K


    Adaptive interface devices make it possible for individuals with physical disabilities to use microcomputers and thus perform many tasks that they would otherwise be unable to accomplish. Special equipment is available that purports to allow functional access to the computer for users with disabilities. As technology moves from purely keyboard applications to include graphic input, it will be necessary for assistive interface devices to support graphics as well as text entry. Headpointing systems that emulate the mouse in combination with on-screen keyboards are of particular interest to persons with severe physical impairment such as high level quadriplegia. Two such systems currently on the market are the HeadMaster and the Free Wheel. The authors have conducted a pilot study comparing graphic input speed using the mouse and two headpointing interface systems on the Macintosh computer. The study used a single subject design with six able-bodied subjects, to establish a baseline for comparison with persons with severe disabilities. Results of these preliminary data indicated that the HeadMaster was nearly as effective as the mouse and that it was superior to the Free Wheel for graphics input. This pilot study, however, demonstrated several experimental design problems that need to be addressed to make the study more robust. It also demonstrated the need to include the evaluation of text input so that the effectiveness of the interface devices with text and graphic input could be compared.

  17. Assessment of cerebral visual impairment with the L94 visual perceptual battery: clinical value and correlation with MRI findings. (United States)

    Ortibus, E; Lagae, L; Casteels, I; Demaerel, P; Stiers, P


    In this article we describe visual perceptual abilities of a clinical population, referred for visual problems to our multidisciplinary team and assessed with the five computer tasks from the L94 visual perceptual battery. Clinical and neuroimaging findings were correlated with the findings on this task battery. Seventy children (35 males, 35 females) constituted our cohort. Age ranged from 4 to 20 years (mean 7y [SD 3y]). Forty children were born before 37 weeks gestational age. Thirty-six children had cerebral palsy (CP), of whom 24 had spastic diplegia, five had spastic hemiplegia, and four had spastic quadriplegia. Three children had ataxic CP. Perceptual visual impairment (PVI) was established in comparison to the performance age obtained on non-verbal intelligence subtests, instead of chronological age. Our results suggest that children with a history of preterm birth and a clinical CP picture are most at risk for a specific PVI. Correlations among other clinical variables did not define a clinical subgroup more at risk. Children with periventricular leucomalacia were almost equally represented in both PVI and non-PVI groups. Normal magnetic resonance imaging did not exclude the presence of PVI. In these children, however, we found another impairment profile, more in favour of dorsal stream impairment.

  18. A systematic review of the effectiveness of aerobic exercise interventions for children with cerebral palsy: an AACPDM evidence report. (United States)

    Rogers, Anna; Furler, Barbara-Lynne; Brinks, Stephen; Darrah, Johanna


    The aim of this review was to assess the evidence regarding the effectiveness of aerobic training interventions for children with cerebral palsy (CP). The target population included children with CP of any severity, aged 2 to 17 years. The following databases were searched for English language studies from 1960 to 2006: MEDLINE, EMBASE, CINAHL, Pascal, Cochrane Library, CSA Neuroscience Abstracts, The Physiotherapy Evidence Database (PEDro), and Sport Discus. Search terms included 'cerebral palsy', 'athetoid', 'ataxic', 'spastic diplegia', 'hemiplegia', 'quadriplegia', 'aerobic', 'exercise', 'training', 'physical activity', 'aquatic/water/pool therapy', and 'continuous exercise'. The American Academy for Cerebral Palsy and Developmental Medicine systematic review guidelines were used to format the review. One thousand, four hundred and eighty nine articles were identified and examined for the stated inclusion and exclusion criteria. Thirteen articles met the criteria for inclusion. The evidence suggests that aerobic exercise with children with CP can improve physiological outcomes, but the influence of these changes on outcomes representing activity and participation are unknown. Future research needs improved methodological rigour in order to determine a specific set of exercise guidelines and safety considerations.

  19. Ocular problems in children with cerebral palsy

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    Esra Ayhan Tuzcu


    Full Text Available The aim of this study is to evaluate eye problemsin children with cerebral palsy in our region.Materials and Methods: 90 patients which was diagnosedas cerebral palsy, treated and followed up in PediatricNeurology Department of Mustafa Kemal University,were included to this study. The history was taken, anda physical examination was performed to determine theetiology of the disease and type of SP. All of the patientswere underwent a detailed ophthalmological examinationincluding visual acuity, refractive error, amblyopia, strabismus,nystagmus and fundus examination.Results: Totally 90 patients, 51 male and 39 female,were included to the study. When the etiologic factorswere evaluated, the asphyxia was seen in 33.3% of thepatients. The most common type of cerebral palsy wasspastic quadriplegia at the rate of 43.3%. Eye problemswere detected in 60% of our cases. Of this, 54.4% wererefractive errors, 35.6% were strabismus, and 22.2%were optic nerve pathologies. Amblyopia was found in11.1% of cases. Although strabismus is more common inspastic diplegia type of cerebral palsy, there was no statisticallysignificant differenceConclusions: In conclusion, eye problems are commonin children with cerebral palsy. Therefore, we recommendroutine eye examination in these patients due to be beneficialin reducing the detection and communication difficulties.Key words: Cerebral palsy, refractive error, strabismus,optic atrophy

  20. Identifying Prognostic Criteria for Survival after Resuscitation Assisted by Extracorporeal Membrane Oxygenation

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    Alexandrine Brunner


    Full Text Available To improve survival rates during CPR, some patients are put on extracorporeal membrane oxygenation (ECMO. Among children who have undergone ECMO cardiopulmonary resuscitation (ECPR, the overall rate of survival to discharge is close to 40%. However, despite its wide acceptance and use, the appropriate indications and organizational requirements for ECPR have yet to be defined. Our objective was to assess the clinical outcomes of children after ECPR and to determine pre-ECPR prognostic factors for survival to guide its indication. Among the 19 patients who underwent ECPR between 2008 and 2014 in our center, 16 patients (84%, 95% confidence interval: 62–95% died during their hospital stay, including nine (47% who were on ECMO and seven (37% after successful weaning from ECMO. All three survivors had normal cognitive status, but one child suffered from spastic quadriplegia. Survivors tended to have lower lactate, higher bicarbonate, and higher pH levels before ECMO initiation, as well as shorter length of resuscitation. In conclusion, in our center, ECPR has a poorer outcome than expected. Therefore, it might be important to identify, a priori, patients who might benefit from this treatment.

  1. Safety and feasibility of countering neurological impairment by intravenous administration of autologous cord blood in cerebral palsy

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    Lee Young-Ho


    Full Text Available Abstract Backgrounds We conducted a pilot study of the infusion of intravenous autologous cord blood (CB in children with cerebral palsy (CP to assess the safety and feasibility of the procedure as well as its potential efficacy in countering neurological impairment. Methods Patients diagnosed with CP were enrolled in this study if their parents had elected to bank their CB at birth. Cryopreserved CB units were thawed and infused intravenously over 10~20 minutes. We assessed potential efficacy over 6 months by brain magnetic resonance imaging (MRI-diffusion tensor imaging (DTI, brain perfusion single-photon emission computed tomography (SPECT, and various evaluation tools for motor and cognitive functions. Results Twenty patients received autologous CB infusion and were evaluated. The types of CP were as follows: 11 quadriplegics, 6 hemiplegics, and 3 diplegics. Infusion was generally well-tolerated, although 5 patients experienced temporary nausea, hemoglobinuria, or urticaria during intravenous infusion. Diverse neurological domains improved in 5 patients (25% as assessed with developmental evaluation tools as well as by fractional anisotropy values in brain MRI-DTI. The neurologic improvement occurred significantly in patients with diplegia or hemiplegia rather than quadriplegia. Conclusions Autologous CB infusion is safe and feasible, and has yielded potential benefits in children with CP.

  2. Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. (United States)

    Sullivan, Peter B; Juszczak, Edmund; Bachlet, Allison M E; Lambert, Bridget; Vernon-Roberts, Angharad; Grant, Hugh W; Eltumi, Muftah; McLean, Liz; Alder, Nicola; Thomas, Adrian G


    We report a longitudinal, prospective, multicentre cohort study designed to measure the outcomes of gastrostomy tube feeding in children with cerebral palsy (CP). Fifty-seven children with CP (28 females, 29 males; median age 4y 4mo, range 5mo to 17y 3mo) were assessed before gastrostomy placement, and at 6 and 12 months afterwards. Three-quarters of the children enrolled (43 of 57) had spastic quadriplegia; other diagnoses included mixed CP (6 of 57), hemiplegia (3 of 57), undiagnosed severe neurological impairment (3 of 57), ataxia (1 of 57), and extrapyramidal disorder (1 of 57). Only 7 of 57 (12%) could sit independently, and only 3 of 57 (5%) could walk unaided. Outcome measures included growth/anthropometry, nutritional intake, general health, and complications of gastrostomy feeding. At baseline, half of the children were more than 38D below the average weight for their age and sex when compared with the standards for typically-developing children. Weight increased substantially over the study period; the median weight z score increased from -3 before gastrostomy placement to -2.2 at 6 months and -1.6 at 12 months. Almost all parents reported a significant improvement in their child's health after this intervention and a significant reduction in time spent feeding. Statistically significant and clinically important increases in weight gain and subcutaneous fat deposition were noted. Serious complications were rare, with no evidence of an increase in respiratory complications.

  3. Neuromuscular disease and hypoventilation. (United States)

    Sivak, E D; Shefner, J M; Sexton, J


    Alveolar hypoventilation associated with neuromuscular disease can occur in acute and chronic forms. In the acute form, progressive weakness of respiratory muscles leads to rapid reduction in vital capacity followed by respiratory failure with hypoxemia and hypercarbia. Symptoms are those of acute respiratory failure, including dyspnea, tachypnea, and tachycardia. In the chronic form, impairment of the respiratory muscles affects mechanical properties of the lungs and chest wall, decreases the ability to clear secretions, and eventually may alter the function of the central respiratory centers. Symptoms include orthopnea, fatigue, disturbed sleep, and hypersomnolence. Treatment and outcome of the disease's chronic form are dependent on the underlying clinical cause of the alveolar hypoventilation. For chronic but stable diseases such as old polio, quadriplegia, or kyposcoliosis, mechanical support of minute ventilation can reverse symptoms. For chronic and progressive disease such as muscular dystrophy and amyotrophic lateral sclerosis, mechanical support of minute ventilation provides only symptomatic relief and is usually associated with deterioration to the point of complete ventilator dependency for survival. For the chronic progressive forms of alveolar hypoventilation, there is currently a need for quality randomized controlled clinical trials to define physiologic indicators and appropriate timing for mechanical support of minute ventilation.

  4. Locked-in syndrome: a critical and time-dependent diagnosis. (United States)

    Barbic, David; Levine, Zachary; Tampieri, Donatella; Teitelbau, Jeanne


    Locked-in syndrome (LIS) is the combination of quadriplegia and anarthria (inability to speak), with the preservation of consciousness. The majority of cases are caused by basilar artery occlusion leading to brainstem infarction in the ventral pons, yet numerous other etiologies have been described. The diagnosis of LIS is completely dependent on the physician's ability to know that these manifestations originate in the brainstem and the posterior circulation that supplies it. This knowledge hinges on the ability of the examining physician to conduct a rapid, yet appropriately thorough neurologic examination. With recent advances in interventional neuroradiology leading to improved patient outcomes, LIS has evolved into a critical, time-dependent diagnosis. Herein, we present the case of a male patient who initially presented to the emergency department of a community hospital with coma of unknown cause. By presenting this case and focusing on the importance of the occulomotor exam, we hope to help in the rapid identification and treatment of patients with LIS in the emergency room and avoid outcomes similar to that of our patient.

  5. Rare neonatal diabetes insipidus and associated late risks: Case report

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    Rivas-Crespo Maximiliano


    Full Text Available Abstract Background Most cases of neonatal central diabetes insipidus are caused by an injury, which often results in other handicaps in the patient. The infant’s prognosis will be determined by his or her own early age and disability as well as by the physician’s skill. However, the rarity of this condition prevents the acquisition of personal experience dealing with it. Case Presentation A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limb paresis, swallowing disability, and central diabetes insipidus in a term infant. The scant oral intake, as a consequence of his disability, caused progressive undernutrition which closed a vicious circle, delaying his development and his ability to overcome the swallowing handicap. On the other hand, nasal desmopressin absorption was blocked by several common colds, resulting in brain bleeding because of severe dehydration. This even greater brain damage hampered the improvement of swallowing, closing a second harmful circle. Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolled intravenous infusion, consummated a pernicious sequence, possibly unreported. Conclusions The child’s overall development advanced rapidly when his nutrition was improved by gastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment. Besides, this case shows potential risks related to intranasal desmopressin treatment in young children.

  6. Investigation of the causes of clinical symptom aggravation in process of intravenous thrombolysis with alteplase

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    LI Chen-hua


    Full Text Available Objective To explore the causes of aggravation of microcirculation disorders in the process of intravenous thrombolysis with alteplase and the clinical outcomes. Methods The clinical data of the aggravated signs and symptoms of 13 cases treated by alteplase were reported, and the onset characteristics and clinical outcomes were analysed to summarize emergency experiences. Results There were 13 patients with stenosis of intracranial large arteries occurred perforating branch infarctions caused by the blocking of carried arteries (8 cases in internal carotid system, 5 cases in vertebral-basilar system. In the process of thrombolytic therapy, main aggravated presentations including cortical ischemic symptom, quadriplegia, exacerbated disturbance of consciousness were seen. Imaging examinations showed multiple new petechial ischemic foci in cortex and watershed region or increasing of infarct foci in cerebellum and brain stem. The prognosis was favorable after expectant treatment. NIHSS score was 8.69 ± 3.42 at 24 h after treatment, and mRS score was 0.94 ±0.37 at 3 month-follow-up. Neurologic deficit and quality of life were evidently improved. Conclusion In the course of intravenous thrombolytic therapy with alteplase. Aggravated clinical signs and symptoms may be related to various factors. Emboli disintegration inducing microcirculation disorder is inferred to be the main cause. For patients presenting aggravated signs and symptoms in thrombolysis process, favorable outcomes may occur as long as intensive care and timely treatment are performed.

  7. Study on the effect of thiamine on the metabolism of yeast by intrinsic fluorescence. (United States)

    Wang, Jun; Cai, Ruxiu; Xu, Jing; Liu, Zhihong


    Thiamine in living human bodies exists mainly as diphosphate, which works as a co-enzyme of the sugar metabolism system (active vitamin B1). Thiamine deficiency brings many clinically significant problems, such as dysphoria, quadriplegia and dyspepsia. Intrinsic fluorescence has an advantage over the extrinsic fluorescence of an unperturbed environment during investigation, especially in complex systems such as biological cells and tissues. Cellular fluorescence provides a sensitive index of the functional state of a living cell (1). Different amounts of thiamine were added to culture medium and the fluorescence of tryptophan and NADH from yeast was determined. When the thiamine concentration was greater than 0-0.16 microg/mL, the intensity of tryptophan fluorescence increased linearly, whereas the NADH fluorescence decreased. When the thiamine concentration was above 0.24 microg/mL, the fluorescence of tryptophan and NADH was almost unchanged. We concluded that low thiamine concentration in culture medium had a large effect on the growth of Saccharomyces cerevisiae and possible reasons are discussed.

  8. Predictors of clinical complications in patients with spinomedullary injury

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    Dionei Freitas De Morais


    Full Text Available Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prognosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality.

  9. Oral health and oral motor function in children with cerebral palsy. (United States)

    de Carvalho, Reyjanne Barros; Mendes, Regina F; Prado, Raimundo R; Moita Neto, José Machado


    The objective of this study was to evaluate the influence of the type of cerebral palsy (CP) and oral motor function (OMF) on the oral health status of children and adolescents with CP in Teresina, Piauí, Brazil. The sample consisted of 52 children with CP, aged 7 to 18 years. The data were statistically analyzed using chi-square tests. In 73.1% of the sample, the subjects’ caregivers carried out the daily oral care. There was a significant association between the frequency of daily care and the subject's level of oral hygiene (p = .037). A diagnosis of Class II malocclusion was made for 55.8% of the sample, and defects of enamel formation were found in 38.5% of the subjects. There was no significant correlation between DMFT (decayed, missing, filled teeth) (mean = 1.09 ± 1.64) and socioeconomic status of the subjects (r = .254, p = .069). A significant association was found between quadriplegia and OMF (χ2 = 7.88, p = .019). The type of CP and OMF did not influence the levels of plaque and caries indices in the children with CP, but increased frequency of toothbrushing did result in an improved oral hygiene index.

  10. Health benefits of seated speed, resistance, and power training for an individual with spastic quadriplegic cerebral palsy: A case report. (United States)

    Gannotti, Mary E; Fuchs, Robyn Kimberly; Roberts, Dawn E; Hobbs, Nedda; Cannon, Ian M


    Children with moderate to severe cerebral palsy are at risk for low bone mass for chronological age, which compounds risk in adulthood for progressive deformity and chronic pain. Physical activity and exercise can be a key component to optimizing bone health. In this case report we present a young adult male with non-ambulatory, spastic quadriplegia CP whom began a seated speed, resistance, and power training exercise program at age 14.5 years. Exercise program continued into adulthood as part of an active lifestyle. The individual had a history of failure to thrive, bowel and bladder incontinence, reduced bone mineral density (BMD) for age, and spinal deformity at the time exercise was initiated. Participation in the exercise program began once a week for 1.5-2 hours/session, and progressed to 3-5 times per week after two years. This exercise program is now a component of his habitual lifestyle. Over the 6 years he was followed, lumbar spine and total hip BMD Z-scores did not worsen, which may be viewed as a positive outcome given his level of gross motor impairment. Additionally, the individual reported less back pain, improved bowel and bladder control, increased energy level, and never sustained an exercise related injury. Findings from this case report suggest a regular program of seated speed, resistance, power training may promote overall well-being, are safe, and should be considered as a mechanism for optimizing bone health.

  11. Outcome of selective motor fasciculotomy in the treatment of upper limb spasticity

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    Aneel Kumar Puligopu


    Full Text Available Objective: The objective was to assess the outcome of selective motor fasciculotomy in relieving upper limb harmful resistant spasticity and thereby to improve motor functions in persons with cerebral palsy. Materials and Methods: Twenty people having cerebral palsy (12 females and 8 males with age ranging from 5 to 35 (mean 12.85 years with upper limb resistant spasticity due to spastic hemiplegia (n=7, triplegia (n=6, and quadriplegia (n=7 were assessed using Modified Ashworth Scale, Selective Voluntary Control Grade, Wee FIM Scale and hand function evaluation. Selective motor fasciculotomy was performed on the musculocutaneous nerve (n=13 for elbow flexors spasticity, median nerve (n=24 for pronators and radial wrist flexors spasticity and ulnar nerve (n=3 for ulnar wrist flexors spasticity. Pre- and post-op therapeutic exercises were performed. Results: Statistical analysis using the Wilcoxon Signed Ranks test showed significant reduction in spasticity and improvement in selective voluntary control, hand functions (grasp to hold a 2 inch rod, and Wee FIM (self-care domain in particular. There was no recurrence in spasticity and complications following surgery. Conclusions: The selective motor fasciculotomy of musculocutaneous, median, and ulnar nerves significantly reduces spasticity in the affected muscle groups and thereby improves the self-care (motor functions in selected people with cerebral palsy who have harmful resistant spasticity without any organic shortening of the muscles. The procedure is safe and the spasticity does not recur.

  12. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

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    Miguel L. Tedde


    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  13. Neurology and diving. (United States)

    Massey, E Wayne; Moon, Richard E


    Diving exposes a person to the combined effects of increased ambient pressure and immersion. The reduction in pressure when surfacing can precipitate decompression sickness (DCS), caused by bubble formation within tissues due to inert gas supersaturation. Arterial gas embolism (AGE) can also occur due to pulmonary barotrauma as a result of breath holding during ascent or gas trapping due to disease, causing lung hyperexpansion, rupture and direct entry of alveolar gas into the blood. Bubble disease due to either DCS or AGE is collectively known as decompression illness. Tissue and intravascular bubbles can induce a cascade of events resulting in CNS injury. Manifestations of decompression illness can vary in severity, from mild (paresthesias, joint pains, fatigue) to severe (vertigo, hearing loss, paraplegia, quadriplegia). Particularly as these conditions are uncommon, early recognition is essential to provide appropriate management, consisting of first aid oxygen, targeted fluid resuscitation and hyperbaric oxygen, which is the definitive treatment. Less common neurologic conditions that do not require hyperbaric oxygen include rupture of a labyrinthine window due to inadequate equalization of middle ear pressure during descent, which can precipitate vertigo and hearing loss. Sinus and middle ear overpressurization during ascent can compress the trigeminal and facial nerves respectively, causing temporary facial hypesthesia and lower motor neuron facial weakness. Some conditions preclude safe diving, such as seizure disorders, since a convulsion underwater is likely to be fatal. Preventive measures to reduce neurologic complications of diving include exclusion of individuals with specific medical conditions and safe diving procedures, particularly related to descent and ascent.

  14. Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke. (United States)

    Hwang, Pyoungsik; Sohn, Min Kyun; Kim, Cuk-Seong; Jee, Sungju


    Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80 years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (Phemiplegic patients.

  15. Research on pattern reversal visual evoked potential of children with spastic cerebral palsy

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    Lu Li


    Full Text Available AIM: To explore the judgment of pattern reversal visual evoked potential on visual function and injured part of children with spastic cerebral palsy.METHODS: There were two groups in this study. 30 children with spastic cerebral palsy(quadriplegia: 15, diplegia: 15were selected as observation group, while 30 normal children were selected as control group with randomized controlled trial. The changes of half-view and full-view incubation period and amplitude were observed by pattern reversal visual evoked potential.RESULTS: Full-view pattern reversal visual evoked potential: the P100 incubation period of the observation group was 113.55±8.14ms, and the P100 amplitude was 23.08±15.41μV. The P100 incubation period of the control group was 105.05±5.58ms, and the P100 amplitude was 31.65±7.37μV. From the comparison on P100 incubation and P100 amplitude between two groups, the difference was statistically significant(PP>0.05. Compared to the control group, each eye and each view latency of observation group were higher, the difference was statistically significant(PCONCLUSION: Pattern reversal visual evoked potential can help people to understand the visual impairment and injury of children with spastic cerebral palsy in order to identify the abnormal children and early intervention.

  16. Cerebral Palsy: Still A Social Problem

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    Angom Bisharda


    Full Text Available Research Problem: What arc the social aspects of cerebral palsy?Objective: To determine the extent and severity of neuromuscular involvement in cases of cerebral palsy and to find out the associated defects among these children.Study Design: Cross sectional study.Setting: Tertiary care hospital, outdoor patients.Participants: Children in the age group of 0 - 12 years.Sample Size: 120 children suffering from cerebral palsy.Study Variables: Social factors, neuromuscular involvement.Statistical Analysis: By proportionsResult: Out of 120 cases, maximum number of cases (66.6% were in the age group of 1- 4 years. 83 cases ( 69.16% were males. Among the various types, spastic type was the commonest (87.5%. Of these spastic cases, 52 (49.52% had quadriplegia. No case of tremor and rigidity was seen. Delayed milestones was the commonest associated disorder, seen in 107 (89.16% cases, followed by speech defect in 58(48.3% cases, visual defect in 34(28.3% cases and convulsions in 24 (20.0% cases. Hearing defect was seen in 5 cases (4.16% only.Conclusion: More concerted efforts arc required to identify children with cerebral palsy and rehabilitate them for the betterment of society.

  17. A model for the development of virtual communities for people with long-term, severe physical disabilities

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    C.M. Tilley


    Full Text Available Introduction. This paper reports results of an investigation into the needs of persons with disabilities wanting to participate in the use of virtual communities. The aim was to investigate 'how virtual communities for persons with long-term, severe physical disabilities can best be facilitated'? Method. A Grounded Theory approach was adopted to inform the investigation. In- depth interviews were conducted with twelve persons with paraplegia, quadriplegia or other severe, long-term physical or mobility disabilities and six health care professionals, service providers, information personnel and policy advisers who were involved in their well-being. Analysis. Rich explanations were derived about the information and communication technology (ICT usage and the technologies' contributions towards restoration of sense of control over their lives. Results. The primary outcome of the investigation is a theory regarding the character of virtual communities for the disabled. The theory is represented as a Virtual Community Model. The model identifies: the need for 'a sense of control' as the foundation element of virtual communities for the disabled; the key domains in which disabled people participate in virtual communities; and the barriers and enablers to their participation. Conclusion. The model provides a framework which can be used by interest groups and other organizations to facilitate the development of virtual communities for persons with severe physical disabilities. The six key types of community need to be represented in such virtual communities if a full 'sense of control' is to be achieved by disabled persons.

  18. Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery. (United States)

    Goodwin, C Rory; Boone, Christine E; Pendleton, James; Elder, Benjamin D; Wei, Zhikui; Hsu, Wesley; Sciubba, Daniel M; Witham, Timothy F


    Pneumocephalus is a collection of air within in the intracranial cavity, most commonly seen following traumatic injury or cranial surgeries. Esophageal injury and cerebrospinal fluid (CSF) leak are rare complications that may occur following anterior cervical discectomy and fusion (ACDF). We present a novel case of pneumocephalus arising from unrestricted leakage of CSF via coincident esophageal injury and durotomy in a patient who underwent an ACDF after trauma. A 21-year-old man presented to an outside hospital with C5/C6 subluxation, complete spinal cord injury, and quadriplegia from a motor vehicle accident. He underwent an ACDF, during which a CSF leak was observed. He was then transferred to our institution for rehabilitation and tracheostomy placement 1 week after the ACDF surgery. Following the tracheostomy, the patient developed intractable fevers and nonspecific symptoms. A CT scan demonstrated frontal pneumocephalus without mass effect. Air was found in the retropharyngeal space. There were no accumulations of CSF in the neck. Extravasation of contrast around instrumentation at C5/C6 on a cine esophagogram demonstrated an esophageal perforation at that level. Pneumocephalus may form when large volumes of CSF escape from the intracranial space and air is drawn into the space by the negative pressure. In this unusual case, the esophageal perforation promoted the formation of the pneumocephalus. Treatment included closure of both defects, disrupting the suspected communication between the intracranial space and the esophagus. Published by Elsevier Ltd.

  19. Spinal Subdural Staphylococcus Aureus Abscess: case report and review of the literature

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    Fligou Fotini


    Full Text Available Abstract Background Only 65 cases (including our case of spinal subdural abscesses have been reported to the literature, mostly to the lumbar spine. Staphylococcus aureus is the most common bacterial. The symptoms are not caracteristic and contrast – enhanced magnetic resonance imaging scan (MRI is the imaging method of choice. The early diagnosis is crucial for the prognosis of the patient. Case presentation We present a patient 75 years old who had a history of diabetes and suffered acute low back pain in the region of the lumbar spine for the last 4 days before his admission to the hospital. He also experienced lower leg weakness, fever and neck stiffness. After having a brain CT scan and a lumbar puncture the patient hospitalized with the diagnosis of meningitis. Five days after his admission the diagnosis of subdural abscess secured with contrast – enhanced MRI but meanwhile the condition of the patient impaired with respiratory failure and quadriplegia and he was admitted to the ICU. A laminectomy was performed eight days after his admission into the hospital but unfortunately the patient died. Conclusion Early diagnosis and treatment are very important for the good outcome in patients with subdural abscess. Although morbidity and mortality are very high, surgical and antibiotic treatment should be established as soon as possible after the diagnosis has secured.

  20. The first report of Japanese patients with asparagine synthetase deficiency. (United States)

    Yamamoto, Takahiro; Endo, Wakaba; Ohnishi, Hidenori; Kubota, Kazuo; Kawamoto, Norio; Inui, Takehiko; Imamura, Atsushi; Takanashi, Jun-Ichi; Shiina, Masaaki; Saitsu, Hirotomo; Ogata, Kazuhiro; Matsumoto, Naomichi; Haginoya, Kazuhiro; Fukao, Toshiyuki


    Asparagine synthetase (ASNS) deficiency was recently discovered as a metabolic disorder of non-essential amino acids, and presents as severe progressive microcephaly, intellectual disorder, dyskinetic quadriplegia, and intractable seizures. Two Japanese children with progressive microcephaly born to unrelated patients were analyzed by whole exome sequencing and novel ASNS mutations were identified. The effects of the ASNS mutations were analyzed by structural evaluation and in silico predictions. We describe the first known Japanese patients with ASNS deficiency. Their clinical manifestations were very similar to reported cases of ASNS deficiency. Progressive microcephaly was noted during the prenatal period in patient 1 but only after birth in patient 2. Both patients had novel ASNS mutations: patient 1 had p.L145S transmitted from his mother and p.L247W which was absent from his mother, while patient 2 carried p.V489D and p.W541Cfs*5, which were transmitted from his mother and father, respectively. Three of the four mutations were predicted to affect protein folding, and in silico analyses suggested that they would be pathogenic. We report the first two Japanese patients with ASNS deficiency. Disease severity appears to vary among patients, as is the case for other non-essential amino acid metabolic disorders. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  1. Delayed diagnosis of post-traumatic C7 vertebra anterior subluxation with an unusual neurological pattern: a case report

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    Sanaullah Maryam


    Full Text Available Abstract Introduction Post-traumatic subluxations are potentially devastating injuries to the axial skeleton. Of utmost priority are an expedient and timely diagnosis and realignment because of its association with spinal cord and nerve root trauma, which lead to progressive deleterious neurological deficits. A good radiological study of the occipitocervical joint and first thoracic vertebra is key to a successful early diagnosis. However, cases might still fail to be diagnosed, leading to trouble. A case of post-traumatic subluxation at the C7 vertebral level with an unusual neurological pattern is presented here. Case presentation A 35-year-old farmer from the Sindh province of Pakistan presented to our neurology department after a fall 2 months earlier and complained of lower limb pain and difficulty in walking. He had numbness in both of his lower limbs up to his umbilical region, with sparing of bladder function along with intact strength in the upper extremities bilaterally. Conclusions Our case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation. Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits. This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists (a to evaluate spine injuries by using computed tomography in trauma patients to identify artifact around a suspected injury and (b to be mindful of negative conventional radiographs.

  2. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. (United States)

    Simon, Anelise de Saldanha; do Pinho, Alexandre Severo; Grazziotin Dos Santos, Camila; Pagnussat, Aline de Souza


    This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (Pcontrol, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.

  3. GOM-Face: GKP, EOG, and EMG-based multimodal interface with application to humanoid robot control. (United States)

    Nam, Yunjun; Koo, Bonkon; Cichocki, Andrzej; Choi, Seungjin


    We present a novel human-machine interface, called GOM-Face , and its application to humanoid robot control. The GOM-Face bases its interfacing on three electric potentials measured on the face: 1) glossokinetic potential (GKP), which involves the tongue movement; 2) electrooculogram (EOG), which involves the eye movement; 3) electromyogram, which involves the teeth clenching. Each potential has been individually used for assistive interfacing to provide persons with limb motor disabilities or even complete quadriplegia an alternative communication channel. However, to the best of our knowledge, GOM-Face is the first interface that exploits all these potentials together. We resolved the interference between GKP and EOG by extracting discriminative features from two covariance matrices: a tongue-movement-only data matrix and eye-movement-only data matrix. With the feature extraction method, GOM-Face can detect four kinds of horizontal tongue or eye movements with an accuracy of 86.7% within 2.77 s. We demonstrated the applicability of the GOM-Face to humanoid robot control: users were able to communicate with the robot by selecting from a predefined menu using the eye and tongue movements.

  4. Neurologic complications of electrolyte disturbances and acid-base balance. (United States)

    Espay, Alberto J


    Electrolyte and acid-base disturbances are common occurrences in daily clinical practice. Although these abnormalities can be readily ascertained from routine laboratory findings, only specific clinical correlates may attest as to their significance. Among a wide phenotypic spectrum, acute electrolyte and acid-base disturbances may affect the peripheral nervous system as arreflexic weakness (hypermagnesemia, hyperkalemia, and hypophosphatemia), the central nervous system as epileptic encephalopathies (hypomagnesemia, dysnatremias, and hypocalcemia), or both as a mixture of encephalopathy and weakness or paresthesias (hypocalcemia, alkalosis). Disabling complications may develop not only when these derangements are overlooked and left untreated (e.g., visual loss from intracranial hypertension in respiratory or metabolic acidosis; quadriplegia with respiratory insufficiency in hypermagnesemia) but also when they are inappropriately managed (e.g., central pontine myelinolisis when rapidly correcting hyponatremia; cardiac arrhythmias when aggressively correcting hypo- or hyperkalemia). Therefore prompt identification of the specific neurometabolic syndromes is critical to correct the causative electrolyte or acid-base disturbances and prevent permanent central or peripheral nervous system injury. This chapter reviews the pathophysiology, clinical investigations, clinical phenotypes, and current management strategies in disorders resulting from alterations in the plasma concentration of sodium, potassium, calcium, magnesium, and phosphorus as well as from acidemia and alkalemia.

  5. Absceso intramedular en paciente con enfermedad de Rendu-Osler-Weber Spinal abscess in a patient with hereditary hemorrhagic telangiectasia

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    Lorena V Maldonado


    Full Text Available La enfermedad de Rendu-Osler-Weber es una enfermedad autosómica dominante que se manifiesta por telangiectasias en piel y mucosas y malformaciones arteriovenosas en diversos órganos. El compromiso neurológico puede ocurrir por la presencia de malformaciones arterio-venosas cerebrales, hemorragia intracraneal, y más habitualmente por accidentes cerebrovasculares isquémicos y abscesos cerebrales secundarios a embolia paradojal, en pacientes con malformaciones arteriovenosas pulmonares. El absceso intramedular es una entidad rara, inusual como complicación de la enfermedad de Rendu-Osler-Weber. Presentamos el caso de una mujer de 56 años de edad, con antecedentes familiares de enfermedad de Rendu-Osler- Weber, que ingresó a Terapia Intensiva con cuadriplejia aguda e hipoxemia, en quien se diagnosticó fístulas arteriovenosas pulmonares y un absceso intramedular cervical.Rendu-Osler-Weber syndrome is an autosomal dominant disorder characterized by multiple skin and mucosal telangiectasis and multiorgan arteriovenous malformations. Neurological manifestations may occur because of cerebral arteriovenous malformations, intracranial hemorrhage, and most commonly by ischemic stroke and brain abscess secondary to paradoxical embolization in patients with pulmonary arteriovenous malformations. Intramedullary abscess is a rare, unusual condition, in Rendu-Osler-Weber syndrome. We report the case of a 56 years old woman, with a familial history of Rendu-Osler-Weber syndrome, admitted to intensive care with acute quadriplegia and hypoxemia. Our diagnosis was pulmonary arteriovenous malformations and intramedullary abscess.

  6. Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy

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    Kaale Helga K


    Full Text Available Abstract Background The effects of intensive training for children with cerebral palsy (CP remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks. Methods A repeated measures design was applied with three baseline and two follow up assessments; immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7, diplegia (n = 11, quadriplegia (n = 2 and ataxia (n = 2 participated, age ranging 3-9 y. All levels of Gross Motor Function Classification System (GMFCS and Manual Ability Classification System (MACS were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures. Results A main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66, mean change being 4.5 (p Conclusions Basic motor abilities and self-care improved in young children with CP after goal-directed activity-focused physiotherapy with involvement of their local environment, and their need for caregiver assistance in self-care and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined.

  7. Spondyloptosis of C6-C7: a rare case report

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    Manish Chadha; Ajay Pal Singh; Arun Pal Singh


    A 35 years old female presented to us after falling from a height. She complained of a neck pain and a complete quadriplegia and was diagnosed as having spondyloptosis of the C6-C7. Skeletal traction was performed on her. CT scan showed fractures of the C5, C6, and C7 vertebral body. The patient underwent anterior approach partial corpectomy with anterior cervical locking plate and strut grafting from ipsilateral iliac crest. Intraoperatively it was found that the disc was completely ruptured and there was a dural tear and cerebrospinal fluid leak. Her postoperative period was complicated by cerebrospinal fluid collection and posterior instrumentation was not performed due to the poor general condition. She had no neural recovery at the last follow-up. Spondyloptosis is a severe and highly unstable injury with a three column ligamentous disruption and may be complicated, as in our case, with a dural tear.Management of these cases is fraught with complications,and prognosis for neural recovery is dismal.

  8. Familial Case of Pelizaeus-Merzbacher Disorder Detected by Oligoarray Comparative Genomic Hybridization: Genotype-to-Phenotype Diagnosis

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    Kimia Najafi


    Full Text Available Introduction. Pelizaeus-Merzbacher disease (PMD is an X-linked recessive hypomyelinating leukodystrophy characterized by nystagmus, spastic quadriplegia, ataxia, and developmental delay. It is caused by mutation in the PLP1 gene. Case Description. We report a 9-year-old boy referred for oligoarray comparative genomic hybridization (OA-CGH because of intellectual delay, seizures, microcephaly, nystagmus, and spastic paraplegia. Similar clinical findings were reported in his older brother and maternal uncle. Both parents had normal phenotypes. OA-CGH was performed and a 436 Kb duplication was detected and the diagnosis of PMD was made. The mother was carrier of this 436 Kb duplication. Conclusion. Clinical presentation has been accepted as being the mainstay of diagnosis for most conditions. However, recent developments in genetic diagnosis have shown that, in many congenital and sporadic disorders lacking specific phenotypic manifestations, a genotype-to-phenotype approach can be conclusive. In this case, a diagnosis was reached by universal genomic testing, namely, whole genomic array.

  9. Management of ruptured anterior communicating artery aneurysms presenting with sudden paraplegia

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    Jiu-hong MA


    Full Text Available Objective  To explore the causes of ruptured anterior communicating artery aneurysms presenting with paraplegia, and summarize the key points of diagnosis and treatment methods. Methods  A total of 260 patients with ruptured anterior communicating artery aneurysms were received medical treatment in the Department of Neurosurgery, Shanxi Provincial People's Hospital from Jan. 2012 to Mar. 2015. Of which 6 patients were clinically presented with paraplegia, their clinical data including CT/MR/DSA were retrospectively analyzed, and based on the analysis, aneurysm embolization and anti-vasospasm treatment were performed. Results  Besides headache and discomfort in the neck, 5 of the 6 patients were with double lower limbs paraplegia, and the another one presented quadriplegia. By symptomatic treatment of aneurysm embolization and anti vasospasm, the myodynamia of the paraplegic limbs recovered from 0-Ⅰto Ⅳ-Ⅴgrade, and 2 of the 6 patients spent a shorter recovery time (about 2 weeks, the other 4 recovered in 3 months. The limbs myodynamia of the 6 patients recovered completely in half-and one year follow up. Conclusions  The mechanism of ruptured anterior communicating artery aneurysms presenting with paraplegia may be the insufficient blood supply to the primary motor area and supplementary motor area (SMA of brain cortex caused by aneurysms rupture. Aneurysm embolization should be performed in clinical treatment, supplemented with anti vasospasm and symptomatic treatment of improving neurological function. DOI: 10.11855/j.issn.0577-7402.2016.09.14

  10. Etiology of Thrombocytosis in a General Medicine Population: Analysis of 801 Cases With Emphasis on Infectious Causes (United States)

    Rose, Stacey R.; Petersen, Nancy J.; Gardner, Tracie J.; Hamill, Richard J.; Trautner, Barbara W.


    Background The clinical importance of an elevated platelet count is often overlooked, particularly as a diagnostic clue to the presence of an underlying infection. We sought to better describe the relationship between thrombocytosis and inflammatory conditions, with a focus on infectious causes. Methods We retrospectively reviewed 801 sequential cases of thrombocytosis (platelet count > 500 × 109/L) at a tertiary care hospital. Results Essential thrombocythemia was the most common cause of primary thrombocytosis, and these patients were more likely to have extreme (> 800 × 109/L) and prolonged (> 1 month) thrombocytosis. Secondary thrombocytosis was more common than primary, with infectious causes accounting for nearly half the cases. Demographic factors associated with an infectious etiology included inpatient status, quadriplegia/paraplegia, an indwelling prosthesis, dementia and diabetes. Clinical and laboratory characteristics associated with an infectious cause of thrombocytosis included fever, tachycardia, weight loss, hypoalbuminemia, neutrophilia, leukocytosis and anemia. Patients with thrombocytosis secondary to infection had a more rapid normalization of platelet count, but higher risk of dying, than those with secondary, non-infectious causes. Conclusions Infection is a common cause of thrombocytosis and should be considered in patients with comorbidities that increase risk of infection and when clinical and/or laboratory data support an infectious etiology. Thrombocytosis may have prognostic implications as a clinical parameter. PMID:23226175

  11. Massive fetomaternal transplacental hemorrhage as a perinatology problem, role of ABO fetomaternal compatibility--case studies. (United States)

    Zizka, Z; Calda, P; Zlatohlavkova, B; Haakova, L; Cerna, M; Jirasek, J E; Fait, T; Hajek, Z; Kvasnicka, J


    Massive fetomaternal transplacental hemorrhage is not simply a problem of possible alloimunization in Rh incompatibility but also endangers the fetus (newborn) by massive anemization. Bleeding from placental vessels can occur after small trauma to the gravid uterus with mild or no clinical signs (bleeding or spotting, pain, hypertonus). The rupture of anchoring villi related to early uterine contractions is also possible. In the case of slow blood loss, the fetus reacts by adequate or inadequate compensatory reactions (hydrops fetus). Rapid and massive blood loss is followed by perinatal hypoxic damage and finally death. Our goal was to map out the diagnostic and therapeutic possibilities in regard to specific neonatal care. We evaluated four cases of fetomaternal transfusion during a 2-year period with special regard to postpartum adaptation of the newborn and the perinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhage was 50% (2 of 4). There was one perinatal death and one infant was affected by spastic quadriplegia. For diagnosis, it is possible to use cardiotocography (decreased variability, sinusoid pattern), ultrasound (biophysical profile) and special hematological tests for quantitative determination of fetal erythrocytes in the maternal blood. For the treatment of such cases one should consider premature termination of pregnancy or intraumbilical transfusion.

  12. New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

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    Komolafe Morenikeji A


    Full Text Available Abstract Introduction Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person. Case presentation We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier. Conclusion Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.

  13. A Case of Hypokalemic Paralysis in a Patient With Neurogenic Diabetes Insipidus (United States)

    Nguyen, Frederic N.; Kar, Jitesh K.; Verduzco-Gutierrez, Monica; Zakaria, Asma


    Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis. A 30-year-old right-handed Hispanic male was admitted for refractory seizures and acute DI after developing a dental abscess. He had a history of pituitary adenoma resection at the age of 13 with subsequent pan-hypopituitarism and was noncompliant with hormonal supplementation. On hospital day 3, he developed sudden onset of quadriplegia with motor strength of 0 of 5 in the upper extremities bilaterally and 1 of 5 in both lower extremities with absent deep tendon reflexes. His routine laboratory studies revealed severe hypokalemia of 1.6 mEq/dL. Nerve Conduction Study (NCS) revealed absent compound motor action potentials (CMAPs) with normal sensory potentials. Electromyography (EMG) did not reveal any abnormal insertional or spontaneous activity. He regained full strength within 36 hours following aggressive correction of the hypokalemia. Repeat NCS showed return of CMAPs in all nerves tested and EMG revealed normal motor units and normal recruitment without myotonic discharges. In patients with central DI with polyuria, hypokalemia can result in sudden paralysis. Hypokalemic paralysis remains an important differential in an acute case of paralysis and early recognition and appropriate management is key. PMID:24707338

  14. Utility of flexion-extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine. (United States)

    Oh, Jason Jaeseong; Asha, Stephen Edward


    Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. Flexion-extension (FE) radiography has traditionally been utilised for the detection of ligamentous injury in patients who have been cleared of bony injury. There are controversies surrounding the use of FE for alert patients with neck pain. There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi-detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Development and treatment of spinal deformity in patients with cerebral palsy

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    Tsirikos Athanasios


    Full Text Available Scoliosis is a common deformity in children and adolescents with cerebral palsy. This is usually associated with pelvic obliquity due to extension of the curve to the sacrum. Sagittal plane deformity is less common and often develops along with scoliosis. Spinal deformity in patients with severe neurological handicaps can affect their ability to sit and cause significant back pain or pain due to rib impingement against the elevated side of the pelvis on the concavity of the curvature. Surgical correction followed by spinal arthrodesis is indicated in patients with progressive deformities which interfere with their level of function and quality of life. Spinal deformity correction is a major task in children with multiple medical co-morbidities and can be associated with a high risk of complications including death. A well-coordinated multidisciplinary approach is required in the assessment and treatment of this group of patients with the aim to minimize the complication rate and secure a satisfactory surgical outcome. Good knowledge of the surgical and instrumentation techniques, as well as the principles of management is needed to achieve optimum correction of the deformity and balancing of the spine and pelvis. Spinal fusion has a well-documented positive impact even in children with quadriplegia or total body involvement and is the only surgical procedure which has such a high satisfaction rate among parents and caregivers.

  16. Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends. (United States)

    Wong, Kelly E; Chang, Peter S; Monasky, Mark S; Samuelson, Rodney M


    Cervical spondyloptosis is defined as the dislocation of the spinal column most often caused by trauma. Due to compression or transection of the spinal cord, severe neurological deficits are common. Here, we review the literature and report a case of traumatic C5-6 spondyloptosis that was successfully treated using an anterior-only surgical approach. The patient presented with quadriplegia and absent sensation distal to the C5 dermatome following a rollover motor vehicle accident. The preoperative American Spinal Injury Association Impairment Scale was A. Computed tomography of the cervical spine revealed C5-6 spondyloptosis, lamina fractures on the right side at the C3-4 level, and widened facet joint on the right side at C6-7. The patient underwent cervical traction and anterior cervical discectomy and fusion at the C5-6, C6-7 levels; no 360° fusion was warranted. Six months postoperatively, the patient remained quadriplegic below the C5 level. Presently, no consensus is present regarding the best treatment for spondyloptosis. Worldwide, the 360° approach is the most commonly used (45%), followed by anterior-only surgery (31%) and posterior-only surgery (25%). The surgical choice depends upon patient-specific features but markedly varies among geographical regions.

  17. Physiotherapy secretion removal techniques in people with spinal cord injury: a systematic review. (United States)

    Reid, W Darlene; Brown, Jennifer A; Konnyu, Kristin J; Rurak, Jennifer M E; Sakakibara, Brodie M


    To address whether secretion removal techniques increase airway clearance in people with chronic spinal cord injury (SCI). MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions and outcomes. Inclusion criteria for articles were a research study, irrespective of design, that examined secretion removal in people with chronic SCI published in English. Two reviewers determined whether articles met the inclusion criteria, abstracted information, and performed a quality assessment using PEDro or Downs and Black criteria. Studies were then given a level of evidence based on a modified Sackett scale. Of 2416 abstracts and titles retrieved, 24 met the inclusion criteria. Subjects were young (mean, 31 years) and 84% were male. Most evidence was level 4 or 5 and only 2 studies were randomized controlled trials. Three reports described outcomes for secretion removal techniques in addition to cough, whereas most articles examined the immediate effects of various components of cough. Studies examining insufflation combined with manual assisted cough provided the most consistent, high-level evidence. Compelling recent evidence supports the use of respiratory muscle training or electrical stimulation of the expiratory muscles to facilitate airway clearance in people with SCI. Evidence supporting the use of secretion removal techniques in SCI, while positive, is limited and mostly of low level. Treatments that increase respiratory muscle force show promise as effective airway clearance techniques.

  18. The tennis player in wheel chair: players‘ categories

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    David Sanz Rivas


    Full Text Available The objective of this article is to offer a typology of disabled tennis players who practice the sport activity in a wheelchair. First, some brief references concerning physical disability are included, an expression whose meaning includes wheelchair tennis players, which is defi ned as an individual who, as a consequence ofa congenital or acquired defi ciency, is impeded of accomplishing, with normality, the basic forms of movement. The three situations dealt with in the text, which come to describe the points mentioned in the “Introduction”, comprise, respectively, of a classifi cation of the physical disabilities which are linked to the different sequelae presented (neurological, myopathic, orthopedic and rheumatic, a summary of the types of marrow injuries (with an indication of the muscle groups involved and the movements affected, and the different situations that demonstrate sequelae caused by marrow injuries, varying in function of number and class of the extremities affected (from monoplegia to quadriplegia, via paraplegia, triplegia, hemiplegia and diplegia. The thematic nucleus of this work is a description of the several categories of tennis players in wheelchairs which should establish in function of their limitations; namely: paraplegic sportsmen, tetraplegic, players with cerebral paralysis, athletes with spina bifida, players with poliomyelitis and players with amputated lower limbs. Examples are used to illustrate ,the points, complementing the theoretical references. RESUMO O presente artigo tem o objetivo de oferecer uma tipologia de jogadores portadores de defi ci��ncia física que praticam a atividade desportiva do tênis em cadeira de rodas. Incluem-se a princípio, umas breves referências concernentes ao defi ciente físico, expressões cujo referente signifi cativo inclui o jogador de tênis em cadeira de rodas, que fi ca defi nido como aquele indivíduo que, como conseqüência de uma defi ciência congênita ou

  19. Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit. (United States)

    Gupta, Anupam; Srivastava, Abhishek; Taly, Arun B; Murali, Thyloth


    To assess the effect of single-stage multilevel soft-tissue surgery (Single Event Multiple Level Resections, SEMLR) on deformities and locomotion in patients with cerebral palsy (CP) with static contracture(s) in lower limbs. Study included 34 patients (M:F, 23:11) with mean age of 9.53 +/- 3.92 years (4-16 years). Among them 22 had diplegia and four each had quadriplegia and right and left hemiplegia. Fourteen patients (41.2%) had their intelligence quotient (IQ) in the normal range (IQ >/= 80), while others had mental retardation (MR) of varying severity: borderline MR (IQ = 70-79) in 12, mild MR (IQ = 50-69) in 5, and moderate MR (IQ = 35-49) in patients 3. All patients underwent surgery (total number of procedures 153, average 4.5 procedures/patient) over a period of 30 months (April 2005 to September 2007). Improvement in functional abilities and locomotion was assessed using Gross Motor Functional Classification Scale (GMFCS) scores and by physical examination. Significant improvement in function was observed (P = 0.000) after surgery when comparing the preoperative and postoperative GMFCS scores. All patients were maintaining ambulation at a mean follow-up duration of 13.12 +/- 6.07 months (3-24 months), with five patients using knee-ankle-foot orthoses (KAFO), 22 using ankle-foot orthoses (AFO), and six patients using knee gaiters. Sixteen patients were using walker, and two were using crutches as assistive devices. This study suggests that CP patients with good trunk control and static contractures at multiple joints in the lower limbs can be made ambulant with single-stage multilevel soft-tissue surgery. It has to be a team effort of the surgeon and the rehabilitation team in the postoperative period for the attainment of satisfactory goal.

  20. Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

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    Yannick Molgat-Seon


    Full Text Available The aim of the present study was to determine whether lung volume recruitment (LVR acutely increases respiratory system compliance (Crs in individuals with severe respiratory muscle weakness (RMW. Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12 and healthy controls (n=12 underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p0.05. LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05. During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05. LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

  1. Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit

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    Gupta Anupam


    Full Text Available Background: To assess the effect of single-stage multilevel soft-tissue surgery (Single Event Multiple Level Resections, SEMLR on deformities and locomotion in patients with cerebral palsy (CP with static contracture(s in lower limbs. Patients and Methods: Study included 34 patients (M:F, 23:11 with mean age of 9.53 ± 3.92 years (4-16 years. Among them 22 had diplegia and four each had quadriplegia and right and left hemiplegia. Fourteen patients (41.2% had their intelligence quotient (IQ in the normal range (IQ ≥ 80, while others had mental retardation (MR of varying severity: borderline MR (IQ = 70-79 in 12, mild MR (IQ = 50-69 in 5, and moderate MR (IQ = 35-49 in patients 3. All patients underwent surgery (total number of procedures 153, average 4.5 procedures/patient over a period of 30 months (April 2005 to September 2007. Improvement in functional abilities and locomotion was assessed using Gross Motor Functional Classification Scale (GMFCS scores and by physical examination. Results: Significant improvement in function was observed ( P = 0.000 after surgery when comparing the preoperative and postoperative GMFCS scores. All patients were maintaining ambulation at a mean follow-up duration of 13.12 ± 6.07 months (3-24 months, with five patients using knee-ankle-foot orthoses (KAFO, 22 using ankle-foot orthoses (AFO, and six patients using knee gaiters. Sixteen patients were using walker, and two were using crutches as assistive devices. Conclusion: This study suggests that CP patients with good trunk control and static contractures at multiple joints in the lower limbs can be made ambulant with single-stage multilevel soft-tissue surgery. It has to be a team effort of the surgeon and the rehabilitation team in the postoperative period for the attainment of satisfactory goal.

  2. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways (United States)



    AIM Cerebral palsy (CP) is frequently linked to white matter injury in children born preterm. Diffusion tensor imaging (DTI) is a powerful technique providing precise identification of white matter microstructure. We investigated the relationship between DTI-observed thalamocortical (posterior thalamic radiation) injury, motor (corticospinal tract) injury, and sensorimotor function. METHOD Twenty-eight children born preterm(16 males, 12 females; mean age 5y 10mo, SD 2y 6mo, range 16mo–13y; mean gestational age at birth 28wks, SD 2.7wks, range 23–34wks) were included in this case–control study. Twenty-one children had spastic diplegia, four had spastic quadriplegia, two had hemiplegia, and one had ataxic hypotonic CP; 15 of the participants walked independently. Normative comparison data were obtained from 35 healthy age-matched children born at term(19 males, 16 females; mean age 5y 9mo, SD 4y 4mo, range 15mo–15y). Two-dimensional DTI color maps were created to evaluate 26 central white matter tracts, which were graded by a neuroradiologist masked to clinical status. Quantitative measures of touch, proprioception, strength (dynamometer), and spasticity (modified Ashworth scale) were obtained from a subset of participants. RESULTS All 28 participants with CP had periventricular white-matter injury on magnetic resonance imaging. Using DTI color maps, there was more severe injury in the posterior thalamic radiation pathways than in the descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity, whereas corticospinal tract injury did not correlate with motor or sensory outcome measures. INTERPRETATION These findings extend previous research demonstrating that CP in preterm children reflects disruption of thalamocortical connections as well as descending corticospinal pathways. PMID:19416315

  3. Associated reactions during a visual pursuit position tracking task in hemiplegic and quadriplegic cerebral palsy. (United States)

    Chiu, Hsiu-Ching; Halaki, Mark; O'Dwyer, Nicholas


    Most previous studies of associated reactions (ARs) in people with cerebral palsy have used observation scales, such as recording the degree of movement through observation. The sensitive quantitative method can detect ARs that are not amply visible. The aim of this study was to provide quantitative measures of ARs during a visual pursuit position tracking task. Twenty-three hemiplegia (H) (mean +/- SD: 21y 8m +/- 11y 10m), twelve quadriplegia (Q) (21y 5m +/- 10y 3m) and twenty-two subjects with normal development (N) (21y 2m +/- 10y 10m) participated in the study. An upper limb visual pursuit tracking task was used to study ARs. The participants were required to follow a moving target with a response cursor via elbow flexion and extension movements. The occurrence of ARs was quantified by the overall coherence between the movements of tracking and non-tracking limbs and the amount of movement due to ARs was quantified by the amplitude of movement the non-tracking limbs. The amplitude of movement of the non-tracking limb indicated that the amount of ARs was larger in the Q group than the H and N groups with no significant differences between the H and N groups. The amplitude of movement of the non-tracking limb was larger during non-dominant than dominant tracking in all three groups. Some movements in the non-tracking limb were correlated with the tracking limb (correlated ARs) and some movements that were not correlated with the tracking limb (uncorrelated ARs). The correlated ARs comprised less than 40% of the total ARs for all three groups. Correlated ARs were negatively associated with clinical evaluations, but not the uncorrelated ARs. The correlated and uncorrelated ARs appear to have different relationships with clinical evaluations, implying the effect of ARs on upper limb activities could be varied.

  4. Head-controlled assistive telerobot with extended physiological proprioception capability (United States)

    Salganicoff, Marcos; Rahman, Tariq; Mahoney, Ricardo; Pino, D.; Jayachandran, Vijay; Kumar, Vijay; Chen, Shoupu; Harwin, William S.


    People with disabilities such as quadriplegia can use mouth-sticks and head-sticks as extension devices to perform desired manipulations. These extensions provide extended proprioception which allows users to directly feel forces and other perceptual cues such as texture present at the tip of the mouth-stick. Such devices are effective for two principle reasons: because of their close contact with the user's tactile and proprioceptive sensing abilities; and because they tend to be lightweight and very stiff, and can thus convey tactile and kinesthetic information with high-bandwidth. Unfortunately, traditional mouth-sticks and head-sticks are limited in workspace and in the mechanical power that can be transferred because of user mobility and strength limitations. We describe an alternative implementation of the head-stick device using the idea of a virtual head-stick: a head-controlled bilateral force-reflecting telerobot. In this system the end-effector of the slave robot moves as if it were at the tip of an imaginary extension of the user's head. The design goal is for the system is to have the same intuitive operation and extended proprioception as a regular mouth-stick effector but with augmentation of workspace volume and mechanical power. The input is through a specially modified six DOF master robot (a PerForceTM hand-controller) whose joints can be back-driven to apply forces at the user's head. The manipulation tasks in the environment are performed by a six degree-of-freedom slave robot (the Zebra-ZEROTM) with a built-in force sensor. We describe the prototype hardware/software implementation of the system, control system design, safety/disability issues, and initial evaluation tasks.

  5. Clinical significance of the corpus callosum in cerebral palsy

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    Lee, Eun Ja; Kim, Ji Chang [The Catholic University of Korea, Seoul (Korea, Republic of); Kim, Jong Chul [School of Medicine, Chungnam National University, Taejon (Korea, Republic of); And Others


    To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. Fifty-two children (30 boys and 22 girls aged between six and 96 (median, 19) months) in whom cerebral palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebral palsy were classified as hemiplegia (n=14), spastic diplegia (n=22), or spastic quadriplegia (n=16), and according to the severity of motor palsy, the condition was also classified as mild (n=26), moderate (n=13), or severe (n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p less than 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p less than 0.05). There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

  6. The relationship between MR images and clinical findings in neuronal migration disorders

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    Onuma, Akira; Kobayashi, Yasuko [Takuto Rehabilitation Center for Disabled Children, Sendai (Japan); Iinuma, Kazuie


    Among the variable manifestating conditions of neuronal migration disorders, mental retardation, motor disturbance and epilepsy are the main features of developmental disabilities. We analyzed the relationship between clinical symptoms and magnetic resonance (MR) images, including surface anatomy scan (SAS). Thirty-nine patients (23 males, 16 females; mean age 6.1 years) with neuronal migration disorders were studied. The diagnoses were cerebral palsy in 23 cases, mental retardation in 4, West syndrome in 4, Fukuyama type congenital muscular dystrophy (FCMD) in 6, Walker-Warburg syndrome in 1 and Dubowitz syndrome in 1. Cortical dysplasias were classified into the following 7 groups, mainly based on the SAS findings: complete agyria (AG 1), mixture of agyria and pachygyria (AG 2), bilateral complete pachygyria (BP 1), diffuse pachygyria with marked widening of the bilateral superior frontal gyrus (BP 2), unilateral pachygyria with hemispheric atrophy or hemimegalencephaly (UP), focal cortical dysplasia (FP) and other findings such as solitary schizencephaly (Others). Most cases of AG 1 and AG 2 showed spastic quadriplegia (6/7) and symptomatic generalized epilepsy (5/7), whereas cases of BP 1 showed spasticity only in 1/8 and epilepsy in 7/8. Hemiplegia was observed in 6/7 of UP, 2/8 of FP and 2/4 of Others. Partial epilepsy was observed in 2/7 of UP and 1/8 of FP. Intellectual level was variable in BP 1, UP, FP and Others, but all cases showed severe mental retardation in AG 1, AG 2 and BP 2. BP 2 was observed in all cases of typical FCMD (5/5). The birth weight was less than 2,500 g in 6/7 of UP. The structural findings well correlated with clinical symptoms and epileptic seizure types. The surface anatomy scan was a very useful technique for detecting cortical dysplasias. (author)

  7. A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority. (United States)

    Bruno, Marie-Aurélie; Bernheim, Jan L; Ledoux, Didier; Pellas, Frédéric; Demertzi, Athena; Laureys, Steven


    Objectives Locked-in syndrome (LIS) consists of anarthria and quadriplegia while consciousness is preserved. Classically, vertical eye movements or blinking allow coded communication. Given appropriate medical care, patients can survive for decades. We studied the self-reported quality of life in chronic LIS patients. Design 168 LIS members of the French Association for LIS were invited to answer a questionnaire on medical history, current status and end-of-life issues. They self-assessed their global subjective well-being with the Anamnestic Comparative Self-Assessment (ACSA) scale, whose +5 and -5 anchors were their memories of the best period in their life before LIS and their worst period ever, respectively. Results 91 patients (54%) responded and 26 were excluded because of missing data on quality of life. 47 patients professed happiness (median ACSA +3) and 18 unhappiness (median ACSA -4). Variables associated with unhappiness included anxiety and dissatisfaction with mobility in the community, recreational activities and recovery of speech production. A longer time in LIS was correlated with happiness. 58% declared they did not wish to be resuscitated in case of cardiac arrest and 7% expressed a wish for euthanasia. Conclusions Our data stress the need for extra palliative efforts directed at mobility and recreational activities in LIS and the importance of anxiolytic therapy. Recently affected LIS patients who wish to die should be assured that there is a high chance they will regain a happy meaningful life. End-of-life decisions, including euthanasia, should not be avoided, but a moratorium to allow a steady state to be reached should be proposed.

  8. Two different manifestations of locked-in syndrome. (United States)

    Golubović, Vesna; Muhvić, Damir; Golubović, Snjezana; Juretić, Mirna; Tokmadzić, Vlatka Sotosek


    Locked-in syndrome (LIS) is an entity that usually occur a consequence of the lesion of ventral part of pons. Etiology of locked-in syndrome can be vascular and nonvascular origin. Locked-in syndrome usually occurs as a consequence of thrombosis of intermedial segment of basilar artery that induces bilateral infarction of the ventrobasal part of the pons. Additionally, LIS can be caused by trauma which often leads to posttraumatic thrombosis of basilar artery. The incidence of locked-in syndrome is still unknown. The basic clinical features of locked-in syndrome are: quadriplegia (a consequence of disruption of corticospinal pathways located in ventral part of pons), different stages of paralysis of mimic musculature, paralysis of pharynx, tongue and palate with mutism and anarthria. The patient can not move, but is conscious and can communicate only by eye movements. Two patients with locked-in syndrome were present in this article. In the first case, the patient had classic locked-in syndrome that was first described by Plum and Posner. Other patient had incomplete form of locket-in syndrome which was first described by Bauer. In these two patients locked-in syndrome occurred as a consequence of trauma. In the first patient locked-in syndrome was caused by direct contusion of ventral part of pons while in other patient locked-in syndrome was a consequence of posttraumatic thrombosis of vertebrobasilar artery. The introduction of anticoagulant therapy, besides the other measures of intensive therapy, has shown complete justification in the second patient. The gradual partial recovery of neurologic deficit has developed in the second patient without any additional complications.

  9. A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?

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    Schneider P


    Full Text Available Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: Demyelination is a hallmark of central pontine myelinolysis (CPM. Neuropsychiatric manifestations of this condition include weakness, quadriplegia, pseudobulbar palsy, mood changes, psychosis, and cognitive disturbances. These psychiatric symptoms are also associated with schizophrenia and alcohol withdrawal. Thus, it is clinically relevant to differentiate between CPM, schizophrenia, and alcohol withdrawal as the treatment and prognostic outcomes for each diagnosis are distinct. We present a series of events that led to a misdiagnosis of a patient admitted to the medical emergency center presenting with confusion, psychomotor agitation, and delirium who was first diagnosed with schizophrenia and alcohol withdrawal by emergency medical physicians and later discovered by the psychiatric consult team to have CPM. With a thorough psychiatric evaluation, a review of the laboratory results first showing mild hyponatremia (127 mmol/L, subsequent hypernatremia (154 mmol/L, and magnetic resonance brain imaging, psychiatrists concluded that CPM was the primary diagnosis underlying the observed neuropsychopathology. This patient has mild impairments in mood, cognition, and motor skills that remain 12 months after her emergency-center admission. This case report reminds emergency clinicians that abnormal sodium metabolism can have long-term and devastating psychopathological and neurological consequences. Differentiating between CPM, schizophrenia, and alcohol withdrawal using neuroimaging techniques and preventing the risks for CPM using slow sodium correction are paramount.Keywords: MRI, alcohol, schizophrenia, central pontine myelinolysis, hyponatremia

  10. Effects of music and music therapy on mood in neurological patients. (United States)

    Raglio, Alfredo; Attardo, Lapo; Gontero, Giulia; Rollino, Silvia; Groppo, Elisabetta; Granieri, Enrico


    Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson's disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson's Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.

  11. Avaliação da capacidade funcional de crianças com paralisia cerebral

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    Carla Ciceri Cesa


    Full Text Available Objetivo descrever a capacidade funcional de crianças com paralisia cerebral que realizavam atendimentos de Fisioterapia e Fisioterapia e Fonoaudiologia. Métodos estudo descritivo, de caráter transversal, composto por 14 crianças com PC do tipo quadriplegia espástica (6 realizavam Fisioterapia e 8 Fisioterapia e Fonoaudiologia. Foram utilizados para avaliação o Inventário de Avaliação Pediátrica de Incapacidade (PEDI e o Sistema de Classificação da Função Motora Grossa (GMFCS. As associações entre as variáveis categóricas foram analisadas por meio do teste exato de Fisher. Comparações entre médias foram realizadas utilizando-se o teste t de Student. Resultados não se obteve melhora estatisticamente significante nas áreas de autocuidado, mobilidade e função social entre os dois grupos nos domínios de habilidade funcional e assistência ao cuidador. Conclusão as crianças do grupo Fisioterapia tiveram escores funcionais mais elevados que as do grupo Fisioterapia associado à Fonoaudiologia, mas não houve diferença estatisticamente significante entre os grupos. Isso se deu, provavelmente, devido ao reduzido número de participantes, à diversidade de quadros clínicos que a patologia pode apresentar e a possíveis diferenças na intervenção fisioterapêutica realizada nos dois estados, que possuem situações socioeconômicas bem diversas.

  12. MR Imaging in intramedullary cysticercosis

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    Parmar, H.; Patwardhan, V.; Patankar, T.; Prasad, S. [Dept. of Radiology, King Edward VII Memorial Hospital, Parel, Mumbai (India); Shah, J.; Patkar, D. [Dept. of Radiology, Dr. Balabhai Nanavati Hospital and Research Center, Mumbai (India); Castillo, M. [Dept. of Neuroradiology, Univ. of North Carolina (United States)


    Although intramedullary spinal cord cysticercosis (IMC) is uncommon, its presence is being increasingly recognised by magnetic resonance imaging. We studied six patients from an endemic region and present the MRI features and clinical correlation of IMC. Six patients who presented with para- or quadriplegia were studied by contrast enhanced spinal MRI. Prompted by the spinal lesions, all patients underwent brain MRI. Clinical data and laboratory studies were reviewed in all patients. Definite diagnosis was established in the form of response to drug therapy (n=4) and histopathology (n=2). Follow-up MRI studies of spine and brain were obtained in four patients 2 months after they started medical treatment, regardless of surgery. Five patients showed fusiform and focal enlargement of the spinal cord (cervical 2, thoracic 3). Well-defined cysts with a slightly hyperintense mural nodule were identified in five patients in T1-weighted images (T1WI). All cysts were hyperintense on T2WI and merged with the surrounding oedema. Oedema extended one to three vertebral levels above or below the cyst. Post-contrast T1WI showed well-defined, ring enhancing lesions with smooth walls in all patients. Symptoms in all patients correlated with the level of the lesions. Brain studies demonstrated lesions in just two patients. Histopathological confirmation was obtained in two patients. Follow-up spinal MRI was normal in two patients, following 2 months of treatment while residual and smaller lesions were seen in two patients. Two patients were asymptomatic and denied follow-up MRI. MRI of spinal cysticercosis were typical of and similar to those seen in cerebral lesions in our patients and corresponded to the level of symptoms. All cysts were surrounded by oedema. Two of four patients showed residual lesions after 2 months of therapy and 33% of patients showed concomitant intracranial lesions. (orig.)

  13. The clinic discuss of prognosis and treatment or brainstem infarction combined coma

    Institute of Scientific and Technical Information of China (English)

    Niu Junying; Wanglei; YinShimin; Zheng Yishan; Shijie Qu; Zhanfen


    Objective Discuss the relationship between the position, bound of brainstem infarction and .consciousness clog,determinan the prognosis and curative effect. Background and Methods Total brainstem infarction 14 patients,9 male and 5 female,43 to 80 years old.all patients had been checked by CT or MRI,brainstem foliun scanning 6 cases,checked by MRI 8 canes micbrain infarction 2 cases,pon infarction 5 cases,medulla infasction 7 cases the midbrain infarction were rise rapid,inmediately coma,the mydrasis in defect side,opposite body mucsle tension heighten.then both lower limbs straight,both pathology sign masculine.the two cases are all alive .tocked-in syndrom has appeared in 1 case of pon infarction ,and died of combined illness 1 year later. 1 case defect affect centrum of breath and hearlbeat, coma,breath rhythm malajustment,breath stop.threr were no consciousness clog in the other 3 cases ,vertigo,force head position to trouble side, nystagmus, trouble side face hypalgesia,and all cureed .2 cases of medulla infarction appeared quactriplegia ,swallow hardness,anarthriad and so on, 5 others were hemi Watlenberg syndrom,all wcre cured. Results and Discussion coma or no in brainstem infaciton was related with is reparted that midbrain infarction coma was 7.6 persent of brainstem infarction. consciousness clog is distinctness which defect position in midbrain lateral-back, pon ventro defect, not involved ARAS ,lwas locked-in synxdom. brainstem infarction combined combined with freedom breath clog,in medulla was 16.1percent,midorain was 1 1.6 percent, pons ws 83.96 percent the prognosis was.all right in lightly brainsterm infarction, lf involved in both medulla, ventro pon,the prognosis was bad, and lose quadriplegia. CT brainstern foliun scanning would enhanced scanning lay, and helpful for chech up the pathological chanoes of brainstem.

  14. Functioning and health-related quality of life of adolescents with cerebral palsy: self versus parent perspectives. (United States)

    Gates, Philip; Otsuka, Norman; Sanders, James; McGee-Brown, Jeanie


    To determine whether there is a difference between perspectives of functioning and health-related quality of life (HRQL) of parents and ambulatory adolescents with spastic cerebral palsy (CP). A total of 139 parent patient pairs (73 females, 66 males; median age 14 y 6 mo, age range 11-18 y, Gross Motor Function Classification System [GMFCS] levels I-III, with hemiplegia [n=23], diplegia [n=103], triplegia [n=9], and quadriplegia [n=4]) were recruited from outpatient CP clinics at three pediatric orthopaedic hospitals, between 2000 and 2006, from whom Pediatric Outcomes Data Collection Instrument (PODCI) responses were collected. Cross-sectional data, calculated with intraclass correlation coefficients [ICC], showed parents and adolescents agreed more on functioning (ICC=0.488-0.748) than HRQL (ICC=0.242-0.568; PODCI). Parents and adolescents both recognized significant comorbidities (ICC=0.502-0.713), but adolescents saw themselves as less limited (ICC=0.330) than parents. The greatest differences between parents and adolescents were in HRQL scales for male adolescents, with only a small part explained by GMFCS level difference between sexes (effect size 0.002-0.143). Age, parent well-being, and parent sex had little effect and comorbidities had no effect. GMFCS level was the most common predictor. Most scales on health conditions, function, and HRQL agreed between parents and adolescents aged 11 to 18 years. Parent proxy is reasonable when necessary, but assessing both parents and adolescents gives additional insight. Adolescents do not consider themselves as limited by health conditions as parents do; parents have greater satisfaction with current level of symptoms than adolescents, and findings vary on expectations for treatment.

  15. Exploration of cerebral palsy complication%脑性瘫痪合并症的临床研究

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    曹建国; 郭新志; 何晓蕊; 卢红云


    目的:探讨小儿脑性瘫痪的合并症原因及特点。方法:回顾性分析1992-1999年间资料完整的385例住院脑瘫患儿。结果:合并癫痫58例(15.06%)、智力低下291例(75.58%)、语言障碍(2岁以上)139例(73.55%)、听觉异常43例(31.6%)、斜视79例(20.5%);主要原因为窒息、早产及低出生体重儿、高胆红素血症、妊娠期感染、颅内出血;痉挛型四肢瘫合并症最多。结论:脑性瘫痪是一种脑损伤引起的多重表现的复合征,其诊治需临床多学科合作。%Objective: To explore the causes and characters of complication of cerebral palsy(CP). Method:385 cases with CP were identified and analysed retrospectivly from 1992 to 1999. Result: 58 cases with epilepsy(15.06%), 291 cases with mental retardation(75.78% ), 139 cases with language impairment(over 2 years)(73.55 % ), 43 cases with hearing impariment(31.6% ), 79 cases with squint (20.5%). Main risk factors of CP: asphyxia, premature and low-birth weight, hyperbilirubinemia,gestration infection,intracranial hemorrhage. The patients with spastic quadriplegia of CP have the most complication. Conclusion: CP is a syndrom caused by brain damage, whose diagnosis, therapy and rehabilitation needs the cooperation of clinical multi- disciplines.

  16. Is Level of Injury a Determinant of Quality of Life Among Individuals with Spinal Cord Injury? A Tertiary Rehabilitation Center Report

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    Seyed Amir Hossein Tavakoli


    Full Text Available Objectives: The role of injury-related variables in determining health-related quality of life (HRQOL among Iranian persons with spinal cord injury (SCI has not yet been fully described. In this study, we compared HRQOL between individuals with injury at cervical level and those with injury at thoracolumbar sections and evaluated the discriminating value of injury level as a determinant of HRQOL among Iranian people with SCI. Methods: Individuals with SCI, who were referred to Brain and Spinal Cord Injury Research Center, were invited to participate in this investigation. HRQOL was assessed using the Short Form (SF-36 questionnaire to determine the quality of life (QOL in eight domains: physical functioning (PF, role limitation due to physical problems (RP, bodily pain (BP, general health (GH, vitality (VT, social functioning (SF, role limitation due to emotional problems (RE, and mental health (MH. Results: Ninety patients with paraplegia and 94 quadriplegic patients participated in this investigation. The mean score of PF domain was significantly lower in patients with injury at cervical level (p < 0.0001. There was no significant difference in other domains of SF-36 between subjects with paraplegia and quadriplegia (p = 0.670, 0.700, 0.910, 0.710, 0.730, 0.290 and 0.850 for RP, RE, VT, MH, SF, BP and GH, respectively. Similarly, the mean physical component summary (PCS score was significantly higher among individuals with injury at thoracolumbar sections (p < 0.0001. The mean mental component summary (MCS score did not differ between the two groups (p = 0.720. Conclusions: Patients with SCI at the cervical level have similar mental health compared to those with injury at thoracolumbar sections, which shows proper mental adaptability in quadriplegic individuals. Injury level can be used as a major determinant of the physical component of QOL among people with SCI.

  17. Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation.

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    Kimbroe J Carter

    Full Text Available BACKGROUND: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. METHODS/FINDINGS: The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. CONCLUSIONS: When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in

  18. Effect of treadmill gait on bone markers and bone mineral density of quadriplegic subjects

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    D.C.L. Carvalho


    Full Text Available Quadriplegic subjects present extensive muscle mass paralysis which is responsible for the dramatic decrease in bone mass, increasing the risk of bone fractures. There has been much effort to find an efficient treatment to prevent or reverse this significant bone loss. We used 21 male subjects, mean age 31.95 ± 8.01 years, with chronic quadriplegia, between C4 and C8, to evaluate the effect of treadmill gait training using neuromuscular electrical stimulation, with 30-50% weight relief, on bone mass, comparing individual dual-energy X-ray absorptiometry responses and biochemical markers of bone metabolism. Subjects were divided into gait (N = 11 and control (N = 10 groups. The gait group underwent gait training for 6 months, twice a week, for 20 min, while the control group did not perform gait. Bone mineral density (BMD of lumbar spine, femoral neck, trochanteric area, and total femur, and biochemical markers (osteocalcin, bone alkaline phosphatase, pyridinoline, and deoxypyridinoline were measured at the beginning of the study and 6 months later. In the gait group, 81.8% of the subjects presented a significant increase in bone formation and 66.7% also presented a significant decrease of bone resorption markers, whereas 30% of the controls did not present any change in markers and 20% presented an increase in bone formation. Marker results did not always agree with BMD data. Indeed, many individuals with increased bone formation presented a decrease in BMD. Most individuals in the gait group presented an increase in bone formation markers and a decrease in bone resorption markers, suggesting that gait training, even with 30-50% body weight support, was efficient in improving the bone mass of chronic quadriplegics.

  19. Um estudo da mediação pedagógica em contexto domiciliar na afasia motora: o desenvolvimento da autonomia intelectual do deficiente neuromotor

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    Fernanda Carvalho Polonio


    Full Text Available This study, which covers language development in people with Ontogenetic Cerebral Dysmetria, aimed to identify educational activities which promote language development in people under such a condition who present motor aphasia. On the one hand, it is necessary to understand how language difficulties can harm the subject with physical neuromotor disabilities in their emotional, social and intellectual development. On the other hand, it is imperative to unveil alternative paths and special features which promote the development of people under the condition in focus. The analyses presented in this study have as theoretical basis the assumptions of historical-cultural psychology, particularly the understanding that language is an essential tool for intellectual development. In its methodology, the research included, in addition to a theoretical investigation, a case study on the conditions of language and development of an adult woman with ontogenetic cerebral dysmetria, a condition known as cerebral palsy, spastic quadriplegia and lack of speech. The case study intended to determine the impact of a stimulation program of expressive language, with augmentative and alternative high technology communication resources which were systematized to meet the needs of the research subject. The Augmentative and Alternative Communication resources are seen as an effective way to minimize the difficulties experienced by individuals with motor aphasia. As a result of the proposed interventions, it was possible to identify a more autonomous behavior of the subject in question regarding the use of written language, which is the communication channel used by her. Furthermore, the study revealed that the expansion of communication possibilities through the virtual writing system resized the social relations of the participant in this research.

  20. The Relationship between Attention Deficit Hyperactivity Disorder and Personality Characteristics in Migrainous Patients

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    Abdol Reza Sabahi


    Full Text Available Background: World Health Organization reports described migraine as one of the 4 most disabling chronic medical disorders. A day with migraine is as disabling as a day with quadriplegia, schizophrenia, or dementia in who is view 87% of people with migraine has some degree of disability. Migraine headaches are associated with psychological factors and personality characteristics. This study compares the personality characteristics of migraine patients with Attention Deficit Hyperactivity Disorder (ADHD and without ADHD. Materials and Methods: Eighty patients with migraine were evaluated in this cross sectional study with simple sampling method. All participants were assessed with semi structured clinical interview, adult ADHD self-report scale (ASRS and Millone clinical multiaxial inventory questionnaire. The migraine patients were divided into two groups, with and without ADHD. The correlation of variables was tested by χ2 test and t-test with 0.05 significance with the use of software SPSS-20. Results: Our participants were 80% female, 56% married and 36.2% with at least graduation from high school. Patients with migraine and ADHD were younger and their first headache experience had occurred in lower age compared with non-ADHD patients (p<0.05. In current study, we showed that there is a significant correlation between ADHD and depressive and independent personality traits and dysthymic clinical syndrome in migraine patients (p<0.05. Conclusion: Our results demonstrate that personality characteristics in migraine patients may be affected by some other mental disorders such as ADHD. These findings might be helpful in early treatment and prevention of dysfunctioning in patients with migraine.

  1. Risk factors associated with venous thromboembolism in patients undergoing spine surgery. (United States)

    Piper, Keaton; Algattas, Hanna; DeAndrea-Lazarus, Ian A; Kimmell, Kristopher T; Li, Yan Michael; Walter, Kevin A; Silberstein, Howard J; Vates, G Edward


    OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.

  2. An evaluation of the fluoroscopy-guided percutaneous gastrostomy with the pull technique

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    Uhm, Chang Wook; Won, Jong Yun; Yu, Jeong Sik; Ko, Heung Kyu; Lee, Kwang Hun; Lee, Do Yun; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate.

  3. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

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    Schötzau Andreas


    Full Text Available Abstract Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%, head (24%, spine (14%, thorax (9%, face (9%, pelvis (7% and abdomen (2%. Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male were included. Falls were most frequent (65%, followed by horse kicks (19% and horse bites (2%. Variables statistically significant for the controls were: Older age (p = 0.015, male gender (p = 0.04 and holding a diploma in horse riding (p = 0.004. Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.

  4. 双(多)胎脑瘫患儿的病因学及临床特征分析%Etiology and Clinical Features of Cerebral Palsy in Twin or Multiple Pregnancies

    Institute of Scientific and Technical Information of China (English)

    孙殿荣; 候梅; 高翔


    目的 探讨双(多)胎儿童发生脑瘫的相关因素及临床特征.方法 对52例双胎或多胎脑瘫患儿进行围产期高危因素调查、临床分型、影像学检查及粗大运动功能测评(GMFCS).结果 和结论双(多)胎之一脑瘫的发生和妊娠并发症无明显相关.同性别双胎、出生体重偏重一胎发生脑瘫的机会大.双(多)胎脑瘫以痉挛型双瘫最多见,影像学改变以侧脑室周围白质软化为主.痉挛型双瘫和偏瘫患儿GMFCS多在Ⅰ~Ⅲ级,而不随意运动型、四肢瘫和混合型患儿多在Ⅳ~Ⅴ级.%Objective To analyze the related factors and clinical features of cerebral palsy in twin or multiple pregnancies. Methods 52 cerebral palsy children in twin or multiple pregnancies were reviewed with the risk factors in perinatal period, the clinical type, findings of radiology and the gross motor function (GMFCS). Results and Conclusion No significant link was found between these pregnancy complications and cerebral palsy in twins or multiple pregnancies. The prevalence of cerebral palsy was higher for the one with more birthweight in twins of the same gender. Spastic diplegia was the most type, and most of them were found with periventricular leucomalacia. The GMFCS levels was Ⅰ ~ Ⅲ in spastic hemiplegic or spastic diplegic children, while was Ⅳ ~ Ⅴ in children with spastic quadriplegia, dyskinesia or mixed CP.

  5. Risk factors for dental caries among children with cerebral palsy in a low-resource setting. (United States)

    Akhter, Rahena; Hassan, Nur Mohammad Monsur; Martin, Elizabeth F; Muhit, Mohammad; Haque, Mohammad Raziul; Smithers-Sheedy, Hayley; Jones, Cheryl; Badawi, Nadia; Khandaker, Gulam


    To describe the oral health status and investigate factors affecting dental caries experience among children with cerebral palsy (CP) in rural Bangladesh. A cross-sectional study was conducted among children with CP who are part of the Bangladesh Cerebral Palsy Register (BCPR) study. Caries experience was measured by identifying decayed, missing, and filled teeth for deciduous and permanent teeth (dmft/DMFT). Clinical periodontal index, body mass index, oral hygiene behaviour, masticatory ability, and dietary habits were recorded. CP motor types and severity of functional mobility (Gross Motor Function Classification System [GMFCS]) were assessed. Of 90 children with CP (mean age 9y 7mo, range 2-17y, 37.8% female and 62.2% male), 35% of 2 to 6 year olds, and 70% of 7 to 11 year olds (p=0.014) experienced caries (dmft+DMFT>0). The mean values (standard deviation [SD]) of dmft and DMFT were 2.46 (3.75) and 0.72 (1.79) respectively. After adjusting for age and sex, binary logistic regression analysis showed a significant relationship with dental caries for children who had quadriplegia (odds ratio [OR] 5.56, p=0.035), tooth cleaning less than one time/day (OR 0.08, p=0.016), using toothpowder or charcoal for cleaning (OR 7.63, p=0.015), and snacking between meals more than one time/day (OR 6.93, p=0.012). Early oral health preventive care is required for children with CP because dental caries is highly prevalent in these children. © 2016 Mac Keith Press.


    Directory of Open Access Journals (Sweden)

    Don F Du Toit


    en la escala ASIA aumentaron de 29/112 a 64/112 a los 6 meses después del tratamiento y se ganó al menos un nivel de la escala ASIA. Conclusión: En comparación con los hallazgos iniciales, se documentó mejoría neurológica cuantificada en la cintura escapular y las extremidades superiores, entre 6 y 12 meses después del trasplante celular autólogo intralesional con SCNT en un caso de cuadriplejia crónica. The scientific literature reports that about 180,000 cases of spinal-cord injuries (SCI occur yearly in the world. Recent publications show neurological benefit in selected quadriplegics undergoing intra-lesion transplantation of autologous cultured bone-marrow mesenchymal stem cells. Objectives: This case-study reports level–III objective evidence and partial neurological clinical recovery in a 32-year old-male with chronic complete quadriplegia that underwent somatic nuclear cell transfer (SCNT and embryonic cell therapy for traumatic spinal-cord injury (SCI sustained 6-years previously. The research question was: “Can autologous SCNT cell-therapy improve extremity motor and sensory impairment in chronic quadriplegia?” The hypothesis tested: “SCNT cell-therapy is unable to improve severe motor and sensory impairment in selected persons with chronic complete quadriplegia and unable to improve functional outcome or independence”. Material and methods: Cell-transplantation was by neuro-surgical implantation into the damaged cervical cord 6-years after SCI that rendered the patient a complete quadriplegic confirmed on neurological examination and magnetic resonance imaging (MRI. Neurologic assessment, restoration of dermatomes and myotomes were evaluated post-procedurally for 12-months together with MRI, and American Spinal Injury Association grading (ASIA. Results: Neurological improvement was asymmetrically improved in the shoulder girdle, upper extremity bilaterally and trunk without dramatic change in leg-function at 12-months. ASIA

  7. Functional recovery in spinal cord injured rats using polypyrrole/iodine implants and treadmill training. (United States)

    Alvarez-Mejia, Laura; Morales, Juan; Cruz, Guillermo J; Olayo, María-Guadalupe; Olayo, Roberto; Díaz-Ruíz, Araceli; Ríos, Camilo; Mondragón-Lozano, Rodrigo; Sánchez-Torres, Stephanie; Morales-Guadarrama, Axayacatl; Fabela-Sánchez, Omar; Salgado-Ceballos, Hermelinda


    Currently, there is no universally accepted treatment for traumatic spinal cord injury (TSCI), a pathology that can cause paraplegia or quadriplegia. Due to the complexity of TSCI, more than one therapeutic strategy may be necessary to regain lost functions. Therefore, the present study proposes the use of implants of mesoparticles (MPs) of polypyrrole/iodine (PPy/I) synthesized by plasma for neuroprotection promotion and functional recovery in combination with treadmill training (TT) for neuroplasticity promotion and maintenance of muscle tone. PPy/I films were synthesized by plasma and pulverized to obtain MPs. Rats with a TSCI produced by the NYU impactor were divided into four groups: Vehicle (saline solution); MPs (PPy/I implant); Vehicle-TT (saline solution + TT); and MPs-TT (PPy/I implant + TT). The vehicle or MPs (30 μL) were injected into the lesion site 48 h after a TSCI. Four days later, TT was carried out 5 days a week for 2 months. Functional recovery was evaluated weekly using the BBB motor scale for 9 weeks and tissue protection using histological and morphometric analysis thereafter. Although the MPs of PPy/I increased nerve tissue preservation (P = 0.03) and promoted functional recovery (P = 0.015), combination with TT did not produce better neuroprotection, but significantly improved functional results (P = 0.000) when comparing with the vehicle group. So, use these therapeutic strategies by separately could stimulate specific mechanisms of neuroprotection and neuroregeneration, but when using together they could mainly potentiate different mechanisms of neuronal plasticity in the preserved spinal cord tissue after a TSCI and produce a significant functional recovery. The implant of mesoparticles of polypyrrole/iodine into the injured spinal cord displayed good integration into the nervous tissue without a response of rejection, as well as an increased in the amount of preserved tissue and a better functional recovery than the group without

  8. Detailed analysis of the clinical effects of cell therapy for thoracolumbar spinal cord injury: an original study

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    Sharma A


    Full Text Available Alok Sharma,1 Nandini Gokulchandran,1 Hemangi Sane,2 Prerna Badhe,1 Pooja Kulkarni,2 Mamta Lohia,3 Anjana Nagrajan,3 Nancy Thomas3 1Department of Medical Services and Clinical Research, 2Department of Research and Development, 3Department of Neurorehabilitation, NeuroGen Brain and Spine Institute, Surana Sethia Hospital and Research Centre, Chembur, Mumbai, India Background: Cell therapy is amongst the most promising treatment strategies in spinal cord injury (SCI because it focuses on repair. There are many published animal studies and a few human trials showing remarkable results with various cell types. The level of SCI determines whether paraplegia or quadriplegia is present, and greatly influences recovery. The purpose of this study was to determine the significance of the clinical effects and long-term safety of intrathecal administration of autologous bone marrow-derived mononuclear cells, along with changes in functional independence and quality of life in patients with thoracolumbar SCI. Methods: We undertook a retrospective analysis of a clinical study in which a nonrandomized sample of 110 patients with thoracolumbar SCI underwent autologous bone marrow-derived mononuclear cell transplantation intrathecally and subsequent neurorehabilitation, with a mean follow-up of 2 years ± 1 month. Changes on any parameters were recorded at follow-up. The data were analyzed using the Wilcoxon's signed-rank test and McNemar's test. Functional Independence Measure and American Spinal Injury Association (ASIA scores were recorded, and a detailed neurological assessment was performed. Results: Overall improvement was seen in 91% of patients, including reduction in spasticity, partial sensory recovery, and improvement in trunk control, postural hypotension, bladder management, mobility, activities of daily living, and functional independence. A significant association of these symptomatic improvements with the cell therapy intervention was established

  9. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria

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    Owolabi L


    Full Text Available Background: Kano is the most populated state in Nigeria with a population totaling 9,383,682. The pattern of neurologic diseases in this area is not known. Objective: To determine the of pattern of neurologic diseases warranting admission in a tertiary hospital in Kano and compare it with those elsewhere in the country with the view to using the data generated as a baseline for planning purposes and for future studies. Materials and Methods: The medical records of all cases admitted with neurologic diseases in the Aminu Kano Teaching Hospital, Kano between January 2005 and September 2008, were retrospectively reviewed and the frequency of neurologic diseases, sex, age, and outcome of these diseases analyzed. Result: Stroke, predominantly ischemic, accounted for 77.6% of the neurological cases for the period of study. Central nervous system infections, comprising mainly of meningitis and tetanus, accounted for 6.6% (64 and 3% (29 of cases, respectively. The myelopathies were the cause of neurologic admissions in 5.4% (53 with paraplegia and quadriplegia resulting from myelopathies accounting for 5% (49 and 0.4% (4 of the cases. Hypertensive encephalopathy and status epilepticus as the causes of admissions accounted for 1.6% each. Gullain Barre syndrome, Parkinson′s disease, and cerebral malaria were relatively rare causes of neurologic admissions in this study. The average duration of hospitalization was 25 days, and regarding outcome, 219 (22.4% of these cases died. Conclusions: Stroke appeared to be the most common neurologic admission and the most common cause of neurologic and medical death in Kano as observed in other regions of the country and a little over one-fifths of stroke patients die. Central nervous system infections mainly meningitis and tetanus are the next common cause of admission. In view of these findings, the provision of a regional stroke unit, the improvement of the sanitary conditions of the home and environment; the

  10. Prolonged Subdural Infusion of Kynurenic Acid Is Associated with Dose-Dependent Myelin Damage in the Rat Spinal Cord.

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    Wojciech Dabrowski

    Full Text Available Kynurenic acid (KYNA is the end stage metabolite of tryptophan produced mainly by astrocytes in the central nervous system (CNS. It has neuroprotective activities but can be elevated in the neuropsychiatric disorders. Toxic effects of KYNA in the CNS are unknown. The aim of this study was to assess the effect of the subdural KYNA infusion on the spinal cord in adult rats.A total of 42 healthy adult rats were randomly assigned into six groups and were infused for 7 days with PBS (control or 0.0002 pmol/min, 0.01 nmol/min, 0.1 nmol/min, 1 nmol/min, and 10 nmol/min of KYNA per 7 days. The effect of KYNA on spinal cord was determined using histological and electron microscopy examination. Myelin oligodendrocyte glycoprotein (MOG was measured in the blood serum to assess a degree of myelin damage.In all rats continuous long-lasting subdural KYNA infusion was associated with myelin damage and myelin loss that was increasingly widespread in a dose-depended fashion in peripheral, sub-pial areas. Damage to myelin sheaths was uniquely related to the separation of lamellae at the intraperiod line. The damaged myelin sheaths and areas with complete loss of myelin were associated with limited loss of scattered axons while vast majority of axons in affected areas were morphologically intact. The myelin loss-causing effect of KYNA occurred with no necrosis of oligodendrocytes, with locally severe astrogliosis and no cellular inflammatory response. Additionally, subdural KYNA infusion increased blood MOG concentration. Moreover, the rats infused with the highest doses of KYNA (1 and 10 nmol/min demonstrated adverse neurological signs including weakness and quadriplegia.We suggest, that subdural infusion of high dose of KYNA can be used as an experimental tool for the study of mechanisms of myelin damage and regeneration. On the other hand, the administration of low, physiologically relevant doses of KYNA may help to discover the role of KYNA in control of

  11. Kennedy病的临床、病理及AR基因分析一例%Clinical,pathological and genetic analysis of a Chinese patient with Kennedy disease

    Institute of Scientific and Technical Information of China (English)

    李海燕; 李楠; 唐北沙; 齐尚书; 杨清成


    Objective To study the clinical, pathological and genetic characteristics of a Chinese patient with Kennedy disease ( KD ). Methods The clinical, electrophysiological and pathological data of the patient were analysed. Blood samples were collected from the patient and his 4 siblings. Mutation analysis of AR gene was made by means of DNA-direct sequencing. Results The patient mainly presented quadriplegia and accompanied with bulbar paralysis, musle atrophy, sensory disturbance and gynaecomastia, blood fat and crestase increased, Electron-eurogram demonstrated sense and motor conductive velocity slowing and electromyogram demonstrated ventricornual motor neurons affecting. Atrophy muscle fibers were found by pathology examination. CAG repeat number of the first exon of AR gene of the patient is 43, but the CAG repeat numbers of his siblings were from 19 to 23. Conclusions A Chinese KD patient is found by AR gene mutation analysis. The symptoms of KD patient are not specified, electro-neurogram and pathology examination are benefical to the diagnosis of KD. AR gene mutation analys is the reliable method for KD diagnosis.%目的 探讨Kennedy病(KD)的临床、病理及基因特点.方法 对1例KD患者进行临床、电生理和病理检查.抽取该患者及4位家族成员外周静脉血并抽提其基因组DNA,采用PCR-DNA直接测序的方法进行AR基因分析.结果 该患者临床表现为缓慢进行性四肢无力,伴有延髓麻痹、肌肉萎缩、肌束跳动、感觉障碍和男性乳房发育;血脂、肌酶升高;肌电图提示前角细胞损害,周围神经感觉及运动传导速度减慢;肌肉病理可见萎缩的肌纤维及肥大固缩的细胞核;AR基因分析发现患者第一外显子CAG重复突变,重复次数为43次,4位家族成员为19~23次.结论该例为散发性KD患者;KD临床表现不典型,肌电图和病理检查提示神经源性损害,确诊需行AR基因分析.

  12. Beneficial Effects of Childhood Selective Dorsal Rhizotomy in Adulthood. (United States)

    Park, T S; Edwards, Caleb; Liu, Jenny L; Walter, Deanna M; Dobbs, Matthew B


     Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults.  Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults.   Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR.  Results: In our study population of 294 patients (18.0 - 37.4 years), patients received SDR during the ages of 2.0 - 17.9 years and were followed up 2.2 to 28.3 years after surgery. Eighty-four percent had spastic diplegia, 12% had spastic quadriplegia, and 4% had spastic triplegia. The majority (88%) of patients reported improved post-SDR quality of life and 1% considered the surgery detrimental. Most (83%) would recommend the procedure to others and 3% would not. However, patients who would not recommend SDR to others ambulated with a walker or were not ambulatory at all prior to SDR. The majority (83%) of patients improved (30%) or remained stable (53%) in ambulation. Twenty-nine percent of patients reported pain, mostly in the back and lower limbs, with a mean pain level of 4.4 ± 2.4 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in small areas of the lower limbs was reported by 8% of patients, though this did not affect daily life. Scoliosis was diagnosed in 28%, with 40% of these patients pursuing treatment. Whether scoliosis was related to SDR is not clear, though scoliosis is known to occur in patients with CP and also in the general population. Only 4% of patients underwent spinal fusion

  13. Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter?

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    Thavorncharoensap M


    Full Text Available Montarat Thavorncharoensap,1,2 Yot Teerawattananon,2 Sirin Natanant,2 Wantanee Kulpeng,2 Jomkwan Yothasamut,2 Pitsaphun Werayingyong21Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Thailand; 2Health Intervention and Technology Assessment Program (HITAP, Ministry of Public Health, ThailandBackground: This study aims to elicit the value of the willingness to pay (WTP for a quality-adjusted life year (QALY and to examine the factors associated with the WTP for a QALY (WTP/QALY value under the Thai health care setting.Methods: A community-based survey was conducted among 1191 randomly selected respondents. Each respondent was interviewed face-to-face to elicit his/her health state preference in each of three pairs of health conditions: (1 unilateral and bilateral blindness, (2 paraplegia and quadriplegia, and (3 mild and moderate allergies. A visual analog scale (VAS and time trade off (TTO were used as the eliciting methods. Subsequently, the respondents were asked about their WTP for the treatment and prevention of each pair of health conditions by using a bidding-game technique.Results: With regards to treatment, the mean WTP for a QALY value (WTP/QALYtreatment estimated by the TTO method ranged from 59,000 to 285,000 baht (16.49 baht = US$1 purchasing power parity [PPP]. In contrast, the mean WTP for a QALY value in terms of prevention (WTP/QALYprevention was significantly lower, ranging from 26,000 to 137,000 baht. Gender, household income, and hypothetical scenarios were also significant factors associated with the WTP/QALY values.Conclusion: The WTP/QALY values elicited in this study were approximately 0.4 to 2 times Thailand's 2008 GDP per capita. These values were in line with previous studies conducted in several different settings. This study's findings clearly support the opinion that a single ceiling threshold should not be used for the resource allocation of all types of interventions.Keywords: ceiling threshold

  14. The use of urologic investigations among patients with traumatic spinal cord injuries

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    Welk B


    Full Text Available Blayne Welk,1,2 Kuan Liu,2 Salimah Z Shariff,2 1Department of Surgery and Epidemiology and Biostatistics, Western University, ON, Canada; 2Institute for Clinical Evaluative Sciences – Western (ICES Western, London, ON, CanadaObjective: To assess the use of urologic investigations among traumatic spinal cord injury (TSCI patients.Methods: This is a retrospective cohort study from Ontario, Canada. We included all adult TSCI patients injured between 2002 and 2012. The primary outcome was the frequency of urodynamic testing, renal imaging, and cystoscopy. Primary exposure was the year of injury. The impact of age, sex, comorbidity, socioeconomic status, and lesion level was assessed with Cox regression models.Results: One thousand five hundred and fifty one incident TSCI patients were discharged from a rehabilitation hospital. The median follow-up time of this cohort was 5.0 years (interquartile range =2.9–7.5. At least one urodynamics, renal imaging, or cystoscopy was performed during follow-up for 50%, 80%, and 48% of the cohort, respectively. The overall rate of these tests was 0.22, 0.60, and 0.22 per person-year of follow-up. The proportion of patients who had regular, yearly urodynamics (<2%, renal imaging (6%, or cystoscopy (<2% was low. There were no significant linear trends in the use of these tests over the 10-year study period. Urodynamics were significantly less likely to be performed in patients over 65 years of age (hazard ratio [HR] =0.63, P<0.01 and those with a higher level of comorbidity (HR =0.72, P<0.01. Patients with quadriplegia were significantly less likely to receive any of the investigations compared to those with paraplegia.Conclusion: Renal imaging is done at least once for the majority of patients with TSCI; however, only half undergo urodynamics or cystoscopy. Few patients have regular urologic testing. The reality of urologic testing after TSCI is very different from urologist's ideals and practice guidelines

  15. Early diagnosis and treatment of acute or subacute spinal epidural hematoma

    Institute of Scientific and Technical Information of China (English)

    YU Hang-ping; FAN Shun-wu; YANG Hui-lin; TANG Tian-si; ZHOU Feng; ZHAO Xing


    Background Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.Methods Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3-48 hours afterappearance of symptoms, and 6 patients were transferred from community hospitals within 21-106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients,B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T1 weighted image and mixed hyperintensity on T2 weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.Results Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1-6 years. A marked difference was noted between

  16. Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. (United States)

    Himes, Benjamin T; Mallory, Grant W; Abcejo, Arnoley S; Pasternak, Jeffrey; Atkinson, John L D; Meyer, Fredric B; Marsh, W Richard; Link, Michael J; Clarke, Michelle J; Perkins, William; Van Gompel, Jamie J


    OBJECTIVE Historically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series. METHODS The authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure. RESULTS In a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2-70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12-0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of

  17. Intelligence Delay in Children with Cerebral Palsy of Preschool Age%学龄前脑性瘫痪患儿智力水平调查

    Institute of Scientific and Technical Information of China (English)

    孙殿荣; 侯梅; 李君; 李媛; 孙爱娟


    目的探讨4~6岁不同类型脑瘫患儿的智力水平分布及特征,对智力特点及相关因素进行分析。方法对215例4~6岁脑瘫患儿进行基础资料登记、智力评定、粗大运动功能分级评定等。结果210例完成智力评定,其中智力低下患儿113例(53.81%)。痉挛型双瘫、偏瘫和不随意运动型患儿的平均智力水平高于痉挛型四肢瘫、共济失调型;其中痉挛型双瘫患儿的言语智商(VIQ)和操作智商(PIQ)有显著性差异(P<0.05)。GMFCS分级Ⅳ~Ⅴ级者及并发癫痫、小头畸形者,智力低下的发生明显高于GMFCS分级Ⅰ~Ⅲ级者及不伴癫痫、小头畸形者(P<0.05)。结论4~6岁脑瘫患儿智力低下的发生和脑瘫类型、GMFCS分级及并发癫痫、小头畸形有关。%Objective To investigate the intelligence level and characters in children with cerebral palsy of 4~6 years old, and the factors related with their intelligence. Methods 215 cerebral palsy children of 4~6 years old were assessed with Wechsler Intelligence Scale for chil-dren, Gross Motor Function Classification System (GMFCS). Results 210 children finished their intelligence test, and 113 presented mental retardation. The intelligence level was higher in the children with spastic diaplegia, hemiplegia and dyskinetic type than those with quadri-plegia and ataxia type. The difference was significant between VIQ and PIQ in the spastic diplegia (P<0.05). The mental retardation was more frequent in the children with GMFCSⅣ~Ⅴ, or with epilepsy or microcephaly than those with GMFCSⅠ~Ⅲor without the compli-cations (P<0.05). Conclusion The incidence of mental retardation in children with cerebral palsy was related with the neurotypes, motor function and complications.

  18. A demographic profile of 7273 traumatic and non-traumatic spinal cord injured patients in Iran (United States)

    Eslami, Vahid; Rahimi-Movaghar, Vafa


    Abstract: Background: To evaluate demographic profile of traumatic and non-traumatic spinal cord injured (SCI) patients. Methods: Mobile rehabilitation teams gathered data in 20 out of 30 provinces in Iran. Of 8104 traumatic and non-traumatic SCI patients under coverage of the State Welfare Organization of Iran registered in the database, 7273 were included in the analysis. The aggregate data on SCIs, including age, gender, place of residence, education level, marital status, etiology of injury, age at the time of injury, time passed since injury, level of injury, type of cord injury, having caregiver, and occupation were recorded. Results: Of 7273 patients, 5175 (71.1%) were male. At the time of the study, 46% were in the age group 20-40 years old, 34% were more than 40, and 20% were less than 20 years old. The residential place of 26% was in villages. 23.9% were illiterate, 6.9% had high school diploma or higher. The distribution of cervical, thoracic, and lumbar levels of injury was 17.7, 24.4, and 57.9%, respectively. Overall, there were 49% married and 45.8% never married, while 1.4% patients were single because their partners had left them, 1.7% of partners had died, 1.9% had divorced, and 0.3% had remarried. At the time of the presentation of patients, 33% were 21-30 years-old, 17% were 31-40, and 16% were less than 20 years. About the type of cord injury, the paraplegia, paraparesia, quadriplegia, quadriparesia, and hemiparesia were present in 72.1, 12.5, 10.2, 4.0, and 1.1% of patients, respectively. Unemployment was reported in 55.6% of patients. However, 17% were unable to work, 7.1% had a job, and 3.4% were retired. Caregiver was not provided for 7.5% of them. The most prevalent causes of the injury were: trauma (57.4%), congenital (14.4%), tumors (4.4%), spinal degenerative disorder such as canal stenosis (2.2%), genetic (2.0%), infection (1.9%), scoliosis (1.1%), and miscellaneous (10.6%). Conclusions: These data will provide the information to guide

  19. Meningite bacteriana neonatal: estudo prospectivo da evolução a longo prazo de 55 crianças Neonatal bacterial meningitis: prospective study of the long term outcome of 55 children

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    Vera Lúcia Jornada Krebs


    Full Text Available Foram estudadas prospectivamente 55 crianças que apresentaram meningite bacteriana no período neonatal, com o objetivo da analisar a frequência e o tipo de sequelas neurológicas. Todas as crianças nasceram a termo, sendo 38 do sexo masculino e 17 do feminino; a idade de início da doença variou de 3 a 28 dias. Os principais agentes etiológicos foram as enterobactérias. O tempo médio de seguimento foi 5 anos. A frequência de sequelas neurológicas foi 67,3%, representadas principalmente pelo atraso do desenvolvimento neuropsicomotor (58,2%, hidrocefalia (45,5% e convulsões (34,5%. As alterações motoras graves ocorreram em 23,6% dos pacientes (tetraplegia, diplegia, hemiparesia e ataxia. As convulsões na fase aguda da doença e a cultura positiva do líquido cefalorraqueano estiveram associadas significativamente com a presença de sequelas. Na avaliação do desempenho escolar, realizada em 25 crianças, observaram-se dificuldades na aprendizagem em 48% dos casos, associadas significativamente à deficiência mental.Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns.There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%, hydrocephaly (45.5% and convulsions (34.5%. Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia. Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

  20. Teardrop fracture following head-first impact in an ice hockey player: Case report and analysis of injury mechanisms. (United States)

    Yue, James J; Ivancic, Paul C; Scott, David L


    We report a case of a young male athlete who sustained a three column displaced teardrop fracture of the C5 vertebra due to a head-first impact in hockey, suffered neurapraxia, yet made full neurological recovery. This full recovery was in sharp contrast to multiple case series which reported permanent quadriplegia in the vast majority of teardrop fracture patients. We investigate the etiology and biomechanical mechanisms of injury. Admission imaging revealed the teardrop fracture which consisted of: a frontal plane fracture which separated an anterior quadrilateral-shaped fragment from the posterior vertebral body; a vertical fracture of the posterior vertebral body in the sagittal plane; and incomplete fractures of the neural arch that initiated superiorly at the anterior aspect of the spinous process and left lamina adjacent to the superior facet. Epidural hematoma in the region of the C5 vertebra was observed in addition to disc and ligamentous disruptions at C4-5 and C5-6. Our patient was ultimately treated surgically with anterior fusion from C4 through C6 and subsequently with bilateral posterior fusion at C5-6. The injuries were caused by high-energy axial compression with the neck in a pre-flexed posture. The first fracture event consisted of the anterior vertebral body fragment being sheared off of the posterior fragment under the compression load due in part to the sagittal plane concavity of the C5 inferior endplate. The etiology of the vertical fracture of the posterior vertebral body fragment in the sagittal plane was consistent with a previously described hypothesis of the mechanistic injury events. First, the C4-5 disc height decreased under load which increased its hoop stress. Next, this increased hoop stress transferred lateral forces to the C5 uncinate processes which caused their outward expansion. Finally, the outward expansion of the uncinate processes caused the left and right sides of the vertebral body to split and spread. Evidence in

  1. O uso da ausculta cervical na inferência de aspiração traqueal em crianças com paralisia cerebral The use of cervical auscultation in tracheal aspiration in children with cerebral palsy

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    Ana Maria Furkim


    Full Text Available OBJETIVO: comparar a detectabilidade da ausculta cervical na avaliação clínica com a comprovação da aspiração na videofluoroscopia da deglutição em crianças com paralisia cerebral tetraparética espástica com disfagia orofaríngea. MÉTODOS: estudo retrospectivo com análise de 101 prontuários de crianças, na faixa etária de 1 a 12 anos, pertencentes a uma instituição, com diagnóstico de paralisia cerebral tetraparética espástica e que foram encaminhadas e avaliadas por equipe interdisciplinar. Foi realizada anamnese com avaliação clínica da alimentação com ausculta cervical e videofluoroscopia da deglutição. RESULTADOS: os resultados estatísticos mostraram que há relação significante entre a ausculta cervical positiva e a penetração ou aspiração laríngea constatada na videofluoroscopia da deglutição e que a ausculta cervical negativa está mais associada à não penetração/aspiração. CONCLUSÃO: concluiu-se que a ausculta cervical pode ser utilizada para inferência do risco de aspiração e, portanto, como alerta para atuação precoce nessa população, além da vantagem de ser um método não invasivo.PURPOSE: to compare the efficacy of cervical auscultation during the clinical evaluation with the confirmation of aspiration in the videofluoroscopy of deglutition in oropharyngeal dysphagic children with tetraparetic cerebral palsy. METHODS: retrospective study with analysis of 101 notes of children, between 1 and 12-year old, enrolled in one institution, with the diagnosis of cerebral palsy spastic quadriplegia and referred and evaluated by interdisciplinary team. Clinical history, clinical evaluation of feeding with cervical auscultation and videofluoroscopy of deglutition were performed. RESULTS: the statistical results showed significance between positive cervical auscultation and laryngeal penetration or aspiration during the videofluoroscopy of deglutition and a negative cervical auscultation is

  2. Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function Classificação da paralisia cerebral: associação entre gênero, idade, tipo motor, topografia e Função Motora Grossa

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    Luzia Iara Pfeifer


    Full Text Available The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887 or between gender and motor type (p=0.731. In relation to body topography most children (88% were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.Este estudo teve como objetivo avaliar a relação entre gênero, idade, tipo motor, topografia e Função Motora Grossa, baseado no Sistema de Função Motora Grossa em crianças com paralisia cerebral. Participaram desta pesquisa 100 crianças com idade entre 5 meses a 12 anos que foram observadas em relação ao controle de tronco, trocas posturais e marcha. Não houve diferenças significativas entre gêneros e grupos etários (p=0,887 e entre gênero e tipo motor (p=0,731. Em relação à topografia corporal, houve predomínio de crianças com quadriplegia, sendo que a maioria (88% era do tipo espástico. Quanto ao nível motor, as crianças hemiplégicas pertenciam em sua maioria ao nível I, as diplégicas ao nível III e as quadriplégicas ao nível V. Sendo a paralisia cerebral uma condição complexa que depende de diversos fatores, beneficia-se de classificações funcionais para compreensão da diversidade e melhor planejamento terapêutico.

  3. 脑瘫患儿语言发育迟缓及其与粗大运动功能分级的关系%Language retardation and its relationship with the GMFCS levels in children with cerebral palsy

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    李倩; 王松青; 侯梅; 苑爱云; 李淑秋; 乔卫卫


    Objective :To analyze the correlation of language development level with types of cerebral palsy (CP) and gross motor function in children with CP .Methods:The children with CP treated in Qingdao Women and Chil-dren's Hospital from January 2012 to January 2013 were assessed with Gross Motor Function Classification System (GMFCS) ,and Sign-Significate Language Development Test .The retardation rate and severity of language reception and expression as well as their relationships with the CP types and GMFCS levels were explored .Results :Among 113 cases ,42 were in GMFCS levels Ⅰ and Ⅱ ,27 in Ⅲ ,and 44 in Ⅳ and Ⅴ .Most children with hemiplegia belonged to the mild movement disorders :18 .75% delay in language reception and 37 .5% delay in language expression .Of the children with spastic diplegia ,half were for mild dyskinesia and half for moderate and severe dyskinesia :28/42 (66 .67% ) delay in language reception and 35 (83 .33% ) delay in language expression .Spastic quadriplegia ,ataxia , dyskinetic and mixed types of CP were mainly associated with moderate and severe dyskinesia :88 .89% ,75 .00% , 91 .67% ,71 .43% delay in language development respectively .The children with dyskinetic and mixed types of CP had obviously better language reception than expression (P<0 .05 for all) ,however ,delay in language reception and expression was fair .There was a positive correlation between language retardation rate and GMFCS levels in children with CP (r=0 .402 and 0 .389 for language reception and expression respectively ,P<0 .01) .Conclusions :Language reception and/or expression retardation are common in children with CP and the incidence and severity are also asso-ciated with CP types as well as the GMFCS levels .Planning appropriate language therapeutic intervention is there-fore vital ,especially for children with spastic quadriplegia ,dyskinetic ,mixed types of CP and those with GMFCS lev-els of Ⅲ to V .%目的:探讨不同类型脑瘫患儿语言

  4. Clinical and MRI Features of Hand - foot - mouth Disease Related to Enterovirus 71 and Associated with Acute Flaccid Paralysis%合并急性弛缓性瘫痪的肠道病毒71型相关手足口病临床及MRI特征研究

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    叶信健; 刘锟; 张桂艳; 白光辉; 周云新; 严志汉


    Objective To investigate the clinical and MRI characteristics of hand - foot - mouth diseases related to enlerovinis 71 ( EV71) combined with acute flaccid paralysis ( AFP) . Methods Hie clinical and MRI manifestations of fourteen infants suffered from hand - foot - mouth diseases related to enterovirus 71 (EV7I) combined with AFP were retrospectively analyzed. Results Among the fourteen infants with AFP, one had paralysis of unilateral upper limbs, one had paralysis of the unilateral lower limbs, two had paralysis of bilateral upper limbs, one had paralysis of bilateral lower limbs, three had hemiplegia, and six had quadriplegia. All cases clinically presented acute limb myaslhenia with tendon reflex and muscular tension lowered. On the spinal MRI, the lesions involved the anterior hom regions of spinal cord had hyperintensity on T2 - weighted images and hypointensity on T1 - weighted images, which were elongated on sagittal images and patchy on transverse images. Six patients simultaneously contained brainstem encephalitis. MRI showed that the lesions located at the posterior portions of the medulla, pons. The lesions had hyperintensity on T2 -weighted images and hypointensity on T1 - weighted images. Conclusion MRI is the most effective method on evaluating the range, degree and prognosis of the injuries on spinal cord and brain of hand - foot - mouth diseases related to enterovirus 71 ( EV71) combined with AFP. MRI findings have relative specificity. The hand - foot - mouth diseases related to enterovirus 71 (EV71) combined with AFP often involve the anterior horn of the spinal cord, medulla oblongata and pons.%目的 探讨合并急性弛缓性瘫痪(AFP)的肠道病毒71型(EV71)相关手足口病(HFMD)的临床及MRI特征.方法 回顾性分析14例伴有AFP的EV71型相关HFMD患儿临床及MRI资料,并总结其临床及MRI特征.结果 14例患儿中,单上肢瘫痪1例、单下肢瘫痪1例、双上肢瘫痪2例、双下肢瘫痪1例、单侧偏瘫3

  5. 急性桥臂梗死的临床特点%Clinical features of acute middle cerebellar peduncles infarction

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    赵媛; 马文平


    Objective To study the clinical features of acute middle cerebellar peduncles infarction.Methods The clinical data of 27 patients with acute middle cerebellar peduncles infarction were analyzed retrospectively.Results This group patients had the manifestation of dizziness 20 cases,with unstable walking 9 cases; nausea,vomiting 10 cases,tinnitus 4 cases,hearing loss 5 cases,horizontal nystagmus 5 cases,ocular motility disorders 2 cases,peripheral facial paralysis 3 cases,central facial palsy 2 cases,upper motor neuron paralysis on one side 5 cases,quadriplegia 1 case,hemifacial sensory disturbance 4 cases,ataxia 9 cases.Head CT examination showed 10 cases (37%) with cerebellar peduncle infarction.Head MRI examination of 23 patients showed cerebellar peduncle with new infarction of long T1 WI,T2WI,DWI high signal (100%),including unilateral 21 cases,bilateral 2 cases.Conclusions The main manifestation of middle cerebellar peduncle infarction are vestibular nerve and cerebellar impairment,and including the manifestation of trigeminal nerve,facial nerve,abducens nerve and pyramidal tract impairment.The diagnostic accuracy of MRI on it is very high,should be used as the first choice for examination.%目的 研究急性桥臂梗死的临床特点.方法 对27例急性桥臂梗死患者的临床资料进行回顾性分析.结果 本组患者表现为头晕20例,其中伴行走不稳9例;恶心、呕吐10例,耳鸣4例,听力减退5例,水平性眼震5例,一侧眼球外展受限2例,中枢性面瘫2例,周围性面瘫3例,一侧肢体中枢性瘫痪5例,四肢瘫痪1例,一侧面部痛觉减退4例,共济失调9例.头颅CT检查示桥臂梗死10例(37%).头颅MRI检查23例患者,均示桥臂长T1、长T2、DWI高信号的新梗死灶(100%),其中21例为单侧、2例为双侧桥臂梗死.结论 急性桥臂梗死以前庭神经和小脑损害的表现为主,以及存在三叉神经、面神经、展神经和锥体束受累的表现.MRI对其诊断的准确性

  6. Fisiopatología de las alteraciones neuromusculares en el paciente crítico Pathophysiology of neuromuscular impairments in the critically ill patients

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    A. García de Lorenzo


    Full Text Available Objetivo: Analizar las causas y manifestaciones de la debilidad muscular que desarrollan los pacientes críticos durante su estancia en la UCI y revisar la bibliografía. Desarrollo: A principios de los años 80 se describió en pacientes críticos sépticos una polineuropatía axonal mixta que clínicamente se caracterizaba por una debilidad muscular de intensidad variable que en su vertiente más grave producía tetraplejia y/o dependencia del ventilador. Casi paralelamente se describió la miopatía aguda de los cuidados intensivos en pacientes asmáticos que eran ingresados en la UCI por exacerbación de su enfermedad. Con posterioridad se observó que esta miopatía se presentaba también en pacientes trasplantados, sépticos o quemados. Hay autores que consideran a la miopatía aguda de los cuidados intensivos como la primera causa de debilidad muscular en la UCI. Conclusiones: En este artículo se describen la clínica, etiopatogenia, diagnóstico y tratamiento de la polineuropatía del paciente crítico y de la miopatía aguda de los cuidados intensivos. Los dos cuadros clínicos son diferenciables en muchas ocasiones, siendo de gran ayuda los estudios neurofisiológicos y eventualmente la biopsia muscular. Aunque algunos autores prefieren englobar estas entidades bajo el nombre de polineuromiopatía, proponemos la denominación general de Síndrome Neuromuscular Agudo en el paciente crítico término más descriptivo, que no presupone un mecanismo ni una etiología única.Objective: to analyze the causes and manifestations of muscle weakness that critically ill patients develop during their staying at the ICU, and literature review. Development: in the early 1980s, a mixed axonal polyneuropathy was described in septic critically ill patients, which clinically manifested by muscle weakness of variable severity, leading to quadriplegia and/or ventilator dependency in its most severe presentation. Almost at the same time, an acute

  7. Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

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    Talieh Zarifian


    ; AAC use patterns; AAC limitations are main issues, an AAC technology for post-stroke patients will be presented which developed by a knowledgebase company in Iran. The system allows patients with communication and motor impairment to state their intentions and feelings by a minimum movement in their body, or just by moving their eyes. Different sensors and switches are available to adopt based on the limited ability of the patients. For detecting eye movements, a novel wearable miniaturized system has been developed that is worn as a headband and detects eye movements based on processing electro-oculogram. A high performance graphical user interface has been developed to type letters and numbers in Persian language. The system also provides words prediction, text to speech conversion with natural voice, and sending/receiving messages in the mobile networks for a convenient communication experience. The developed system has been tested successfully by more than 20 patients with different disabilities, and is now commercially available. The proposed system can also help the severely disabled people with amyotrophic lateral sclerosis, quadriplegia, muscular dystrophy or cerebral palsy to communicate with others and mention their intentions, needs and feelings. This low-cost wearable device assures high level of comfort for the user without fatigue and do not need long time training. The system can also be adapted for the patients who can speak, but could not move their hands, to work with the computer and enjoy using the internet.

  8. Relationships of magnetic resonance imaging characters and clinic presentations of children cerebral palsy%儿童脑性瘫痪MRI特征与临床表现的相关性

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    王莹; 王海宝; 余永强; 徐丽艳; 陈玉萍


    Objective To explore the valuation of MRI in clinic diagnosis of children cerebral palsy( CP) by tes-ting relationships between types of CP, gross motor function( GMFCS) ,gestational age at birth and MRI findings of the brain. Methods The clinic and MRI data were collected and their correlations were analyzed. Results A-mong 143 cases of cerebral palsy,52 cases were periventricular white matter injury( PWMI) ,31 cases were diffusive encephalopathy,19 cases were brain malformations,11 cases were focal cerebral vascular accident,24 cases were normal and 6 cases were unclassifiable. Distributions of GMFCS were significantly different among various neuroim-aging findings(χ2 =87.974,P=0.000,Fisher exact test). For PWMI, preterm infants were mainly involved with spastic diplegia or spastic hemiplegia, and GMFCS levels wereⅠ~Ⅲ. Diffusive encephalopathy was most com-monly shown in dyskinetic CP and spastic quadriplegia,and GMFCS levels were Ⅳ~Ⅴ. Brain malformations and focal cerebral vascular accident were common in term infant patients, and for GMFCS levels the former were Ⅳ~Ⅴ,while the latter wereⅠ~II. Conclusion Correlations are significant between MRI findings with types of CP, gross motor function and gestational age at birth and it's important for MRI in earlier diagnosis and prognosis valua-tion of cerebral palsy.%目的通过分析脑性瘫痪( CP)患儿磁共振表现与其类型、粗大运动功能分级( GMFCS)及出生胎龄的关系,探讨MRI在小儿CP临床诊断中的价值。方法收集143例CP患儿的临床和MRI资料,回顾性分析其间相关性。结果MRI表现为室周白质损伤(PWMI)52例,弥漫性脑损伤31例,脑发育异常19例,局灶性脑血管意外11例,正常24例,无法分类性病变6例。不同类型MRI表现的GMFCS分布差异有统计学意义(χ2=87.974,P =0.000, Fisher 精确检验)。 PWMI的患儿中,早产儿多见,且主要为双瘫及偏瘫, GMFCSⅠ~Ⅲ级较多。弥漫性脑损伤中,四肢瘫及不

  9. Consecuencias clínicas de las alteraciones neuromusculares en el paciente crítico Clinical consequences of neuromuscular impairments in critically ill patients

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    A. Mesejo


    weakness and quadriplegia which most typical manifestation is the need for assisted ventilation and/or weaning difficulty/impossibility. Triggering factors considered are multiorgan failure and sepsis in polyneuropathy, and steroids and neuromuscular blockers in myopathy, with malnutrition, particularly hypoalbuminemia, and hyperglycemia being co-adjuvant in both conditions.Considering that neuropathic and myopathic conditions may frequently coexist, the term polyneuromyopathy of the critically ill patient has been coined. Both Guillain-Barré syndrome and polyneuropathy of the critically ill patient involve peripheral nerves, so that the differential diagnosis has to be made between both.The presenting picture is different, since the former is an acute pathology that motivates ICU admission, whereas the latter is a polyneuropathy acquired during hospitalization. In the former, involvement of the autonomous nervous system and CSF albumin-cytology dissociation are common, which do not occur in polyneuropathy. Electrophysiological studies show demyelinating signs with decreased conduction velocity and normal amplitude of motor potentials in Guillain-Barré syndrome versus normal conduction velocity and reduced amplitude of motor potentials in axonal polyneuropathy. Myasthenic crisis affects the neuromuscular junction and its diagnosis tends to be easier since in most of the cases a previous diagnosis of myasthenia gravis exists.Muscle weakness increases during repeated activity (muscle fatigue and improves on resting. Diagnostic confirmation is done by means of edrophonium test and by repeated nerve stimulation, which leads to a rapid decrease by 10-15% of the amplitude of evoked responses. Myopathy of the critically ill patient involves the muscle and provokes a generalized weakness with quadriplegia, very similar to that from polyneuropathy, which prevents or delays weaning from mechanical ventilation, and which may lead to CPK and myoglobin increase in more advanced

  10. Simultaneous multilevel surgery in the treatment of spastic cerebral palsy hand: a short-term follow up%同步多平面手术治疗痉挛性脑瘫手近期随访

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    王树; 王加宽; 盛春勇; 李俊; 陈智博; 王玉欢; 顾加祥


    目的 探讨同步多平面手术治疗痉挛性脑瘫手的手术方法和临床疗效.方法 回顾性分析2010年1月至2014年6月同步多平面手术治疗获得半年以上随访的25例30肢痉挛性脑瘫手的资料,四肢痉挛型5例,偏瘫痉挛型20例,所有手的畸形均合并下肢痉挛.同步采取的多平面手术方法有肌皮神经、正中神经、尺神经显微神经微缩术,肱骨内上髁屈肌旋前圆肌群松解,腕关节稳定拇指功能重建或伸腕功能加强拇指功能重建及下肢畸形的显微神经微缩术与软组织手术.肌张力按Lazareff分级评定,手功能按脑瘫儿手功能分级系统(MACS)评定,对术后疗效进行统计学分析.结果 术后随访6个月至2年,平均1.6年.肌张力恢复有显著差异(z=-5.869,P<0.01),术前Ⅲ级14例,术后改善有效率为92.86%;术前Ⅳ级11例,术后改善有效率为100%.手功能恢复有显著差异(z=-6.139,P<0.01),术前Ⅳ级16例,术后改善有效率为93.75%;术前Ⅴ级9例,术后改善有效率为88.89%.结论 采用上肢显微神经微缩术配合上肢软组织矫治的同步多平面手术在降低肌张力的同时,一期矫正多关节的畸形,缩短手术疗程,预防痉挛复发,为手功能康复治疗创造条件.对合并下肢畸形也可实施同步手术矫正.术后制定个体化的康复方法,配合合理的支具固定,提高手术疗效.%Objective To evaluate the surgical techniques and clinical outcomes of simultaneous multilevel surgery in the treatment of spastic cerebral palsy hand.Methods A retrospective study was conducted to review the clinical data 25 cases of 30 spastic cerebral palsy hands treated with simultaneous multilevel surgery between January 2010 and June 2014 that had more than half a year follow-up.There were 5 cases of quadriplegia spastic hand and 20 cases of hemiplegia spastic hand.All had lower limb spasm as well.The simultaneous multilevel surgery included microsurgical manipulation

  11. Associations between Manual Abilities, Gross Motor Function, Epilepsy, and Mental Capacity in Children with Cerebral Palsy

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    Full Text Available How to Cite This Article: Gajewska E, Sobieska M, Samborski W. Associations between Manual Abilities, Gross Motor Function, Epilepsy, and Mental Capacity in Children with Cerebral Palsy. Iran J Child Neurol. 2014 Spring 8(2:45-52.ObjectiveThis study aimed to evaluate gross motor function and hand function in children with cerebral palsy to explore their association with epilepsy and mental capacity. Material & MethodsThe research investigating the association between gross and fine motor function and the presence of epilepsy and/or mental impairment was conducted on a group of 83 children (45 girls, 38 boys. Among them, 41 were diagnosedwith quadriplegia, 14 hemiplegia, 18 diplegia, 7 mixed form, and 3 athetosis.A neurologist assessed each child in terms of possible epilepsy and confirmed diagnosis in 35 children. A psychologist assessed the mental level (according toWechsler and found 13 children within intellectual norm, 3 children with mild mental impairment, 18 with moderate, 27 with severe, and 22 with profound.Children were then classified based on Gross Motor Function Classification System and Manual Ability Classification Scale.ResultsThe gross motor function and manual performance were analysed in relation to mental impairment and the presence of epilepsy. Epilepsy was found to disturb conscious motor functions, but also higher degree of mental impairment wasobserved in children with epilepsy.ConclusionThe occurrence of epilepsy in children with cerebral palsy is associated with worse manual function. The occurrence of epilepsy is associated with limitations in conscious motor functions. There is an association between epilepsy in children with cerebral palsy and the degree of mental impairment.The occurrence of epilepsy, mainly in children with hemiplegia and diplegia is associated with worse mental capacities.ReferencesRichards CL, Malouin F. Cerebral palsy: definition, assessment and rehabilitation. Handb Clin Neurol

  12. Analysis for Clinical Features of Medullary Infarction(31 cases)%31例延髓梗死患者的临床分析

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    吴菁; 李威


    Aim: To study the clinical features of medullary infarction with the results of MRI and the anatomy feature. Methods: 31 acute medullary infarctions were observed and their lesion distribution, symptoms, signs and general disability status were analyzed. Results: Based on the lesion distribution, 31 medullary infarction cases could be classified into: 16 cases of lateral medullary infarction(LMI), 13 cases of medial medullary infarction (MMI), and 2 cases of bilateral infarctions. LMI included patients with lesions in the dorsolateral or lateral medulla. MMI included patients with lesions in the ventromedial medulla, and most of them had involvement of the rostral medulla. LMI usually led to atypical or partial Wallenberg syndrome. Vertigo, Horner's sign, dysarthria, dysphagia, uranoplegia and limb ataxia were the most frequent symptoms or signs for LMI. MMI usually led to sensorimotor stroke or pure motor stroke. Contralateral hemiparalysis, dysarthria, central facial palsy and central lingual paralysis were the most frequent symptoms or signs for MMI. The two cases of bilateral infarctions were bilateral medial medullary infarctions. One represented clinical manifestation as quadriplegia, bilateral sensory disturbance, internuclear ophthalmoplegia, dysarthria and dysphagia. And the other represented manifestation ashemiplegia, dysarthria and forced crying. Conclusion: The classic medullary syndromes were not common. LMI usually led to atypical or partial Wallenberg syndrome. MMI often seemed to present as capsular/pontine lacunar stroke. Bilateral medial medullary infarctions mostly involved the bilateral pyramidal tracts, represented bilateral motor deficits, so had poorer outcome.%目的:根据头颅MRI对延髓梗死病灶的定位并结合延髓的解剖学特点,探讨延髓梗死临床表现的特征.方法:31例急性延髓梗死患者均行头颅MRI检查,对其病灶位置分布、神经系统症状体征,出院当天改良Rankin量表(mRS)评

  13. Clinical study of 15 children with hand foot and month disease and acute flaccid paralysis%手足口病合并急性弛缓性瘫痪15例临床分析

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    王玉光; 陈志海; 张璐; 卢联合; 冯亮; 王凌航; 徐艳利; 任娜; 庞琳; 李兴旺


    Objective To discuss the clinical characteristics and prognosis of 15 children with hand foot and mouth disease (HFMD) and acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Method The epidemiology, clinical manifestations, cerebrospinal fluid (CSF),magnetic resonance imaging and prognosis of 15 children with HFMD and AFP were retrospectively reviewed. The recovery of the patients' affected extremities were monitored for 4 weeks. Results The mean age of these patients was (22.47 ± 20.68) months (range: 5~72 months). Acute paralysis developed (3.47 ± 1.68) days after the onset of fever and progressed to maximum severity within (1~2) days. Poliomyelitis-like syndrome was observed in all cases. Of the 15 cases, 10 had monoplegia of lower limbs, two had paraplegia, one had monoplegia of upper limbs and two had quadriplegia. In these cases, the muscle power varied from level 0 to level 4, and six even showed no muscle power in their affected extremities. Thirteen cases developed neurologic complications (encephalitis, meningitis or ataxia) and three had transient urinary retention. Cerebrospinal MRI examination in eight cases showed hyperintense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord (C2~C7 for cases with upper extremity impairments and T12~L1 for cases with lower extremity impairments), and displayed long T1 signals and long T2 signals. In addition, the midbrain, brain-stem or medulla was also involved in four cases who also contracted encephalitis or meningitis. The muscle strength in 11 patients with single lower extremity impairment showed improvements in the distal limb muscles within 4~8 days, and the other cases showed recovery 2~3 weeks later. Conclusions HFMD in combination with AFP most commonly occurs in children aged less than 2 years old. Acute paralysis develops during the early stage of infection and progresses to a

  14. 手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度研究%The reliability of hand-held electronic dynamometer tests for lower limb muscle strength measurement in children with spastic cerebral palsy

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    史惟; 朱默; 骆丹丹; 杨红; 陈冬冬; 黄华玉


    Objective To determine the reliability of hand-held electronic dynamometer (HHD) tests for lower limb muscle strength measurement in children with spastic cerebral palsy (CP). Methods Twenty-eight children ( 15 boys and 13 girls; mean age 5 years 8 months) with different types of CP (2 with spastic quadriplegia,8 spastic diplegia, 6 hemiplegia, 1 triplegia and 1 monoplegia) , and at different functional levels ( 19 graded at gross motor function classification system level Ⅰ, 6 level Ⅱ, 2 level Ⅲ and 1 level Ⅳ ) were recruited from the Rehabilitation Center of the Children's Hospital of Fudan University. Standardized HHD protocols were used to measure the strength of their hip, knee and ankle muscles. The HHD test was performed by the same examiner twice with an interval of 10 min in between. The HDD test was also performed with 15 randomly selected CP children by 2 examiners with an interval of 10 min in between. The test-retest and inter-rater reliabilities of the HDD readings were determined by calculating the intra- and inter-class correlation coefficients. Results The HHD measurements showed fine testretest reliability ( ICC = 0.74-0.97 ) and inter-rater reliability ( ICC = 0.63-0.97 ) in measuring lower-limb muscle strength of children with spastic CP, with the highest test-retest reliability for the hip flexion, foot plantar flexion and knee extension muscle groups. The highest inter-rater reliability was achieved with the hip flexion and foot dorsiflexion muscle groups. Conclusions Standardized HHD testing of lower-limb muscle strength in children with spastic CP shows fine test-retest and inter-rater reliability. The HHD can reliably assess the lower-limb muscle strength of children with spastic CP.%目的 探讨手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度.方法 以2009年2月至11月在复旦大学附属儿科医院康复中心接受康复治疗的28例3岁以上的痉挛型脑瘫患儿为研究对象,采

  15. 34 Cases of Twin Pregnancies Complicated by Single Intrautterine Death%双胎妊娠一胎宫内死亡34例临床分析

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    谯小勇; 曹曦; 邢爱耘


    were less than dichorionic twins.There were 6 perinatal deaths in 30 surviving twins except 4 cases for induced labor. 2 neonates were dropped out in 24 survival neonates. In 22 survival neonates with follow-up, there were 3 cases with cerebral palsy(quadriplegia, dysphasia), 4 cases with other cerebral impairment (delayed growth of speaking and movement) ,while the other 15 cases were normal. Conclusions: Single intrauterine death is more common in monochorionic twin pregnancies. Chorionicity and gestational week are the most important factors affecting the perinatal outcome and long-term prognosis. Expectant treatment is an effective choice for twin pregnancy complicated by slUD without severe maternal complications or fetal distress.

  16. 痉挛型脑瘫患儿的社会生活能力特征及其相关性研究%The study of characteristics and correlation of social life ability for children with spastic cerebral palsy

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    徐开寿; 何璐; 麦坚凝; 李金玲; 靳晓坤; 王丽娟


    Objective: To study the situation, characteristics and correlation of social life ability for children with spastic cerebral palsy (SCP).Method: After signing the informed consent, one hundred and fifty-four children with SCP, 1 to 12 years of age,and their caregivers were assessed with the social life ability scale for infant-junior middle school student. According to ages, gender, types of paralysis, level of gross motor function classification system (GMFCS) of children with SCP, the situation, characteristics and correlation of social life ability in children with SCP was performed with nonparametric test, one-way analysis of variances, multiple analysis of variances, Pearson and Spearman analyses.Result: Based on the raw and standard scores of social life ability, 63% of children with SCP were almost normal. The children having normal social life ability in infants group were more than preschool group and school-aged group (P<0.05). The difference of amount of children who had normal social life ability was statistically significant among GJMFCS groups (P<0.05), as well as among hemiplegia, diplegia, and quadriplegia groups (P<0.05). A1l 6 domains scores of social life ability were statistically significantly different among 3 aged groups (P<0.05), and 4 GMFCS level groups (P<0.05). The difference in self-help, locomotion, occupation, and socialization domains scores were statistically significant among 3 types of paralysis groups (P<0.05). The standard scores were negatively correlated with age (r=-0.223, P=0.005) and GJMFCS level (r=-0.479, P=0.000).Conclusion: With the growing of age, the social life ability of CP children improved better. However, compared with the same aged normal children,the gap was more obvious. The social life ability for children with SCP was associated strongly with activity limitation. However, the more activity limitation, the poorer social life ability;whereas they might have good ability in communication and self

  17. Activities of daffy living performance in children with cerebral palsy with different gross motor function%不同粗大运动功能脑性瘫痪患儿的日常生活活动能力分析

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    史惟; 杨红; 黄华玉; 陈冬冬


    Objective To analyze the activities of daily living (ADL) performance in children with cerebral palsy (CP) with different gross motor function and the correlation between gross motor function and ADL perform-ance. Methods A total of 118 children (81 boys and 37 girls; mean age: 47.7 months, SD: 20.1 months, age range: 18-90 months) with CP were recruited from three different rehabilitation centers in Shanghai. Types of CP included hemiplegia (n = 27), spastic diplegia (n = 53), spastic quadriplegia(n = 29), athetoid (n = 4), dystonic (n = 4), ataxic (n = 1). Gross motor function classification system (GMFCS) and Gross motor function measure (GMFM) were adopted to assess and classify the gross motor function. Pediatric evaluation of disability inventory (PEDI) was adopted to assess ADL performance. Differences of PEDI scores were compared among different levels of GMFCS; and the correlation between GMFCS levels, GMFM scores and PEDI scores were analyzed. Resnlts PEDI scores showed significant differences among CP children with different levels of GMFCS. The PEDI score usually de-creased with the increase of the GMFCS level, and mobility ability was the lowest. Significant correlations were found between PEDI scaled scores and GMFCS (rs = 0.85~0. 50, P < 0.001). Various levels of correlations (r = 0. 85~ 0.54, P<0.001) were found between GMFM scores and PEDI scaled scores. Higher correlations were found between GMFCS levels, GMFM scores and mobility ability. Conclusion ADL performance was significantly different among CP children with different gross motor function. The higher the gross motor function, the better the performance of ADL. Mobility would be improved by promoting gross motor function in CP children. The training of self-care and so-cial communication ability should be emphasized.%目的 分析不同程度粗大运动功能脑瘫患儿的日常生活活动能力表现,明确脑瘫患儿粗大运动功能与日常生活活

  18. Artrodese Cervical C1-C2 pelas técnicas de Harms e Magerl Artrodesis cervical C1-C2 por las técnicas de Harms y Magerl Harms and Magerl types of C1-C2 cervical artrodesis

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    Cristina Maria Varino Sousa


    ón. OBJETIVO: describir la casuística de las artrodesis atlantoaxiales realizadas en los últimos cinco años del Centro Hospitalario del Porto, particularmente, la tasa de consolidaciones, complicaciones observadas, reintervenciones y comparación con los estudios publicados. Métodos: estudio retrospectivo, con cinco años, de los pacientes sometidos a la artrodesis atlantoaxial en el Centro Hospitalario del Porto. RESULTADOS: fueron operados 11 pacientes en el periodo del estudio, la mayoría con inestabilidad de causa traumática. El método de la artrodesis más utilizado fue descrito por Magerl. No fueron observadas lesiones vasculares. Fueron registradas complicaciones infecciosas en cuatro pacientes, siendo que estas infecciones fueron más comunes en pacientes con patologías inflamatorias de base. Se obtuvo una tasa de consolidación de la artrodesis de 100%, no fueron necesarias cirugías de revisión. CONCLUSIÓN: en nuestra serie, las artrodesis posteriores por las técnicas de Harms y Magerl resultaron en un excelente control de la inestabilidad C1-C2. Pacientes con indicación de artrodesis por inestabilidad reumática presentaron una tasa alta de complicaciones infecciosas.INTRODUCTION: The atlantoaxial instability may result in neurological disorders, pain and limitation of neck mobility. It is associated with serious risks of quadriplegia or sudden death. There are several techniques of C1-C2 surgical stabilization described in literature, and the most commonly used in our department and emphasized in this article are those of Harms and Magerl. OBJECTIVE: To describe the cases of the atlantoaxial arthrodesis performed in the last five years at Centro Hospitalar do Porto, Portugal, regarding the rate of consolidation, observed complications, re-intervention and comparison with published studies. METHODS: A five years retrospective study of patients who underwent atlantoaxial arthrodesis at Centro Hospitalar do Porto. RESULTS: Eleven patients were operated

  19. Autologous Bone Marrow Stem Cells in Spinal Cord Injury; Our Experience in Clinical Studies, Animal Studies, Obstacles faced and steps for future

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    Ayyappan S


    Full Text Available BACKGROUND: Following traumatic vertebral injuries and resultant spinal cord injury, most patients are doomed to a life either of quadriplegia or paraplegia. Current treatment option is limited to the stabilization of the vertebral fracture along with medications to prevent secondary damage leading to further deterioration and wishful waiting for recovery. In most instances recovery is insignificant. Safety of intrathecal injection of autologous bone marrow stem cells is proven but its efficacy varies between patients (1. Intralesional application has been reported to be more efficacious than intrathecal application (2, 3, 4. We have analyzed our experience in human patients followed up for 3 year period and have found several grey areas in spinal cord injury(5 one of them is to explore the differences between Intrathecal and intralesional application of stem cells with and without scaffolds in the latter technique. Towards achieving this goal we started a pilot study in animals where instead of post-vertebral fixation intrathecal injection, we have performed intralesional application of autologous BMSC along with scaffolds (6. These scaffolds not only help retain the transplanted cells at the site of injury but also allow more neural precursors to grow compared to application without scaffolds (7. This study analyses the data retrospectively to plan further prospective studies with a view to improvise the results. MATERIALS AND METHODS: Study 1 : 100 to 120 ml of Bone marrow was tapped from the right posterior iliac crest under local anesthesia from human spinal injury victims (n=108; 76 males, 32 females about 3 weeks to 18 months after surgical fixation of the vertebrae. The Level of injury was varied- Cervical (13 patients. Upper Thorax- T1-T7 (35 patients Lower thorax T8-T12 (46 patients Lumbar (2 patients. Age Group Range: 8 yrs to 55 yrs. The bone marrow mononuclear cells were processed under cGMP SOP’s Class 10000 clean room and class

  20. Assessment of gross motor function development in children with cerebral palsy by nonlinear mixed effect model%非线性混合效应模型评估脑瘫患儿粗大运动功能发育进程

    Institute of Scientific and Technical Information of China (English)

    史惟; 丁俊杰; 杨红; 廖元贵; 朱默; 侯方华; 王艺


    Objective To describe the patterns of gross motor development of children with cerebral palsy ( CP ) in each level of the Gross Motor Function Classification System ( GMFCS ) using nonlinear mixed effect model, as a basis for planning clinical management. Methods Patients with CP were enrolled from 7 rehabilitation centers in Shanghai form August 2000 to December 2007. Severity of CP was based solely on GMFCS level and motor function was assessed with Gross Motor Function Measure-66 ( GMFM-66 ). The stable limit model was used to make the gross motor development curve for children in each of the 5 GMFCS levels. The stable limit model has two parameters, corresponding to limit of motor function and the rate which can transforms to age-90. Age-90 means the age at which children are expected to achieve 90% of their predicted limit in GMFM-66. In addition, the results of our study were compared with those of Canada study. Results A total of 228 children ( 152 males, 76 females ) with CP were enrolled in the study. Types of CP in these children were spastic quadriplegia ( n = 63 ), spastic diplegia ( n = 87 ), spastic hemiplegia ( n = 48 ), athetotic ( n = 11 ), dystonia ( n = 4 ) and ataxic ( n = 11 ). Based on a total of 986 GMFM assessments ( 4. 32 assessments per child ), distinct motor development curves were constructed. The limit of GMFM-66 in GMFCS Ⅰ - Ⅴ level was 81.2, 62. 4, 52. 9, 40. 8 and 24. 4 scores, the corresponding age-90 was 3.8, 2. 7, 2. 1, 2. 0 and 1. 5 years respectively. GMFM-66 limit in GMFCS level I and II of our study was lower than that in Canada study, however GMFM-66 limit in GMFCS level Ⅲ — Ⅴ was closer to that in Canada study. Moreover, the corresponding age-90 in each 5 levels of GMFCS in our study was lower than that in Canada study. Conclusions The gross motor development more quickly reached its limit in GMFCS level Ⅰ and Ⅱ , however the limit of GMFM-66 was lower than that in Canada study. More attention should be paid

  1. Relationship between the clinical manifestations and prognosis of posterior circulation stroke: a prospective case series study%后循环卒中的临床表现及其与预后的关系:前瞻性病例系列研究

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    郭义坤; 施国文; 李焰生


    Objective To investigate the major clinical manifestations and their effect on prognosis in patients with posterior circulation stroke (PCS).Methods The clinical data of 129 consecutive hospitalized patients with acute PCS confirmed by clinical and imaging were registered prospectively,and they were followed up for 3 months.The patients were divided into a good prognosis group (modified Rankin scale [ mRS] score ≤ 2) and a poor prognosis group (mRS score ≥ 3) according to their mRS scores.Results 90.7% patients had 4 to 12 symptoms and signs,only 1 presented an isolated symptom.The most common symptoms and signs were unilateral.Crossed paralysis (1.6%) or quadriplegia (0.8% ) was rare.Univariate analysis showed that the symptoms of unilateral limb weakness (relative risk [RR] 1.262,95% confidence interval [ CI] 1.030-1.546; P =0.030),slurred speech (RR 1.434,95%CI 1.133 - 1.816; P=0.004),dysphagia (RR 2.216,95% CI 1.131 -4.341; P =0.017),and the signs of decreased unilateral muscle strength (RR 1.288,95% CI1.047-1.583; P=0.021),central facial/tongue paralysis (RR 1.467,95%CI 1.164- 1.850; P=0.002),dysarthria (RR 1.468,95%CI 1.154- 1.867; P=0.002),ocular motor dysfunction (RR 3.073,95%CI1.346 - 7.017; P =0.005),and conscious disturbance (RR 5.736,95% CI 1.268 - 25.946; P =0.023) were the risk factors for poor prognosis,while ataxia (RR O.478,95% CI 0.284 -0.804; P =0.002) was associated with good prognosis.Multivariate logistic regression analysis demonstrated that after adjusted for all risk factors,the baseline National Institutes of Health Stroke Scale (NIHSS) (odds ratio [ OR] 1.513,95% CI1.107-2.066; P=0.009),dysarthria (OR,7.11,95% CI 1.207-41.877; P=0.030),ocular motor dysfunction (OR 8.653,95% CI 1.230- 60.887; P=0.030),and large-artery atherosclerotic stroke (OR5.482,95% CI 1.008 -29.803; P =0.049) were the independent risk factors for poor prognosis in patients with PCS,while ataxia (OR 0.251,95% CI 0.067- 0.941; P=0

  2. Poliomyelitis sequela in Pizhou city%邳州市小儿麻痹后遗症评估分析报告

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    许光旭; 顾绍钦; 励建安


    科合作的团队,建立集体讨论制度,使这批小儿麻痹后遗症患者的康复功能达到最好的水平.%BACKGROUND: An epidemic outbreak of poliomyelitis occurred in Pizhou City, Jangsu Province, 15 years ago. It is important to appraise the daily living and function of those survived children.OBJECTIVE: To investigate the physical status of the survived children and propose appropriate suggestions on rehabilitation.DESIGN: Case-based cross-sectional study based on patients.SETTING: Department of Rehabilitative Medicine of First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 545 patients with poliomyelitis sequela, which was onset in 1989, were found in Qizhou, and 333 of them were randomly selected from the local"New Hope" nursing house and its surrounding areas.All patients were assayed in one week.METHODS: The survey included 333 polio victims in the nursing house or from the surrounding areas. The study was conducted by five research groups, with two physiatrists and one therapist in each group. Assessment included muscle strength, joint rang of motion, limb deformities, activities of daily living, previous surgical interventions and orthosis. The distance was measured from the anterior superior iliac to medial malleolus and from nave to the medial malleolus, respectively. Anatomic length and functional length were also measured.MAIN OUTCOME MEASURES: Major outcomes included the forms,shapes, or functions of foot, pelvic, hip, knee and ankle joints.RESULTS: According to intention-to-treat analyses, 333 patients with poliomyelitis sequela entered the final analysis. Most of them aged from 15 to 17 years old, which accounted for 97%. Totally 135 patients(40.5% )walked independently and 148 (44.4%) walked with-orthsis and/or crutches. The discrepancy was between 0. 5 cm to 13.0 cm. Patients with paraplegia were 112(33.6% ), which was lesser than those with monoplegia (211, 65.8% ). There were 3 cases with quadriplegia and 2

  3. Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral Complicaciones respiratorias en pacientes con parálisis cerebral sometidos a la anestesia general Respiratory complications in patients with cerebral palsy undergoing general anesthesia

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    Sérgio Silva de Mello


    of this prospective study was to determine the prevalence and risk of respiratory complications in children with CP undergoing general inhalational anesthesia for computed tomography. METHODS: Patients with ages ranging from 1 to 17 years, physical status ASA I to III, undergoing general inhalational anesthesia with sevoflurane and laryngeal mask for a CT scan from June 2002 to June 2003, participated in this study. Patients were divided in 3 groups: quadriplegic CP (CPQ, other types of CP (CPO, and patients without CP (NCP. Parents or guardians answered a questionnaire that assessed the past medical history of the patient, upper respiratory infections (URI, asthma, seizures, oropharyngeal dysfunction, gastroesophageal reflux, etc. Data on the incidence and severity of respiratory complications were gathered prospectively (cough, bronchospasm, laryngeal spasm, hypoxemia, aspiration, etc. The size of the study group was calculated for an expected 5% incidence in the NCP group, with a 15% difference among groups (alpha = 0.05 and beta = 0.1, using the Chi-square test, Fisher exact test, and test t Student. RESULTS: Two hundred and ninety patients, divided in three groups, participated in this study. Groups were composed of: CPQ = 100 patients, CPO = 79 patients, and NCP = 111 patients. There were no differences on the prevalence of respiratory infections among the CPQ (4%, CPO (8.9%, and NCP (7.3% groups. There was a correlation between the presence of URI and the development of complications (relative risk of 10.71. CONCLUSIONS: Children with cerebral palsy with spastic quadriplegia do not seem to have an increased risk of respiratory complications during general inhalational anesthesia with sevoflurane and laryngeal mask. This study confirms URI as a risk factor for the development of those complications.