Association between spasticity and the level of motor function with quality of life in community dwelling Iranian young adults with spastic cerebral palsy

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Nasrin Salehi Dehno

2012-11-01

Full Text Available  Abstract Background: Consequences of cerebral palsy in adulthood can affect physical, psychological capabilities and quality of life. The purpose of this study was to investigate the relationship between quality of life with spasticity and level of motor function in Iranian young adults with spastic cerebral palsy who were community dweller. Methods: In an analytical cross sectional study, 77 participants with spastic cerebral palsy (44 women، 33 men with age range of 20 to 40 years; (mean age 26.19±5 yr took part in this study. They were enrolled from three Raad Rehabilitation Goodwill complexes in Tehran and Karaj cities. All subjects were recruited through convenient sampling. Severity of Spasticity for knee flexors was measured with Modified Tardieu Scale. In addition, the level of motor function, and quality of life were assessed respectively through Gross Motor Function Classification System and World Health Organization Quality of life questionnaire (WHOQOL- BREF. To analyze data, Pearson and spearman correlation coefficient was used. Results: No correlation found between quality of life with knee flexor muscles spasticity and level of motor function (p> 0.05. Conclusion: Quality of life as a multi dimensional concept has been impacted by many factors such as physical status, environmental issues and culture. Possibly, severity of spasticity and level of function have a less pronounced effect on quality of life in community dwelling adults with cerebral palsy. 

Effects of interactive games on motor performance in children with spastic cerebral palsy

OpenAIRE

AlSaif, Amer A.; Alsenany, Samira

2015-01-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Method...

The early markers for later dyskinetic cerebral palsy are different from those for spastic cerebral palsy

NARCIS (Netherlands)

Einspieler, C; Cioni, G; Paolicelli, PB; Bos, AF; Dressler, A; Ferrari, F; Roversi, MF; Prechtl, HFR

Qualitative abnormalities of spontaneous motor activity in new-borns and young infants are early predictive markers for later spastic cerebral palsy. Aim of this research was to identify which motor patterns may be specific for later dyskinetic cerebral palsy. In a large, prospectively performed

Spasticity and Its Contribution to Hypertonia in Cerebral Palsy

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Lynn Bar-On

2015-01-01

Full Text Available Spasticity is considered an important neural contributor to muscle hypertonia in children with cerebral palsy (CP. It is most often treated with antispasticity medication, such as Botulinum Toxin-A. However, treatment response is highly variable. Part of this variability may be due to the inability of clinical tests to differentiate between the neural (e.g., spasticity and nonneural (e.g., soft tissue properties contributions to hypertonia, leading to the terms “spasticity” and “hypertonia” often being used interchangeably. Recent advancements in instrumented spasticity assessments offer objective measurement methods for distinction and quantification of hypertonia components. These methods can be applied in clinical settings and their results used to fine-tune and improve treatment. We reviewed current advancements and new insights with respect to quantifying spasticity and its contribution to muscle hypertonia in children with CP. First, we revisit what is known about spasticity in children with CP, including the various definitions and its pathophysiology. Second, we summarize the state of the art on instrumented spasticity assessment in CP and review the parameters developed to quantify the neural and nonneural components of hypertonia. Lastly, the impact these quantitative parameters have on clinical decision-making is considered and recommendations for future clinical and research investigations are discussed.

Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis

NARCIS (Netherlands)

Hoving, M.A.; Evers, S.M.A.A.; Ament, A.J.H.A.; van Raak, E.P.M.; Becher, J.G.; Rotteveel, J.; Vles, J.S.H.

2008-01-01

In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we

Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis.

NARCIS (Netherlands)

Hoving, M.A.; Evers, S.M.; Ament, A.J.; Raak, E.P. van; Vles, J.S.; Becher, J.G.; Vermeulen, R.; Brouwer, O.F.; Maathuis, C.G.B.; Catsman-Berrevoets, C.E.; Gerritsen, J.; Geerts, M.J.; Jongerius, P.H.; Nieuwenhuizen, O.F.; Rotteveel, J.J.; Speth, L.A.; Stroink, H.; Ziel, E.G. van der

2008-01-01

In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we

Altered sense of agency in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Ritterband-Rosenbaum, Anina; Christensen, Mark S; Kliim-Due, Mette

2011-01-01

ABSTRACT: Background Children diagnosed with spastic Cerebral Palsy (CP) often show perceptual and cognitive problems, which may contribute to their functional deficit. Here we investigated if altered ability to determine whether an observed movement is performed by themselves (sense of agency...

Survey on Types and Associated disorders of Cerebral Palsy in Eastern and Northern Districts of Tehran

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Farin Soleimani

2011-10-01

Conclusion: In this study, unilateral - spastic cerebral palsy was found as the most common type. Therefore, more evaluation to determine the about etiology of this type of cerebral palsy in our population is necessary.

Maternal thyroid disorder in pregnancy and risk of cerebral palsy in the child: a population-based cohort study.

Science.gov (United States)

Petersen, Tanja Gram; Andersen, Anne-Marie Nybo; Uldall, Peter; Paneth, Nigel; Feldt-Rasmussen, Ulla; Tollånes, Mette Christophersen; Strandberg-Larsen, Katrine

2018-05-31

Cerebral palsy is the most frequent motor disability in childhood, but little is known about its etiology. It has been suggested that cerebral palsy risk may be increased by prenatal thyroid hormone disturbances. The objective of this study was to investigate whether maternal thyroid disorder is associated with increased risk of cerebral palsy. A population-based cohort study using two study populations. 1) 1,270,079 children born in Denmark 1979-2007 identified in nationwide registers, and 2) 192,918 children born 1996-2009 recruited into the Danish National Birth Cohort and The Norwegian Mother and Child Cohort study, combined in the MOthers and BAbies in Norway and Denmark (MOBAND) collaboration cohort. Register-based and self-reported information on maternal thyroid disorder was studied in relation to risk of cerebral palsy and its unilateral and bilateral spastic subtypes using multiple logistic regression. Children were followed from the age of 1 year to the age of 6 years, and cerebral palsy was identified in nationwide registers with verified diagnoses. In register data, hypothyroidism was recognized in 12,929 (1.0%), hyperthyroidism in 9943 (0.8%), and unclassifiable thyroid disorder in 753 (cerebral palsy was 1.0 (95% CI: 0.7-1.5). Maternal thyroid disorder identified during pregnancy was associated with elevated risk of unilateral spastic cerebral palsy (odds ratio 3.1 (95% CI: 1.2-8.4)). In MOBAND, 3042 (1.6%) of the mothers reported a thyroid disorder in pregnancy, which was not associated with cerebral palsy overall (odds ratio 1.2 (95% CI: 0.6-2.4)). Maternal thyroid disorder overall was not related to bilateral spastic cerebral palsy, but maternal thyroid disorder identified in pregnancy was associated with increased risk of unilateral spastic cerebral palsy. These findings should be replicated in studies making use of maternal blood samples.

Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy

International Nuclear Information System (INIS)

Kulak, W.; Okurowska-Zawada, B.; Sobaniec, W.; Goscik, M.; Olenski, J.

2008-01-01

Purpose: Analysis of the incidence of congenital brain malformations in children with spastic cerebral palsy (CP) in a hospital based study. Material and Methods: The present study included 74 boys and 56 girls with spastic tetraplegia, diplegia, and hemiplegia CP. Magnetic resonance imaging MRI findings were analyzed in children with CP. Results: Significant abnormalities relevant to the CP were evident on MRI in 124 (95.3%) subjects. Periventicular leukomalacia (PVL) was detected more frequently in children with spastic diplegia than in patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 15 (10.7%) children with spastic CP. Brain malformations included: schizencephaly (5), agenesis corpus callosum (4), polymicrogyria (2), holoprosencephaly (2) and lissencephaly (2). Intractable epilepsy and mental retardation were observed more often in children with brain anomalies. Twelve patients with congenital brain malformations were born at term and three born at preterm. Conclusions: Neuroimaging results in children with CP may help determine the etiology and make better prognosis of CP. (authors)

Effects of hippotherapy on gait parameters in children with bilateral spastic cerebral palsy.

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Kwon, Jeong-Yi; Chang, Hyun Jung; Lee, Ji Young; Ha, Yumi; Lee, Peter K; Kim, Yun-Hee

2011-05-01

To evaluate the effects of hippotherapy on temporospatial parameters and pelvic and hip kinematics of gait in children with bilateral spastic cerebral palsy. Nonrandomized prospective controlled trial. Outpatient therapy center. Children (N=32) with bilateral spastic cerebral palsy, Gross Motor Function Classification System level 1 or 2. Hippotherapy (30 min twice weekly for 8 consecutive weeks). Temporospatial parameters and pelvic and hip kinematic parameters in 3-dimensional motion analysis, Gross Motor Function Measure (GMFM)-88, and score for dimensions D (standing) and E (walking, running, jumping) of the GMFM, GMFM-66, and Pediatric Balance Scale (PBS). Hippotherapy significantly improved walking speed, stride length, and pelvic kinematics (average pelvic anterior tilt, pelvic anterior tilt at initial contact, pelvic anterior tilt at terminal stance). Scores for dimension E of the GMFM, GMFM-66 and PBS also increased. Hippotherapy provided by licensed health professionals using the multidimensional movement of the horse may be used in conjunction with standard physical therapy for improvement of gait and balance in children with bilateral spastic cerebral palsy. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of interactive games on motor performance in children with spastic cerebral palsy.

Science.gov (United States)

AlSaif, Amer A; Alsenany, Samira

2015-06-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6-10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.

Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments

NARCIS (Netherlands)

Scholtes, Vanessa A. B.; Becher, Jules G.; Beelen, Anita; Lankhorst, Gustaaf J.

2006-01-01

This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase,

Speech Respiratory Measures in Spastic Cerebral Palsied and Normal Children

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Hashem Shemshadi

2007-10-01

Full Text Available Objective: Research is designed to determine speech respiratory measures in spastic cerebral palsied children versus normal ones, to be used as an applicable tool in speech therapy plans.  Materials & Methods: Via a comparative cross-sectional study (case–control, and through a directive goal oriented sampling in case and convenience approach for controls twenty spastic cerebral palsied and twenty control ones with age (5-12 years old and sex (F=20, M=20 were matched and identified. All possible inclusion and exclusion criteria were considered by thorough past medical, clinical and para clinical such as chest X-ray and Complete Blood Counts reviews to rule out any possible pulmonary and/or systemic disorders. Their speech respiratory indices were determined by Respirometer (ST 1-dysphonia, made and normalized by Glasgow University. Obtained data were analyzed by independent T test. Results: There were significant differences between cases and control groups for "mean tidal volume", "phonatory volume" and "vital capacity" at a=0/05 values and these values in patients were less (34% than normal children (P<0/001. Conclusion: Measures obtained are highly crucial for speech therapist in any speech therapy primary rehabilitative plans for spactic cerebral palsied children.

A COMPARATIVE STUDY ON EFFECTIVENESS OF OPEN VERSUS CLOSED KINETIC CHAIN EXERCISES TO IMPROVE GAIT IN SPASTIC DIPLEGIC CEREBRAL PALSY

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Trishna Saikia Baruah

2016-04-01

Full Text Available Background: Cerebral Palsy (CP describes a non- progressive but not unchanging disorder of movement and posture due to an insult to or anomaly of the developing brain. People with spastic diplegia typically walk slowly and have difficulties in performing activities such as walking running or jumping. Children with spastic diplegic cerebral palsy are relied more on cadence to increase speed. Hence, the purpose of this study is to compare the effectiveness of open and closed kinetic chain (OKC and CKC exercises in improving gait in spastic diplegic cerebral palsy. Methods: 30 children with spastic diplegic cerebral palsy of both genders with age 4-12 years was taken. Cadence and distance covered in 1Minute Walk Test was calculated before and after the test. The intervention for group A was CKC exercises and group B was OKC exercises for 3 days a week for 6 weeks and each session lasted for 30-45 minutes was given for both the groups. Results: Paired t-test was performed to find effectiveness of CKC and OKC improving gait in spastic diplegic CP to see the difference of means of 1minute walk, t = 10.789 which is significant (p = 0.000 and for cadence, t = 3.37 which is highly significant (p = 0.00 implying that cadence and distance covered in1minute walk was more with CKC exercises. Conclusion: Based on the result it is concluded that CKC exercises are effective in improving gait than OKC exercises in spastic diplegic cerebral palsy.

Body-Sensor-Network-Based Spasticity Detection.

Science.gov (United States)

Misgeld, Berno J E; Luken, Markus; Heitzmann, Daniel; Wolf, Sebastian I; Leonhardt, Steffen

2016-05-01

Spasticity is a common disorder of the skeletal muscle with a high incidence in industrialised countries. A quantitative measure of spasticity using body-worn sensors is important in order to assess rehabilitative motor training and to adjust the rehabilitative therapy accordingly. We present a new approach to spasticity detection using the Integrated Posture and Activity Network by Medit Aachen body sensor network (BSN). For this, a new electromyography (EMG) sensor node was developed and employed in human locomotion. Following an analysis of the clinical gait data of patients with unilateral cerebral palsy, a novel algorithm was developed based on the idea to detect coactivation of antagonistic muscle groups as observed in the exaggerated stretch reflex with associated joint rigidity. The algorithm applies a cross-correlation function to the EMG signals of two antagonistically working muscles and subsequent weighting using a Blackman window. The result is a coactivation index which is also weighted by the signal equivalent energy to exclude positive detection of inactive muscles. Our experimental study indicates good performance in the detection of coactive muscles associated with spasticity from clinical data as well as measurements from a BSN in qualitative comparison with the Modified Ashworth Scale as classified by clinical experts. Possible applications of the new algorithm include (but are not limited to) use in robotic sensorimotor therapy to reduce the effect of spasticity.

USE OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

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Ljiljana Lazić

2011-06-01

Full Text Available Cerebral palsy has an incidence of about 1-2 per 1000 live births, and in spite of the progress of neonatal medicine, it seems that the incidence will not subside in the near future. The most important characteristic of cerebral palsy is movement abnormality: spasticity, chorea, athetosis, ataxia, dystonia, as well as their different combinations. About 70% of children who suffer from cerebral palsy also suffer from some form of spasticity. Spasticity is a type of muscle hypertonicity characterized by rapid increase in resistance to passive stretching of muscles. The interest for botulinum toxin application in the treatment of spasticity has dramatically increased in the last 10 years. Botulinum toxin is the most powerful neurotoxin that is found in nature. It is produced by anaerobic bacteria – clostridium botulinum. It is produced in eight serotypes of which type A is the most commonly used. Botulinum toxin blocks neuromuscular transmission and causes irreversible weakness of the treated muscle. It has been used since 1993 in the treatment of cerebral palsy in children. The toxin effect is permanent and it results in irreversible denervation. Functional recovery is possible after 2-4 months, due to sprouting of nerve endings and the formation of new synaptic contacts. Treatment with botulinum toxin is safe. Adverse effects are rare, temporary and completely reversible. Application of botulinum toxin prevents or reduces contractures and deformities, and thus delays or avoids surgical treatment. Yet, physical therapy, which prolongs and improves the effects of botulinum toxin, remains an essential and most important form of therapy in the treatment of children with cerebral palsy.

Swedish Massage and Abnormal Reflexes of Children with Spastic Cerebral Palsy

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Vida Alizad

2007-09-01

Full Text Available Objectives: Massage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of wedish massage on abnormal reflexes in children with spastic cerebral palsy (CP. Methods: This study was a single blind clinical trial conducted on forty children with spastic CP who were recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. The routine occupational therapy (OT techniques were performed during a 3 month-period in both groups. The intervention group also received Swedish massage for 30 minutes before every OT session. Primary, spinal, brain stem, midbrain, cortical and automatic reflexes were evaluated at the beginning of the study and 3 months later. The data analysis was done by parametric and nonparametric tests. Results: Finally, thirteen subjects in the intervention group and 14 subjects in the control group were remained and studied. The average ages in the intervention and control groups were 49.5 and 42.1 months respectively. There were no statistically significant differences in abnormal reflexes in the intervention group in comparison to the control (P>0.05. Discussion: Adding Swedish massage to traditional OT techniques had no significant effects on abnormal reflexes in children with spastic cerebral palsy. Evidently more research is required in order to completely reject the effects of Swedish massage on abnormal reflexes of children with CP.

Hyperacute unilateral contrast-induced parotiditis during cerebral angiography

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Song J. Kim, MD

2018-02-01

Full Text Available An uncommon complication of iodinated contrast administration is the development of bilateral sialadenitis. We report a unique case of hyperacute unilateral parotiditis during diagnostic cerebral angiography of the external carotid artery, which mimicked possible iatrogenic vascular event associated with cerebral endovascular procedures. Discussion includes the differential diagnosis, diagnostic studies, and treatments for this unusual condition.

Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review.

Science.gov (United States)

Moll, Irene; Vles, Johannes S H; Soudant, Dan L H M; Witlox, Adhiambo M A; Staal, Heleen M; Speth, Lucianne A W M; Janssen-Potten, Yvonne J M; Coenen, Marcel; Koudijs, Suzanne M; Vermeulen, R Jeroen

2017-12-01

To assess the effect of functional electrical stimulation (FES) of ankle dorsiflexors in children and adolescents with spastic cerebral palsy (CP) during walking. A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for studies applying interventions to patients aged younger than 20 years. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). Seven hundred and eighty abstracts were found, 35 articles were fully screened, and 14 articles were used for analysis. Only five articles (three studies) were of level I to III evidence. At ICF participation and activity level, there is limited evidence for a decrease in self-reported frequency of toe-drag and falls. At ICF body structure and function level, there is clear evidence (I-III) that FES increased (active) ankle dorsiflexion angle, strength, and improved selective motor control, balance, and gait kinematics, but decreased walking speed. Adverse events include skin irritation, toleration, and acceptation issues. There are insufficient data supporting functional gain by FES on activity and participation level. However, evidence points towards a role for FES as an alternative to orthoses in children with spastic CP. Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES. © 2017 Mac Keith Press.

Effectiveness of Functional Power Training on Walking Ability in Young Children With Cerebral Palsy : Study Protocol of a Double-Baseline Trial

NARCIS (Netherlands)

van Vulpen, Liesbeth F.; de Groot, Sonja; Rameckers, Eugene A. A.; Becher, Jules G.; Dallmeijer, Annet J.

Purpose: To evaluate the effect of functional high-velocity resistance (power) training to improve walking ability of young children with cerebral palsy. Methods: Twenty-two children with bi-or unilateral spastic cerebral palsy, Gross Motor Function Classification System levels I and II, aged 4 to

Reproducibility of Tactile Assessments for Children with Unilateral Cerebral Palsy

Science.gov (United States)

Auld, Megan Louise; Ware, Robert S.; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie

2012-01-01

A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were…

Spasticity

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... Easter Seals March of Dimes National Multiple Sclerosis Society United Cerebral Palsy (UCP) See all related organizations Publications Order NINDS Publications Definition Spasticity is a condition in which there is ...

The effect of hippotherapy on gait in patients with spastic cerebral palsy

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Veronika Fízková

2013-12-01

Full Text Available BACKGROUND: Disorders of motor skills, especially regarding gait, are prevalent in nearly all forms of cerebral palsy. Through a horse’s back movement, the patient is exposed to proprioceptive stimulation, thus improvement in gait performance could be expected. OBJECTIVE: The aim of our study was to determine the effect of hippotherapy on gait in patients with spastic cerebral palsy. METHODS: Eleven subjects (age 14.3 ± 4.8 years, height 148.2 ± 17.6 cm, weight 43.3 ± 20.2 kg with spastic cerebral palsy participated in the study. Gait assessment was performed before and after a weeklong stay. The hippotherapy was conducted daily. Kinematic data from three trials for each child was obtained using the Vicon MX system (seven infrared cameras, frequency 200 Hz. Comparison of ankle, knee, hip and pelvis movement before and after hippotherapy intervention was performed in Statistica (version 10.0 using the Wilcoxon test. To determine the effect size, Cohen’s d was used. RESULTS: After completing the short-term hippotherapy intervention, we observed a decrease in the second plantar flexion during initial swing (p < .05, decrease in knee flexion during the stance phase (p < .05, decrease in the hip range of motion in sagittal plane (p < .05 and decrease in the pelvic obliquity (p < .05. The effect size for all statistically significant differences was low. CONCLUSIONS: Hippotherapy combined with individually defined physiotherapy can lead to some changes in bipedal locomotion in terms of improvement and thus contribute to greater self-sufficiency, self-reliance and independence of patients with cerebral palsy.

Papiledema unilateral na síndrome do pseudotumor cerebral

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Mário L. R. Monteiro

1985-06-01

Full Text Available São apresentadas as fotografias de fundo de olho de 6 mulheres com papiledema unilateral e a síndrome do pseudotumor cerebral. Achados associados foram: obesidade em 5 e a sindrome da sela vazia parcial em 2. São discutidas as possíveis explicações para o desenvolvimento de papiledema unilateral nesses pacientes e que favorecem um mecanismo presente na porção distal dos nervos ópticos.

Ocular disorders in children with spastic subtype of cerebral palsy.

Science.gov (United States)

Ozturk, A Taylan; Berk, A Tulin; Yaman, Aylin

2013-01-01

To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors. Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student's t tests were used in the statistical analysis. The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5%) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6%) had nystagmus and 107 children (55.2%) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2%). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000). Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.

Reproducibility and validity of video screen measurements of gait in children with spastic cerebral palsy.

NARCIS (Netherlands)

Grunt, S.; van Kampen, P.M.; van der Krogt, M.M.; Brehm, M.A.; Doorenbosch, C.A.M.; Becher, J.G.

2010-01-01

Purpose: To determine the reproducibility and validity of video screen measurement (VSM) of sagittal plane joint angles during gait. Methods: 17 children with spastic cerebral palsy walked on a 10. m walkway. Videos were recorded and 3d-instrumented gait analysis was performed. Two investigators

Reproducibility and validity of video screen measurements of gait in children with spastic cerebral palsy

NARCIS (Netherlands)

Grunt, Sebastian; van Kampen, Petra J.; van der Krogt, Marjolein M.; Brehm, Merel-Anne; Doorenbosch, Caroline A. M.; Becher, Jules G.

2010-01-01

PURPOSE: To determine the reproducibility and validity of video screen measurement (VSM) of sagittal plane joint angles during gait. METHODS: 17 children with spastic cerebral palsy walked on a 10m walkway. Videos were recorded and 3d-instrumented gait analysis was performed. Two investigators

Unilateral glaucoma in Sotos syndrome (cerebral gigantism).

Science.gov (United States)

Yen, M T; Gedde, S J; Flynn, J T

2000-12-01

To report a patient with unilateral glaucoma associated with Sotos syndrome. Sotos syndrome (cerebral gigantism) is a disorder of growth and development with characteristic facial changes and normal endocrine function. Ocular manifestations may also include megalocornea, iris hypoplasia, cataracts, megalophthalmos, strabismus, nystagmus, and retinal dystrophy. Case report. A 50 year-old man with the clinical features of Sotos syndrome presented with complaints of decreased vision in the left eye. Ophthalmologic examination revealed bilateral megalocornea, megalophthalmos, iris hypoplasia and transillumination defects, cataracts, and unilateral glaucoma. Intraocular pressure was lowered, and visual field loss was stabilized with topical medications. Sotos syndrome patients should be examined routinely to allow for early detection and treatment of potential ocular problems, including glaucoma.

Botulinum toxin type A chemodenervation treatment in spastic forms of cerebral palsy

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A. L. Kurenkov

2013-01-01

Full Text Available Cerebral palsy (CP is one of the most serious outcomes of the perinatal lesion of central nervous system and the most common reason for neurological disability in children. Being the key cause of pathological dynamic stereotypes that frequently result in pathological posture and contractures, spasticity is critically important for CP. The use of botulinum toxin type A (BTA in complex treatment 2-6 years old CP patients allows significantly to improve motor abilities, help to change the surgical procedure, delay or even avoid some types of surgery. For elder children the use of BTA allows to improve local motor impairment. The treatment of spasticity in CP with BTA is safe (evidence level A and highly effective (evidence level A. It leads to the positive change of pathological dynamic stereotype, significantly improves gait, decreases muscle tone with Ashworth and Tardeu scales and rises the gross motor function score. Our own experience of onabotulinumtoxinA treatment as a part of complex therapy in 68 patients with spastic forms of CP demonstrates the significant improvement of motor function, most noticeable in younger patients(early pre-school age with GMFS I-III.

MRI of patients with cerebral palsy and normal CT scan

International Nuclear Information System (INIS)

Bogaert, P. van; Szliwowski, H.B.

1992-01-01

Three children with clinical evidence of cerebral palsy (CP) and normal cerebral computed tomography (CT) scans were evaluated by magnetic resonance imaging (MRI) to identify CT-undetectable white matter lesions in the watershed zones of arterial territories. The two patients with spastic diplegia showed bilateral lesions either in the subcortical regions or in the occipital periventricular regions. The patient with congenital hemiplegia exhibited unilateral lesions in the periventricular region. We conclude that MRI is more informative than CT for the evaluation of patients with CP. (orig.)

MRI of patients with cerebral palsy and normal CT scan

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Bogaert, P. van; Szliwowski, H.B. (Hopital Erasme, Brussels (Belgium). Dept. of Neurology); Baleriaux, D.; Christophe, C. (Hopital Erasme, Brussels (Belgium). Dept. of Radiology (Neuroradiology))

1992-02-01

Three children with clinical evidence of cerebral palsy (CP) and normal cerebral computed tomography (CT) scans were evaluated by magnetic resonance imaging (MRI) to identify CT-undetectable white matter lesions in the watershed zones of arterial territories. The two patients with spastic diplegia showed bilateral lesions either in the subcortical regions or in the occipital periventricular regions. The patient with congenital hemiplegia exhibited unilateral lesions in the periventricular region. We conclude that MRI is more informative than CT for the evaluation of patients with CP. (orig.).

Ocular disorders in children with spastic subtype of cerebral palsy

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Aylin Yaman

2013-04-01

Full Text Available AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP and to find out whether any correlation exists between their occurance and etiologic factors. METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student’s t tests were used in the statistical analysis. RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4% and tetraplegia (36.1% were found to be higher than the frequency of hemiplegia (16.5% in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000. Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6% had nystagmus and 107 children (55.2% had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively. Abnormal morphology of the optic disc was present in 152 eyes (39.2%. Severe periventricular leukomalacia (PVL was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000. CONCLUSION: Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.

Unilateral traumatic hemorrhage of the basal ganglion and bihemisferic cerebral infarction

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Moscote-Salazar Luis Rafael

2017-09-01

Full Text Available Among the various injuries caused by the cerebral tramatic lesion are traumatic brain contusions. Hemorrhagic contusions of the basal ganglia are unusual. Different injuries such as cranial fractures, epidural hemorrhage, subdural hematoma, subarachnoid hemorrhage among others may be associated with brain contusions. In some cases traumatic brain injury arises. We present a case of a patient with unilateral cerebral contusion associated with bihemispheric cerebral infarction.

Best seating condition in children with spastic cerebral palsy : One type does not fit all

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Angsupaisal, Mattana; Dijkstra, Linze-Jaap; la Bastide-van Gemert, Sacha; van Hoorn, Jessika F.; Burger, Karine; Maathuis, Carel G. B.; Hadders-Algra, Mijna

2017-01-01

Background: The effect of forward-tilting of the seat surface and foot-support in children with spastic cerebral palsy (CP) is debated. Aim: To assess the effect of forward-tilting of the seat surface and foot-support in children with CP on kinematic head stability and reaching. Methods: Nineteen

TO STUDY THE EFFECT OF PLAY THERAPY AND CHILD FRIENDLY CONSTRAINT INDUCED MOMEMENT THERAPY TO IMPROVE HAND FUNCTION IN SPASTIC HEMIPLEGIC CEREBRAL PALSY CHILDREN: A COMPARATIVE STUDY

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Anjuman Nahar

2015-12-01

Full Text Available Background: Cerebral Palsy (CP is a neurodevelopmental disorder caused by nonprogressive lesion in the developing brain. The early central nervous system (CNS damage results in chronic physical disabilities and often includes sensory impairments. In addition CP is often associated with epilepsy and abnormalities of speech, vision, and intellect; it is the selective vulnerability of the brains motor systems that defines the disorder. Child friendly CIMT involves intensive targeted practice with the involved extremity coordination above and beyond their unilateral impairments. Ply Therapy is designed for active involvement of child in performing various tasks. The aim of the study is to evaluate the effectiveness of constraint induced movement therapy and play therapy to improve hand function in spastic hemiplegic cerebral palsy children. Methods: A sample of 30 patients was divided in two groups, each group having 15 children. Convenient sampling was done on the basis of base line assessment and diagnosis of their condition. Duration of the study was 3 months and data collection started at day 0 and at the end of 90 days. Children in group A wore a bivalve plaster cast on the non-involved upper extremity from shoulder to finger tips for the entire time during the session lasting for 2 hours and the plaster cast was removed at the end of the session. B group consists of 15 subjects who received play therapy. The treatment program was conducted individually and adjusted to current needs and abilities of each of the patients. Outcomes: Box and Block test, QOM scale and AOU scale. Results: It was found that there is an improvement in the hand function on application of child friendly CIMT in the patients with spastic hemiplegic cerebral palsy which was found significant using the Mann-Whitney U test (p≤0.005. Conclusion: In this study it has been found that the use of Child friendly CIMT and PLAY THERAPY produces significant improvement in hand

Dyke-Davidoff-Masson syndrome: case report of fetal unilateral ventriculomegaly and hypoplastic left middle cerebral artery.

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Piro, Ettore; Piccione, Maria; Marrone, Gianluca; Giuffrè, Mario; Corsello, Giovanni

2013-05-14

Prenatal ultrasonographic detection of unilateral cerebral ventriculomegaly arises suspicion of pathological condition related to cerebrospinal fluid flow obstruction or cerebral parenchimal pathology. Dyke-Davidoff-Masson syndrome is a rare condition characterized by cerebral hemiatrophy, calvarial thickening, skull and facial asymmetry, contralateral hemiparesis, cognitive impairment and seizures. Congenital and acquired types are recognized and have been described, mainly in late childhood, adolescence and adult ages. We describe a female infant with prenatal diagnosis of unilateral left ventriculomegaly in which early brain MRI and contrast enhanced-MRI angiography, showed cerebral left hemiatrophy associated with reduced caliber of the left middle cerebral artery revealing the characteristic findings of the Dyke-Davidoff-Masson syndrome. Prenatal imaging, cerebral vascular anomaly responsible for the cerebral hemiatrophy and the early clinical evolution have never been described before in such a young child and complete the acquired clinical descriptions in older children. Differential diagnosis, genetic investigations, neurophysiologic assessments, short term clinical and developmental follow up are described. Dyke-Davidoff-Masson syndrome must be ruled out in differential diagnosis of fetal unilateral ventriculomegaly. Early clinical assessment, differential diagnosis and cerebral imaging including cerebral MRI angiography allow the clinicians to diagnose also in early infancy this rare condition.

[Effects of acupuncture on quality of life in children with spastic cerebral palsy].

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Liu, Zhen-huan; Pan, Pei-guang; Ma, Mei-mei

2007-03-01

To investigate the effect of acupuncture in children with spastic cerebral palsy (SCP). One hundred SCP children, 2 to 7 years old, were randomly assigned to two groups equally. The control group was treated with rehabilitation training using Bobath and Vojta physical training methods and the acupuncture group treated also with the same training but with acupuncture conducted additionally. The therapeutic course was 3-12 months arranged according to the state of illness. The total effective rate, development quotient (DQ), improvement rate of brain hypogenesis and atrophy showed by skull CT, and recovery rate of cerebral emission computed tomography (ECT) were all higher in the acupuncture group than those in the control group (all P cerebral function and shows a favorable effect in improving quality of life of the children with SCP.

The effect of Sub-maximal exercise-rehabilitation program on cardio-respiratory endurance indexes and oxygen pulse in patients with spastic cerebral palsy

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M Izadi

2006-05-01

Full Text Available Background: Physical or cardio-respiratory fitness are of the best important physiological variables in children with cerebral palsy (CP, but the researches on exercise response of individuals with CP are limited. Our aim was to determine the effect of sub-maximal rehabilitation program (aerobic exercise on maximal oxygen uptake, oxygen pulse and cardio- respiratory physiological variables of children with moderate to severe spastic cerebral palsy diplegia and compare with able-bodied children. Methods: In a controlled clinical trial study, 15 children with diplegia spastic cerebral palsy, were recruited on a voluntarily basis (experimental group and 18 subjects without neurological impairments selected as control group. In CP group, aerobic exercise program performed on the average of exercise intensity (144 beat per minute of heart rate, 3 times a week for 3 months. The time of each exercise session was 20-25 minutes. Dependent variables were measured in before (pretest and after (post test of rehabilitation program through Mac Master Protocol on Tantories cycle ergometer in CP group and compared with the control group. Results: The oxygen pulse (VO2/HR during ergometery protocol was significantly lower in CP group than normal group (P<0.05. No significant statistical difference in maximal oxygen uptake (VO2 max was found between groups. The rehabilitation program leads to little increase of this variable in CP group. After sub-maximal exercise in pretest and post test, the heart rate of patient group was greater than control group, and aerobic exercise leads to significant decrease in heart rate in CP patients(P<0.05. Conclusion: The patients with spastic cerebral palsy, because of high muscle tone, severe spasticity and involuntarily movements have higher energy cost and lower aerobic fitness than normal people. The rehabilitation exercise program can improve physiological function of muscle and cardio-respiratory endurance in these

Research on the performance of the spastic calf muscle of young adults with cerebral palsy.

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Lampe, Renee; Mitternacht, Jurgen

2011-02-12

The aim of this study was to find an objective graduation of pes equinus in infantile cerebral palsy, especially with regard to functional aspects, to allow a differentiated choice of the therapeutic options. Very often raises the question of whether a surgical lengthening of the Achilles tendon may let expect a functional improvement. For this documentation 17 patients with pes equinus and a diagnosis of spastic cerebral palsy, primarily of the lower limbs, and hemiplegia were examined first clinically and then by a procedure for calculating the functional kinetic parameters from an in-shoe plantar pressure distribution measurement (novel pedar-X system), which is used in many orthopedic practices and clinics as a standard measuring device. Using additional video motion analysis, the flexion in the ankle joint and the ankle joint torque were determined. From this the physical performance of the spastically shortened calf muscle was calculated. The course of the curves of torque and joint performance allows a functional classification of the pes equinus. Approximately three quarters of all pes equinus demonstrated functional activity of the most part of the normal push-off propulsion power. Even the rigid pes equinus was capable of performing push-off propulsion work, provided it converted energy that was absorbed during the heel-strike phase and released it again during the push-off phase. This suggests that the function of paretic ankle joint is better than its kinematics of motion. A heel strike with a pes equinus triggers via stretching stimuli in the muscle-ligament structure reflex motor functions, thereby causing the typical spastic gait pattern. This remarkable gait pattern is often evaluated as dysfunctional and as absolutely requiring correction. However, an aspect possibly neglected in this instance is the fact that this gait pattern may be efficient for the patient and may in fact be a suitable means allowing for economic locomotion despite the cerebral

Motor Learning of a Bimanual Task in Children with Unilateral Cerebral Palsy

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Hung, Ya-Ching; Gordon, Andrew M.

2013-01-01

Children with unilateral cerebral palsy (CP) have been shown to improve their motor performance with sufficient practice. However, little is known about how they learn goal-oriented tasks. In the current study, 21 children with unilateral CP (age 4-10 years old) and 21 age-matched typically developed children (TDC) practiced a simple bimanual…

Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia.

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Çifter, Muhsin; Cura, Nil

2016-10-01

This report describes the clinical orthodontic management of a patient with spastic quadriplegia and cerebral palsy. Guidelines to overcome difficulties encountered during the treatment period are suggested. A 13-year-old boy with cerebral palsy and spastic quadriplegia complained of an undesirable oral appearance because of his malocclusion. He had a Class II molar relationship, with severe maxillary and moderate mandibular anterior crowding. Enamel hypoplasia was apparent on all teeth. He had losses of body function and upper extremity function of 70% and 39%, respectively. His physical limitations necessitated a treatment approach that did not rely on patient-dependent appliances. The treatment plan called for maxillary first premolar extractions, mandibular incisor protrusion, and air rotor stripping. The patient's oral function and esthetic appearance were significantly improved. Aligned dental arches with good occlusion were obtained. The patient's self-confidence improved during the treatment period. Physical appearance can influence personality and social acceptability. Corrective orthodontic treatment for patients with physical handicaps can improve not only oral function, but also self-confidence and self-esteem. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Experience of using hippotherapy in complex effects on muscle spirals in children with spastic forms of cerebral palsy.

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Strashko, Evhen Y; Kapustianska, Аnna A; Bobyreva, Lyudmyla E

Matters of physical and medical rehabilitation of children with organic lesions of the nervous system, in particular, with cerebral palsy, are actual in countries around the world. Hippotherapy is neurophysiologically oriented therapy using horses. Determine whether a combination of hippotherapy as a method of rehabilitation in the aftermath of outpatient comprehensive impact on MS on a stationary phase; Study of the effect of hippotherapy as securing and preparation method for learning new postures and movements in children with spastic cerebral palsy forms; The study of the possible optimization of psychophysical state, activation motivations of patients; Determination of the optimal timing of hippotherapy sessions, the number of procedures, the study of possible fatigue factor children. HT classes were conducted at the Ippotsentra "Wind of Change" in the period 2010-2013 the main group of children surveyed (36 people) with spastic forms of cerebral palsy. HT procedure took place twice a day - morning and evening - 30 minutes during 10-12 days. Thus, the proposed integration of the HT program of complex effects on muscle spirals children with spastic cerebral palsy forms is physiologically and anthropologically based on 4-5 day training children adequately transferred the full amount of lessons learned new postures and movements, HT does not cause complications in the somatic and psycho-emotional state of the children, HT enables sensorimotor and psychomotor effects, save and normalize muscle tone for a longer period (up to three months), compared with traditional methods of physiotherapy. HT can serve as a method of learning a new "postures and movements", the preparation of the locomotor apparatus to learn walking.

Neuro-musculoskeletal simulation of instrumented contracture and spasticity assessment in children with cerebral palsy.

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van der Krogt, Marjolein Margaretha; Bar-On, Lynn; Kindt, Thalia; Desloovere, Kaat; Harlaar, Jaap

2016-07-16

Increased resistance in muscles and joints is an important phenomenon in patients with cerebral palsy (CP), and is caused by a combination of neural (e.g. spasticity) and non-neural (e.g. contracture) components. The aim of this study was to simulate instrumented, clinical assessment of the hamstring muscles in CP using a conceptual model of contracture and spasticity, and to determine to what extent contracture can be explained by altered passive muscle stiffness, and spasticity by (purely) velocity-dependent stretch reflex. Instrumented hamstrings spasticity assessment was performed on 11 children with CP and 9 typically developing children. In this test, the knee was passively stretched at slow and fast speed, and knee angle, applied forces and EMG were measured. A dedicated OpenSim model was created with motion and muscles around the knee only. Contracture was modeled by optimizing the passive muscle stiffness parameters of vasti and hamstrings, based on slow stretch data. Spasticity was modeled using a velocity-dependent feedback controller, with threshold values derived from experimental data and gain values optimized for individual subjects. Forward dynamic simulations were performed to predict muscle behavior during slow and fast passive stretches. Both slow and fast stretch data could be successfully simulated by including subject-specific levels of contracture and, for CP fast stretches, spasticity. The RMS errors of predicted knee motion in CP were 1.1 ± 0.9° for slow and 5.9 ± 2.1° for fast stretches. CP hamstrings were found to be stiffer compared with TD, and both hamstrings and vasti were more compliant than the original generic model, except for the CP hamstrings. The purely velocity-dependent spasticity model could predict response during fast passive stretch in terms of predicted knee angle, muscle activity, and fiber length and velocity. Only sustained muscle activity, independent of velocity, was not predicted by our model. The

Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy.

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Rushton, Paul R P; Nasto, Luigi A; Aujla, Ranjit K; Ammar, Amr; Grevitt, Michael P; Vloeberghs, Michael H

2017-06-01

To compare scoliosis progression in quadriplegic spastic cerebral palsy with and without intrathecal baclofen (ITB) pumps. A retrospective matched cohort study was conducted. Patients with quadriplegic spastic cerebral palsy, GMFCS level 5, treated with ITB pumps with follow-up >1 year were matched to comparable cases by age and baseline Cobb angle without ITB pumps. Annual and peak coronal curve progression, pelvic obliquity progression and need for spinal fusion were compared. ITB group: 25 patients (9 female), mean age at pump insertion 9.4 and Risser 0.9. Initial Cobb angle 25.6° and pelvic tilt 3.2°. Follow-up 4.3 (1.0-7.8) years. Cobb angle at follow-up 76.1° and pelvic tilt 18.9°. Non-ITB group: 25 patients (14 female), mean age at baseline 9.2 and Risser 1.0. Initial Cobb angle 29.7° and pelvic tilt 7.1°. Follow-up 3.5 (1.0-7.5) years. Cobb angle at follow-up 69.1° and pelvic tilt 21.0°. The two groups were statistically similar for baseline age, Cobb angle and Risser grade. Mean curve progression was 13.6°/year for the ITB group vs 12.6°/year for the non-ITB group (p = 0.39). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable; ITB group 4.5°/year vs non-ITB 4.6°/year (p = 0.97). During follow-up 5 patients in the ITB group and 9 in the non-ITB group required spinal fusion surgery for curve progression (p = 0.35). Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population.

[Spasticity and dynamic plantar pressure distribution measurements in hemiplegic spastic children].

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Femery, V; Moretto, P; Renaut, H; Thévenon, A

2001-02-01

The aim of this study was to analyse the plantar pressure distribution in nine hemiplegic spastic children to illustrate the dynamic alteration during stance phase linked spasticity grade. The graduation of the lower limbs muscle tone related to the Aschworth spasticity scale enabled us to identify two groups of hemiplegics subjects. The groups Asch 1 and Asch 3 have respectively presented a low and a strong spasticity. The peak pressures during consecutive gait cycles were determined under the feet of 30 healthy subjects and two cerebral palsy groups using a wearable footprint analysis system. A statistical study showed a similarity between the two disabled groups. Peak pressures under the midfoot were significantly higher compared to the control group. While the plantar pressure distribution profile was specific for each group under all other anatomical structures. The significant alterations were observed under the forefoot and hallux. Spasticity modifies the foot contact to ground and leads to a specific plantar pressure distribution profile linked to the spasticity grade. The equinovarus with clawed toes deformity due to higher spasticity seems to be an important factor in terminal stance phase perturbations. However spastic hemiplegic subjects seem to adopt a gait pattern in agreement with stability optimization criteria.

Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.

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Schasfoort, Fabienne; Dallmeijer, Annet; Pangalila, Robert; Catsman, Coriene; Stam, Henk; Becher, Jules; Steyerberg, Ewout; Polinder, Suzanne; Bussmann, Johannes

2018-01-10

Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. Children with spastic cerebral palsy, age range 4-12 years, cerebral palsy-severity Gross Motor Function Classification System levels I-III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross

The Role of Exercise – Rehabilitation on Energy Cost and Metabolic Efficiency in Dipelegic Spastic Cerebral Palsy Children

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M. Izadi

2005-07-01

Full Text Available Introduction & Objective: The aim of this study was to compare the resting energy expenditure and metabolic efficiency before and after of aerobic exercise in spastic cerebral palsy children (mean age of 11 years and also to compare with those of normal children. Materials & Methods : Fifteen dipelegia spastic cerebral palsy children (experimental group participated in exercise–rehabilitation program by voluntarily and the peers eighteen able body children(control group were selected randomly. The experimental group(cp performed rehabilitation program for 3 months,3 session in week with work intensity(%HRR=462.5equal to144bpm of heart rate. The values were measured on tantory cycle ergometer according to Macmaster protocol.Results: Rest and exercise heart rate and exercise intensity(%HRR in patients decreased after rehabilitation program(P<0.05. The resting energy expenditure was similar in cp and normal groups. The rate of oxygen cost of patients decreased in post test(P<0.05 that showed increasing in metabolic efficiency.Conclusion: cerebral palsy children have greater exercise energy cost and lower cardiovascular fitness than normal children and exercise–rehabilitation leads to enhance of metabolic efficiency in this patients that is remarkable from clinical perception.

Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols.

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Schnackers, Marlous; Beckers, Laura; Janssen-Potten, Yvonne; Aarts, Pauline; Rameckers, Eugène; van der Burg, Jan; de Groot, Imelda; Smeets, Rob; Geurts, Sander; Steenbergen, Bert

2018-04-18

Home-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge. Here we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the

Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.

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Lynn Bar-On

Full Text Available The definition of spasticity as a velocity-dependent activation of the tonic stretch reflex during a stretch to a passive muscle is the most widely accepted. However, other mechanisms are also thought to contribute to pathological muscle activity and, in patients post-stroke and spinal cord injury can result in different activation patterns. In the lower-limbs of children with spastic cerebral palsy (CP these distinct activation patterns have not yet been thoroughly explored. The aim of the study was to apply an instrumented assessment to quantify different muscle activation patterns in four lower-limb muscles of children with CP. Fifty-four children with CP were included (males/females n = 35/19; 10.8 ± 3.8 yrs; bilateral/unilateral involvement n =  32/22; Gross Motor Functional Classification Score I-IV of whom ten were retested to evaluate intra-rater reliability. With the subject relaxed, single-joint, sagittal-plane movements of the hip, knee, and ankle were performed to stretch the lower-limb muscles at three increasing velocities. Muscle activity and joint motion were synchronously recorded using inertial sensors and electromyography (EMG from the adductors, medial hamstrings, rectus femoris, and gastrocnemius. Muscles were visually categorised into activation patterns using average, normalized root mean square EMG (RMS-EMG compared across increasing position zones and velocities. Based on the visual categorisation, quantitative parameters were defined using stretch-reflex thresholds and normalized RMS-EMG. These parameters were compared between muscles with different activation patterns. All patterns were dominated by high velocity-dependent muscle activation, but in more than half, low velocity-dependent activation was also observed. Muscle activation patterns were found to be both muscle- and subject-specific (p<0.01. The intra-rater reliability of all quantitative parameters was moderate to good. Comparing RMS-EMG between

Influence of Botulinum Toxin Therapy on Postural Control and Lower Limb Intersegmental Coordination in Children with Spastic Cerebral Palsy

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Bernard Dan

2013-01-01

Full Text Available Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II. We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3–12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition and in the frontal plane (AFO condition. Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy is needed in order to learn new motor strategies.

Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study

NARCIS (Netherlands)

F.C. Schasfoort (Fabiënne); A.J. Dallmeijer (Annet); R.F. Pangalila (Robert); C. Catsman (Coriene); H.J. Stam (Henk); J.G. Becher (Jules); E.W. Steyerberg (Ewout W.); S. Polinder (Suzanne); J.B.J. Bussmann (Hans); H.L.D. Horemans (Herwin); E.M. Sneekes (E.); Bolster, E. (Eline); Viola, I. (Irma); Beek, K. (Karlijn) van; J.M.A. Verheijden (Johannes)

2018-01-01

textabstractObjective: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. Design: A pragmatically designed, multi-centre trial, comparing the effectiveness of

CT findings in patients with cerebral palsy

International Nuclear Information System (INIS)

Konno, Kimiichi

1982-01-01

Clinical findings and CT findings in 73 cases of cerebral palsy were studied. The causes of cerebral palsy were presumed to be as follows: abnormal cerebral development (36%), asphyxial delivery (34%), and immature delivery (19%), etc. CT findings were abnormal in 58% of the 73 cases, 83% of the spastic tetraplegia patients and all of the spastic hemiplegia patients showed abnormal CT findings. All the patients with spastic monoplegia presented normal CT findings. In 75% of the spastic hemiplegia cases, the CT abnormalities were due to cerebral parenchymal abnormality such as porencephaly and regional low absorption. In cases of spastic tetraplegia, cerebral parenchymal abnormality was found only in 10%. Cortical atrophy was found only in 15 of the 73 cases, whereas central atrophy was found in 36 cases. (Ueda, J.)

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy.

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Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy.

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study

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Marise Bueno Zonta

2013-07-01

Full Text Available Objective To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP. Only the study group (SG received early treatment of spasticity with botulinum neurotoxin type A (BXT-A. Methods Gross Motor Function Measure (GMFM, functional performance (Pediatric Evaluation of Disability Inventory - PEDI, range of movement, gait pattern (Physician Rating Scale - PRS and the speed of hand movements were considered. Results The SG, composed of 11 HCP (45.64±6.3 months, was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months. SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. Conclusion Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.

The Effect of Resistance Training on Performance of Gross Motor Skills and Balance in Children with Spastic Cerebral Palsy

OpenAIRE

Ebrahim Zarrinkalam; Majid Ebadi Fara

2016-01-01

Objective: Cerebral palsy is the most common chronic motor disability in children and can have negative effect on motor functions. The purpose of this study was to investigate the effect of eight weeks resistance training on gross motor ability, balance and walking speed in a group of such children. Methods: 21 cerebral palsy boys with spastic diplegia, aged between 12 and 16 years (mean, 13.66 years), participated in this study. A pre-test, involving walking, sitting, standing and walkin...

Changes in Muscle Activation Following Ankle Strength Training in Children with Spastic Cerebral Palsy: An Electromyography Feasibility Case Report

Science.gov (United States)

Olsen, Jamie E.; Ross, Sandy A.; Foreman, Matthew H.; Engsberg, Jack R.

2013-01-01

Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No…

Phonologically based assessment and intervention in Spastic Cerebral Palsy: A case analysis

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Michael A. Crary

1981-11-01

Full Text Available The articulation errors of one adult subject demonstrating a spastic variety of congenital cerebral palsy were evaluated via a phonological process analysis. This analysis indicated that a stopping process (replacement of fricatives with homorganic stops was the most detrimental to the subject's, intelligibility. Subsequent to this analysis a phonemic contrasting programme was initiated toward the goal of minimizing the influence of the stopping process. Results of  spontaneous speech sample analyses indicated that this approach was successful in increasing the percentage of correctly produced fricative patterns. Success in this case suggests the applicability of  a linguistically based intervention approach in structural/functional disturbances of speech articulation.

Spasticity Measurement Based on Tonic Stretch Reflex Threshold in Children with Cerebral Palsy Using the PediAnklebot

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Marco Germanotta

2017-05-01

Full Text Available Nowadays, objective measures are becoming prominent in spasticity assessment, to overcome limitations of clinical scales. Among others, Tonic Stretch Reflex Threshold (TSRT showed promising results. Previous studies demonstrated the validity and reliability of TSRT in spasticity assessment at elbow and ankle joints in adults. Purposes of the present study were to assess: (i the feasibility of measuring TSRT to evaluate spasticity at the ankle joint in children with Cerebral Palsy (CP, and (ii the correlation between objective measures and clinical scores. A mechatronic device, the pediAnklebot, was used to impose 50 passive stretches to the ankle of 10 children with CP and 3 healthy children, to elicit muscles response at 5 different velocities. Surface electromyography, angles, and angular velocities were recorded to compute dynamic stretch reflex threshold; TSRT was computed with a linear regression through angles and angular velocities. TSRTs for the most affected side of children with CP resulted into the biomechanical range (95.7 ± 12.9° and 86.7 ± 17.4° for Medial and Lateral Gastrocnemius, and 75.9 ± 12.5° for Tibialis Anterior. In three patients, the stretch reflex was not elicited in the less affected side. TSRTs were outside the biomechanical range in healthy children. However, no correlation was found between clinical scores and TSRT values. Here, we demonstrated the capability of TSRT to discriminate between spastic and non-spastic muscles, while no significant outcomes were found for the dorsiflexor muscle.

A case of left-sided unilateral spatial neglect owing to the cerebral infarction in the distribution of the right posterior cerebral artery

International Nuclear Information System (INIS)

Odagaki, Yuji; Oka, Iori; Kon, Yutaka; Asano, Yutaka

1985-01-01

We report a case of left-sided unilateral spatial neglect (USN) induced by the cerebral infarction in the distribution of right posterior cerebral artery (PCA). A 69-year-old, right-handed man, who had had a sudden onset of left hemiparesis in August 1983, was admitted to our hospital on January 16, 1984, because of nocturnal delirium. He became alert a few days after admission, but was euphoric and sometimes irritable. Neurologic examination disclosed left homonymous hemianopsia, dysarthria, left central facial weakness, spastic left hemiparesis, hyperactive reflexes on the left with no Babinski sign, left hemisensory loss, and left thalamic pain. On neuropsychologic examination it was revealed that he had a tendency to neglect the left half of his extrapersonal space. When asked to locate cities on a blank map of Japan, he located most of them not only on the right side of the map but also incorrectly. He also had a severe acalculia. There was gradual improvement in these neuropsychologic symptoms. CT demonstrated an area of decreased density in the territory of the right PCA, posterolateral portion of the right thalamus, and the posterior limb of right internal capsule, sparing parietal and temporal lobes. Single-photon emission computed tomography (SPECT) using the Xenon-133 inhalation method showed, however, diminished regional cerebral blood flow (rCBF) in an area larger than the area of infarction demonstrated by CT, including the right parieto-temporo-occipital junctional area, which has been considerd to be responsible for left-sided USN. The authors ascribed the patient's left-sided USN to the lesion of this area that was revealed not morphologically by CT but functionally by SPECT, although the possibility that the lesions of the medial portion of the right occipital lobe and/or subcortical lesions of such areas as the thalamus and the internal capsule more or less influenced the neuropsychologic symptoms could not be excluded. (author)

Bone mineral density and insulin-like growth factor-1 in children with spastic cerebral palsy.

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Nazif, H; Shatla, R; Elsayed, R; Tawfik, E; Osman, N; Korra, S; Ibrahim, A

2017-04-01

Children with cerebral palsy (CP) have significant decrease linear growth rate and low bone mineral density (BMD). This study is to evaluate BMD in children with CP and its relation to the levels of insulin-like growth factor-1 (IGF-1). This cross-sectional study was carried out on 58 children suffering from spastic CP with the age range 4-12 years compared to 19 controls. All assessed by dual energy x-ray absorptiometry (DXA) to measure BMD, serum level of IGF-1, and serum vitamin D. The patients were classified according to their GMFCS. Fractures were reported in seven (12.1%) of cases. Our study demonstrated that, IGF-1 level and BMD decrease in correlation with the severity of CP. IGF-1correlates positively with serum vitamin D, BMI, and BMD. CP children with severe GMFCS level or who use anticonvulsive drugs are at a high risk for low BMD and low levels of IGF-1. Both BMD and IGF-1 were significantly in low children with spastic CP; IGF-1 negatively correlates with the severity of osteopenia in children with spastic. Children with CP who are not independently ambulant or with severe GMFCS level or who use anticonvulsive drugs are at a high risk for developing low BMD.

Botulinum toxin treatment for limb spasticity in childhood cerebral palsy

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Vito ePavone

2016-02-01

Full Text Available CP is the most common cause of chronic disability in childhood occurring in 2 to 2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects and possible resistance as well as specific use in the upper and lower limbs muscles

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy

OpenAIRE

Park, Myoung-Ok

2017-01-01

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification S...

Dyke-Davidoff-Masson syndrome: case report of fetal unilateral ventriculomegaly and hypoplastic left middle cerebral artery

OpenAIRE

Piro, Ettore; Piccione, Maria; Marrone, Gianluca; Giuffr?, Mario; Corsello, Giovanni

2013-01-01

Prenatal ultrasonographic detection of unilateral cerebral ventriculomegaly arises suspicion of pathological condition related to cerebrospinal fluid flow obstruction or cerebral parenchimal pathology. Dyke-Davidoff-Masson syndrome is a rare condition characterized by cerebral hemiatrophy, calvarial thickening, skull and facial asymmetry, contralateral hemiparesis, cognitive impairment and seizures. Congenital and acquired types are recognized and have been described, mainly in late childhood...

The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy

NARCIS (Netherlands)

Jelsma, Jennifer; Pronk, Marieke; Ferguson, Gillian; Jelsma-Smit, Dorothee

2013-01-01

Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy. Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given

MR imaging of cerebral palsy

International Nuclear Information System (INIS)

Saginoya, Toshiyuki; Yamaguchi, Keiichiro; Kuniyoshi, Kazuhide

1996-01-01

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)

MR imaging of cerebral palsy

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

1996-06-01

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)

Brain State Before Error Making in Young Patients With Mild Spastic Cerebral Palsy.

Science.gov (United States)

Hakkarainen, Elina; Pirilä, Silja; Kaartinen, Jukka; van der Meere, Jaap J

2015-10-01

In the present experiment, children with mild spastic cerebral palsy and a control group carried out a memory recognition task. The key question was if errors of the patient group are foreshadowed by attention lapses, by weak motor preparation, or by both. Reaction times together with event-related potentials associated with motor preparation (frontal late contingent negative variation), attention (parietal P300), and response evaluation (parietal error-preceding positivity) were investigated in instances where 3 subsequent correct trials preceded an error. The findings indicated that error responses of the patient group are foreshadowed by weak motor preparation in correct trials directly preceding an error. © The Author(s) 2015.

Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy

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Santos, Maria Teresa Botti Rodrigues; Diniz, Michele Baffi; Gouw-Soares, Sheila Cynthia; Lopes-Martins, Rodrigo Alvaro Brandão; Frigo, Lucio; Baeder, Fernando Martins

2016-02-01

Spasticity is a motor disorder frequently present in individuals with cerebral palsy (CP). This study aimed to evaluate the effect of low-level laser therapy (LLLT) on the spasticity of the masseter and anterior temporal muscle fibers in children with CP over three weeks of intermittent laser exposures. The bite force (BF) of the masticatory muscles and the amplitude of mouth opening were evaluated before and after laser irradiation in 30 children with CP. Both sides of the masseter and temporalis muscles were irradiated with low-intensity diode laser pulses of 808-nm wavelength six times over three consecutive weeks. During the subsequent three weeks of postlaser exposures, although no laser treatment was applied, the evaluation parameters were measured and recorded. A significant improvement in the amplitude of mouth opening and a decrease in the BF were observed in the weeks following LLLT (Peffective short-term therapeutic tool. This method increased the amplitude of mouth opening and decreased the muscle tonus of children with spastic CP over a time course of three weeks of intermittent laser applications.

Effect of Adding Swedish Massage to Occupational Therapy on Muscle Tone of Spastic Cerebral Palsied Children

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Firouzeh Sajedi

2007-10-01

Full Text Available Objective: Cerebral palsy is a nonprogressive disorder in body posture and movement, due to different etiologies. Different medical and rehabilitation interventions include massage have been used in these children. This study has been done to determine the effect of adding massage to occupational therapy on muscle tone of children with spastic cerebral palsy. Materials & Methods: This study was a double blind clinical trial. The children were recruited from clinics of University of Welfare & Rehabilitation Sciences. The individuals were divided to intervention and control groups. The routine rehabilitation techniques were done in 3 months in both groups. The intervention group received massage for 30 minutes before rehabilitation. Muscle tonicity was evaluated at the beginning of the study and 3 months later by Ashworth test. The data analysis was done by parametric (t test, paired t test and nonparametric (Mann Whitney, Wilcoxon tests. Results: Thirteen subjects of case (intervention group and 14 subjects of control group were studied. The average age in case group and control group was 49.5, and 42.1 months respectively. There were no statistically significant differences in Tonicity of upper and lower limbs, trunk and neck between intervention group and control group (P>0/05. Conclusion: In general based on the results of this study, adding massage to occupational therapy had no effect on tonicity of spastic cerebral palsied children. Regarding to some effects of massage mentioned in different articles on physical abilities of children with C.P. as well as executive limitations in this research, it is not possible to reject the effects of homeopathy on physical abilities of children with C.P.

Disruption of basal lamina components in neuromotor synapses of children with spastic quadriplegic cerebral palsy.

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Karyn G Robinson

Full Text Available Cerebral palsy (CP is a static encephalopathy occurring when a lesion to the developing brain results in disordered movement and posture. Patients present with sometimes overlapping spastic, athetoid/dyskinetic, and ataxic symptoms. Spastic CP, which is characterized by stiff muscles, weakness, and poor motor control, accounts for ∼80% of cases. The detailed mechanisms leading to disordered movement in spastic CP are not completely understood, but clinical experience and recent studies suggest involvement of peripheral motor synapses. For example, it is recognized that CP patients have altered sensitivities to drugs that target neuromuscular junctions (NMJs, and protein localization studies suggest that NMJ microanatomy is disrupted in CP. Since CP originates during maturation, we hypothesized that NMJ disruption in spastic CP is associated with retention of an immature neuromotor phenotype later in life. Scoliosis patients with spastic CP or idiopathic disease were enrolled in a prospective, partially-blinded study to evaluate NMJ organization and neuromotor maturation. The localization of synaptic acetylcholine esterase (AChE relative to postsynaptic acetylcholine receptor (AChR, synaptic laminin β2, and presynaptic vesicle protein 2 (SV2 appeared mismatched in the CP samples; whereas, no significant disruption was found between AChR and SV2. These data suggest that pre- and postsynaptic NMJ components in CP children were appropriately distributed even though AChE and laminin β2 within the synaptic basal lamina appeared disrupted. Follow up electron microscopy indicated that NMJs from CP patients appeared generally mature and similar to controls with some differences present, including deeper postsynaptic folds and reduced presynaptic mitochondria. Analysis of maturational markers, including myosin, syntrophin, myogenin, and AChR subunit expression, and telomere lengths, all indicated similar levels of motor maturation in the two groups

Stimulus Evaluation, Event Preparation, and Motor Action Planning in Young Patients With Mild Spastic Cerebral Palsy : An Event-Related Brain Potential Study

NARCIS (Netherlands)

Hakkarainen, Elina; Pirila, Silja; Kaartinen, Jukka; van der Meere, Jaap J.

The study investigated stimulus evaluation time, event preparation, and motor action planning of patients with mild spastic cerebral palsy and a peer control group in the age range of 9 to 18 years. To this end, participants were carrying out a stimulus recognition task. Findings indicated an

Unilateral papilledema in cerebral venous sinus thrombosis

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Girish Baburao Kulkarni

2017-01-01

Full Text Available In the majority of patients with raised intracranial pressure, the papilledema is bilateral. Unilateral papilledema is rare in conditions causing intracranial hypertension, and it has been described in Foster–Kennedy syndrome and in some cases of idiopathic intracranial hypertension. It has never been reported in cerebral venous thrombosis. We report a young lady presenting with features of subacute onset of headache with seizures, on evaluation she had superior sagittal and bilateral lateral sinus thrombosis. The risk factors found on evaluation were Vitamin B12 deficiency and hyperhomocysteinemia. On optic fundus examination, she had swollen optic disc on the right side with normal fundus on the left side, confirmed with the orbital ultrasound B-scan and optic coherence tomography. Her magnetic resonance imaging showed features of raised intracranial pressure with thrombosis of the superior sagittal and bilateral lateral sinus thrombosis. She was treated with anticoagulation (heparin followed by oral anticoagulants, antiedema measures, and vitamin supplementation for hyperhomocysteinemia. She improved over time and was asymptomatic during follow-up. We discuss the possible mechanisms described in the literature for unilateral papilledema. This report highlights the need for carefully performing bilateral fundus examination so as not to miss the vision or life-threatening causes of a headache.

The positive effect of mirror visual feedback on arm control in children with Spastic hemiparetic cerebral palsy is dependent on which arm is viewed

NARCIS (Netherlands)

Smorenburg, A; Ledebt, A.; Feltham, M.; Deconinck, F.; Savelsbergh, G.J.P.

2011-01-01

Mirror visual feedback has previously been found to reduce disproportionate interlimb variability and neuromuscular activity in the arm muscles in children with Spastic Hemiparetic Cerebral Palsy (SHCP). The aim of the current study was to determine whether these positive effects are generated by

The effect of reflexology upon spasticity and function among children with cerebral palsy who received physiotherapy: Three group randomised trial.

Science.gov (United States)

Özkan, Filiz; Zincir, Handan

2017-08-01

To assess the effectiveness of reflexology method upon spasticity and function among children with cerebral palsy who received physiotherapy. A three group, randomised trial with blinded evaluator. Randomization was made sealed and opaque envelopes. 45 children with cerebral palsy who were trained at a Special Education and Rehabilitation Centre. In the reflexology and placebo group; a 20min reflexology was performed twice a week in a total 24 sessions. In the control group; no intervention was done. Before and after the implementation; measurements of the participants were obtained. The data were collected using Gross Motor Function Measure, Modified Ashworth Scale (MAS), Modified Tardieu Scale, Pediatric Functional Independence Scale, Pediatric Quality of Life Scale (PedsQL) and demographic data. A total of 45 children completed the study. The groups were homogeneous at baseline. Between right MAS Gastrocnemius muscle was a difference and right and left Soleus muscles was significant among the groups (p0.05). Reflexology with physiotherapy reduced spasticity in legs, improved gross motor functions, decreased dependency but led to no change in quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study.

Science.gov (United States)

Hoare, Brian; Ditchfield, Michael; Thorley, Megan; Wallen, Margaret; Bracken, Jenny; Harvey, Adrienne; Elliott, Catherine; Novak, Iona; Crichton, Ali

2018-05-08

Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks. This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain - lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive - standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both

Developmental Profiles of Preschool Children With Spastic Diplegic and Quadriplegic Cerebral Palsy

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Ya-Chen Lee

2010-07-01

Full Text Available Cerebral palsy (CP is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD CP and spastic quadriplegic (SQ CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 ± 2.1 years, and we classified them into two groups: SD (n = 59 and SQ (n = 78. The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01. There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to

The Distribution of Body Weight Force on Toe and Heel before and after Exercise Therapy in Children with Spastic Diplegia Cerebral Palsy

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Keyvan Sharif-Moradi

2005-07-01

Full Text Available Objective: The purpose of this study was to assess the distribution of body weight force on toe and heel before and after exercise therapy and its effects on relaxation of children with spastic diplegia cerebral palsy. Materials & Methods: Ten children with spastic diplegia cerebral palsy between 8 to15 years of age participated in this study. Their mean weight and height were (30.8kg ± 5.7kg and (1.35m±0.09m respectively. Subjects underwent a 12 weeks of exercise therapy. A dynamic stability platform system (BIODEX was used to measure the mean percentage of body weight pressure on toe and heal. The balance tests were repeated on stable, almost stable and unstable base of support as well as with and without shoes. Results: Showed that the mean percentage of body weight pressure on toe and heal after exercise therapy was not significant (p>0.05. The mean percentage of body weight pressure on toe and heal was significantly decrease after exercise therapy in both with and without shoes (p<0.05. The greatest improvement achieved on almost stable and unstable conditions. Wearing shoes resulted in a balance percentage of body weight pressure on toe and heal on stable situation of stability platform the percentage of body weight pressure on toe and heal has no difference before and after exercise therapy. After exercise therapy strengthening the muscle of the ankle joint balance the percentage of body weight pressure on toe and heal. Wearing shoes decrease the muscle stretch and therefore balance the percentage of body weight pressure on toe and heal. Conclusion: The flexibility of spastic muscle and strengthening of the relax muscle must be perform. This result provides good information for physician in recognizing and therapy impacts on cerebral palsy children.

SPASTICITY PATTERNS OF HAND MUSCLES AND BOTULINUM TOXIN THERAPY APPLICATION IN PATIENTS WITH CEREBRAL PALSY WITH UPPER LIMB INVOLVEMENT

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O. A. Klochkova

2013-01-01

Full Text Available Botulinum toxin therapy is an effective and safe method of treatment of local spasticity in patients with cerebral palsy (CP. Calculation of botulinum toxin A (BTA dosage based on the spasticity patterns and functional capabilities of the patient proved effective for the hypertonic lower limb muscle spasm treatment and is being applied to BTA injections in hand muscles more often. The article presents contemporary scientific data and results of the original study of BTA injections efficacy for pathologic tension reduction in hand muscles of 52 patients with CP. The authors give detailed description of the upper limb spasticity patterns, their frequency and role in the pathological movement pattern formation. The authors propose BTA dosage calculation for the functional segments of upper limbs, which allows minimizing the total amount of the administered drug and avoiding excessive weakness. The authors have also conducted a follow-up analysis of changes in hand muscle tone for the period of 6 months after the first BTA injection, compared results of botulinum toxin therapy at various clinical forms of CP and given recommendations on the optimum duration of the follow-up period.

Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy.

Science.gov (United States)

Kwak, Eunmi Emily

2007-01-01

The purpose of this study was to use Rhythmic Auditory Stimulation (RAS) for children with spastic cerebral palsy (CP) in a clinical setting in order to determine its effectiveness in gait training for ambulation. RAS has been shown to improve gait performance in patients with significant gait deficits. All 25 participants (6 to 20 years old) had spastic CP and were ambulatory, but needed to stabilize and gain more coordinated movement. Participants were placed in three groups: the control group, the therapist-guided training (TGT) group, and the self-guided training (SGT) group. The TGT group showed a statistically significant difference in stride length, velocity, and symmetry. The analysis of the results in SGT group suggests that the self-guided training might not be as effective as therapist-guided depending on motivation level. The results of this study support three conclusions: (a) RAS does influence gait performance of people with CP; (b) individual characteristics, such as cognitive functioning, support of parents, and physical ability play an important role in designing a training application, the effectiveness of RAS, and expected benefits from the training; and (c) velocity and stride length can be improved by enhancing balance, trajectory, and kinematic stability without increasing cadence.

Recovery of cerebral blood flow in unilateral chronic subdural hematoma. The correlation with cerebral re-expansion in elders

International Nuclear Information System (INIS)

Nemoto, Akio

2003-01-01

CT and SPECT were used to investigate the relationship between cerebral re-expansion and changes in cerebral blood flow underneath hematoma in elderly patients after surgery for chronic unilateral subdural hematoma. I studied 22 patients with mild hematoma, aged 43 to 82 years (mean 67 years). The patients were placed in either Group A (under 70 years) or Group B (70 years or over) to observe postoperative changes. CT and SPECT examinations were conducted before surgery and 1, 7 and 30 days after surgery, 4 times in total. Cerebral re-expansion was represented by the re-expansion rate (PER) comparing the pre- and postoperative thickness of the maximal hematoma in CT images. The rate of cerebral re-expansion was slowed in Group B (p<0.01). Cerebral re-expansion was characterized by biphasic, rapid or gradual re-expansion on postoperative day 1 with a significant difference between groups (p<0.01). Before surgery, cerebral blood flow on the affected side correlated with age (p<0.01), thougn blood flow was diminished in both groups. After surgery, cerebral blood flow on the affected side exceeded that on the unaffected side in Group A and transiently increased on postoperative day 1. Cerebral blood flow improved after surgery in both groups, with a significant difference in those changes over time (p<0.01). In both groups, cerebral re-expansion on postoperative days 7 and 30 correlated with cerebral blood flow on the affected side (p<0.05). The present results suggest that improvement in cerebral blood flow on the affected side is delayed in elderly patients, due to slower postoperative cerebral re-expansion. (author)

Cerebral metabolic and structural alterations in hereditary spastic paraplegia with thin corpus callosum assessed by MRS and DTI

International Nuclear Information System (INIS)

Dreha-Kulaczewski, Steffi; Dechent, Peter; Helms, Gunther; Frahm, Jens; Gaertner, Jutta; Brockmann, Knut

2006-01-01

Hereditary spastic paraplegia with thin corpus callosum (HSP-TCC) is a complicated form of autosomal-recessive hereditary spastic paraplegia. Characteristic clinical features comprise progressive spastic gait, cognitive impairment, and ataxia. Diagnostic MRI findings include thinning of the corpus callosum and non-progressive white matter (WM) alterations. To study the extent of axonal involvement, we performed localized proton magnetic resonance spectroscopy (MRS) of the cerebral WM and cortical grey matter (GM) in a patient with HSP-TCC at 20 and 25 years of age. The second investigation included diffusion tensor imaging (DTI). While MRS of the GM was normal, affected WM was characterized by major metabolic alterations such as reduced concentrations of N-acetylaspartate and N-acetylaspartyl-glutamate, creatine and phosphocreatine, and choline-containing compounds as well as elevated levels of myo-inositol. These abnormalities showed progression over a period of 5 years. DTI revealed increased mean diffusivity as well as reduced fractional anisotropy in periventricular WM. The metabolic and structural findings are consistent with progressive neuroaxonal loss in the WM accompanied by astrocytic proliferation - histopathological changes known to occur in HSP-TCC. Our results are in agreement with the hypothesis that the primary pathological process in HSP-TCC affects the axon, possibly due to impaired axonal trafficking. (orig.)

Passive muscle properties are altered in children with cerebral palsy before the age of 3 years and are difficult to distinguish clinically from spasticity

DEFF Research Database (Denmark)

Willerslev-Olsen, Maria; Lorentzen, Jakob; Sinkjær, Thomas

2013-01-01

AIM: Clinical determination of spasticity is confounded by the difficulty in distinguishing reflex from passive contributions to muscle stiffness. There is, therefore, a risk that children with cerebral palsy (CP) receive antispasticity treatment unnecessarily. To investigate this, we aimed...... to determine the contribution of reflex mechanisms to changes in the passive elastic properties of muscles and tendons in children with CP. METHOD: Biomechanical and electrophysiological measures were used to determine the relative contribution of reflex and passive mechanisms to ankle muscle stiffness in 35...... tetraplegia. According to the Gross Motor Function Classification System, 31 children were classified in level I, two in level II, and two in level III. RESULTS: Only seven children with spastic CP showed reflex stiffness outside the range of the control children. In contrast, 20 children with spastic CP...

Quantifying spasticity in individual muscles using shear wave elastography

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Sarah F. Eby, BS

2017-06-01

Full Text Available Spasticity is common following stroke; however, high subject variability and unreliable measurement techniques limit research and treatment advances. Our objective was to investigate the use of shear wave elastography (SWE to characterize the spastic reflex in the biceps brachii during passive elbow extension in an individual with spasticity. The patient was a 42-year-old right-hand-dominant male with history of right middle cerebral artery-distribution ischemic infarction causing spastic left hemiparesis. We compared Fugl-Meyer scores (numerical evaluation of motor function, sensation, motion, and pain, Modified Ashworth scores (most commonly used clinical assessment of spasticity, and SWE measures of bilateral biceps brachii during passive elbow extension. We detected a catch that featured markedly increased stiffness of the brachialis muscle during several trials of the contralateral limb, especially at higher extension velocities. SWE was able to detect velocity-related increases in stiffness with extension of the contralateral limb, likely indicative of the spastic reflex. This study offers optimism that SWE can provide a rapid, real-time, quantitative technique that is readily accessible to clinicians for evaluating spasticity.

Estimation of motive possibilities and manipulative activity of children with cerebral paralysis of spastic form 3-5 years

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Baybuza I.V.

2012-03-01

Full Text Available In this work the conducted estimation of motive possibilities and manipulative activity of children is with the cerebral paralysis of spastic form 3-5 years accordingly standard norms. The experiment was attended by 30 children. Proven lack of fine motor skills and basic static and motor skills decreased muscle strength and improve muscle tone. Providing a more objective assessment of physical development of patients with this pathology would contribute a program hydrokinesotherapy as a means of gradual formation of motor skills.

Hereditary spastic paraplegias: membrane traffic and the motor pathway

OpenAIRE

Blackstone, Craig; O’Kane, Cahir J.; Reid, Evan

2011-01-01

Voluntary movement is a fundamental way in which animals respond to, and interact with, their environment. In mammals, the main CNS pathway controlling voluntary movement is the corticospinal tract, which encompasses connections between the cerebral motor cortex and the spinal cord. Hereditary spastic paraplegias (HSPs) are a group of genetic disorders that lead to a length-dependent, distal axonopathy of fibres of the corticospinal tract, causing lower limb spasticity and weakness. Recent wo...

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

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D.C. Garção

2011-01-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

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Diogo Costa Garção

2011-09-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Our Approach to the Spastic Hip Subluxation and Dislocation in Children with Cerebral Palsy

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Pavel Šponer

2006-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1–3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.

Prevalence and risk factors for epilepsy in children with spastic cerebral palsy

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Dedy Rahmat

2010-03-01

Conclusions The prevalence of epilepsy in spastic CP is 39%. The risk factors for epilepsy in spastic CP are post central nervous system infection, and ocurrence of seizure in the first year of life. [Paediatr Indones. 2010;50:11-7].

Outcomes in spasticity after repetitive transcranial magnetic and transcranial direct current stimulations

OpenAIRE

Gunduz, Aysegul; Kumru, Hatice; Pascual-Leone, Alvaro

2014-01-01

Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhibits satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in improving ...

SPASTIC FORM OF CEREBRAL PALSY, EPILEPSY WITH BENIGN EPILEPTIFORM DISCHARGE OF CHILDHOOD ON ELECTROENCEPHALOGRAM, AND IATROGENIC STEVENS–JOHNSON SYNDROME (CASE DESCRIPTION

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A. S. Kotov

2016-01-01

Full Text Available The article describes the phenomenon of dual pathology – a combination of structural changes in the brain and benign epileptiform discharge of childhood on electroencephalogram. The uniqueness lies in the observation that the child, since birth suffering from spastic form of cerebral palsy and severe epilepsy, demonstrated the development of Stevens–Johnson syndrome due to intolerance of one of the antiepileptic drugs. Therapeutic approaches to overcome a whole range of violations are discussed in the article.

Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by means of electrical stimulation

NARCIS (Netherlands)

Warnink-Kavelaars, Jessica; Vermeulen, Roland Jeroen; Becher, Jules Guilhelmus

2013-01-01

Background: Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is

Clinical Observation on Treatment of Spastic Cerebral Palsy with Tuina plus Music Therapy

Institute of Scientific and Technical Information of China (English)

马美美; 刘振寰; 赵勇; 罗冠君; 李诺; 招文健; 万瑞平; 韩丑萍

2009-01-01

目的:观察小儿推拿结合音乐疗法对改善痉挛型小儿脑性瘫痪患者踝关节活动度及下肢肌肉痉挛的作用.方法:对符合小儿脑性瘫痪诊断标准的286例痉挛型患儿,在背景音乐下进行通督循经点穴推拿、益肾健脾推拿、捏脊疗法、足底推拿、节段性推拿、促肌力恢复推拿及关节活动度推拿7种推拿治疗,每次25～30min,每日1～2次.30天为1个疗程.于治疗前后进行股内收肌角、足背屈角和综合痉挛量表(CompositeSpastic@Scale,CSS)评分,以评价疗效.结果:治疗前后足背屈角、股内收肌角、CSS评分统计学处理,差异有统计学意义(P<0.01).总体疗效为显效106例,有效172例,无效8例.结论:推拿结合音乐疗法治疗痉挛型小儿脑瘫,有滑利关节,松解肌腱挛缩,缓解肌肉痉挛作用,能改善剪刀步态和尖足步态.对患儿坐、跪、站、行大运动功能恢复有极积治疗作用.%Objective: To observe the effect oftuina plus music therapy on range of motion of ankle joints and muscle spasm of lower limbs in children with spastic cerebral palsy. Method:All of 286 cases that conformed to the diagnostic criteria of infantile cerebral palsy were treated with 7 types of tuina manipulations respectively to unblock the Governor Vessel, reinforce the kidney and strengthen the spleen, pinch along the spine, stimulate specific foot-reflex area and different spinal segments, accelerate recovery of muscle strength and increase joint range of motion, 25-30 rain each treatment, once or twice a day, 30 d constitute a course of treatment.After this, the efficacy on femoral medial adduction and dorsiflexion angle and composite spasticity score (CSS) was evaluated. Result: The statistical analysis showed significant differences in dorsiflexion and femoral medial adduction angle and CCS scores (P<0.01) after the treatments. Conclusion: Tuina plus music therapy can lubricate the joints, relax contraction of tendons, alleviate

MRI in spastic cerebral palsy - correlations with motor development and mental retardation

International Nuclear Information System (INIS)

Kulal, W.; Sobaniec, W.; Kubas, B.

2004-01-01

The introduction of magnetic resonance (MR) has improved our understanding of the pathophysiology and early diagnosis of cerebral palsy (CP). The aim of this study was to evaluate types of lesions on MR in children with CP in correlations with motor development, cognitive impairment and risk factors. Twenty-two children aged 4-17 years (boys 12, girls 10) with CP diplegia - 16 and tetraplegia - 6 were studied. Routine MR images were performed in all children. Results: All patients had periventricular leukomalacia (PVL) in MR findings. In addition three different degrees of MRI lesion patterns were defined: a mild pattern (nucleus lentiformis and thalamus) moderate (nucleus lentiformis, thalamus and pericentral region)and a severe pattern (nucleus lentiformis , thalamus, pericentral region and hippocampus). Significant correlations of the MR findings with the motor development and mental retardation were found. No significant relationships between the MR findings and the etiological factors (prematurity, low birthweight, Apgar score, sepsis, seizures, pre-eclamsia , and gestational age) were noted. MR imaging is useful in the evaluation structural abnormalities in the brains in the children with spastic diplegia and tetraplegia. (author)

Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy.

Science.gov (United States)

Shin, Yoon Kyum; Lee, Dong Ryul; Kim, Do Hyun; Lee, Jae Jin; You, Sung Joshua Hyun; Yi, Chung Hwi; Jeon, Hye Seon

2014-01-01

Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP.

Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial.

Science.gov (United States)

Unger, Marianne; Jelsma, Jennifer; Stark, Christina

2013-01-01

This study aimed to determine whether strengthening trunk muscles using vibration can improve posture and gait in children with spastic-type cerebral palsy (STCP). A total of 27 children (6-13 years) participated in a single-blinded pre-post crossover experimental trial. The 1-Minute Walk Test, 2D-posturography, ultrasound imaging and sit-ups in one minute were used to assess effect on gait, posture, resting abdominal muscle thickness and functional strength. Significant increase in distance walked (p posture, an increase in sit-ups executed (p posture were maintained at 4-weeks post-intervention. A trunk-targeted intervention using vibration can improve posture and gait in children with STCP without any known side effects. It is recommended that vibration and specific trunk strengthening is included in training or rehabilitation programmes. Effects of vibration on force generation and spasticity need further investigation.

Comparison of Tc-99m ECD brain SPECT between patients with delayed development and cerebral palsy

International Nuclear Information System (INIS)

Cho, I.; Chun, K.; Won, K.; Lee, H.; Jang, S.; Lee, J.

2002-01-01

Purpose: In previous study, thalamic or cerebellar hypoperfusion were reported in patients with cerebral palsy. This study was performed to evaluate cerebral perfusion abnormalities using Tc-99m ECD brain SPECT in patients with delayed motor development. Methods: Nineteen patients (9 boys, 10 girls, mean age 25.5 months) with delayed development underwent brain SPECT after injection of 185∼370 MBq of Tc-99m ECD. The imaging was obtained between 30 minutes and 1hr after injection. The patients were divided clinically as follows, patients with delayed development (n=5) and patients with cerebral palsy (n=14) who has delayed development and abnormal movement. The clinical subtypes of cerebral palsy were spastic quadriplegia (n=5), spastic diplegia (n=6) and spastic hemiplegia (n=3). In each group, decrease of cerebral perfusion was evaluated visually as mild, moderate and severe and quantitation of cerebral perfusion after Lassen's correction was also obtained. Results: SPECT findings showed normal or mildly decreased thalamic perfusion in patients with delayed development and severe decrease of thalamic or cerebellar perfusion in patients with spastic quadriplegia. In patients with spastic diplegia, mild decrease of perfusion was observed in thalamus. In quantified data, thalamic perfusion was lowest in patients with spastic quadriplegia and highest in patients with delayed development, but there were no statistically significant differences. Conclusion: Brain SPECT with Tc-99m ECD has a role in the detection of perfusion abnormalities in patients with delayed development and cerebral palsy

Validation and absolute quantification of MR perfusion compared with CT perfusion in patients with unilateral cerebral arterial stenosis

Energy Technology Data Exchange (ETDEWEB)

Chiu, Fang-Ying, E-mail: fychiou@hotmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Kao, Yi-Hsuan, E-mail: yhkao@ym.edu.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Teng, Michael Mu Huo, E-mail: mhteng@gmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); School of Medicine, National Yang-Ming University, Taipei City, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Chung, Hsiao-Wen, E-mail: chung@cc.ee.ntu.edu.tw [Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan (China); Chang, Feng-Chi, E-mail: fcchang374@gmail.com [School of Medicine, National Yang-Ming University, Taipei City, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Cho, I-Chieh, E-mail: jessie8030@yahoo.com.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Chen, Wen-Chun, E-mail: sky7408695@hotmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China)

2012-12-15

Objective: The aim of the study was to assess absolute quantification of dynamic susceptibility contrast-enhanced magnetic resonance perfusion (MRP) comparing with computed tomography perfusion (CTP) in patients with unilateral stenosis. Materials and methods: We retrospectively post-processed MRP in 20 patients with unilateral occlusion or stenosis of >79% at the internal carotid artery or the middle cerebral artery (MCA). Absolute quantification of MRP was performed after applying the following techniques: cerebrospinal fluid removal, vessel removal, and automatic segmentation of brain to calculate the scaling factors to convert relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values to absolute values. For comparison between MRP and CTP, we manually deposited regions of interest in bilateral MCA territories at the level containing the body of the lateral ventricle. Results: The correlation between MRP and CTP was best for mean transit time (MTT) (r = 0.83), followed by cerebral blood flow (CBF) (r = 0.52) and cerebral blood volume (CBV) (r = 0.43). There was no significant difference between CTP and MRP for CBV, CBF, and MTT on the lesion side, the contralateral side, the lesion-contralateral differences, or the lesion-to-contralateral ratios (P > 0.05). The mean differences between MRP and CTP were as follows: CBV −0.57 mL/100 g, CBF 2.50 mL/100 g/min, and MTT −0.90 s. Conclusion: Absolute quantification of MRP is possible. Using the proposed method, measured values of MRP and CTP had acceptable linear correlation and quantitative agreement.

Validation and absolute quantification of MR perfusion compared with CT perfusion in patients with unilateral cerebral arterial stenosis

International Nuclear Information System (INIS)

Chiu, Fang-Ying; Kao, Yi-Hsuan; Teng, Michael Mu Huo; Chung, Hsiao-Wen; Chang, Feng-Chi; Cho, I-Chieh; Chen, Wen-Chun

2012-01-01

Objective: The aim of the study was to assess absolute quantification of dynamic susceptibility contrast-enhanced magnetic resonance perfusion (MRP) comparing with computed tomography perfusion (CTP) in patients with unilateral stenosis. Materials and methods: We retrospectively post-processed MRP in 20 patients with unilateral occlusion or stenosis of >79% at the internal carotid artery or the middle cerebral artery (MCA). Absolute quantification of MRP was performed after applying the following techniques: cerebrospinal fluid removal, vessel removal, and automatic segmentation of brain to calculate the scaling factors to convert relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values to absolute values. For comparison between MRP and CTP, we manually deposited regions of interest in bilateral MCA territories at the level containing the body of the lateral ventricle. Results: The correlation between MRP and CTP was best for mean transit time (MTT) (r = 0.83), followed by cerebral blood flow (CBF) (r = 0.52) and cerebral blood volume (CBV) (r = 0.43). There was no significant difference between CTP and MRP for CBV, CBF, and MTT on the lesion side, the contralateral side, the lesion-contralateral differences, or the lesion-to-contralateral ratios (P > 0.05). The mean differences between MRP and CTP were as follows: CBV −0.57 mL/100 g, CBF 2.50 mL/100 g/min, and MTT −0.90 s. Conclusion: Absolute quantification of MRP is possible. Using the proposed method, measured values of MRP and CTP had acceptable linear correlation and quantitative agreement.

Teeth grinding, oral motor performance and maximal bite force in cerebral palsy children.

Science.gov (United States)

Botti Rodrigues Santos, Maria Teresa; Duarte Ferreira, Maria Cristina; de Oliveira Guaré, Renata; Guimarães, Antonio Sergio; Lira Ortega, Adriana

2015-01-01

Identify whether the degree of oral motor performance is related to the presence of teeth grinding and maximal bite force values in children with spastic cerebral palsy. Ninety-five spastic cerebral palsy children with and without teeth grinding, according to caregivers' reports, were submitted to a comprehensive oral motor performance evaluation during the feeding process using the Oral Motor Assessment Scale. Maximal bite force was measured using an electronic gnathodynamometer. The teeth grinding group (n = 42) was younger, used anticonvulsant drugs, and was more frequently classified within the subfunctional oral motor performance category. Teeth grinding subfunctional spastic cerebral palsy children presented lower values of maximal bite force. The functional groups showing the presence or absence of teeth grinding presented higher values of maximal bite force compared with the subfunctional groups. In spastic cerebral palsy children, teeth grinding is associated with the worse oral motor performance. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

Body Posture Asymmetry Differences between Children with Mild Scoliosis and Children with Unilateral Cerebral Palsy

Directory of Open Access Journals (Sweden)

Małgorzata Domagalska-Szopa

2013-01-01

Full Text Available Patients with unilateral cerebral palsy (CP often have impaired movement coordination, reduced between-limb synchronization, and less weight bearing on the affected side, which can affect the maintenance of an upright weight-bearing position and gait. This study evaluated whether the different postural patterns of children with unilateral CP could be statistically recognized using cluster analysis. Forty-five outpatients with unilateral CP (mean age, 9 years and 5 months and 51 able-bodied children with mild scoliosis (mean age, 9 years and 2 months were included. One observer performed moiré topography (MT examinations using a CQ Electronic System (Poland device. A weight distribution analysis on the base of support (BOS between the body sides was performed simultaneously. A force plate dynamographic platform (PDM, ZEBRIS (Germany, with FootPrint software was used for these measurements. Cluster analysis revealed three groups: Cluster 1 (, 73.96%, Cluster 2 (, 8.33%, and Cluster 3 (, 17.71%. Based on the MT parameters (extracted using a data reduction technique, three typical asymmetrical postural patterns were described: (1 the postural pattern of children with mild scoliosis (SCOL, (2 the progravitational postural pattern (PGPP, and (3 the antigravitational pattern. Patterns two and three were identified in children with unilateral CP.

Surgical management of spasticity | Enslin | South African Medical ...

African Journals Online (AJOL)

The management of patients with cerebral palsy and other causes of spasticity is a challenge to an entire rehabilitation team and to caregivers. In South Africa, neurosurgeons have had limited involvement in this field owing to a perceived lack of options, leaving the care of these patients largely in the hands of paediatric ...

Three Case Reports of Successful Vibration Therapy of the Plantar Fascia for Spasticity Due to Cerebral Palsy-Like Syndrome, Fetal-Type Minamata Disease.

Science.gov (United States)

Usuki, Fusako; Tohyama, Satsuki

2016-04-01

Fetal-type Minamata disease is caused by the exposure to high concentrations of methylmercury in the fetal period and shows cerebral palsy-like clinical features. Relief of spasticity is a major task of rehabilitation to improve their activities of daily living. Here we report the effect of long-term vibration therapy on bilateral lower-limb spasticity in 3 patients with fetal-type Minamata disease. We used a simple, inexpensive, and noninvasive approach with hand-held vibration massagers, which were applied to the plantar fascia at 90 Hz for 15 minutes. The effect was observed soon after the first treatment and resulted in better performance of the repetitive facilitation. Vibration therapy for 1 year improved Modified Ashworth Scale for the ankle flexors in 2 cases. The labored gait improved and gait speed increased in another case. Continued vibration therapy for another 1 year further improved Modified Ashworth Scale score and range of motion of ankle dorsiflexion in 1 case. This case showed the decreased amplitude of soleus H-reflex after the 15-minute vibration therapy, suggesting that α-motor neuron excitability was suppressed. Vibration therapy using a hand-held vibration massager may offer safe and effective treatment for lower-limb spasticity in patients with chronic neurological disorders.

Computerized tomographic studies in cerebral palsy

International Nuclear Information System (INIS)

Sugie, Yoko

1981-01-01

Computed tomographic (CT) findings in 200 children with cerebral palsy (CP) were analysed from the viewpoint of clinical manifestations, disease complications and etiological factors. CT scans of 135 cases (67.5%) were found to be abnormal and there were 14 (7%) borderline cases. The major abnormality found on CT scans was cerebral atrophy. Other important changes included focal or diffuse low density area in the brain tissue, congenital malformation, and cerebellar atrophy. From the clinical point of view, a large number of patients with spastic tetraplegia and spastic diplegia showed highly abnormal CT scans. On the other hand, in patients with spastic monoplegia, spastic paraplegia, and athetotic type, CT findings were normal or revealed only minor cerebral atrophy. Most children showing asymmetric clinical symptoms had corresponding asymmetric CT abnormalities which included ventricular enlargement, low density area in the brain tissue, and hemispherical volume. There was a significant correlation between the severity of physical impairment and the extent of CT abnormalities. Severely affected children had grossly abnormal CT scans such as hydranencephaly, polycystic change, and extensive cerebral atrophy. In the patients complicated with epilepsy, the incidence and severity of abnormal CT were higher than those of non-epileptic patients. Mentally retarded patients had variable enlargement of the subarachnoidal space depending on the severity of their mental retardation. Patients with suspected postnatal etiology also had high incidence of severe CT abnormality. CT scan is a valuable tool for evaluating patients with CP and in some cases, possible etiology of the disease may be discovered. (author)

Quantitative comparison of cortical and deep grey matter in pathological subtypes of unilateral cerebral palsy.

Science.gov (United States)

Scheck, Simon M; Pannek, Kerstin; Fiori, Simona; Boyd, Roslyn N; Rose, Stephen E

2014-10-01

The aim of this study was to quantify grey matter changes in children with unilateral cerebral palsy (UCP), differentiating between cortical or deep grey matter (CDGM) lesions, periventricular white matter (PWM) lesions, and unilateral and bilateral lesions. In a cross-sectional study we obtained high resolution structural magnetic resonance images from 72 children (41 males, 31 females, mean age 10y 9mo [SD 3y 1mo], range 5y 1mo-17y 1mo) with UCP (33 left, 39 right hemiplegia; Manual Ability Classification System level I n=29, II n=43; Gross Motor Function Classification System level I n=46, II n=26), and 19 children with typical development (CTD; eight males, 11 females, mean age 11y 2mo [SD 2y 7mo], range 7y 8mo-16y 4mo). Images were classified by lesion type and analyzed using voxel-based morphometry (VBM) and subcortical volumetric analysis. Deep grey matter volumes were not significantly different between children with CDGM and PWM lesions, with the thalamus, putamen, and globus pallidus being reduced unilaterally in both groups compared with CTD (p≤0.001). Children with CDGM lesions additionally showed widespread cortical changes involving all lobes using VBM (p<0.01). Children with bilateral lesions had reduced thalamus and putamen volumes bilaterally (p<0.001). The thalamic volume was reduced bilaterally in children with unilateral lesions (p=0.004). Lesions to the PWM cause secondary changes to the deep grey matter structures similar to primary changes seen in CDGM lesions. Despite having a unilateral phenotype, grey matter changes are observed bilaterally, even in children with unilateral lesions. © 2014 Mac Keith Press.

Lipid myopathy associated with renal tubular acidosis and spastic diplegia in two brothers.

Science.gov (United States)

Tung, Y C; Tsau, Y K; Chu, L W; Young, C; Shen, Y Z

2001-07-01

Lipid myopathy is a group of disorders involving mitochondrial fatty acid oxidation. We describe two brothers, 3 years 8 months old and 2 years 9 months old, respectively, with progressive spastic diplegia, developmental delay, failure to thrive, and chronic metabolic acidosis who had lipid myopathy and renal tubular acidosis. Brain magnetic resonance imaging revealed demyelinating changes in the periventricular white matter, which was compatible with spastic diplegia. These symptoms may be related to errors in fatty acid metabolism. Cerebral palsy had been misdiagnosed in both of these patients at another hospital. Therefore, for patients with late-onset and progressive spastic diplegia, detailed investigations for underlying diseases are warranted.

Analysis of structure-function network decoupling in the brain systems of spastic diplegic cerebral palsy.

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Lee, Dongha; Pae, Chongwon; Lee, Jong Doo; Park, Eun Sook; Cho, Sung-Rae; Um, Min-Hee; Lee, Seung-Koo; Oh, Maeng-Keun; Park, Hae-Jeong

2017-10-01

Manifestation of the functionalities from the structural brain network is becoming increasingly important to understand a brain disease. With the aim of investigating the differential structure-function couplings according to network systems, we investigated the structural and functional brain networks of patients with spastic diplegic cerebral palsy with periventricular leukomalacia compared to healthy controls. The structural and functional networks of the whole brain and motor system, constructed using deterministic and probabilistic tractography of diffusion tensor magnetic resonance images and Pearson and partial correlation analyses of resting-state functional magnetic resonance images, showed differential embedding of functional networks in the structural networks in patients. In the whole-brain network of patients, significantly reduced global network efficiency compared to healthy controls were found in the structural networks but not in the functional networks, resulting in reduced structural-functional coupling. On the contrary, the motor network of patients had a significantly lower functional network efficiency over the intact structural network and a lower structure-function coupling than the control group. This reduced coupling but reverse directionality in the whole-brain and motor networks of patients was prominent particularly between the probabilistic structural and partial correlation-based functional networks. Intact (or less deficient) functional network over impaired structural networks of the whole brain and highly impaired functional network topology over the intact structural motor network might subserve relatively preserved cognitions and impaired motor functions in cerebral palsy. This study suggests that the structure-function relationship, evaluated specifically using sparse functional connectivity, may reveal important clues to functional reorganization in cerebral palsy. Hum Brain Mapp 38:5292-5306, 2017. © 2017 Wiley Periodicals

Hereditary spastic paraplegias: membrane traffic and the motor pathway.

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Blackstone, Craig; O'Kane, Cahir J; Reid, Evan

2011-01-01

Voluntary movement is a fundamental way in which animals respond to, and interact with, their environment. In mammals, the main CNS pathway controlling voluntary movement is the corticospinal tract, which encompasses connections between the cerebral motor cortex and the spinal cord. Hereditary spastic paraplegias (HSPs) are a group of genetic disorders that lead to a length-dependent, distal axonopathy of fibres of the corticospinal tract, causing lower limb spasticity and weakness. Recent work aimed at elucidating the molecular cell biology underlying the HSPs has revealed the importance of basic cellular processes — especially membrane trafficking and organelle morphogenesis and distribution— in axonal maintenance and degeneration.

Evaluation of the effect of the reduction of the hip spastic dislocation in adolescent and young adult with cerebral paralysis

International Nuclear Information System (INIS)

Contreras Calderon, Jose; Zambrano, Gladis Cecilia; Villanueva, Erland; Turriago, Camilo Andres

2006-01-01

We present the results obtained in the Instituto de Ortopedia Infantil Roosevelt for the treatment of the hip dislocation in adolescent patients and young adults with spastic cerebral palsy with the open reduction of the hip, accompanied by femoral osteotomy and, if as necessary, pelvic osteotomy. 14 hips (10 patients) were intervened from January of 1996 to July of 2003. Pain was completely released in 54 percent and improved in 36 percent of cases. Abduction improved in 63 percent of patients allowing the perinea cleaning in 63 percent and better tolerance to scar in 64% of the cases. Our complications were one patient developed a sacred pressure ulcer with the spica cast treated with a free flap transposition; one hip had redislocation at 31 months from surgery; another hip had instability without clinical repercussion; one patient had a not displaced supracondylar femoral fracture treated with immobilization. The results of our study showed that the open reduction of the spastic hip in adolescents and young adults is a procedure that improves, in most of the cases, the stability, mobility and pain of the hip and provides better quality life for these patients

The Effect of Resistance Training on Performance of Gross Motor Skills and Balance in Children with Spastic Cerebral Palsy

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Ebrahim Zarrinkalam

2016-03-01

Full Text Available Objective: Cerebral palsy is the most common chronic motor disability in children and can have negative effect on motor functions. The purpose of this study was to investigate the effect of eight weeks resistance training on gross motor ability, balance and walking speed in a group of such children. Methods: 21 cerebral palsy boys with spastic diplegia, aged between 12 and 16 years (mean, 13.66 years, participated in this study. A pre-test, involving walking, sitting, standing and walking up stairs. They were randomly divided into an experimental and control groups. Then, the experimental group participated in 8 weeks of resistance training.  The data was attained from a 10 meter walk test, Berg Balance Test, gross motor ability Section E, D and GMFCS tests.  Kolmogorov-Smirnov test, sample t-test were used for analyzing the data. Results: The results showed a significant improvement in the performance of experimental group in gross motor abilities section  E and D, balance and walking speed after 8 weeks of resistance training (P <0.05(. However, significant differences were not observed in the control group before and after the study (P <0.05.  Conclusion: The results showed that resistance training improves gross motor ability, balance and gait in children with cerebral palsy hence, it is recommended that resistance exercise be used as a therapeutic modality for children with cerebral palsy.

COMPARISON BETWEEN PHYSIOLOGICAL COST INDEX IN HEALTHY NORMAL CHILDREN AS AGAINST AMBULATORY SPASTIC DIPLEGIC CEREBRAL PALSY (WITH AND WITHOUT ORTHOSIS IN THE AGE GROUP 6 TO 18 YEARS

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Swatia Bhise

2016-08-01

Full Text Available Background: Efficacy of rehabilitation program for subjects with orthosis with objective measurement. The study aiming to objectively compare the PCI and walking speed of normal children with ambulatory spastic diaplegic. Also we aimed to analyze whether BMIhad impact on energy cost. Methods: 41 normal children and 41 community walking spastic diaplegic aged between 6 to 18 yrs. were assessed to compare the PCI. Speed of walking and heart rate were checked constantlyboth barefoot and in shoes in normal children and with and without conventional AFO in children with spastic diaplegic at their chosen velocities over four consecutive lengths of a 12.5m walkway i.e. total 50m.,Pre and Post readings are taken. Heart rate is affected by speed; PCI with speed of walking and heart rate was calculated for each child. Results: The mean PCI in shoes and barefoot was same in normal children i.e. 0.05 ±0.039beats/meter. The PCI for children with pathological gait i.e. spastic diaplegic without orthosis and with orthosis is 0.199 ±0.176 and 0.104± 0.093beats/meter appreciably greater than that for normal children(p less than 0.05. Conclusion: This study showed that walking with orthosis in spastic diplegic CP children showed higher costs of energy and slower walking speed compared normal children with age matched. The PCI of walking, with orthosis in children with spastic Diplegic cerebral palsy is less as compared to without orthosis i.e. gait is more energy efficient with orthosis. BMI doesn’t show any correlation with PCI further study may require.

Detection of misery perfusion in the cerebral hemisphere with chronic unilateral major cerebral artery steno-occlusive disease using crossed cerebellar hypoperfusion: comparison of brain SPECT and PET imaging

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Matsumoto, Yoshiyasu; Ogasawara, Kuniaki; Saito, Hideo; Takahashi, Yoshihiro; Ogasawara, Yasushi; Kobayashi, Masakazu; Ogawa, Akira [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Terasaki, Kazunori [Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Yoshida, Kenji; Beppu, Takaaki; Kubo, Yoshitaka; Fujiwara, Shunrou [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Tsushima, Eiki [Hirosaki University, Graduate School of Health Sciences, Hirosaki (Japan)

2013-10-15

In patients with unilateral internal carotid or middle cerebral artery (ICA or MCA) occlusive disease, the degree of crossed cerebellar hypoperfusion that is evident within a few months after the onset of stroke may reflect cerebral metabolic rate of oxygen in the affected cerebral hemisphere relative to that in the contralateral cerebral hemisphere. The aim of the present study was to determine whether the ratio of blood flow asymmetry in the cerebellar hemisphere to blood flow asymmetry in the cerebral hemisphere on positron emission tomography (PET) and single photon emission computed tomography (SPECT) correlates with oxygen extraction fraction (OEF) asymmetry in the cerebral hemisphere on PET in patients with chronic unilateral ICA or MCA occlusive disease and whether this blood flow ratio on SPECT detects misery perfusion in the affected cerebral hemisphere in such patients. Brain blood flow and OEF were assessed using {sup 15}O-PET and N-isopropyl-p-[{sup 123}I]iodoamphetamine ({sup 123}I-IMP) SPECT, respectively. All images were anatomically standardized using SPM2. A region of interest (ROI) was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a three-dimensional stereotaxic ROI template, and affected-to-contralateral asymmetry in the MCA territory or contralateral-to-affected asymmetry in the cerebellar hemisphere was calculated. Sixty-three patients with reduced blood flow in the affected cerebral hemisphere on {sup 123}I-IMP SPECT were enrolled in this study. A significant correlation was observed between MCA ROI asymmetry of PET OEF and the ratio of cerebellar hemisphere asymmetry of blood flow to MCA ROI asymmetry of blood flow on PET (r = 0.381, p = 0.0019) or SPECT (r = 0.459, p = 0.0001). The correlation coefficient was higher when reanalyzed in a subgroup of 43 patients undergoing a PET study within 3 months after the last ischemic event (r = 0.541, p = 0.0001 for PET; r = 0.609, p < 0

Computed tomographic findings in children with spastic diplegia

International Nuclear Information System (INIS)

Yokochi, Kenji; Horie, Masayo; Inukai, Kazuhisa; Kito, Hideyuki; Shimabukuro, Satoshi; Kodama, Kazuo.

1989-01-01

Computed tomographic findings of 46 children with spastic diplegia examined at nine months to three years of age corrected for preterm births were analyzed. Both the size of the lateral ventricles measured by the width of the anterior horns, and the volume of the extracerebral low-density areas were enlarged in some patiens. Both enlargements did not, however, correlate to the severity of the motor abnormality in the patients. The low-density areas of the periventricular white matter, especially adjacent to the trigone, were reduced in many children, probably due to the atrophy of the cerebral white matter having periventricular leukomalacia. The anterior expansion of the white matter reduction from the trigone corresponded to the severer motor abnormality in the children with spastic diplegia. (author)

A pilot single-blind multicentre randomized controlled trial to evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on the arm function of children with spastic cerebral palsy.

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Preston, Nick; Weightman, Andrew; Gallagher, Justin; Levesley, Martin; Mon-Williams, Mark; Clarke, Mike; O'Connor, Rory J

2016-10-01

To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy. A single-blind randomized controlled trial design. Power calculations indicated that 58 children would be required to demonstrate a clinically important difference. Intervention was home-based; recruitment took place in regional spasticity clinics. A total of 15 children with cerebral palsy aged five to 12 years were recruited; eight to the device group. Both study groups received 'usual follow-up treatment' following spasticity treatment with botulinum toxin; the intervention group also received a rehabilitation gaming device. ABILHAND-kids and Canadian Occupational Performance Measure were performed by blinded assessors at baseline, six and 12 weeks. An analysis of covariance showed no group differences in mean ABILHAND-kids scores between time points. A non-parametric analysis of variance on Canadian Occupational Performance Measure scores showed a statistically significant improvement across time points (χ 2 (2,15) = 6.778, p = 0.031), but this improvement did not reach minimal clinically important difference. Mean daily device use was seven minutes. Recruitment did not reach target owing to unanticipated staff shortages in clinical services. Feedback from children and their families indicated that the games were not sufficiently engaging to promote sufficient use that was likely to result in functional benefits. This study suggests that computer-assisted arm rehabilitation gaming does not benefit arm function, but a Type II error cannot be ruled out. © The Author(s) 2015.

[Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy for treating spastic cerebral paralysis of the upper limbs caused by cerebral palsy].

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Zhang, Peng; Hu, Wei; Cao, Xu; Xu, Shi-gang; Li, De-kui; Xu, Lin

2009-10-01

To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy. From March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment. All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.

Assessment of upper limb capacity in children with unilateral cerebral palsy: construct validity of a Rasch-reduced Modified House Classification

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Geerdink, Yvonne; Lindeboom, Robert; de Wolf, Sander; Steenbergen, Bert; Geurts, Alexander C. H.; Aarts, Pauline

2014-01-01

The aim of this study was to test and improve the unidimensionality and item hierarchy of the Modified House Classification (MHC) for the assessment of upper limb capacity in children with unilateral cerebral palsy (CP) using Rasch analysis. The construct validity of the Rasch-reduced item set was

Everyday psychological functioning in children with unilateral cerebral palsy: does executive functioning play a role?

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Whittingham, Koa; Bodimeade, Harriet L; Lloyd, Owen; Boyd, Roslyn N

2014-06-01

To identify whether executive functioning mediates the effect of having unilateral cerebral palsy (CP) on executive functioning in everyday life, psychological functioning, and social functioning. A cross-sectional cohort of 46 children with unilateral CP (25 males, 21 females; mean age 11y 1mo, SD 2y 5mo; 24 right-sided, 22 left-sided) and 20 children with typical development (nine males, 11 females; mean age 10y 10mo, SD 2y 4mo). Cognitive executive functioning was tested using a neuropsychological battery. Executive functioning in everyday life was measured with the Behavior Rating Inventory of Executive Function (BRIEF; teacher and parent reports) and psychological and social functioning by the Strengths and Difficulties Questionnaire (SDQ). Analysis included analysis of covariance and bootstrapping. Children with unilateral CP were found to have significantly decreased functioning, compared with children with typical development, on the BRIEF Behavioral Regulation Index, the BRIEF Metacognition Index, and on the SDQ emotion, conduct, hyperactivity, and peer problems subscales. Group differences were mediated by cognitive executive functioning for the BRIEF Metacognition Index (teacher and parent report), the BRIEF Behavioral Regulation Index (parent report only), the SDQ conduct subscale, and the SDQ hyperactivity subscale. This study suggests that the increased risk of children with unilateral CP experiencing executive functioning difficulties in everyday life, conduct problems, and hyperactivity can be partly explained by decreased cognitive executive functioning abilities relative to children with typical development. © 2014 Mac Keith Press.

The effect of botulinum toxin A (Botox) injections used to treat limb spasticity on speech patterns in children with dysarthria and cerebral palsy: A report of two cases.

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Workinger, Marilyn Seif; Kent, Raymond D; Meilahn, Jill R

2017-05-19

Botulinum toxin A (Btx-A) injections are used to treat limb spasticity in children with cerebral palsy (CP) resulting in improved gross and fine motor control. This treatment has also been reported to have additional functional effects, but the effect of treatment on speech has not been reported. This report presents results of longitudinal speech evaluation of two children with CP given injections of Btx-A for treatment of limb spasticity. Speech evaluations were accomplished at baseline (date of injections) and 4- and 10-weeks post-injections. Improvements in production of consonants, loudness control, and syllables produced per breath were found. Parental survey also suggested improvements in subjects' speech production and willingness to speak outside the testing situation. Future larger studies are warranted to assess the nature of the changes observed related to Btx-A.

Spatial patterns of whole brain grey and white matter injury in patients with occult spastic diplegic cerebral palsy.

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Mu, Xuetao; Nie, Binbin; Wang, Hong; Duan, Shaofeng; Zhang, Zan; Dai, Guanghui; Ma, Qiaozhi; Shan, Baoci; Ma, Lin

2014-01-01

Spastic diplegic cerebral palsy (SDCP) is a common type of cerebral palsy (CP), which presents as a group of motor-impairment syndromes. Previous conventional MRI studies have reported abnormal structural changes in SDCP, such as periventricular leucomalacia. However, there are roughly 27.8% SDCP patients presenting normal appearance in conventional MRI, which were considered as occult SDCP. In this study, sixteen patients with occult SDCP and 16 age- and sex-matched healthy control subjects were collected and the data were acquired on a 3T MR system. We applied voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analysis to investigate whole brain grey and white matter injury in occult SDCP. By using VBM method, the grey matter volume reduction was revealed in the bilateral basal ganglia regions, thalamus, insula, and left cerebral peduncle, whereas the white matter atrophy was found to be located in the posterior part of corpus callosum and right posterior corona radiata in the occult SDCP patients. By using TBSS, reduced fractional anisotropy (FA) values were detected in multiple white matter regions, including bilateral white matter tracts in prefrontal lobe, temporal lobe, internal and external capsule, corpus callosum, cingulum, thalamus, brainstem and cerebellum. Additionally, several regions of white matter tracts injury were found to be significantly correlated with motor dysfunction. These results collectively revealed the spatial patterns of whole brain grey and white matter injury in occult SDCP.

Assessment of bone density in patients with scoliosis neuromuscular secondary to cerebral palsy

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Charbel Jacob Júnior

2014-09-01

Full Text Available OBJECTIVE: To evaluate bone mineral density in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy. METHODS: A prospective descriptive study in which, in addition to bone densitometry, the anthropometric data of the patients were assessed. As inclusion criterion we adopted patients with spastic quadriplegic cerebral palsy, wheelchair users, aged between 10 and 20 years and with neuromuscular scoliosis. RESULTS: We evaluated 31 patients, 20 female, whose average age was 14.2 years. The mean bone density was -3.2 standard deviation (Z-score, with mean biceps circumference of 19.4 cm, calf circumference 18.6 cm and BMI of 13.6 kg/m². CONCLUSION: There is a high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy.

[Efficacy on hemiplegic spasticity treated with plum blossom needle tapping therapy at the key points and Bobath therapy: a randomized controlled trial].

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Wang, Fei; Zhang, Lijuan; Wang, Jianhua; Shi, Yan; Zheng, Liya

2015-08-01

To evaluate the efficacy on hemiplegic spasticity after cerebral infarction treated with plum blossom needle tapping therapy at the key points and Bobath therapy. Eighty patients were collected, in compliance with the inclusive criteria of hemiplegic spasticity after cerebral infarction, and randomized into an observation group and a control group, 40 cases in each one. In the control group, Bobath manipulation therapy was adopted to relieve spasticity and the treatment of 8 weeks was required. In the observation group, on the basis of the treatment as the control group, the tapping therapy with plum blossom needle was applied to the key points, named Jianyu (LI 15), Jianliao (LI 14), Jianzhen (SI 9), Hegu (LI 4), Chengfu (BL 36), Zusanli (ST 36), Xiyangguan (GB 33), etc. The treatment was given for 15 min each time, once a day. Before treatment, after 4 and 8 weeks of treatment, the Fugl-Meyer assessment (FMA) and Barthel index (BI) were adopted to evaluate the motor function of the extremity and the activity of daily life in the patients of the two groups separately. The modified Ashworth scale was used to evaluate the effect of anti-spasticity. In 4 and 8 weeks of treatment, FMA: scores and BI scores were all significantly increased as compared with those before treatment in the two groups: (both PBobath therapy effectively relieves hemiplegic spasticity in the patients of cerebral infarction and improves the motor function of extremity and the activity of daily life.

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy.

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Park, Myoung-Ok

2017-02-01

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification Systems, and manual function was measured using the Manual Ability Classification System. [Results] Motor skills in daily activities were significantly different on Gross Motor Function Classification System level and Manual Ability Classification System level. According to the results of multiple regression analysis, children categorized as Gross Motor Function Classification System level III scored lower in terms of performance based motor skills than Gross Motor Function Classification System level I children. Also, when analyzed with respect to Manual Ability Classification System level, level II was lower than level I, and level III was lower than level II in terms of performance based motor skills. [Conclusion] The results of this study indicate that performance-based motor skills differ among children categorized based on Gross Motor Function Classification System and Manual Ability Classification System levels of cerebral palsy.

Protective effect of green tea polyphenol EGCG against neuronal damage and brain edema after unilateral cerebral ischemia in gerbils.

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Lee, Hyung; Bae, Jae Hoon; Lee, Seong-Ryong

2004-09-15

Previous studies have demonstrated that a green tea polyphenol, (-)-epigallocatechine gallate (EGCG), has a potent free radical scavenging and antioxidant effect. Glutamate leads to excitotoxicity and oxidative stress, which are important pathophysiologic responses to cerebral ischemia resulting in brain edema and neuronal damage. We investigated the effect of EGCG on excitotoxic neuronal damage in a culture system and the effect on brain edema formation and lesion after unilateral cerebral ischemia in gerbils. In vitro, excitotoxicity was induced by 24-hr incubation with N-methyl-D-aspartate (NMDA; 10 microM), AMPA (10 microM), or kainate (20 microM). EGCG (5 microM) was added to the culture media alone or with excitotoxins. We examined malondialdehyde (MDA) level and neuronal viability to evaluate the effect of EGCG. In vivo, unilateral cerebral ischemia was induced by occlusion of the right common carotid artery for 30, 60, or 90 min and followed by reperfusion of 24 hr. Brain edema, MDA, and infarction were examined to evaluate the protective effect of EGCG. EGCG (25 or 50 mg/kg, intraperitoneally) was administered twice, at 30 min before and immediately after ischemia. EGCG reduced excitotoxin-induced MDA production and neuronal damage in the culture system. In the in vivo study, treatment of gerbils with the lower EGCG dose failed to show neuroprotective effects; however, the higher EGCG dose attenuated the increase in MDA level caused by cerebral ischemia. EGCG also reduced the formation of postischemic brain edema and infarct volume. These results demonstrate EGCG may have future possibilities as a neuroprotective agent against excitotoxicity-related neurologic disorders such as brain ischemia.

Interception of moving objects while walking in children with spastic hemiparetic cerebral palsy.

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Ricken, Annieck X C; Savelsbergh, G J P; Bennett, S J

2007-01-15

The purpose of the study was to examine the coordination of reaching and walking behaviour when children with Spastic Hemiparetic Cerebral Palsy (SHCP) intercept an approaching and hence externally-timed object. Using either the impaired or non-impaired arm, children intercepted a ball approaching from a fixed distance with one of three velocities. Each participant's initial starting position was scaled to their maximum walking velocity determined prior to testing; for the medium ball velocity, participants would arrive at the point of interception at the correct time if they walked with their maximum velocity. Children with SHCP adapted their reaching and walking behaviour to the different ball approach velocities. These adaptations were exhibited when using the impaired and non-impaired arm, and resulted in similar outcome performance irrespective of which arm was used. Still, children with SHCP found it necessary to increase trunk movement to compensate for the decreased elbow excursion and a decreased peak velocity of the impaired arm. Children with SHCP exhibited specific adaptations to their altered movement capabilities when performing a behaviourally-realistic task. The provision of an external timing constraint appeared to facilitate both reaching and walking movements and hence could represent a useful technique in rehabilitation.

A DESCRIPTIVE STUDY ON THE ASSESSMENT OF FUNCTIONAL MOTOR DISABILITY IN CHILDREN WITH CEREBRAL PALSY

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Wadugodapitiya .S .I

2015-08-01

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.

Association of Early-Onset Spasticity and Risk for Cognitive Impairment With Mutations at Amino Acid 499 in SPAST.

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Gillespie, Meredith K; Humphreys, Peter; McMillan, Hugh J; Boycott, Kym M

2018-04-01

Hereditary spastic paraplegia is a phenotypically and genetically heterogeneous group of neurodegenerative disorders characterized by lower extremity weakness and spasticity. Spastic paraplegia 4 (SPG4), caused by heterozygous mutations in the gene SPAST, typically causes a late-onset, uncomplicated form of hereditary spastic paraplegia in affected individuals. Additional clinical features in SPG4 have been reported on occasion, but no genotype-phenotype correlation has been established. Through targeted clinical testing, we identified 2 unrelated female patients with the same de novo p.Arg499His mutation in SPAST. Both patients presented with early-onset spasticity resulting in delayed motor milestones, which led to a diagnosis of cerebral palsy in one child and tethered cord in the other. Review of the literature identified several patients with mutations at amino acid 499 and early-onset symptoms associated with a risk of cognitive impairment. Early and accurate diagnosis of children with early-onset spasticity is important for informed prognosis and genetic counselling.

Cerebral Palsy: General Information. Fact Sheet Number 2 = La Paralisis Cerebral: Informacion General. Fact Sheet Number 18.

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Interstate Research Associates, McLean, VA.

This fact sheet on cerebral palsy is offered in both English and Spanish. First, it provides a definition and considers various causes (e.g., an insufficient amount of oxygen reaching the fetal or newborn brain). The fact sheet then offers incidence figures and explains characteristics of the three main types of cerebral palsy: spastic, athetoid,…

Monitoring cerebral hemodynamics with transcranial Doppler ultrasound during cognitive and exercise testing in adults following unilateral stroke.

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Watt, Brian P; Burnfield, Judith M; Truemper, Edward J; Buster, Thad W; Bashford, Gregory R

2012-01-01

An observational study was performed as a preliminary investigation into the use of transcranial Doppler ultrasound (TCD) for recording cerebral hemodynamic changes during multiple tasks. TCD is a method of measuring cerebral blood flow (CBF) using ultrasound transducers in contact with the surface of the head. Using the maximum flow envelope of the Doppler spectrum returning from the middle cerebral artery (MCA), standard clinical flow indices can be calculated and displayed in real time providing information concerning perturbations in CBF and their potential cause. These indices as well as flow velocity measurements have been recognized as useful in measuring changes in responses to various stimulus that can be used to indicate cardiovascular health. For this study, the pulsatility index (PI) and resistivity index (RI) were chosen since they indicate composite changes indicative of vasoconstriction and vasodilatation which are normal hemodynamic responses under appropriate conditions. A total of eleven participants were recruited to take part in this study. Nine of these individuals had no known disability (Controls); two had experienced unilateral cerebrovascular accidents (Strokes) in the ipsilateral MCA distribution. Maximum velocity envelopes of the spectral Doppler data were recorded using a fixation device designed to stabilize two ultrasound probes (2 MHz) to sample the bilateral MCAs CBF. These measures were performed separately while the subject performed four activities: 1) rest, 2) cognitive challenge, 3) cardiovascular exercise, and 4) simultaneous exercise and cognitive challenge. Cardiovascular parameters were calculated from the data by extracting maximum (Vs) and minimum flow velocities (Vd), PI, RI, and time signatures for each cardiac cycle. The data for all participants shows significant changes in cardiovascular parameters between states of rest and exercise, as well as slight trends across time. Although the data are preliminary, they show

Why is joint range of motion limited in patients with cerebral palsy?

NARCIS (Netherlands)

de Bruin, M.; Smeulders, M. J. C.; Kreulen, M.

2013-01-01

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand

Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

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van Rhijn Lodewijk W

2010-06-01

Full Text Available Abstract Background Cerebral palsy (CP may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis. Methods We performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS, Gross Motor Function Measure (GMFM and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS for spasticity, pain and ease of care. Results A total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options. Conclusion RF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial.

[Functional electric stimulation (FES) in cerebral palsy].

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Miyazaki, M H; Lourenção, M I; Ribeiro Sobrinho, J B; Battistella, L R

1992-01-01

Our study concerns a patient with cerebral palsy, submitted to conventional occupational therapy and functional electrical stimulation. The results as to manual ability, spasticity, sensibility and synkinesis were satisfactory.

Different horse's paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study.

Science.gov (United States)

Antunes, Fabiane Nunes; Pinho, Alexandre Severo do; Kleiner, Ana Francisca Rozin; Salazar, Ana Paula; Eltz, Giovana Duarte; de Oliveira Junior, Alcyr Alves; Cechetti, Fernanda; Galli, Manuela; Pagnussat, Aline Souza

2016-12-01

Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separate days: Protocol 1: the horse's pace was a walking pace; and Protocol 2: the horse's pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context). The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot. The walk-trot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Atypical unilateral posterior reversible encephalopathy syndrome mimicking a middle cerebral artery infarction

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Camidag, Ilkay [Dept. of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkmenistan); Cho, Yang Je; Park, Mina; Lee, Seung Koo [Yonsei University Severance Hospital, Seoul (Korea, Republic of)

2015-10-15

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.

Atypical unilateral posterior reversible encephalopathy syndrome mimicking a middle cerebral artery infarction

International Nuclear Information System (INIS)

Camidag, Ilkay; Cho, Yang Je; Park, Mina; Lee, Seung Koo

2015-01-01

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion

Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

International Nuclear Information System (INIS)

Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W.

1997-01-01

The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84±17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78±10.36), mild defect ( 2 test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients

Apparent brain temperature imaging with multi-voxel proton magnetic resonance spectroscopy compared with cerebral blood flow and metabolism imaging on positron emission tomography in patients with unilateral chronic major cerebral artery steno-occlusive disease

Energy Technology Data Exchange (ETDEWEB)

Nanba, Takamasa; Nishimoto, Hideaki; Murakami, Toshiyuki; Fujiwara, Shunrou; Ogasawara, Kuniaki [Iwate Medical University, Department of Neurosurgery, Iwate (Japan); Yoshioka, Yoshichika [Osaka University, Open and Transdisciplinary Research Initiatives, Osaka (Japan); Sasaki, Makoto; Uwano, Ikuko [Iwate Medical University, Institute for Biomedical Science, Iwate (Japan); Terasaki, Kazunori [Iwate Medical University, Cyclotron Research Center, Iwate (Japan)

2017-09-15

The purpose of the present study was to determine whether apparent brain temperature imaging using multi-voxel proton magnetic resonance (MR) spectroscopy correlates with cerebral blood flow (CBF) and metabolism imaging in the deep white matter of patients with unilateral chronic major cerebral artery steno-occlusive disease. Apparent brain temperature and CBF and metabolism imaging were measured using proton MR spectroscopy and {sup 15}O-positron emission tomography (PET), respectively, in 35 patients. A set of regions of interest (ROIs) of 5 x 5 voxels was placed on an MR image so that the voxel row at each edge was located in the deep white matter of the centrum semiovale in each cerebral hemisphere. PET images were co-registered with MR images with these ROIs and were re-sliced automatically using image analysis software. In 175 voxel pairs located in the deep white matter, the brain temperature difference (affected hemisphere - contralateral hemisphere: ΔBT) was correlated with cerebral blood volume (CBV) (r = 0.570) and oxygen extraction fraction (OEF) ratios (affected hemisphere/contralateral hemisphere) (r = 0.641). We excluded voxels that contained ischemic lesions or cerebrospinal fluid and calculated the mean values of voxel pairs in each patient. The mean ΔBT was correlated with the mean CBF (r = - 0.376), mean CBV (r = 0.702), and mean OEF ratio (r = 0.774). Apparent brain temperature imaging using multi-voxel proton MR spectroscopy was correlated with CBF and metabolism imaging in the deep white matter of patients with unilateral major cerebral artery steno-occlusive disease. (orig.)

Cerebral Palsy: Still A Social Problem

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Angom Bisharda

1997-08-01

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.

Cerebral Palsy: Still A Social Problem

Directory of Open Access Journals (Sweden)

Angom Bisharda

1997-08-01

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 proportions Result: 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.

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))

1981-06-01

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.

Analysis of cranial CT-scan findings in cerebral palsy

International Nuclear Information System (INIS)

Wada, Fumio; Andoh, Tadashi; Une, Koji; Takamatsu, Tsurukichi

1981-01-01

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. (author)

Stair-shaped Achilles tendon lengthening in continuity - A new method to treat equinus deformity in patients with spastic cerebral palsy.

Science.gov (United States)

Li, Zhengxun; Zhang, Ning; Wang, Yang; Cao, Songhua; Huang, Zheng; Hu, Yong

2017-10-27

Equinus of the ankle is a common deformity in spastic cerebral palsy. Achilles tendon lengthening is one of the effective options for the treatment of equinus deformity. In the study, a new stair-shaped Achilles tendon lengthening (ATL) procedure that preserves of the tendon continuity was performed in 28 tendons with equinus deformity (20 patients, mean age=10.5±2.6 years). The results were compared with a group of patients treated with the Z-lengthening procedure. During the latest follow-up visit, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale score was much higher in the stair-shaped ATL group than in the Z-lengthening group (pantigravity stability and quicker recovery in patients. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

THE INFLUENCE OF COMBINATION NON-MEDICAL TREATMENT INCLUDING FUNCTIONAL PROGRAMMED ELECTRICAL STIMULATION ON THE CLINICAL AND INSTRUMENTAL PARAMETERS IN PATIENTS WITH CEREBRAL PALSY WITH SPASTIC DIPLEGIA

Directory of Open Access Journals (Sweden)

V. V. Eliseev

2015-01-01

Full Text Available Background: Cerebral palsy is the leading cause of physical disability in pediatric  age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part  of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had  been  randomized  into two groups  depending on the type of treatment. In  the  first group,  the  patients  (n = 38 received a course of functional programmed electric stim- ulation  in combination with  other  non-medical treatment  methods.  The  second   group   (n = 33 underwent a usual  course  of electrical  stimula- tion in combination with non-medical  treatment, similar to that  in the first group. The third group (control   included   41   children   without    cere- bral palsy. Clinical and  instrumental parameters were  assessed  in all study  participants. Results: After the course of combination treatment in the group  1, the  tonus  of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group  of femur muscles by 43%, adductor group of femur muscles by 36%. In the group  2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power  endurance was  increased  signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps  by 19.8 and 7.2 sec, of m. anterior  tibialis by 12.1 and 4.6 sec, respec- tively. After the  treatment, the  active movement volume in the large joints of lower extremities  in the group 1 patients  improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by

Mapping cortical thickness of the patients with unilateral end-stage open angle glaucoma on planar cerebral cortex maps.

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Piotr Bogorodzki

Full Text Available PURPOSE: To estimate and compare cerebral cortex thickness in patients with unilateral end-stage glaucoma with that of age-matched individuals with unaffected vision. METHODS: 14 patients with unilateral end-stage primary open angle glaucoma (POAG and 12 age-matched control individuals with no problems with vision were selected for the study based on detailed ophthalmic examination. For each participant 3D high-resolution structural brain T1-weighted magnetization prepared MR images were acquired on a 3.0 T scanner. Brain cortex thickness was estimated using the FreeSurfer image analysis environment. After warping of subjects' cortical surfaces to FreeSurfer common space, differences between POAG and control groups were inferred at the group analysis level with the General Linear Model. RESULTS: The analysis performed revealed local thinning in the visual cortex areas in the POAG group. Statistically significant differences form 600 mm2 clusters located in the Brodmann area BA19 in the left and right hemisphere. CONCLUSION: Unilateral vision loss due to end-stage neuropathy from POAG is associated with significant thinning of cortical areas employed in vision.

Identification of the neural component of torque during manually-applied spasticity assessments in children with cerebral palsy

NARCIS (Netherlands)

Bar-On, L.; Desloovere, K.; Molenaers, G.; Harlaar, J.; Kindt, T.; Aertbelien, E.

2014-01-01

Clinical assessment of spasticity is compromised by the difficulty to distinguish neural from non-neural components of increased joint torque. Quantifying the contributions of each of these components is crucial to optimize the selection of anti-spasticity treatments such as botulinum toxin (BTX).

Physical activity as a prescription for the children with cerebral palsy

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Arghavan Shariat

2014-03-01

Full Text Available After so many years devoted to practicing medicine as children physiotherapists, the therapists finally found the importance of balance training exercises in children who suffer from cerebral palsy. It is only through controlling balance that we can achieve improvement in body movement and position that will culminate into performance independence in a child. Formerly, working over controlling balance in cerebral palsy children has been very difficult, because contracture and spasticity did not let us to have an effective balance training exercise. In this respect, we have summarized the results of previous authors that specify the level of effectiveness of exercise therapy. The results of different studies showed that level of effectiveness of exercise therapy on alleviating the symptoms of spastic cerebral palsy is average in accordance with Cohen's effect size Interpretation table.

Unilateral megalencephaly associated with contralateral neuronal migration defect

International Nuclear Information System (INIS)

Arslan, A.; Demirci, A; Ciftci, E.

1999-01-01

A case of unilateral megalencephaly associated with contralateral cortical dysplasia and grey matter heterotopia is reported. The corpus callosum is agenetic and the basal ganglia are dysplastic. Unilateral megalencephaly (UM) is a rare malformation characterized by unilateral enlargement of one cerebral hemisphere with ipsilateral lateral ventricle dilatation, abnormal gyral pattern and cortical thickening. Association of UM with contralateral cortical dysplasia, grey matter heterotopia and corpus callosum agenesis has not been reported in previous studies. Copyright (1999) Blackwell Science Pty Ltd

Efficacy of Repeated Botulinum Toxin Type A Injections for Spastic Equinus in Children with Cerebral Palsy-A Secondary Analysis of the Randomized Clinical Trial.

Science.gov (United States)

Hong, Bo Young; Chang, Hyun Jung; Lee, Sang-Jee; Lee, Soyoung; Park, Joo Hyun; Kwon, Jeong-Yi

2017-08-21

Botulinum toxin A is considered an important tool to control spasticity in children with cerebral palsy. Several factors are known to affect the efficacy of botulinum toxin, such as dosage, appropriate muscle selection and application, age, and accompanying therapy. A multicenter, double-blind, randomized, prospective phase III clinical trial of botulinum toxin A for the treatment of dynamic equinus in 144 children with cerebral palsy was performed to compare the efficacies of letibotulinumtoxin A and onabotulinumtoxin A. Secondary analyses were performed to evaluate factors that affected the outcome, focusing on the number of times injections were repeated. Effectiveness was defined as a change of 2 or more in the physician's rating scale. Multivariate regression analyses were performed with multiple variables. The first injection of botulinum toxin A significantly improved D subscale of Gross Motor Function Measure-88 scores at 3 months compared to repeated injections ( p < 0.05). After 6 months, patients who had one injection or none before the study showed significantly better outcomes than those who had more than one injection in terms of observational gait scores.

Selective dorsal rhizotomy opportunities with foot deformitiesin children with cerebral palsy

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Vladimir Markovich Kenis

2015-03-01

Full Text Available Foot deformities are the most common orthopedic condition in children with cerebral palsy. The aim of the study was to evaluate the influence of selective dorsal rhizotomy (SDR on foot deformities in children with cerebral palsy. The results were assessed clinically by measurement of changes in muscle spaticity and foot posture. Percentage of resection of dorsal rootlets was from 40 to 90 % of total thickness. The degree of tone reduction had a tendency to be more pronounced in the more proximal muscles and was minimal in calf muscles. Nevertheless, foot posture improved more significantly. That can be explained by generalimprovement of pathological posture at the level of more proximal joints. Thus, SDR has insignificant direct effect on spastic foot deformity and can not be recommended as a basic method of treatment even in pure spasticity. However, SDR should be considered as a part of multidisciplinary management protocol if foot deformity reflects more complex postural disturbance due to generalized spasticity.

Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy).

Science.gov (United States)

Benda, William; McGibbon, Nancy H; Grant, Kathryn L

2003-12-01

To evaluate the effect of hippotherapy (physical therapy utilizing the movement of a horse) on muscle activity in children with spastic cerebral palsy. Pretest/post-test control group. Therapeutic Riding of Tucson (TROT), Tucson, AZ. Fifteen (15) children ranging from 4 to 12 years of age diagnosed with spastic cerebral palsy. Children meeting inclusion criteria were randomized to either 8 minutes of hippotherapy or 8 minutes astride a stationary barrel. Remote surface electromyography (EMG) was used to measure muscle activity of the trunk and upper legs during sitting, standing, and walking tasks before and after each intervention. After hippotherapy, significant improvement in symmetry of muscle activity was noted in those muscle groups displaying the highest asymmetry prior to hippotherapy. No significant change was noted after sitting astride a barrel. Eight minutes of hippotherapy, but not stationary sitting astride a barrel, resulted in improved symmetry in muscle activity in children with spastic cerebral palsy. These results suggest that the movement of the horse rather than passive stretching accounts for the measured improvements.

Assessment Impact of Foot Sensory Modulation on Inhibition of Hypertonicity of the Lower Limb in Children with Diplegia Spastic

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Saeed Fatoureh-Chi

2005-01-01

Full Text Available Objective: The purpose of this study was to assess impact of foot sensory modulation on inhibition of hypertonicity of the lower limb in children with diplegia spastic cerebral palsy. Materials & Methods: 24 selected children (aged 2.5 to 4.5 years were randomly assigned to a control and experimental groups. Muscle tone was assessed using modified Ashworth scale, passive Range of motion by goniameter (Pedretti, neurodevelopmental level by Bobath scale. All children were pre-post tested in an interval of ten weeks. Results: Significant reduction was observed in hypertonicity of hip extensor (p<0/1 and ankle planter flexor (P<0/05. Significant increase was observed in passive Range of motion of hip flexion (P<0/1, knee extension (P<0/05 and ankle dorsi flexion (P<0/05. There was found no significant difference of reduction in hypertonicity of knee flexor and improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip extensor (P<0/05 and improvement of neurodevelopmental level (P<0/05. Conclusion: Impact of sensory modulation on children with diplegia spastic cerebral palsy reduces spasticity of lower limb and also extends joints domain of motion.

Intrathecal Baclofen Pump for Spasticity

Science.gov (United States)

2005-01-01

Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of intrathecal baclofen for spasticity. The Technology Spasticity is a motor disorder characterized by tight or stiff muscles that may interfere with voluntary muscle movements and is a problem for many patients with multiple sclerosis (MS), spinal cord injury (SCI), cerebral palsy (CP), and acquired brain injury (ABI).(1). Increased tone and spasm reduces mobility and independence, and interferes with activities of daily living, continence and sleep patterns. Spasticity may also be associated with significant pain or discomfort (e.g., due to poor fit in braces, footwear, or wheelchairs), skin breakdown, contractures, sleep disorders and difficulty in transfer. Goals of treatment are to decrease spasticity in order to improve range of motion, facilitate movement, reduce energy expenditure and reduce risk of contractures. Existing treatments include physical therapy, oral medications, injections of phenol or botulinum toxin, or surgical intervention. Baclofen is the oral drug most frequently prescribed for spasticity in cases of SCI and MS.(1) Baclofen is a muscle relaxant and antispasticity drug. In the brain, baclofen delivered orally has some supraspinal activity that may contribute to clinical side effects. The main adverse effects of oral baclofen include sedation, excessive weakness, dizziness, mental confusion, and somnolence.(2) The incidence of adverse effects is reported to range from 10% to 75%.(2) Ochs et al. estimated that approximately 25-30% of SCI and MS patients fail to respond to oral baclofen.(3;4) Adverse effects appear to be dose-related and may be minimized by initiating treatment at a low dose and gradually titrating upwards.(2) Adverse effects usually appear at doses >60 mg/day.(2) The rate of treatment discontinuation due to intolerable adverse effects has generally been reported to range from 4% to 27%.(2) When baclofen is

Analysing coupling architecture in the cortical EEG of a patient with unilateral cerebral palsy

Science.gov (United States)

Kornilov, Maksim V.; Baas, C. Marjolein; van Rijn, Clementina M.; Sysoev, Ilya V.

2016-04-01

The detection of coupling presence and direction between cortical areas from the EEG is a popular approach in neuroscience. Granger causality method is promising for this task, since it allows to operate with short time series and to detect nonlinear coupling or coupling between nonlinear systems. In this study EEG multichannel data from adolescent children, suffering from unilateral cerebral palsy were investigated. Signals, obtained in rest and during motor activity of affected and less affected hand, were analysed. The changes in inter-hemispheric and intra-hemispheric interactions were studied over time with an interval of two months. The obtained results of coupling were tested for significance using surrogate times series. In the present proceeding paper we report the data of one patient. The modified nonlinear Granger causality is indeed able to reveal couplings within the human brain.

Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

Energy Technology Data Exchange (ETDEWEB)

Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W. [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

1997-07-01

The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84{+-}17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78{+-}10.36), mild defect (<50MQ : n=9, MQ=66.11{+-}13.87). The degree of rCBF decrease between the two groups was evaluated by {chi}{sup 2} test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients.

Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

Science.gov (United States)

Löwing, Kristina; Thews, Karin; Haglund-Åkerlind, Yvonne; Gutierrez-Farewik, Elena M

2017-08-01

To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

Stability and Harmony of Gait in Children with Cerebral Palsy

Science.gov (United States)

Iosa, Marco; Marro, Tiziana; Paolucci, Stefano; Morelli, Daniela

2012-01-01

The aim of this study was to quantitatively assess the stability and harmony of gait in children with cerebral palsy. Seventeen children with spastic hemiplegia due to cerebral palsy (5.0 [plus or minus] 2.3 years old) who were able to walk autonomously and seventeen age-matched children with typical development (5.7 [plus or minus] 2.5 years old,…

Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy.

Science.gov (United States)

Emara, Hatem A; El-Gohary, Tarek M; Al-Johany, Ahmed A

2016-06-01

Suspension training and treadmill training are commonly used for promoting functional gross motor skills in children with cerebral palsy. The aim of this study was to compare the effect of body-weight suspension training versus treadmill training on gross motor functional skills. Assessor-blinded, randomized, controlled intervention study. Outpatient rehabilitation facility. Twenty children with spastic diplegia (7 boys and 13 girls) in the age ranged from 6 to 8 years old were randomly allocated into two equal groups. All children were assessed at baseline, after 18-session and after 36-session. During the twelve-week outpatient rehabilitation program, both groups received traditional therapeutic exercises. Additionally, one group received locomotor training using the treadmill while the other group received locomotor training using body-weight suspension through the dynamic spider cage. Assessment included dimensions "D" standing and "E" walking of the gross motor function measure, in addition to the 10-m Walking Test and the five times sit to stand test. Training was applied three times per week for twelve consecutive weeks. No significant difference was found in standing or walking ability for measurements taken at baseline or after 18-session of therapy. Measurements taken at 36-session showed that suspension training achieved significantly (Ptraining for dimension D as well as for dimension E. No significant difference was found between suspension training and treadmill training regarding walking speed or sit to stand transitional skills. Body-weight suspension training is effective in improving walking and locomotor capabilities in children with spastic diplegia. After three month suspension training was superior to treadmill training. Body-weight suspension training promotes adequate postural stability, good balance control, and less exertion which facilitates efficient and safe gait.

Use of Botulinum toxin in 55 children with cerebral palsy

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Mohammadi M

2000-10-01

Full Text Available Botulinum toxin A (BTA inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders.To evaluate the effect of botulinum toxin on cerebral palsied children with spastic or mixed type of the disease, especially those patiens having spasticity as a cardinal symptom without joint contracture, we designed the following study. Ninety-one cases (55 of referred patients to pediatic Neurology outpatient clinics of children’s Medical Center were given BTA injections in affected muscles of the lower limb. They were reevaluating 3 to 5 weeks and 3 months later for type of walking and range of affected joints’ movement. The study showed a clinically significant gait improvement in 71.2% of patients (P<0.0005 and also an overall increased range of motion in affected limbs after BTA injection (P<0.04. Side effects occurred only in two cases as transient generalized weakness, gent recurvatum and ptosis. Drug effectiveness was time-limited, lasting abot 3 months in all patients ( a golden time for rehabilitation therapists to improve the patients’ condition. Overall, BTA has improved both the type of walking as well as the range of joints motion in our patients. So its’ administration is suggested in cerebral palsied children if the spasticity is a major and disabling sign

The usage of playing studies for development of spatial reasoning of 5-8-year-old children with spastic diplegi.

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Shlapachenko O.A.

2012-09-01

Full Text Available In the article is shown the influence of rehabilitation-correction program with the usage of outdoor games on the level of influence of spatial thinking and constructive activity of 5-8-year-old children with spastic diplegi. 64 children took part in the experiment, all had main diagnosis - children cerebral paralysis, spastic diplegi. The experiment was conducted in a few phases during the year. It is proved that conducting of outdoor games promote positive influence on forming the level of influence of spatial thinking of children, increasing capacity of work. It is revealed that the level of development of spatial thinking of children with spastic diplegi depends on clinical display of an illness. It is mentioned that involving parents for participation in games with children promote rehabilitation of children in home conditions.

UCAO (UNILATERAL CEREBRAL ARTERY OCCLUSSION METHOD INCREASES THE LEVEL OF MMP- 9 BRAIN TISSUE IN RATS MODEL OF ISCHEMIC STROKE

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M. Rasjad Indra

2016-07-01

Full Text Available Background. For the last 5 years, 15.4% of total population died because of stroke, which 42.9% of those are caused by ischemic stroke. UCAO (Unilateral Cerebral Artery Occlusion is a stroke induction method by ligating mice’s carotid artery for 45 minutes. Thus, giving a hypoxic condition similar to stroke attack in human. This method is less complicated and far more efficient. MMP-9 is a stroke marker which is assayed by ELISA from the blood of test animal. Objective. This research was conducted to prove UCAO (Unilateral Cerebral Artery Occlusion method is capable to raise MMP-9 concentration in mice’s blood. Methods. This research was an experimental laboratory research with post-test only controlled group design. 8 male rats (8-10 weeks were divided into 2 groups, control and treatment which would be inducted into stroke by UCAO method. A day after the treatment group had been induced to stroke, both group were tested to measure the MMP-9 blood concentration through ELISA. Results. In this research, UCAO method had increased MMP-9 blood concentration in treatment group, compared to the control group. It is proved by the statistic tests, Mann-Whitney and Kruskal-Wallis, which showed a significant increase in treatment group (p < 0.05. Conclusion. Based on this result, it can be concluded that UCAO method is accepted as a method to create an ischemic stroke mice model.

Gerstmann's syndrome and unilateral optic ataxia in the emergency department

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Barbosa, Breno José Alencar Pires; de Brito, Marcelo Houat; Rodrigues, Júlia Chartouni; Kubota, Gabriel Taricani; Parmera, Jacy Bezerra

2017-01-01

ABSTRACT. A 75-year-old right-handed woman presented to the emergency department with simultanagnosia and right unilateral optic ataxia. Moreover, the patient had agraphia, acalculia, digital agnosia and right-left disorientation, consistent with complete Gerstmann's syndrome. This case highlights the concurrence of Gerstmann's syndrome and unilateral optic ataxia in the acute phase of a left middle cerebral artery stroke. PMID:29354229

Gerstmann's syndrome and unilateral optic ataxia in the emergency department

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Breno José Alencar Pires Barbosa

Full Text Available ABSTRACT. A 75-year-old right-handed woman presented to the emergency department with simultanagnosia and right unilateral optic ataxia. Moreover, the patient had agraphia, acalculia, digital agnosia and right-left disorientation, consistent with complete Gerstmann's syndrome. This case highlights the concurrence of Gerstmann's syndrome and unilateral optic ataxia in the acute phase of a left middle cerebral artery stroke.

Correlations between risk factors and functional evolution in patients with spastic quadriplegia.

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

2016-01-01

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.

IMPACT OF BODY WEIGHT SUPPORTED BACKWARD TREADMILL TRAINING ON WALKING SPEED IN CHILDREN WITH SPASTIC DIPLEGIA

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Hamada El Sayed Abd Allah Ayoub

2016-10-01

Full Text Available Background: A lot of the ambulating children with spastic diplegia were able to walk with flexed hips, knees and ankles this gait pattern is known as crouch gait. The most needed functional achievement of diplegic children habilitation is to be able to walk appropriately. The development of an independent and efficient walking is one of the main objectives for children with cerebral palsy especially those with spastic diplegia. Method: Twenty children with spastic diplegia enrolled in this study, they were classified into two groups of equal number, eligibility to our study were ages ranged from seven to ten years, were able to ambulate, They had gait problems and abnormal gait kinematics. The control group (A received selected physical therapy program based on neurodevelopmental approach for such cases, while the study group (B received partial body weight supported backward treadmill training in addition to regular exercise program. Gait pattern was assessed using the Biodex Gait Trainer II for each group pre and post three months of the treatment program. Results: There was statistically significant improvement in walking speed in the study group (P<0.05 with significant difference when comparing post treatment results between groups (p<0.05. Conclusion: These findings suggested that partial body weight supported backward treadmill training can be included as a supplementary therapeutic modality to improve walking speed and functional abilities of children with diplegic cerebral palsy.

NEYROPSYCHOLOGICAL CONSECUENCES OF CEREBRAL PALSY

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ANA MARÍA NAVARRO MELENDRO

2005-01-01

Full Text Available Cerebral Palsy is defined as a movement alteration result of a non progressive damage witch is permanent in anencephalon that has not acquired its final maturation. Patients that suffer cerebral palsy present learning disabilities,that varies between being completely normal to severe as a consequence of memory, gnosis, praxis, perceptive andlanguage impairments. Nevertheless the consequences of this disease are not always predictable. This paper pretendsto make a description of the cognitive and behavioral deficits that overcomes along with the manifestation of thecerebral palsy and its possible treatment. We used a complete neuropsychological battery to evaluate a 7 years oldpatient who was diagnosed of cerebral palsy and spastic diplegia finding some cognitive impairment in fields such asmnesic, gnosic and attention processes.

Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children.

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Pavão, Silvia L; Santos, Adriana N; Oliveira, Ana B; Rocha, Nelci A C F

2015-01-01

The purpose of this study was to compare postural control in typically developing (TD) children and children with cerebral palsy (CP) during the sit-to-stand (STS) movement and to assess the relationship between static (during static standing position) and dynamic postural control (during STS movement) in both groups. The center of pressure (CoP) behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II) was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP) and mediolateral (ML) amplitudes of CoP displacement and the area and velocity of CoP oscillation. According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement.

Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy.

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Santos, Maria Teresa Botti Rodrigues; Nascimento, Karla Santos; Carazzato, Simone; Barros, Alina Oliveira; Mendes, Fausto Medeiros; Diniz, Michele Baffi

2017-08-01

The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm 2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm 2 ; irradiance: 3 W/cm 2 ; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.

Spastic paretic hemifacial contracture as a presenting feature of multiple sclerosis.

Science.gov (United States)

Koutsis, Georgios; Breza, Marianthi; Evangelopoulos, Maria-Eleftheria; Anagnostouli, Maria; Andreadou, Elisavet; Karagiorgis, Georgios; Kokotis, Panagiotis; Kilidireas, Costas; Karandreas, Nikolaos

2017-04-01

Spastic paretic hemifacial contracture (SPHC) is characterized by sustained unilateral contraction of the facial muscles associated with mild ipsilateral facial paresis. Rarely described in the context of multiple sclerosis (MS), it has never been reported as presenting symptom of MS. Two patients developed SPHC within the context of a clinically isolated syndrome suggestive of MS. EMG revealed continuous resting activity of irregularly firing motor unit potentials, associated with impaired recruitment upon voluntary contraction. SPHC remitted fully in both patients. SPHC, a rare but distinct clinical and EMG entity, can occasionally be the presenting feature of MS. Copyright © 2017 Elsevier B.V. All rights reserved.

Neonatal cerebral infarction

International Nuclear Information System (INIS)

Fujimoto, Shinji; Togari, Hajime; Sobajima, Hisanori; Suzuki, Shigesumi; Wada, Yoshiro; Yokochi, Kenji; Nishimura, Yutaka; Inukai, Kazuhisa; Futamura, Masahide.

1992-01-01

In a retrospective multi-center study, we investigated eighteen infants with unilateral cerebral infarctions confirmed by computed tomography (CT) scans. The initial symptoms were observed in all the patients between 0 and 3 days of age. Convulsions or apneic attacks were the initial symptoms in all but one. Only 4 patients had complicated obstetric histories and none showed polycythemia or electrolyte abnormalities. All of the initial CT scans revealed unilaterally localized hypodense areas. In 10, the initial CT scans were performed within 24 hours after the clinical onset. In 16, the lesions were within the territory of the middle cerebral artery, 9 of which also involved the cortico-spinal tract (CST). In the remaining 2 patients, the lesions were located whithin the territory of the posterior cerebral artery. None of the 9 patients without CST involvement developed hemiplegia, whereas 5 (56%) of the 9 with CST involvement had hemiplegia, which is a fairly low incidence compared with that in adult cases. This difference was thought to be related to neonatal brain plasticity. (author)

Cortical somatosensory reorganization in children with spastic cerebral palsy: a multimodal neuroimaging study

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CHRISTOS ePAPADELIS

2014-09-01

Full Text Available Although cerebral palsy (CP is among the most common causes of physical disability in early childhood, we know little about the functional and structural changes of this disorder in the developing brain. Here, we investigated with three different neuroimaging modalities (magnetoencephalography (MEG, diffusion tension imaging (DTI, and resting state fMRI whether spastic CP is associated with functional and anatomical abnormalities in the sensorimotor network. Ten children participated in the study: four with diplegic CP (DCP, three with hemiplegic CP (HCP, and three typically-developing (TD children. Somatosensory evoked fields (SEFs were recorded in response to pneumatic stimuli applied to digits D1, D3, and D5 of both hands. Several parameters of water diffusion were calculated from DTI between the thalamus and the precentral and postcentral gyri in both hemispheres. The sensorimotor resting state networks (RSNs were examined by using an independent component analysis method. Tactile stimulation of the fingers elicited the first prominent cortical response at ~50 ms, in all except one child, localized over the primary somatosensory cortex (S1. In five CP children, abnormal somatotopic organization was observed in the affected (or more affected hemisphere. Euclidean distances were markedly different between the two hemispheres in the HCP children, and between DCP and TD children for both hemispheres. DTI analysis revealed decreased fractional anisotropy and increased apparent diffusion coefficient for the thalamocortical pathways in the more affected compared to less affected hemisphere in CP children. Rs-fMRI results indicated absent and/or abnormal sensorimotor RSNs for children with HCP and DCP consistent with the severity and location of their lesions. Our findings suggest an abnormal somatosensory processing mechanism in the sensorimotor network of children with CP possibly as a result of diminished thalamocortical projections.

Executive Functions in Youth With Spastic Cerebral Palsy

NARCIS (Netherlands)

Pirila, Silja; van der Meere, Jaap J.; Rantanen, Kati; Jokiluoma, Maria; Eriksson, Kai

Dependent on criteria used, between 35% and 53% of the participants with cerebral palsy fulfilled the criteria of clinically relevant executive function problems as defined by Conners' (1994) Continuous Performance Test. Executive function problems were noticed mainly in participants with bilateral

Effects of a Supported Speed Treadmill Training Exercise Program on Impairment and Function for Children with Cerebral Palsy

Science.gov (United States)

Johnston, Therese E.; Watson, Kyle E.; Ross, Sandy A.; Gates, Philip E.; Gaughan, John P.; Lauer, Richard T.; Tucker, Carole A.; Engsberg, Jack R.

2011-01-01

Aim: To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function. Method: Twenty-six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n =…

X-Ray Hip Examination in Patients with Cerebral Palsy

OpenAIRE

Holiuk, Ye.L.

2017-01-01

Background. X-ray indicators of the hip are important diagnostic factors of spastic hip dislocation in cerebral palsy. Correct X-ray examination has a decisive influence on the treatment strategy. Correct positioning parameters are well known, but their importance is often underestimated. This could be a trigger factor for further diagnostic and treatment errors. Materials and me-thods. The material was radiographs of the hip joints of 126 patients with cerebral palsy aged 2 to 18 years. Retr...

SPG3A-linked hereditary spastic paraplegia associated with cerebral glucose hypometabolism.

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Terada, Tatsuhiro; Kono, Satoshi; Ouchi, Yasuomi; Yoshida, Kenichi; Hamaya, Yasushi; Kanaoka, Shigeru; Miyajima, Hiroaki

2013-04-01

SPG3A-linked hereditary spastic paraplegia (HSP) is a rare autosomal dominant motor disorder caused by a mutation in the SPG3A gene, and is characterized by progressive motor weakness and spasticity in the lower limbs, without any other neurological abnormalities. SPG3A-linked HSP caused by a R239C mutation has been reported to present a pure phenotype confined to impairment of the corticospinal tract. However, there is still a debate about the etiology of this motor deficit with regard to whether it is peripheral or central. We herein report two patients who were heterozygous for a R239C mutation in the SPG3A gene. Two middle-aged Japanese sisters had been suffering from a pure phenotype of HSP since their childhood. Both patients had a significant decrease in glucose metabolism in the frontal cortex medially and dorsolaterally in a [(18)F]-fluorodeoxyglucose (FDG) positron emission photography (PET) study and low scores on the Frontal Assessment Battery. A real-time PCR analysis in normal subjects showed the frontal cortex to be the major location where SPG3A mRNA is expressed. The present finding that the frontal glucose hypometabolism was associated with frontal cognitive impairment indicates that widespread neuropathology associated with mutations in the SPG3A gene may be present more centrally than previously assumed.

Cerebral palsy

International Nuclear Information System (INIS)

Truwit, C.L.; Barkovich, A.J.; Koch, T.; Ferreiro, D.

1990-01-01

This paper reviews cranial MR findings in patients with cerebral palsy (CP) to clarify and categorize this disorder. The MR images of 40 patients with clinical CP were retrospectively reviewed. All patients suffered either varying spastic plegias, hypotonicity, or choreoathetosis. Concomitantly, the patients suffered from static encephalopathy, developmental delay, and/or microcephaly. Twenty-four patients were born at or near term, 10 were premature, and incomplete birth histories were available in six. The MR images revealed mild to severe degrees of white matter damage in 24 patients (12 term, nine premature, three unknown)

Attentional and executive impairments in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Bottcher, Louise; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function.......Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function....

Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection.

Science.gov (United States)

Legg, Julian; Davies, Evan; Raich, Annie L; Dettori, Joseph R; Sherry, Ned

2014-04-01

Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

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Kerkum, Yvette L; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap; Brehm, Merel-Anne

2015-01-01

Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (ppush-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Dutch Trial Register NTR3418.

Use of outdoor games in physical rehabilitation of children with a cerebral paralysis.

Directory of Open Access Journals (Sweden)

Vindiuk P.A.

2011-07-01

Full Text Available We considered the estimation of energy in children's organism with cerebral paralysis. 16 children of secondary school age took part in research with spastic forms of a cerebral paralysis. It is established that children with a cerebral paralysis have the reduced energy parameters of the organism in comparison with children of the basic group of health. It is proved that specially organized outdoor games at the studies contribute to the growth of these indicators.

Working memory and fine motor skills predict early numeracy performance of children with cerebral palsy.

Science.gov (United States)

Van Rooijen, Maaike; Verhoeven, Ludo; Steenbergen, Bert

2016-01-01

Early numeracy is an important precursor for arithmetic performance, academic proficiency, and work success. Besides their apparent motor difficulties, children with cerebral palsy (CP) often show additional cognitive disturbances. In this study, we examine whether working memory, non-verbal intelligence, linguistic skills, counting and fine motor skills are positively related to the early numeracy performance of 6-year-old children with CP. A total of 56 children (M = 6.0, SD = 0.61, 37 boys) from Dutch special education schools participated in this cross-sectional study. Of the total group, 81% of the children have the spastic type of CP (33% unilateral and 66% bilateral), 9% have been diagnosed as having diskinetic CP, 8% have been diagnosed as having spastic and diskinetic CP and 2% have been diagnosed as having a combination of diskinetic and atactic CP. The children completed standardized tests assessing early numeracy performance, working memory, non-verbal intelligence, sentence understanding and fine motor skills. In addition, an experimental task was administered to examine their basic counting performance. Structural equation modeling showed that working memory and fine motor skills were significantly related to the early numeracy performance of the children (β = .79 and p working memory and early numeracy (β = .57, p working memory for early numeracy performance in children with CP and they warrant further research into the efficacy of intervention programs aimed at working memory training.

Congenital Unilateral Deafness Affects Cerebral Organization of Reading

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Alice Mado Proverbio

2013-06-01

Full Text Available It is known that early sensory deprivation modifies brain functional structure and connectivity. The aim of the present study was to investigate the neuro-functional organization of reading in a patient with profound congenital unilateral deafness. Using event-related potentials (ERPs, we compared cortical networks supporting the processing of written words in patient RA (completely deaf in the right ear since birth and in a group of control volunteers. We found that congenital unilateral hearing deprivation modifies neural mechanisms of word reading. Indeed, while written word processing was left-lateralized in controls, we found a strong right lateralization of the fusiform and inferior occipital gyri activation in RA. This finding goes in the same direction of recent proposals that the ventral occipito-temporal activity in word reading seem to lateralize to the same hemisphere as the one involved in spoken language processing.

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy

International Nuclear Information System (INIS)

Pagnozzi, Alex M.; Fiori, Simona; Boyd, Roslyn N.; Guzzetta, Andrea; Doecke, James; Rose, Stephen; Dowson, Nicholas; Gal, Yaniv

2016-01-01

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach. (orig.)

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy.

Science.gov (United States)

Pagnozzi, Alex M; Fiori, Simona; Boyd, Roslyn N; Guzzetta, Andrea; Doecke, James; Gal, Yaniv; Rose, Stephen; Dowson, Nicholas

2016-02-01

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy

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Pagnozzi, Alex M. [Royal Brisbane and Women' s Hospital, CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Herston, QLD (Australia); The University of Queensland, School of Medicine, Brisbane (Australia); Fiori, Simona [Stella Maris Scientific Institute, Pisa (Italy); Boyd, Roslyn N. [The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Brisbane (Australia); Guzzetta, Andrea [Stella Maris Scientific Institute, Pisa (Italy); University of Pisa, Department of Clinical and Experimental Medicine, Pisa (Italy); Doecke, James; Rose, Stephen; Dowson, Nicholas [Royal Brisbane and Women' s Hospital, CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Herston, QLD (Australia); Gal, Yaniv [The University of Queensland, Centre for Medical Diagnostic Technologies in Queensland, Brisbane (Australia)

2016-02-15

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach. (orig.)

Understanding spasticity from patients' perspectives over time.

Science.gov (United States)

Bhimani, Rozina H; McAlpine, Cynthia Peden; Henly, Susan J

2012-11-01

  The purpose of this paper was to report patients' understanding and perceptions of personal spasticity experiences over time.   Spasticity is an unpleasant and poorly understood experience associated with upper motor neuron disease.   An original qualitative study was conducted in 2008-2009.   Content analysis was used to extract meaning from the responses of 23 patients to semi-structured interviews during 7 days of acute rehabilitation for neurological diseases associated with spasticity. Findings.  Patients used words reflecting muscle tone and spasms to describe spasticity. Themes reflecting the spasticity experience over time were Ambiguous Experiences, Navigating Symptom Experience, Wounded Self, and Unending Journey.   Spasticity as experienced is complex, involving a wide range of unusual sensations sensitive to stressors in everyday life. Clinical evaluation of spasticity should include patient reports. Knowledge about patient word choice used to describe spasticity can enhance communication with healthcare providers. © 2012 Blackwell Publishing Ltd.

Cerebral perfusion and metabolism in relation to the evolution of unilateral spatial neglect due to cerebral infarction. Contribution of bilateral hemispheres in appearance and recovery

International Nuclear Information System (INIS)

Kato, Haruhisa

2006-01-01

To investigate the mechanisms underlying the evolution of unilateral spatial neglect (USN) due to cerebral infarction, the cerebral oxygen metabolism was measured quantitatively by positron emission tomography (PET). Out of 189 consecutive patients with right hemisphere lesions who underwent PET, we recruited 13 patients (group A) who exhibited USN at the time of PET examination, 11 patients (group B) who had already recovered from USN, and 27 patients (group C) with right hemisphere infarction who failed to present with USN throughout. Eight normal volunteers (group NV) served as controls. Statistical comparisons were performed on the local values of the cerebral metabolic rate of oxygen (CMRO 2 ) from the region of interest (ROI) in the right dorsolateral frontal lobe, superior temporal gyrus, inferior parietal lobule, cingulate gyrus, basal ganglia and thalamus which are associated with USN. We also obtained CMRO 2 values for the contralateral areas. As compared with group C or NV, there were significant decreases in CMRO 2 in the right frontal, right temporal and right parietal lobes, right basal ganglia, right thalamus and bilateral cingulate gyri in groups A and B. Except for the left inferior parietal lobule, no significant differences in regional CMRO 2 were noted between groups A and B. These findings indicate that extensive right hemisphere lesions may produce USN, but no specific brain region is associated with its recovery. Different from aphasics, no definite relationship is evident between recovery from USN and the role of the contralateral left hemisphere. This could be explained partly by the complexity of the pathogenetic mechanisms underlying USN. (author)

Usefulness of magnetic resonance imaging (MRI) for patients with unilateral tinnitus

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Katsura, Motoyasu [Sasebo Central Hospital, Nagasaki (Japan); Yoshida, Haruo; Kumagami, Hidetaka; Takahashi, Haruo [Nagasaki Univ. (Japan). Graduate School of Biomedical Sciences; Oosato, Yasuo [Sasebo City Hospital, Nagasaki (Japan); Dotsu, Mitsuru [National Nagasaki Medical Center, Omura (Japan)

2004-06-01

Audiography, X-ray (Stenvers view) and Magnetic Resonance Imaging (MRI) were performed on 88 patients exhibiting unilateral tinnitus. We diagnosed 4 cases (4.5%) of vestibular schwannoma and 41 cases (46.6%) of other abnormalities, including 2 cases of meningioma, 24 cases of old cerebral infarction, and 5 cases of mastoiditis. MRI was considered to be a first-line clinical examination for patients with unilateral tinnitus. (author)

Usefulness of magnetic resonance imaging (MRI) for patients with unilateral tinnitus

International Nuclear Information System (INIS)

Katsura, Motoyasu; Yoshida, Haruo; Kumagami, Hidetaka; Takahashi, Haruo; Dotsu, Mitsuru

2004-01-01

Audiography, X-ray (Stenvers view) and Magnetic Resonance Imaging (MRI) were performed on 88 patients exhibiting unilateral tinnitus. We diagnosed 4 cases (4.5%) of vestibular schwannoma and 41 cases (46.6%) of other abnormalities, including 2 cases of meningioma, 24 cases of old cerebral infarction, and 5 cases of mastoiditis. MRI was considered to be a first-line clinical examination for patients with unilateral tinnitus. (author)

Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children

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Silvia L. Pavão

2015-02-01

Full Text Available OBJECTIVE: The purpose of this study was to compare postural control in typically developing (TD children and children with cerebral palsy (CP during the sit-to-stand (STS movement and to assess the relationship between static (during static standing position and dynamic postural control (during STS movement in both groups. METHOD: The center of pressure (CoP behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP and mediolateral (ML amplitudes of CoP displacement and the area and velocity of CoP oscillation. RESULTS: According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. CONCLUSIONS: Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement.

[Evaluation of pendulum testing of spasticity].

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Le Cavorzin, P; Hernot, X; Bartier, O; Carrault, G; Chagneau, F; Gallien, P; Allain, H; Rochcongar, P

2002-11-01

To identify valid measurements of spasticity derived from the pendulum test of the leg in a representative population of spastic patients. Pendulum testing was performed in 15 spastic and 10 matched healthy subjects. The reflex-mediated torque evoked in quadriceps femoris, as well as muscle mechanical parameters (viscosity and elasticity), were calculated using mathematical modelling. Correlation with the two main measures derived from the pendulum test reported in the literature (the Relaxation Index and the area under the curve) was calculated in order to select the most valid. Among mechanical parameters, only viscosity was found to be significantly higher in the spastic group. As expected, the computed integral of the reflex-mediated torque was found to be larger in spastics than in healthy subjects. A significant non-linear (logarithmic) correlation was found between the clinically-assessed muscle spasticity (Ashworth grading) and the computed reflex-mediated torque, emphasising the non-linear behaviour of this scale. Among measurements derived from the pendulum test which are proposed in the literature for routine estimation of spasticity, the Relaxation Index exhibited an unsuitable U-shaped pattern of variation with increasing reflex-mediated torque. On the opposite, the area under the curve revealed a linear regression, which is more convenient for routine estimation of spasticity. The pendulum test of the leg is a simple technique for the assessment of spastic hypertonia. However, the measurement generally used in the literature (the Relaxation Index) exhibits serious limitations, and would benefit to be replaced by more valid measures, such as the area under the goniometric curve, especially for the assessment of therapeutics.

Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy.

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Kassee, Caroline; Hunt, Carolyn; Holmes, Michael W R; Lloyd, Meghann

2017-05-17

This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.

Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics?

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Remijn, L; Groen, B E; Speyer, R; van Limbeek, J; Vermaire, J A; van den Engel-Hoek, L; Nijhuis-van der Sanden, M W G

2017-02-01

The aim of this study was to explore the feasibility of the Mastication Observation and Evaluation (MOE) instrument, dynamic ultrasound and 3D kinematic measurements to describe mastication in children with spastic cerebral palsy and typically developing children. Masticatory movements during five trials of eating a biscuit were assessed in 8 children with cerebral palsy, spastic type (mean age 9.08years) and 14 typically developing children (mean age 9.01years). Differences between trials were tested (t-test) and the mastication of individual children with cerebral palsy was analyzed. MOE scores ranged from 17 to 31 (median 24) for the children with cerebral palsy and from 28 to 32 (median 31) for the typically developing children. There was an increased chewing cycle duration, a smaller left-right and up-down tongue displacement and larger anterior mandible movements for the trials (n=40) of cerebral palsy children (pmastication between individual children with cerebral palsy. The MOE items 'jaw movement' and 'fluency and coordination' showed the most similarity with the objective measurements. Objective measurements of dynamic ultrasound and 3D kinematics complemented data from the MOE instrument. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Influence of Age at Single-Event Multilevel Surgery on Outcome in Children with Cerebral Palsy Who Walk with Flexed Knee Gait

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Svehlik, Martin; Steinwender, Gerhard; Kraus, Tanja; Saraph, Vinay; Lehmann, Thomas; Linhart, Wolfgang E.; Zwick, Ernst B.

2011-01-01

Aim: Information on the timing and long-term outcome of single-event multilevel surgery in children with bilateral spastic cerebral palsy (CP) walking with flexed knee gait is limited. Based on our clinical experience, we hypothesized that older children with bilateral spastic CP would benefit more from single-event multilevel surgery than younger…

Intramuscular Connective Tissue Differences in Spastic and Control Muscle: A Mechanical and Histological Study

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de Bruin, Marije; Smeulders, Mark J.; Kreulen, Michiel; Huijing, Peter A.; Jaspers, Richard T

2014-01-01

Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown. Using biopsies, we compared mechanical as well as histological properties of flexor carpi ulnaris muscle (FCU) from CP patients (n = 29) and healthy controls (n = 10). The sarcomere slack length (mean 2.5 µm, SEM 0.05) and slope of the normalized sarcomere length-tension characteristics of spastic fascicle segments and single myofibre segments were not different from those of control muscle. Fibre type distribution also showed no significant differences. Fibre size was significantly smaller (1933 µm2, SEM 190) in spastic muscle than in controls (2572 µm2, SEM 322). However, our statistical analyses indicate that the latter difference is likely to be explained by age, rather than by the affliction. Quantities of endomysial and perimysial networks within biopsies of control and spastic muscle were unchanged with one exception: a significant thickening of the tertiary perimysium (3-fold), i.e. the connective tissue reinforcement of neurovascular tissues penetrating the muscle. Note that this thickening in tertiary perimysium was shown in the majority of CP patients, however a small number of patients (n = 4 out of 23) did not have this feature. These results are taken as indications that enhanced myofascial loads on FCU is one among several factors contributing in a major way to the aetiology of limitation of movement at the wrist in CP and the characteristic wrist position of such patients. PMID:24977410

Cerebral Palsy Symptoms in Children Decreased Following Massage Therapy

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Hernandez-Reif, Maria; Field, Tiffany; Largie, Shay; Diego, Miguel; Manigat, Natasha; Seoanes, Jacqueline; Bornstein, Joan

2005-01-01

Twenty young children (mean age = 32 months) with cerebral palsy (CP) recruited from early intervention programs received 30 minutes of massage or reading twice weekly for 12 weeks. The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms, and improved fine…

BoNT-A related changes of cortical activity in patients suffering from severe hand paralysis with arm spasticity following ischemic stroke.

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Veverka, Tomáš; Hluštík, Petr; Tomášová, Zuzana; Hok, Pavel; Otruba, Pavel; Král, Michal; Tüdös, Zbyněk; Zapletalová, Jana; Herzig, Roman; Krobot, Alois; Kaňovský, Petr

2012-08-15

Investigations were performed to localize and analyze the botulinum toxin (BoNT-A) related changes of cerebral cortex activation in chronic stroke patients suffering from severe hand paralysis with arm spasticity. Effects on task- related cerebral activation were evaluated by functional magnetic resonance imaging (fMRI). 14 patients (5 males, 9 females, mean age 55.3 years) suffering from upper limb post-stroke spasticity were investigated. The change of arm spasticity was assessed by using the modified Ashworth scale (MAS). FMRI sessions were performed before (W0), four weeks (W4) and 11 weeks (W11) after BoNT-A application. Patients were scanned while performing imaginary movement with the impaired hand. Group fMRI analysis included patient age as a covariate. BoNT-A treatment was effective in alleviation of arm spasticity. Mean MAS was at Week 0: 2.5 (SD 0.53), at Week 4: 1.45 (SD 0.38), at Week 11: 2.32 (SD 0.44). Task-related fMRI prior to the treatment showed extensive activation of bilateral frontoparietal sensorimotor cortical areas, anterior cingulate gyrus, pallidum, thalamus and cerebellum. Effective BoNT-A treatment (W4) resulted in partial reduction of active network volume in most of the observed areas, whereas BoNT-free data (W11) revealed further volume reduction in the sensorimotor network. On direct comparison, significant activation decreases associated with BoNT-A treatment were located in areas outside the classical sensorimotor system, namely, ipsilesional lateral occipital cortex, supramarginal gyrus and precuneus cortex. On comparison of W4 and W11, no activation increases were found, instead, activation further decreased in ipsilesional insular cortex, contralesional superior frontal gyrus and bilateral frontal pole. Whole brain activation patterns during BoNT-A treatment of post-stroke arm spasticity and further follow up document predominantly gradual changes both within and outside the classical sensorimotor system. Copyright © 2012

The Impact of Cranios acral Therapy on Inhibition of Hypertonicity of the Lower Limb in Children with Dipelgia Spastic Cerebral Palsy of 3-8 Years Old

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Ebrahim Pishyareh

2001-01-01

Full Text Available Objective: The purpose of this study was to assess the facilitating impact of craniosacral therapy on inhibition of hypertonicity of the lower limb in children with spastic dipelgic cerebral palsy. Materials & Methods: 100 children with cerebral palsy were studied and 36 children selected, aged 3 to 8 years, were randomly assigned to a control and an experimental group. Muscle tone was assessed using modified Ashworth scale, passive range of motion by goniometer, neurodevelopment level by Bobath scale. All children were Pre-Post-tested with in an interval of three months. Results: A further finding of the analyses revealed that significant reduction was observed in hypertonicity of the hip adductors and the ankle plantar flexors. Significant increase was observed in passive range of motion of the hip abduction and the ankle dorsiflexion. There was found no significant difference of reduction in hypertonicity of the knee flexors, of increase in passive range of motion of the knee extensor, of improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip adductors and improvement of the neurodevelopmental level. Conclusion: It should be mentioned that in all above cases the was set at 5%. Implications for clinical O.T. are mentioned.

Spasticity-assessment: a review

DEFF Research Database (Denmark)

Biering-Sørensen, F.; Nielsen, Jens Bo; Klinge, Klaus Peter

2006-01-01

Study design:Review of the literature on the validity and reliability of assessment of spasticity and spasms.Objectives:Evaluate the most frequently used methods for assessment of spasticity and spasms, with particular focus on individuals with spinal cord lesions.Setting:Clinic for Spinal Cord...... Injuries, Rigshospitalet, University Hospital of Copenhagen, and Department of Medical Physiology, University of Copenhagen, Denmark.Methods:The assessment methods are grouped into clinical, biomechanical and electrophysiological, and the correlation between these is evaluated.Results:Clinical methods......: For assessment of spasticity, the Ashworth and the modified Ashworth scales are commonly used. They provide a semiquantitative measure of the resistance to passive movement, but have limited interrater reliability. Guidelines for the testing procedures should be adhered to. Spasm frequency scales seem...

Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy.

LENUS (Irish Health Repository)

Spirtos, Michelle

2012-02-01

OBJECTIVE: We examined the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function. METHOD: Three occupational therapists independently scored 34 videotaped assessments of children with hemiplegic cerebral palsy aged 6 yr, 1 mo, to 14 yr, 5 mo. Intraclass correlation coefficients (ICCs) at a 95% confidence interval were calculated for total scores, category scores, and item scores. RESULTS: The correlation between raters\\' total scores was high (ICC = .961). The highest correlation for test components between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683). The ICCs for individual test item scores varied and ranged from .368 to .899. CONCLUSION: This study demonstrated high interrater reliability for total scores, with scoring of some individual components and items requiring further consideration from both a clinical and a research perspective.

Multilevel Botulinum Toxin A (Abobotulinum Toxin A Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

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O. A. Klochkova

2016-01-01

Full Text Available Background: The contemporary application of Botulinum toxin A (BTA in cerebral palsy (CP implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months. Multilevel BTA injections were indicated for the majority (n = 634, 87.6% of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U, the repeated injections doses up to 45 U/kg (1000 U (in most centers. The median intervals between the repeated injections were 180–200 days in 484 (66.9% patients and 140–180 days in 157 (24.7% patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.

Brain MRI and single photon emission computed tomography in severe athetotic cerebral palsy. A comparative study with mental and motor disorders

International Nuclear Information System (INIS)

Yamada, Kazutaka; Tsuzura, Shigenobu; Matsuda, Hiroshi.

1995-01-01

Single photon emission computed tomography (SPECT) using N-isopropyl-p-[ 123 I]-iodoamphetamine ( 123 I-IMP) was performed in twelve patients with severe athetotic cerebral palsy (Ath; 5 males and 7 females) who had both motor delay (unable to move) and mental retardation (I.Q, or D.Q, below 30). The neuroimaging findings of those patients were compared with those of patients mental and motor disorders. In five caes suffering from neonatal asphyxia, SPECT demonstrated a decreased regional cerebral blood flow (rCBF) in corpus striatum, thalamus, orbitofrontal areas, pericentral gyrus areas, prefrontal areas and medial temporal areas. In seven cases suffering from neonatal jaundice, SPECT demonstrated a decreased rCBF in orbito-frontal areas, prefrontal areas and medial temporal areas. SPECT showed hypoperfusion of peri-central gyrus areas in cases with complications of spastic palsy. The decreased rCBF in medial temporal areas mostly corresponded to an alteration in hippocampal formation as assessed by magnetic resonance imaging (MRI). Cases with hypoperfusion of bilateral medial temporal areas showed a lower score of language understanding than those with the unilateral damage. In cases with hypofusion of bilateral prefrontal areas and bilateral medial temporal areas, the grade of understanding of language was almost below 12 months. In cases with hypoperfusion of orbitofrontal areas, psychomotor hypersensitivity had been observed. Those results suggest that IMP-SPECT and MRI of the brain is useful tool for neurological assessment in handicapped patients with athetotic cerebral palsy. (author)

Brain MRI and single photon emission computed tomography in severe athetotic cerebral palsy. A comparative study with mental and motor disorders

Energy Technology Data Exchange (ETDEWEB)

Yamada, Kazutaka; Tsuzura, Shigenobu [Metropolitan Medical Center of the Severely Handicapped, Fuchu, Tokyo (Japan); Matsuda, Hiroshi

1995-07-01

Single photon emission computed tomography (SPECT) using N-isopropyl-p-[{sup 123}I]-iodoamphetamine ({sup 123}I-IMP) was performed in twelve patients with severe athetotic cerebral palsy (Ath; 5 males and 7 females) who had both motor delay (unable to move) and mental retardation (I.Q, or D.Q, below 30). The neuroimaging findings of those patients were compared with those of patients mental and motor disorders. In five caes suffering from neonatal asphyxia, SPECT demonstrated a decreased regional cerebral blood flow (rCBF) in corpus striatum, thalamus, orbitofrontal areas, pericentral gyrus areas, prefrontal areas and medial temporal areas. In seven cases suffering from neonatal jaundice, SPECT demonstrated a decreased rCBF in orbito-frontal areas, prefrontal areas and medial temporal areas. SPECT showed hypoperfusion of peri-central gyrus areas in cases with complications of spastic palsy. The decreased rCBF in medial temporal areas mostly corresponded to an alteration in hippocampal formation as assessed by magnetic resonance imaging (MRI). Cases with hypoperfusion of bilateral medial temporal areas showed a lower score of language understanding than those with the unilateral damage. In cases with hypofusion of bilateral prefrontal areas and bilateral medial temporal areas, the grade of understanding of language was almost below 12 months. In cases with hypoperfusion of orbitofrontal areas, psychomotor hypersensitivity had been observed. Those results suggest that IMP-SPECT and MRI of the brain is useful tool for neurological assessment in handicapped patients with athetotic cerebral palsy. (author).

Percutaneous Adductor Release in Nonambulant Children with Cerebral Palsy

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Ramji Lal Sahu

2014-03-01

Full Text Available Introduction: Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anesthesia. Methods: From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children. Results: Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (p = 0.01.The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%. Conclusions: Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis. Keywords: Adductor contracture, Percutaneous, Cerebral palsy, Minimal invasive procedure.

Energy expenditure in adults with cerebral palsy playing Wii Sports.

Science.gov (United States)

Hurkmans, Henri L; van den Berg-Emons, Rita J; Stam, Henk J

2010-10-01

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. Cross-sectional study. University medical center. Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Comparative study of muscular tonus in spastic tetra paretic cerebral palsy in children with predominantly cortical and subcortical lesions in computerized tomography of the skull

International Nuclear Information System (INIS)

Iwabe, Cristina; Piovesana, Ana Maria Sedrez Gonzaga

2003-01-01

The objective was to compare distribution and intensity of muscular tonus in spastic tetra paretic cerebral palsy (CP), correlating the clinical data with lesion location in the central nervous system. Twelve children aged two to four years old with predominantly cortical lesions (six children) and subcortical lesions (six children) were included. The tonus was analyzed in the upper (UULL) and lower limbs (LLLL) based on Durigon and Piemonte protocol. The result showed that there was no significant difference regarding tonus intensity and distribution in the UULL and LLLL in both groups. Comparing the upper and lower limbs of subjects in the same group, the LLLL presented more asymmetry and higher tonus intensity than the UULL. It was concluded that in this study children with CP as a result of predominantly cortical or subcortical lesions present a similar deficit in tonus modulation, causing a symmetric and homogeneous distribution of hypertonicity, which is predominant in the LLLL. (author)

Muscle growth is reduced in 15-month-old children with cerebral palsy

DEFF Research Database (Denmark)

Herskind, Anna; Ritterband-Rosenbaum, Anina; Willerslev-Olsen, Maria

2016-01-01

AimLack of muscle growth relative to bone growth may be responsible for development of contractures in children with cerebral palsy (CP). Here, we used ultrasonography to compare growth of the medial gastrocnemius muscle in children with and without CP.MethodTwenty-six children with spastic CP (15...

Resting and hypercapnic rCBF in patients with unilateral occlusive disease of the internal carotid artery

International Nuclear Information System (INIS)

Keyeux, A.; Laterre, C.; Beckers, C.

1988-01-01

Regional cerebral blood flow was measured by the 133 Xe inhalation technique in 15 patients with severe unilateral internal carotid artery stenosis (75%) or occlusion, and in the absence of evidence of any sign of occlusive disease in other main afferent cerebral arteries. A comparison with normal subjects showed that lowered resting flow in both hemispheres was a common finding in all patients. Interhemispheric asymmetry was present only in patients with occlusion and the precentral, posterior temporal, and occipital regions were the most seriously affected. The CO 2 reactivity was substantially reduced in both hemispheres of all stenotic and occluded patients, but occluded patients showed an increased reduction of CO 2 reactivity only in the ipsilateral hemisphere. In addition to an hypothetical age effect, the atherosclerotic involvement of the cerebral vascular system leads to a reduction of flow and loss of CO 2 reactivity in both hemispheres. In this context, the collateral supply capacity is not overloaded in case of a unilateral severe stenosis but fails in case of a unilateral occlusion of the internal carotid artery. A suitable estimate of the blood flow reduction as a result of occlusion is made by the hemispheric and regional laterality indices applied in resting and hypercapnia conditions. These indices could be used as indicators for endarterectomy or bypass surgery as well as a sensitive means for appreciating cerebral blood flow response to treatment

Intrathecal baclofen pump for spasticity: an evidence-based analysis.

Science.gov (United States)

2005-01-01

To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of intrathecal baclofen for spasticity. Spasticity is a motor disorder characterized by tight or stiff muscles that may interfere with voluntary muscle movements and is a problem for many patients with multiple sclerosis (MS), spinal cord injury (SCI), cerebral palsy (CP), and acquired brain injury (ABI).(1). Increased tone and spasm reduces mobility and independence, and interferes with activities of daily living, continence and sleep patterns. Spasticity may also be associated with significant pain or discomfort (e.g., due to poor fit in braces, footwear, or wheelchairs), skin breakdown, contractures, sleep disorders and difficulty in transfer. Goals of treatment are to decrease spasticity in order to improve range of motion, facilitate movement, reduce energy expenditure and reduce risk of contractures. Existing treatments include physical therapy, oral medications, injections of phenol or botulinum toxin, or surgical intervention. Baclofen is the oral drug most frequently prescribed for spasticity in cases of SCI and MS.(1) Baclofen is a muscle relaxant and antispasticity drug. In the brain, baclofen delivered orally has some supraspinal activity that may contribute to clinical side effects. The main adverse effects of oral baclofen include sedation, excessive weakness, dizziness, mental confusion, and somnolence.(2) The incidence of adverse effects is reported to range from 10% to 75%.(2) Ochs et al. estimated that approximately 25-30% of SCI and MS patients fail to respond to oral baclofen.(3;4) Adverse effects appear to be dose-related and may be minimized by initiating treatment at a low dose and gradually titrating upwards.(2) Adverse effects usually appear at doses >60 mg/day.(2) The rate of treatment discontinuation due to intolerable adverse effects has generally been reported to range from 4% to 27%.(2) When baclofen is administered orally, only a small portion of the

Public health issues related to infection in pregnancy and cerebral palsy

DEFF Research Database (Denmark)

Schendel, Diana E.; Schuchat, Anne; Thorsen, Poul

2002-01-01

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline...... in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold...... increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal...

Using Telemedicine to Improve Spasticity Diagnosis Rates

Science.gov (United States)

2018-02-20

Spasticity, Muscle; Muscular Diseases; Musculoskeletal Disease; Muscle Hypertonia; Muscle Spasticity; Neuromuscular Manifestations; Signs and Symptoms; Nervous System Diseases; Neurologic Manifestations

Clinical significance of the corpus callosum in cerebral palsy

International Nuclear Information System (INIS)

Lee, Eun Ja; Kim, Ji Chang; Kim, Jong Chul; And Others

2000-01-01

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

Clinical significance of the corpus callosum in cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

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

2000-10-01

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.

Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral palsy

DEFF Research Database (Denmark)

Bandholm, Thomas Quaade; Jensen, Bente Rona; Nielsen, Lone M

2012-01-01

Objective: To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP). Methods: Fourteen children with CP performed supervised...

Influence of Hippotherapy on Body Balance in the Sitting Position Among Children with Cerebral Palsy.

Science.gov (United States)

Matusiak-Wieczorek, Ewelina; Małachowska-Sobieska, Monika; Synder, Marek

2016-03-23

Cerebrally palsied children demonstrated limited independence while performing various activities of daily living, which is due to disorders of postural control. The best solution to improve postural control is the use of therapies that simultaneously focus on the sense of balance and motor skills. Such possibilities for patients with cerebral palsy are offered, for example, by hippotherapy. To assess the influence of hippotherapy on body balance in the sitting position among children with cerebral palsy. The study enrolled thirty-nine children aged 6-12 years with GMFCS level 1 or 2 spastic diplegia or spastic hemiplegia. The participants were divided into an intervention group (n=19) and a control group (n=20). Children from the intervention group attended 30 minutes of hippotherapy once weekly for 12 consecutive weeks. The Sitting Assessment Scale (SAS) was used to assess the patients' posture and balance. Some children improved their posture and balance during the study. Generally, control of trunk and head position and function of arms were getting better, while footwork was the weakest. Hippotherapy has positive effects on the position and function of individual parts of the body, thus making it possible for cerebrally palsied children to improve posture and the ability to maintain balance in the sitting position.

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy.

Science.gov (United States)

Whitney, Daniel G; Singh, Harshvardhan; Miller, Freeman; Barbe, Mary F; Slade, Jill M; Pohlig, Ryan T; Modlesky, Christopher M

2017-01-01

Nonambulatory children with severe cerebral palsy (CP) have underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Ambulatory children with mild spastic CP and typically developing children (4 to 11years; 12/group) were compared. Magnetic resonance imaging was used to estimate cortical bone, bone marrow and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Accelerometer-based activity monitors worn on the ankle were used to assess physical activity. There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44%) than controls (both pChildren with CP also had lower cortical bone volume (30%), cortical bone width in the posterior (16%) and medial (32%) portions of the shaft, total bone width in the medial-lateral direction (15%), Z in the medial-lateral direction (34%), J (39%) and muscle volume (39%), and higher bone marrow fat concentration (82.1±1.8% vs. 80.5±1.9%), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0±8.0% vs. 16.1±3.3%) than controls (all pfat infiltration estimates, except posterior cortical bone width, were still present (all pchildren with CP compared to controls emerged (pchildren with mild spastic CP exhibit an underdeveloped bone architecture and low bone strength in the midtibia and a greater infiltration of fat in the bone marrow and surrounding musculature compared to typically

New insights into the pathophysiology of post-stroke spasticity

Directory of Open Access Journals (Sweden)

Sheng eLi

2015-04-01

Full Text Available Spasticity is one of many consequences after stroke. It is characterized by a velocity-dependent increase in resistance during passive stretch, resulting from hyperexcitability of the stretch reflex. The underlying mechanism of the hyperexcitable stretch reflex, however, remains poorly understood. Accumulated experimental evidence has supported supraspinal origins of spasticity, likely from an imbalance between descending inhibitory and facilitatory regulation of spinal stretch reflexes secondary to cortical disinhibition after stroke. The excitability of reticulospinal and vestibulospinal tracts has been assessed in stroke survivors with spasticity using non-invasive indirect measures. There are strong experimental findings that support the reticulospinal hyperexcitability as a prominent underlying mechanism of post-stroke spasticity. This mechanism can at least partly account for clinical features associated with spasticity and provide insightful guidance for clinical assessment and management of spasticity. However, the possible role of VST hyperexcitability can not be ruled out from indirect measures. In vivo measure of individual brainstem nuclei in stroke survivors with spasticity using advanced fMRI techniques in the future is probably able to provide direct evidence of pathogenesis of post-stroke spasticity.

New insights into the pathophysiology of post-stroke spasticity.

Science.gov (United States)

Li, Sheng; Francisco, Gerard E

2015-01-01

Spasticity is one of many consequences after stroke. It is characterized by a velocity-dependent increase in resistance during passive stretch, resulting from hyperexcitability of the stretch reflex. The underlying mechanism of the hyperexcitable stretch reflex, however, remains poorly understood. Accumulated experimental evidence has supported supraspinal origins of spasticity, likely from an imbalance between descending inhibitory and facilitatory regulation of spinal stretch reflexes secondary to cortical disinhibition after stroke. The excitability of reticulospinal (RST) and vestibulospinal tracts (VSTs) has been assessed in stroke survivors with spasticity using non-invasive indirect measures. There are strong experimental findings that support the RST hyperexcitability as a prominent underlying mechanism of post-stroke spasticity. This mechanism can at least partly account for clinical features associated with spasticity and provide insightful guidance for clinical assessment and management of spasticity. However, the possible role of VST hyperexcitability cannot be ruled out from indirect measures. In vivo measure of individual brainstem nuclei in stroke survivors with spasticity using advanced fMRI techniques in the future is probably able to provide direct evidence of pathogenesis of post-stroke spasticity.

Defining the mechanical properties of a spring-hinged ankle foot orthosis to assess its potential use in children with spastic cerebral palsy.

Science.gov (United States)

Kerkum, Yvette L; Brehm, Merel-Anne; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap

2014-12-01

A rigid ventral shelf ankle foot orthosis (AFO) may improve gait in children with spastic cerebral palsy (SCP) whose gait is characterized by excessive knee flexion in stance. However, these AFOs can also impede ankle range of motion (ROM) and thereby inhibit push-off power. A more spring-like AFO can enhance push-off and may potentially reduce walking energy cost. The recent development of an adjustable spring-hinged AFO now allows adjustment of AFO stiffness, enabling tuning toward optimal gait performance. This study aims to quantify the mechanical properties of this spring-hinged AFO for each of its springs and settings. Using an AFO stiffness tester, two AFO hinges and their accompanying springs were measured. The springs showed a stiffness range of 0.01-1.82 N · m · deg(-1). The moment-threshold increased with increasing stiffness (1.13-12.1 N · m), while ROM decreased (4.91-16.5°). Energy was returned by all springs (11.5-116.3 J). These results suggest that the two stiffest available springs should improve joint kinematics and enhance push-off in children with SCP walking with excessive knee flexion.

Unilateral neglect syndrome after stroke: the role of Occupational Therapy

Directory of Open Access Journals (Sweden)

Tamara Pereira de Oliveira

2014-09-01

Full Text Available Unilateral Neglect Syndrome is one of the consequences of cerebral vascular accident (CVA generally following right parietal lobe lesion, leading to the impairment of perceptive visual, spatial and attention functions. The patient affected does not realize the environmental stimuli on the contralesional hemibody. Occupational therapy plays an important role in caring for this patient, seeking the recovery of perception, attention and social engagement. This study aimed to describe and evaluate the results of occupational therapy intervention and treatment in a single Unilateral Neglect Syndrome post CVA patient. Data were obtained from a survey of the patient’s medical records and interviews of his therapist and caretaker. The analysis of the patient’s medical records and his therapist’s report showed that the patient responded satisfactorily to treatment, presenting a decrease of the left unilateral neglect at the end of the study period. The favorable outcome of the patient outlined the relevance of evaluating the effects of Occupational Therapy interventions for clinical unilateral neglect syndrome.

Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy

NARCIS (Netherlands)

De Gooijer-van de Groep, K.L.; De Vlugt, E.; De Groot, J.H.; Van der Heijden-Maessen, H.C.M.; Wielheesen, D.H.M.; Van Wijlen-Hempel, R.M.S.; Arendzen, J.H.; Meskers, C.G.M.

2013-01-01

Background Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: “spasticity” vs. “contracture”).

The effect of walking speed on hamstrings length and lengthening velocity in children with spastic cerebral palsy

NARCIS (Netherlands)

Krogt, van der M.M.; Doorenbosch, C.A.M.; Harlaar, J.

2009-01-01

0.001). These data are important as a reference for valid interpretation of hamstrings length and velocity data in gait analyses at different walking speeds. The results indicate that the presence of spasticity is associated with reduced hamstrings length and lengthening velocity during gait, even

Unimanual versus bimanual therapy in children with unilateral cerebral palsy: Same, same, but different.

Science.gov (United States)

Hoare, Brian; Greaves, Susan

2017-01-01

There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.

Does calf muscle spasticity contribute to postural imbalance? A study in persons with pure hereditary spastic paraparesis

NARCIS (Netherlands)

Niet, M. de; Weerdesteyn, V.G.M.; Bot, S.T. de; Warrenburg, B.P.C. van de; Geurts, A.C.H.

2013-01-01

OBJECTIVES: The contribution of spasticity to postural imbalance in patients with upper motor neuron syndrome is still unclear. This study aimed to evaluate the responses to support-surface perturbations in patients with hereditary spastic paraparesis (HSP). These patients typically suffer from

Effect of Knee Orthoses on Hamstring Contracture in Children With Cerebral Palsy: Multiple Single-Subject Study.

Science.gov (United States)

Laessker-Alkema, Kristina; Eek, Meta Nyström

2016-01-01

To examine the effect of knee orthoses on extensibility of the hamstrings in children with spastic cerebral palsy (CP). The short-term effects of knee orthoses on passive range of motion (ROM), spasticity, and gross motor function of the hamstrings. Ten children with spastic CP, aged 5 to 14 years, at Gross Motor Function Classification System levels I to V, were followed. The orthoses were worn for a minimum of 30 minutes day, 5 days per week, during the intervention period of 8 weeks. Visual analysis using the Two Standard Deviation Band Method supported improvements in passive ROM for all 20 hamstring muscles and in 12 of 14 knee extension measurements. Analyses with the Wilcoxon signed rank test confirm the individual results and support a significant increase in hamstring muscles (P = .005) and knee extension (right: P =.028; left: P =.018) compared with baseline. In children with spastic CP, 8 weeks of treatment with knee orthoses can improve extensibility of the hamstrings.

Spasticity complicating metrizamide myelography

Energy Technology Data Exchange (ETDEWEB)

Earl, H M; Earl, C J; Kendall, B E

1985-09-01

Temporary but considerable increase in spasticity following myelography using metrizamide at 300 mgsI/ml concentration occurred in 4 patients. In 3 of the patients the diagnosis is uncertain, but it is likely to be some form of degenerative disease involving motor pathways in two of them; the fourth case has cervical spondylotic myelopathy. The spasticity might be related to the anticholinesterase activity of metrizamide or to competative inhibition by the deoxyglucose component of the metrizamide molecule of endogenous glucose metabolism.

Computed tomographic (CT) scans in cerebral palsy (CP)

International Nuclear Information System (INIS)

Kolawole, T.M.; Patel, P.J.; Mahdi, A.H.

1989-01-01

The CT findings in 120 cerebral palsied children are analysed. The 72.5% positive findings are correlated with the clinical types, as well as the aetiological basis for the cerebral palsy. The spastic type, 83.3% of the total number of children, had the highest positive findings. The yield was increased in children with seizures (91.3%) and those in the postnatal group (90%), as well as those with birth trauma and neonatal asphyxia (94%). The findings were those of atrophy in 30.8%, hydrocephalus, in 10%, infarct in 11.6%, porencephaly in 8.3% and others. The atropic changes and their patterns are explained. Treatable lesions, such as tumour, hydrocephalus, subdural haematoma, porencephaly and hygroma were identified in 22.5% of cases. It is concluded that CT scan is definitely efficacious in the management of cerebral palsied children. (orig.)

Spasticity: its physiology and management. Part IV. Current and projected treatment procedures for spasticity.

Science.gov (United States)

Bishop, B

1977-04-01

Today's prescriptions for treating spasticity may include pharmacological, surgical, or physical procedures. All derive their rationale from the classical concepts of decerebrate rigidity and of brain organization as discussed in Part I. This paper describes the advantages and disadvantages of these current treatment procedures and proposes that recent discoveries about the "recovery" capabilities of the central nervous system may influence the means for managing spasticity in the future.

Aquatic exercise in the treatment of children with cerebral palsy

Directory of Open Access Journals (Sweden)

Dimitrijević Lidija

2012-01-01

Full Text Available Introduction. Aquatic exercise is one of the most popular supplementary treatments for children with neuro-motor impairment, especially for cerebral palsy (CP. As water reduces gravity force which increases postural stability, a child with CP exercises more easily in water than on land. Objective. The aim of the study was to examine aquatic exercise effects on gross motor functioning, muscle tone and cardiorespiratory endurance in children with spastic CP. Methods. The study included 19 children of both sexes, aged 6 to 12 years, with spastic CP. They were included in a 12-week aquatic exercise program, twice a week. Measurements of GMFM (Gross Motor Function Measurement, spasticity (MAS – Modified Ashworth Scale, heart rate (HR and maximal oxygen consumption (VO2max were carried out before and after treatment. The measurement results were compared before and after treatment. Results. GMFM mean value before therapy was 80.2% and statistically it was significantly lower in comparison to the same value after therapy, which was 86.2% (p<0.05. The level of spasticity was considerably decreased after therapy; the mean value before treatment was 3.21 according to MAS, and after treatment it was 1.95 (p<0.001. After treatment there was a statistically significant improvement of cardiorespiratory indurance, i.e., there was a significant decrease in the mean value of HR and a significant increase of VO2max (p<0.001. Conclusion. Aquatic exercise program can be useful in improving gross motor functioning, reducing spasticity and increasing cardiorespiratory endurance in children with spastic CP. [Projekat Ministarstva nauke Republike Srbije, br. 175092

Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length.

Science.gov (United States)

Smith, Lucas R; Lee, Ki S; Ward, Samuel R; Chambers, Henry G; Lieber, Richard L

2011-05-15

Cerebral palsy (CP) results from an upper motoneuron (UMN)lesion in the developing brain. Secondary to the UMNl esion,which causes spasticity, is a pathological response by muscle - namely, contracture. However, the elements within muscle that increase passive mechanical stiffness, and therefore result in contracture, are unknown. Using hamstring muscle biopsies from pediatric patients with CP (n =33) and control (n =19) patients we investigated passive mechanical properties at the protein, cellular, tissue and architectural levels to identify the elements responsible for contracture. Titin isoform, the major load-bearing protein within muscle cells, was unaltered in CP. Correspondingly, the passive mechanics of individual muscle fibres were not altered. However, CP muscle bundles, which include fibres in their constituent ECM, were stiffer than control bundles. This corresponded to an increase in collagen content of CP muscles measured by hydroxyproline assay and observed using immunohistochemistry. In vivo sarcomere length of CP muscle measured during surgery was significantly longer than that predicted for control muscle. The combination of increased tissue stiffness and increased sarcomere length interact to increase stiffness greatly of the contracture tissue in vivo. These findings provide evidence that contracture formation is not the result of stiffening at the cellular level, but stiffening of the ECM with increased collagen and an increase of in vivo sarcomere length leading to higher passive stresses.

Unilateral traumatic oculomotor nerve paralysis

International Nuclear Information System (INIS)

Asari, Syoji; Satoh, Toru; Yamamoto, Yuji

1982-01-01

The present authors report a case of unilateral traumatic oculomotor nerve paralysis which shows interesting CT findings which suggest its mechanism. A 60-year-old woman was admitted to our hospital with a cerebral concussion soon after a traffic accident. A CT scan was performed soon after admission. A high-density spot was noted at the medial aspect of the left cerebral peduncle, where the oculomotor nerve emerged from the midbrain, and an irregular, slender, high-density area was delineated in the right dorsolateral surface of the midbrain. Although the right hemiparesis had already improved by the next morning, the function of the left oculomotor nerve has been completely disturbed for the three months since the injury. In our case, it is speculated that an avulsion of the left oculomotor nerve rootlet occurred at the time of impact as the mechanism of the oculomotor nerve paralysis. A CT taken soon after the head injury showed a high-density spot; this was considered to be a hemorrhage occurring because of the avulsion of the nerve rootlet at the medial surface of the cerebral peduncle. (J.P.N.)

Lung vital capacity and oxygen saturation in adults with cerebral palsy

Directory of Open Access Journals (Sweden)

Lampe R

2014-12-01

Full Text Available Renée Lampe,1,2 Tobias Blumenstein,2 Varvara Turova,2 Ana Alves-Pinto2 1Markus Würth Stiftungsprofessur, Technical University of Munich, Munich, Germany; 2Research Unit for Cerebral Palsy and Children Neuroorthopaedics of the Buhl-Strohmaier Foundation, Orthopedic Department of the Clinic “rechts der Isar” of the Technical University of Munich, Munich, Germany Background: Individuals with infantile cerebral palsy have multiple disabilities. The most conspicuous syndrome being investigated from many aspects is motor movement disorder with a spastic gait pattern. The lung function of adults with spasticity attracts less attention in the literature. This is surprising because decreased thoracic mobility and longstanding scoliosis should have an impact on lung function. With increasing age and the level of disability, individuals become susceptible to lung infections and reflux illness, and these are accompanied by increased aspiration risk. This study examined, with different methods, to what extent adults with congenital cerebral palsy and acquired spastic paresis – following traumatic brain injury – showed restriction of lung function. It also assessed the contribution of disability level on this restriction.Methods: The oxygen saturation of 46 adults with a diagnosis of cerebral palsy was measured with an oximeter. Lung vital capacity was measured with a mobile spirometer and excursion of the thorax was clinically registered. The gross motor function levels and the presence or absence of scoliosis were determined.Results: A significantly positive correlation between lung vital capacity and chest expansion was established. Both the lung vital capacity and the thorax excursion decreased with increases in gross motor function level. Oxygen saturation remained within the normal range in all persons, in spite of reduced values of the measured lung parameters. No statistically significant dependency between lung vital capacity and oxygen

Análise do equilíbrio estático e de deformidades nos pés de crianças com paralisia cerebral Analysis of static balance and deformities on feet of children with cerebral palsy

Directory of Open Access Journals (Sweden)

Thaís Delamuta Ayres da Costa

2011-06-01

Full Text Available O presente estudo analisou, por meio de um sistema de baropodometria, os tipos de pé, a influência da visão no equilíbrio estático na postura ortostática e a distribuição da pressão plantar em 16 crianças, de 6 a 15 anos, com diagnóstico de paralisia cerebral. Os resultados indicaram que o pé valgo foi o mais comum dentre os tipos de paralisia cerebral estudadas, diparesia espástica, hemiparesia espástica direita, hemiparesia espástica esquerda e ataxia; o equilíbrio estático na postura ortostática de olhos vendados apresentou maior instabilidade do que quando com os olhos abertos; a distribuição de pressão plantar não apresentou significância estatística e não houve correlação significativa entre a idade e as variáveis de equilíbrio e de distribuição da pressão plantar. Desse modo, conclui-se que a visão é um fator importante no controle postural de crianças com paralisia cerebral.The present study analyzed through baropodometry system, the feet's types, the vision's influence during static balance on orthostatic posture and the plantar pressure distribution in 16 children, aged from 6 to 15 years-old with diagnostic of cerebral palsy. We noted that the valgus foot was more common on the sample studied, diparetic spastic, hemiparetic spastic right, and hemiparetic spastic left and ataxic; the static balance on orthostatic posture with closed eyes was more instable compared to the orthostatic posture with opened eyes. In relation to the distribution of plantar pressure, we did not observe statistical significance and there was no correlation between age and the balance's variables and the plantar pressure's distribution. Therefore, we concluded that the vision is an important factor on postural control in children with cerebral palsy.

Comprehensive visual impairment evaluation for cerebral palsy children

Directory of Open Access Journals (Sweden)

Ping Wang

2015-01-01

Full Text Available AIM: To evaluate the visual impairment in cerebral palsy children with series objective indicators, and conclude their clinical features of visual function.METHODS: Objective tests including following pursuing test, optokinetic nystagmus(OKNdrum test, refractive error examination, fundus examination, ocular deviation examination, pattern visual evoked potential(P-VEPtests and brain magnetic resonance imaging(MRIwere carried out in 43 cerebral palsy children(86 eyeswith ocular visual dysfunction; The visual impairment data of the cerebral palsy children were collected, and the clinical features and possible mechanism were analyzed.RESULTS: 1. Of the 43 cerebral palsy children(86 eyeswith the visual impairment presented diversified, 25(50 eyes, 58.1%of refractive error, 24(48 eyes, 55.8%of strabismus, 12(24 eyes, 27.9%with nystagmus, 19(38 eyes, 44.2%of optical nerve atrophy or hyperplasia, 35(70 eyes, 81.4%of VEP abnormality. Among children with spastic cerebral palsy, the incidence of visual impairment was statistically significant difference compared with other groups(PP>0.05, no nystagmus in patients with severe occipital cortex damage.CONCLUSION: Cerebral palsy children were usually with visual impairment, and presented with special clinical features; Comprehensive objective visual tests are accurate and reliable for evaluation of the visual function in cerebral palsy children.

Pharmacological management of spasticity in multiple sclerosis

DEFF Research Database (Denmark)

Otero-Romero, Susana; Sastre-Garriga, Jaume; Comi, Giancarlo

2016-01-01

Background and objectives: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients. Methods...... improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity...... and suboptimal response to oral drugs. Conclusion: The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence...

Contralateral flow reduction in unilateral stroke: evidence for transhemispheric diaschisis

International Nuclear Information System (INIS)

Lagreze, H.L.; Levine, R.L.; Pedula, K.L.; Nickles, R.J.; Sunderland, J.S.; Rowe, B.R.

1987-01-01

Using clinical presentation, angiography, computed tomography, and nuclear magnetic resonance imaging, 7 patients were identified who had strictly unilateral hemispheric infarction and unilateral cerebrovascular disease. In 6, cerebral blood flow measured by fluorine-18-fluoromethane inhalation and positron emission tomography was reduced in the contralateral hemisphere (p less than 0.05). Multiple regression analysis demonstrated a high correlation between contralateral flow reduction and the degree of flow impairment in the infarcted area (r = 0.941, p = 0.0014) but not with age, risk factor profile, blood pressure, PCO 2 , hematocrit, or duration of stroke. We conclude that transhemispheric diaschisis best explains the contralateral flow reduction seen in supratentorial ischemic stroke

The effect and complication of botulinum toxin type a injection with serial casting for the treatment of spastic equinus foot.

Science.gov (United States)

Lee, Sook Joung; Sung, In Young; Jang, Dae Hyun; Yi, Jin Hwa; Lee, Jin Ho; Ryu, Ju Seok

2011-06-01

To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS). The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (pcasting. Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.

Neonatal cerebral infarction; Symptoms, CT findings and prognosis

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Fujimoto, Shinji; Togari, Hajime; Sobajima, Hisanori; Suzuki, Shigesumi; Wada, Yoshiro (Nagoya City Univ. (Japan). Faculty of Medicine); Yokochi, Kenji; Nishimura, Yutaka; Inukai, Kazuhisa; Futamura, Masahide

1992-01-01

In a retrospective multi-center study, we investigated eighteen infants with unilateral cerebral infarctions confirmed by computed tomography (CT) scans. The initial symptoms were observed in all the patients between 0 and 3 days of age. Convulsions or apneic attacks were the initial symptoms in all but one. Only 4 patients had complicated obstetric histories and none showed polycythemia or electrolyte abnormalities. All of the initial CT scans revealed unilaterally localized hypodense areas. In 10, the initial CT scans were performed within 24 hours after the clinical onset. In 16, the lesions were within the territory of the middle cerebral artery, 9 of which also involved the cortico-spinal tract (CST). In the remaining 2 patients, the lesions were located whithin the territory of the posterior cerebral artery. None of the 9 patients without CST involvement developed hemiplegia, whereas 5 (56%) of the 9 with CST involvement had hemiplegia, which is a fairly low incidence compared with that in adult cases. This difference was thought to be related to neonatal brain plasticity. (author).

Transient acute renal failure and functional hemispheric depression after cerebral arteriography in diabetic patients

DEFF Research Database (Denmark)

Olsen, Tom Skyhøj; Lund, P; Praestholm, J

1981-01-01

Cerebral angiography was carried out in two diabetic patients in the evaluation of minor vascular ischemic episodes. A transient acute renal failure following cerebral angiography was accompanied by a transient comatose episode with severe unilateral neurological deficits. A functional depression...

Comparison of Efficacy and Side Effects of Oral Baclofen Versus Tizanidine Therapy with Adjuvant Botulinum Toxin Type A in Children With Cerebral Palsy and Spastic Equinus Foot Deformity.

Science.gov (United States)

Dai, Alper I; Aksoy, Sefika N; Demiryürek, Abdullah T

2016-02-01

This retrospective study aimed to compare the therapeutic response, including side effects, for oral baclofen versus oral tizanidine therapy with adjuvant botulinum toxin type A in a group of 64 pediatric patients diagnosed with static encephalopathy and spastic equinus foot deformity. Following botulinum toxin A treatment, clinical improvement led to the gradual reduction of baclofen or tizanidine dosing to one-third of the former dose. Gross Motor Functional Measure and Caregiver Health Questionnaire scores were markedly elevated post-botulinum toxin A treatment, with scores for the tizanidine (Gross Motor Functional Measure: 74.45 ± 3.72; Caregiver Health Questionnaire: 72.43 ± 4.29) group significantly higher than for the baclofen group (Gross Motor Functional Measure: 68.23 ± 2.66; Caregiver Health Questionnaire: 67.53 ± 2.67, P botulinum toxin A and a low dose of tizanidine in treating children with cerebral palsy appears to be more effective and has fewer side effects versus baclofen with adjuvant botulinum toxin A. © The Author(s) 2015.

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

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Yvette L Kerkum

Full Text Available Rigid Ankle-Foot Orthoses (AFOs are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP. While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years were prescribed with a ventral shell spring-hinged AFO (vAFO. The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05 was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power

Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking

DEFF Research Database (Denmark)

Streja, Elani; Miller, Jessica; Bech, Bodil H

2013-01-01

OBJECTIVE: The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP). STUDY DESIGN: We included the 81,066 mothers of singletons born between 1996...... and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: Self-reported vaginal...

Cerebral glucose metabolism in Parkinson's disease

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Martin, W R.W.; Beckman, J H; Calne, D B; Adam, M J; Harrop, R; Rogers, J G; Ruth, T J; Sayre, C I; Pate, B D [British Columbia Univ., Vancouver (Canada). TRIUMF Facility

1984-02-01

Local cerebral glucose utilization was measured in patients with predominantly unilateral Parkinson's disease using sup(18)F-2-fluoro-deoxyglucose and positron emission tomography. Preliminary results indicate the presence of asymmetric metabolic rates in the inferior basal ganglia. The structure comprising the largest portion of basal ganglia at this level is globus pallidus. These findings are consistent with metabolic studies on animals with unilateral nigrostriatal lesions in which pallidal hypermetabolism on the lesioned side has been demonstrated. Increased pallidal activity is likely secondary to a loss of inhibitory dopaminergic input to the striatum from substantia nigra.

Cerebral glucose metabolism in Parkinson's disease

International Nuclear Information System (INIS)

Martin, W.R.W.; Beckman, J.H.; Calne, D.B.; Adam, M.J.; Harrop, R.; Rogers, J.G.; Ruth, T.J.; Sayre, C.I.; Pate, B.D.

1984-01-01

Local cerebral glucose utilization was measured in patients with predominantly unilateral Parkinson's disease using sup(18)F-2-fluoro-deoxyglucose and positron emission tomography. Preliminary results indicate the presence of asymmetric metabolic rates in the inferior basal ganglia. The structure comprising the largest portion of basal ganglia at this level is globus pallidus. These findings are consistent with metabolic studies on animals with unilateral nigrostriatal lesions in which pallidal hypermetabolism on the lesioned side has been demonstrated. Increased pallidal activity is likely secondary to a loss of inhibitory dopaminergic input to the striatum from substantia nigra

[Oral motor dysfunction, feeding problems and nutritional status in children with cerebral palsy].

Science.gov (United States)

Hou, Mei; Fu, Ping; Zhao, Jian-hui; Lan, Kun; Zhang, Hong

2004-10-01

This study was undertaken to investigate the clinical features of oral motor dysfunction and feeding problems as well as the nutritional status of children with cerebral palsy (CP). Fifty-nine CP children, 39 boys and 20 girls, mean age 31 months (20 to 72 months), were recruited. Their parents were interviewed for high risk factors and feeding history. Each case was assessed for oral motor and feeding problems based on oral motor and feeding skill score; for nutritional status by measurement of weight, height; neurologically for type of cerebral palsy and for developmental age by Gesell's developmental scale. Equal number of age and sex matched controls were included for comparison of nutritional status, oral motor and feeding skill score. Among 59 patients, 51 cases had oral motor dysfunction and 55 cases had feeding problems including all athtosis, spastic tetraplegia, and 16 had spastic diplegia. The scores of both the mean oral motor function and feeding skill of CP children were significantly lower than those of the controls (P children with cerebral palsy consisted of liquid and semisolid diet. Body weight and height below the 25th percentile were found in 13 cases and 19 cases, respectively. The majority of the children with cerebral palsy had oral motor dysfunction and feeding problems which appeared in early age and disturbed the growth and nutritional status. Thorough assessment for oral motor function, feeding problems and nutritional status of CP children is indicated in order to start timely rehabilitation and nutritional interventions which can significantly improve their nutritional status and quality of life.

Evaluation of Hand Stereognosis Level in 3-6 years Old Children with Spastic Hemiplegia and Diplegia

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Minou Kalantari

2013-07-01

Full Text Available Objective: One of the most prevalent sensory problems in cerebral palsy is Astereognosis which has special importance in daily manual functions. The purpose of this study was to determine the level of hand stereognosis using common objects and geometric shapes in children with spastic hemiplegia and diplegia. Materials & Methods: In this cross sectional study, 20 children with cerebral palsy between 3-6 years old (9 males, 11 females with mean age (hemiplegya: 55months, diplegya: 57months were selected through nonrandomized convinience sampling referd to Occupational Therapy centers of Shahid Beheshti University of Medical Sciences. Stereognosis was evaluated using geometric shapes (square, circle, rectangular, triangle and common objects (pencil, key, coin, nail, teaspoon and screw and test special board. The data were analyzed by Mixed Analysis of Variance and Regression statistical tests. Results: There was no significant regression between common objects stereognosis score and age in hemiplegic childrenbut this regression was significant for stereognosis score of geometric shapes (P=0.027. There was no significant regression between stereognosis score of common objects and geometric shapes in diplegic children. The Main effects of gender was not significant in stereognosis of children with spastic hemiplegia and diplegia, also main effects of hand were not significant in two groups. Conclusion: There was no significant difference between stereognosis of affected and unaffected hand in hemiplegic childrenand between right and left hands in diplegic children. Also There was no significant regression between age and stereognosis score of geometric shapes in diplegic children .

The validity and reliability of modelled neural and tissue properties of the ankle muscles in children with cerebral palsy

NARCIS (Netherlands)

Sloot, L.H.; van der Krogt, M.M.; de Gooijer-van Groep, K.; van Eesbeek, S.; de Groot, J.; Buizer, A.I.; Meskers, C.; Becher, J.G.; de Vlugt, E.; Harlaar, J.

2015-01-01

Spastic cerebral palsy (CP) is characterized by increased joint resistance, caused by a mix of increased tissue stiffness, as well as involuntary reflex and background muscle activity. These properties can be quantified using a neuromechanical model of the musculoskeletal complex and instrumented

Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review

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Martin A

2014-01-01

Full Text Available Alison Martin,1 Seye Abogunrin,1 Hannah Kurth,2 Jerome Dinet2 1Evidera, London, UK; 2Ipsen, Boulogne Billancourt Cedex, France Background: The purpose of this study was to investigate the epidemiological, humanistic, and economic burden of illness associated with adult lower limb spasticity (LLS and its complications. Methods: A systematic search of MEDLINE and EMBASE identified 23 studies published between January 2002 and October 2012 that assessed the epidemiology, impact, and resource use associated with LLS. A hand-search of four neurology conferences identified abstracts published between 2010 and 2012. Results: LLS was found to occur in one third of adults after stroke, half to two thirds with multiple sclerosis, and three quarters with cerebral palsy. LLS limits mobility and reduces quality of life. No clear association was found between LLS and occurrence of pain, development of contractures, or risk of falls. Conclusion: The evidence on the burden of LLS and its complications is surprisingly limited given the condition's high prevalence among adults with common disorders, such as stroke. Further research is needed to clarify the impact of LLS, including the likelihood of thrombosis in spastic lower limbs. The dearth of high-quality evidence for LLS suggests a lack of awareness of, and interest in, the problem, and therefore, the unmet need among patients and their carers. Keywords: muscle spasticity, cost of illness, complications, quality of life

Full Body Gait Analysis May Improve Diagnostic Discrimination Between Hereditary Spastic Paraplegia and Spastic Diplegia: A Preliminary Study

Science.gov (United States)

Bonnefoy-Mazure, A.; Turcot, K.; Kaelin, A.; De Coulon, G.; Armand, S.

2013-01-01

Hereditary spastic paraplegia (HSP) and spastic diplegia (SD) patients share a strong clinical resemblance. Thus, HSP patients are frequently misdiagnosed with a mild form of SD. Clinical gait analysis (CGA) has been highlighted as a possible tool to support the differential diagnosis of HSP and SD. Previous analysis has focused on the lower-body…

Changes in Trunk and Head Stability in Children with Cerebral Palsy after Hippotherapy: A Pilot Study

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Shurtleff, Tim L.; Engsberg, Jack R.

2010-01-01

Hippotherapy (HPOT) is a therapy that uses horse movement. This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a…

NEUROORTHOPEDICAL APPROACH TO THE CORRECTION OF EQUINES CONTRACTURE IN PATIENTS WITH SPASTIC PARALYSIS

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Valery Vladimirovich Umnov

2014-03-01

Full Text Available The frequency of recurrent contractures of the joints of the lower limb after their correction by means of tendon-muscle plasty remains significant. Therefore, the search for effective ways to correct contractures with the most resistant long-term result is relevant. The objective of the study is to improve treatment outcomes of equinus contracture in children with spastic paralysis. Materials and methods. We analyzed the results of correction of contractures in joints of lower limbs in 40 patients with cerebral palsy and the influence of spasticity of patognomonic muscles on them. The mean age was 6 years 7 months. In addition, for the correction of hypertonus of triceps muscle of tibia, the 330 lower limb segments were performed selective neurotomy of appropriate motor branches of the general tibial nerve. This operation in 304 cases was combined with achilloplastics or Strayer operation. Results. A mean degree of correlation between the degree of contracture in the ankle and increased tone of triceps tibia was determined (r value ranged from 0.451 to 0.487. Short-term results of the combined neuroorthopedic method for correction of contractures were good in estimating within 1 year post surgery, but a study of its short-run effect requires long-term follow-up.

Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event.

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Lundström, Erik; Smits, Anja; Borg, Jörgen; Terént, Andreas

2010-02-01

The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no health economic studies on costs associated with spasticity after stroke. The objective of our study was to estimate direct costs of stroke with spasticity for patients surviving up to 1 year after the stroke event in comparison to costs of stroke without spasticity. A representative sample of patients with first-ever stroke hospitalized at Uppsala University Hospital was eligible for our cross-sectional survey. All direct costs during 1 year were identified for each patient, including costs for hospitalization (acute and rehabilitation), primary health care, medication, and costs for municipality services. Swedish currency was converted to Purchasing Power Parities US dollar (PPP$). Median age (interquartile range) was 73 years (18), and the proportion of women was 48%. The majority of the direct costs (78%) was associated with hospitalization, whereas 20% was associated with municipality services during 1 year after a first-ever stroke. Only 1% of all direct costs were related to primary health care and 1% to medication. The level of costs for patients with stroke was correlated with the presence of spasticity as measured with the modified Ashworth scale (r(s)=0.524) and with the degree of disability as measured with modified Rankin Scale (r(s)=0.624). The mean (median, interquartile range) direct cost for stroke patients with spasticity was PPP$ 84,195 (72,116, 53,707) compared with PPP$ 21,842 (12,385, 17,484) for patients with stroke without spasticity (Pstroke survivors are 4 times higher than direct costs for patients with stroke without spasticity during the first year after the event.

How multi segmental patterns deviate in spastic diplegia from typical developed.

Science.gov (United States)

Zago, Matteo; Sforza, Chiarella; Bona, Alessia; Cimolin, Veronica; Costici, Pier Francesco; Condoluci, Claudia; Galli, Manuela

2017-10-01

The relationship between gait features and coordination in children with Cerebral Palsy is not sufficiently analyzed yet. Principal Component Analysis can help in understanding motion patterns decomposing movement into its fundamental components (Principal Movements). This study aims at quantitatively characterizing the functional connections between multi-joint gait patterns in Cerebral Palsy. 65 children with spastic diplegia aged 10.6 (SD 3.7) years participated in standardized gait analysis trials; 31 typically developing adolescents aged 13.6 (4.4) years were also tested. To determine if posture affects gait patterns, patients were split into Crouch and knee Hyperextension group according to knee flexion angle at standing. 3D coordinates of hips, knees, ankles, metatarsal joints, pelvis and shoulders were submitted to Principal Component Analysis. Four Principal Movements accounted for 99% of global variance; components 1-3 explained major sagittal patterns, components 4-5 referred to movements on frontal plane and component 6 to additional movement refinements. Dimensionality was higher in patients than in controls (p<0.01), and the Crouch group significantly differed from controls in the application of components 1 and 4-6 (p<0.05), while the knee Hyperextension group in components 1-2 and 5 (p<0.05). Compensatory strategies of children with Cerebral Palsy (interactions between main and secondary movement patterns), were objectively determined. Principal Movements can reduce the effort in interpreting gait reports, providing an immediate and quantitative picture of the connections between movement components. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cellular Pathways of Hereditary Spastic Paraplegia*

OpenAIRE

Blackstone, Craig

2012-01-01

Human voluntary movement is controlled by the pyramidal motor system, a long CNS pathway comprising corticospinal and lower motor neurons. Hereditary spastic paraplegias (HSPs) are a large, genetically diverse group of inherited neurologic disorders characterized by a length-dependent distal axonopathy of the corticospinal tracts, resulting in lower limb spasticity and weakness. A range of studies are converging on alterations in the shaping of organelles, particularly the endoplasmic reticul...

Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy

OpenAIRE

Shin, Ji-won; Song, Gui-bin; Hwangbo, Gak

2015-01-01

[Purpose] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy. [Subjects] Sixteen children (9 males, 7 females) with spastic diplegic cerebral palsy were recruited and randomly assigned to the conventional neurological physical therapy group (CG) and virtual reality training group (VRG). [Methods] Eight children in the control group performed 45 minutes of th...

Balneotherapy in treatment of spastic upper limb after stroke.

Science.gov (United States)

Erceg-Rukavina, Tatjana; Stefanovski, Mihajlo

2015-02-01

After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke. A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. ischaemic stroke, developed spasticity of upper limb, post-stroke interval balneotherapy and inability to follow commands. Experimental group (Ex) (n=35) was treated with sulphurous baths (31°-33°C) and controlled group (Co) with taped water baths, during 21 days. All patients were additionally treated with kinesitherapy and cryotherapy. The outcome was evaluated using Modified Ashworth scale for spasticity and VAS scale for pain. The significance value was sat at pbalneotherapy with sulphurous bath on spasticity and pain in affected upper limb. Reduction in tone of affected upper limb muscles was significant in Ex group (pbalneotherapy with sulphurous water reduces spasticity and pain significantly and can help in treatment of post-stroke patients.

Unilateral Eye Blinking Arising From the Ictal Ipsilateral Occipital Area.

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Falsaperla, Raffaele; Perciavalle, Valentina; Pavone, Piero; Praticò, Andrea Domenico; Elia, Maurizio; Ruggieri, Martino; Caraballo, Roberto; Striano, Pasquale

2016-07-01

We report on an 18-month-old boy with unilateral left eye blinking as a single ictal manifestation without facial twitching. The clinical onset of this phenomenon was first recorded (as an occasional event) at age 3 months, and it was overlooked. By age 6 months, the child's blinking increased to almost daily occurrence in clusters: during blinking the infant showed intact awareness and occasional jerks in the upper limbs and right leg. A video-electroencephalography (video-EEG) documented clinical correlation with a focal pattern arising from the left occipital region, and brain magnetic resonance imaging (MRI) revealed severe brain damage, consisting in poroencephalic hollows and increased spaces in the convexities involving a large area of the left cerebral hemisphere. The boy was prescribed sodium valproate (30 mg/kg/d), resulting in drastic reduction of his clinical seizures. Follow-up to his current age documented good general status, with persistent partial right hemilateral seizures. The blinking progressively disappeared, and is no longer recorded. The pathogenic hypotheses of the unilateral ictal blinking include involvement of the ipsilateral cerebral hemisphere and/or the cerebellar pathways. Review of previous reports of unilateral eye blinking, arising from the ictal ipsilateral brain, revealed that different damaged regions may give rise to blinking ictal phenomena, likely via the trigeminal fibres innervating the subdural intracranial structures and the pial vessels in the ipsilateral affected brain. The eye blinking in the present child represents a further example of an ictal phenomenon, which is predictive of the damaged brain region. © EEG and Clinical Neuroscience Society (ECNS) 2014.

Non-Invasive Brain Stimulation in Children With Unilateral Cerebral Palsy: A Protocol and Risk Mitigation Guide

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Bernadette T. Gillick

2018-03-01

Full Text Available Non-invasive brain stimulation has been increasingly investigated, mainly in adults, with the aims of influencing motor recovery after stroke. However, a consensus on safety and optimal study design has not been established in pediatrics. The low incidence of reported major adverse events in adults with and without clinical conditions has expedited the exploration of NIBS in children with paralleled purposes to influence motor skill development after neurological injury. Considering developmental variability in children, with or without a neurologic diagnosis, adult dosing and protocols may not be appropriate. The purpose of this paper is to present recommendations and tools for the prevention and mitigation of adverse events (AEs during NIBS in children with unilateral cerebral palsy (UCP. Our recommendations provide a framework for pediatric NIBS study design. The key components of this report on NIBS AEs are (a a summary of related literature to provide the background evidence and (b tools for anticipating and managing AEs from four international pediatric laboratories. These recommendations provide a preliminary guide for the assessment of safety and risk mitigation of NIBS in children with UCP. Consistent reporting of safety, feasibility, and tolerability will refine NIBS practice guidelines contributing to future clinical translations of NIBS.

Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy

NARCIS (Netherlands)

Dallmeijer, A.J.; Baker, R.; Dodd, K.; Taylor, N.

2011-01-01

The purpose of this study was to determine the association between isometric muscle strength of the lower limbs and gait joint kinetics in adolescents and young adults with cerebral palsy (CP). Twenty-five participants (11 males) with bilateral spastic CP, aged 14-22 years (mean: 18.9, sd: 2.0. yr)

A Descriptive Study of Lower Limb Torsional Kinematic Profiles in Children With Spastic Diplegia.

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Simon, Anne-Laure; Ilharreborde, Brice; Megrot, Fabrice; Mallet, Cindy; Azarpira, Reza; Mazda, Keyvan; Presedo, Ana; Penneçot, Georges F

2015-09-01

Lower limb rotational anomalies in spastic diplegic children with cerebral palsy (CP) are common and difficult to identify through physical examination alone. The identification and treatment of the overall rotational disorders must be considered to restore physiological lever-arms lengths and lever-arms orientation.The aims of the study were to assess the prevalence of lower limb rotational malalignment and to describe the distribution of the different kinematic torsional profiles in children with spastic diplegia. Instrumented gait analysis data from 188 children with spastic diplegia were retrospectively reviewed. None of the patients had undergone surgery previously or received botulinum toxin treatment within 6 months before the review. Kinematic data, collected at the midstance phase, included: pelvic, hip, and ankle rotation and foot progression angle. The prevalence of kinematic rotational deviations was 98.4%. Sixty-one percent of the children walked with an internal foot progression angle and 21% exhibited external alignment. The pelvis was internally rotated in 41% of the cases and externally in another 27%. Hip rotation was internal in 29% and external in 27% of the cases. Ankle rotation was internal in 55% and external in 16% of the cases. Lower limb rotational anomalies involved more than one level in 77% of the limbs. A kinematic compensatory deviation was identified in at least one level in 48% of the limbs. Kinematic rotational anomalies were identified in nearly all the 188 children in the study. The multilevel involvement of lower limb malalignment was not systematically associated with compensatory mechanisms between the levels. Ankle rotational anomalies were the most frequent cause of lower limb torsional deviations followed by pelvic malalignment. Level IV.

Effectiveness of functional progressive resistance exercise training on walking ability in children with cerebral palsy: A randomized controlled trial

NARCIS (Netherlands)

Scholtes, V.A.; Becher, J.G.; Janssen-Potten, Y.J.; Dekkers, H.; Smallenbroek, L.; Dallmeijer, A.J.

2012-01-01

The objective of the study was to evaluate the effectiveness of functional progressive resistance exercise (PRE) training on walking ability in children with cerebral palsy (CP).Fifty-one ambulant children with spastic CP (mean age 10 years 5 months, 29 boys) were randomized to an intervention (n=

Somatosensory discrimination deficits following pediatric cerebral malaria.

Science.gov (United States)

Dugbartey, A T; Spellacy, F J; Dugbartey, M T

1998-09-01

Pathologic studies of central nervous system damage in human falciparum malaria indicate primary localization in the cerebral white matter. We report a sensory-perceptual investigation of 20 Ghanaian children with a recent history of cerebral malaria who were age-, gender-, and education-matched with 20 healthy control subjects. Somatosensory examinations failed to show any evidence of hemianesthesia, pseudohemianesthesia, or extinction to double simultaneous tactile stimulation. While unilateral upper limb testing revealed intact unimanual tactile roughness discrimination, bimanual tactile discrimination, however, was significantly impaired in the cerebral malaria group. A strong negative correlation (r = -0.72) between coma duration and the bimanual tactile roughness discrimination test was also found. An inefficiency in the integrity of callosal fibers appear to account for our findings, although alternative subcortical mechanisms known to be involved in information transfer across the cerebral hemispheres may be compromised as well.

Procedure-Oriented Torsional Anatomy of the Hand for Spasticity Injection.

Science.gov (United States)

John, Joslyn; Cianca, John; Chiou-Tan, Faye; Pandit, Sindhu; Furr-Stimming, Erin; Taber, Katherine H

To provide musculoskeletal ultrasound (MSKUS) images of hand anatomy in the position of hemiparetic flexion as a reference for spasticity injections. After a stroke, spasticity can result in anatomic distortion of the hand. Spasticity may require treatment with botulinum toxin or phenol injections. Anatomic distortion may decrease the accuracy of injections. Standard anatomic references are of limited utility because they are not in this spastic hemiparetic position. There presently is no anatomic reference in the literature for these spastic postures. This study is part three of a series examining torsional anatomy of the body. Ultrasound (US) images were obtained in a healthy subject. The muscles examined included the lumbricals and the flexor pollicis brevis. A marker dot was placed at each dorsal and palmar anatomic injection site for these muscles. The US probe was placed on these dots to obtain a cross-sectional view. A pair of US images was recorded with and without power Doppler imaging: the first in anatomic neutral and second in hemiparetic spastic positions. In addition, a video recording of the movement of the muscles during this rotation was made at each site. On the palmar view, the lumbricals rotated medially. On dorsal view, the lumbricals can be seen deep to the dorsal interossei muscles, with spastic position, and they become difficult to identify. The flexor pollicis brevis (FPB) muscle contracts with torsion, making abductor pollicis brevis (APB) predominately in view. The anatomic location of the lumbrical muscles makes them difficult to inject even with ultrasound guidance. However, recognizing the nearby digital vasculature allows for improved identification of the musculature for injection purposes. The FPB muscle also can be identified by its adjacent radial artery lateral to the flexor pollicus longus tendon. Normal anatomy of hand can become distorted in spastic hemiparesis. Diagnostic ultrasound is able to discern these anatomic

Feasibility and reliability of measuring strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy

NARCIS (Netherlands)

De Groot, Sonja; Janssen, Thomas W. J.; Evers, Marijn; Van der Luijt, Pieter; Nienhuys, Kirsten N. G.; Dallmeijer, Annet J.

Aim The aim of this study was to analyse the feasibility and reliability of the tests used to determine muscle strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy (CP). Methods Twenty individuals with spastic CP (four females, 16 males; age range 1849y;

Splint: The efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

NARCIS (Netherlands)

Maas, J.C.; Dallmeijer, A.J.; Huijing, P.A.; Brunstrom-Hernandez, J.E; van Kampen, P.J.; Jaspers, R.T.; Becher, J.G.

2012-01-01

Background: Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP). Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range

Repetitive Transcranial Magnetic Stimulation in Patients with Hereditary Spastic Paraplegia

Directory of Open Access Journals (Sweden)

Mehmet Ağırman

2011-06-01

Full Text Available Hereditary spastic paraplegia (HSPP is a heterogeneous genetic disease characterized by progressive spasticity of lower extremities. Spasticity is a major cause of long-term disability in HSPP and significantly affects the functional life of patients. Repetitive transcranial magnetic stimulation (rTMS is widely used in diagnosis and treatment of many neurological and psychiatric diseases. Although the positive impacts of rTMS for spasticity have been reported, no study has been found on HSPP. We present two HSPP patients treated with low frequency rTMS (20 minutes at a frequency of 1 Hz (1200 pulses, for a period of 10 treatment sessions.

Repetitive Transcranial Magnetic Stimulation in Patients with Hereditary Spastic Paraplegia

Directory of Open Access Journals (Sweden)

Mehmet Ağırman

2011-06-01

Full Text Available Hereditary spastic paraplegia (HSPP is a heterogeneous genetic disease characterized by progressive spasticity of lower extremities. Spasticity is a major cause of long-term disability in HSPP and significantly affects the functional life of patients. Repetitive transcranial magnetic stimulation (rTMS is widely used in diagnosis and treatment of many neurological and psychiatric diseases. Although the positive impacts of rTMS for spasticity have been reported, no study has been found on HSPP. We present two HSPP patients treated with low frequency rTMS (20 minutes at a frequency of 1 Hz (1200 pulses, for a period of 10 treatment sessions

Gait Stability in Children with Cerebral Palsy

Science.gov (United States)

Bruijn, Sjoerd M.; Millard, Matthew; van Gestel, Leen; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat

2013-01-01

Children with unilateral Cerebral Palsy (CP) have several gait impairments, amongst which impaired gait stability may be one. We tested whether a newly developed stability measure (the foot placement estimator, FPE) which does not require long data series, can be used to asses gait stability in typically developing (TD) children as well as…

Hereditary spastic paraplegia.

Science.gov (United States)

Blackstone, Craig

2018-01-01

The hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurologic disorders with the common feature of prominent lower-extremity spasticity, resulting from a length-dependent axonopathy of corticospinal upper motor neurons. The HSPs exist not only in "pure" forms but also in "complex" forms that are associated with additional neurologic and extraneurologic features. The HSPs are among the most genetically diverse neurologic disorders, with well over 70 distinct genetic loci, for which about 60 mutated genes have already been identified. Numerous studies elucidating the molecular pathogenesis underlying HSPs have highlighted the importance of basic cellular functions - especially membrane trafficking, mitochondrial function, organelle shaping and biogenesis, axon transport, and lipid/cholesterol metabolism - in axon development and maintenance. An encouragingly small number of converging cellular pathogenic themes have been identified for the most common HSPs, and some of these pathways present compelling targets for future therapies. Copyright © 2018 Elsevier B.V. All rights reserved.

Creative Dance Practice Improves Postural Control in a Child With Cerebral Palsy.

Science.gov (United States)

Stribling, Kate; Christy, Jennifer

2017-10-01

To investigate the effect of creative dance instruction on postural control and balance in an 11-year-old with spastic triplegic cerebral palsy, Gross Motor Function Classification Scale level II. We conducted 1-hour dance interventions twice weekly for 8 weeks, with a focus on somatosensory awareness and movement in all planes of motion. Computerized dynamic posturography using the SMART Balance Master/EquiTest (NeuroCom) was used to assess postural control and balance reactions before the first class and following the final class. Gains in standing stability, balance recovery, directional control, and endpoint excursion of movement were found. Participation in creative dance lessons appears to improve somatosensory effectiveness and postural control in a child with cerebral palsy. Dance is a fun way to improve balance and coordination. These interventions could be easily implemented into programs for children with cerebral palsy.

Brain magnetic resonance imaging and motor and intellectual functioning in 86 patients born at term with spastic diplegia.

Science.gov (United States)

Numata, Yurika; Onuma, Akira; Kobayashi, Yasuko; Sato-Shirai, Ikuko; Tanaka, Soichiro; Kobayashi, Satoru; Wakusawa, Keisuke; Inui, Takehiko; Kure, Shigeo; Haginoya, Kazuhiro

2013-02-01

To investigate the association between magnetic resonance imaging (MRI) patterns and motor function, epileptic episodes, and IQ or developmental quotient in patients born at term with spastic diplegia. Eighty-six patients born at term with cerebral palsy (CP) and spastic diplegia (54 males, 32 females; median age 20 y, range 7-42 y) among 829 patients with CP underwent brain MRI between 1990 and 2008. The MRI and clinical findings were analysed retrospectively. Intellectual disability was classified according to the Enjoji developmental test or the Wechsler Intelligence Scale for Children (3rd edition). The median ages at diagnosis of CP, assignment of Gross Motor Function Classification System (GMFCS) level, cognitive assessment, and MRI were 2 years (range 5 mo-8 y), 6 years (2 y 8 mo-19 y), 6 years (1 y 4 mo-19 y), and 7 years (10 mo-30 y) respectively. MRI included normal findings (41.9%), periventricular leukomalacia, hypomyelination, and porencephaly/periventricular venous infarction. The frequency of patients in GMFCS levels III to V and intellectual disability did not differ between those with normal and abnormal MRI findings. Patients with normal MRI findings had significantly fewer epileptic episodes than those with abnormal ones (p=0.001). Varied MRI findings, as well as the presence of severe motor dysfunction and intellectual disability (despite normal MRI), suggest that patients born at term with spastic diplegia had heterogeneous and unidentified pathophysiology. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI)

NARCIS (Netherlands)

Salavati, M.; Rameckers, E.A.A.; Steenbergen, B.; Schans, C.P. van der

2014-01-01

Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method: Data

Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI)

NARCIS (Netherlands)

Salavati, Masoud; Rameckers, E.A.A.; Steenbergen, B.; van der Schans, Cees

2014-01-01

Abstract Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method:

Feasibility and reliability of measuring strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy

NARCIS (Netherlands)

de Groot, S.; Janssen, T.W.J.; Evers, M.; Van der Luijt, P.; Nienhuys, K.N.G.; Dallmeijer, A.J.

2012-01-01

Aim The aim of this study was to analyse the feasibility and reliability of the tests used to determine muscle strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy (CP). Methods Twenty individuals with spastic CP (four females, 16 males; age range 18-49y;

Management of spastic hand by selective peripheral neurotomies ...

African Journals Online (AJOL)

Introduction: Selective peripheral neurotomies (SPN) are proposed when spasticity is focalized on muscles that are under the control of a single or few peripheral nerves. Objective: This study was done to evaluate the functional results of SPN of median and ulnar nerves in 10 patients who had spastic hyperflexion of the ...

Computed tomographic findings in cerebral palsy: Analysis of hemisphere and lateral ventricular volume

International Nuclear Information System (INIS)

Cho, Seoung Hwan; Kim, Hak Jin; Sol, Chang Hyo; Kim, Byung Soo

1989-01-01

Authors analysed the CT findings of 28 cerebral palsy patients at Pusan National University Hospital from January, 1984 to December, 1987. Volumes of hemispheres, lateral ventricles and paranchymes were measured in patients who showed no remarkable abnormality on CT film, and compared with those of normal control group. 1. Among the 28 cerebral palsy patients, there were 6 cases of diffuse atrophy in CT findings, and unilateral atrophy in 2 cases and encephalomalacia and diffuse white matter low density in 1 case and generalized symmetrical white matter low density in 1 case, but remaining 18 cases had no specific abnormal finding on CT. 2. Difference in volumes of brain parenchyma and lateral ventricles of each hemisphere was greater than that of control group. 3. There were more enlarged lateral ventricles and prominent unilateral brain atrophy in 18 cases of cerebral palsy who showed no specific abnormality on CT as compared with normal control group

Impact of Spasticity on Balance Control during Quiet Standing in Persons after Stroke

Directory of Open Access Journals (Sweden)

Reza Rahimzadeh Khiabani

2017-01-01

Full Text Available Background. Balance impairments, falls, and spasticity are common after stroke, but the effect of spasticity on balance control after stroke is not well understood. Methods. In this cross-sectional study, twenty-seven participants with stroke were divided into two groups, based on ankle plantar flexor spasticity level. Fifteen individuals with high spasticity (Modified Ashworth Scale (MAS score of ≥2 and 12 individuals with low spasticity (MAS score <2 completed quiet standing trials with eyes open and closed conditions. Balance control measures included centre of pressure (COP root mean square (RMS, COP velocity, and COP mean power frequency (MPF in anterior-posterior and mediolateral (ML directions. Trunk sway was estimated using a wearable inertial measurement unit to measure trunk angle, trunk velocity, and trunk velocity frequency amplitude in pitch and roll directions. Results. The high spasticity group demonstrated greater ML COP velocity, trunk roll velocity, trunk roll velocity frequency amplitude at 3.7 Hz, and trunk roll velocity frequency amplitude at 4.9 Hz, particularly in the eyes closed condition (spasticity by vision interaction. ML COP MPF was greater in the high spasticity group. Conclusion. Individuals with high spasticity after stroke demonstrated greater impairment of balance control in the frontal plane, which was exacerbated when vision was removed.

Cranial MRI findings in pediatric patients with bilateral spastic paralysis. Comparison with neonatal cranial echography and correlation with neurological sequelae

International Nuclear Information System (INIS)

Yamashita, Yushiro; Horikawa, Mizuho; Matsuishi, Toyojiro; Utsunomiya, Hidetsuna; Okudera, Toshio; Fukuda, Seiichi; Hashimoto, Takeo; Nakamura, Yasuhiro.

1994-01-01

Fourteen patients with bilateral spastic paralysis (an average age of 2 years and 5 months) were examined using magnetic resonance imaging (MRI). Common MRI findings were an enlarged cerebral ventricle, irregular wall, abnormal signal area in the vicinity of the cerebral ventricle, decrease in the content of white matter, and thickening of the callosum. These findings seemed to reflect pathological lesions in periventricular leukomalacia (PVL). Of 3 patients who had been diagnosed as having cystic PVL on neonatal ultrasonography, 2 had cystic lesions in the corresponding areas on MRI. In the other patient with cystic PVL, membrane-like wall between the cyst and the enlarged cerebral ventricle was different from that seen definitely in porencephalie on spin density images. In patients in whom PVL was missed on neonatal ultrasonography, MRI demonstrated PVL. There was correlation between MRI findings and neurological sequelae: the severity of exercise function tended to correlate with the degree of decreased white matter; however, there was no correlation between spread of abnormal signal areas and the severity of exercise function. (N.K.)

Cranial MRI findings in pediatric patients with bilateral spastic paralysis. Comparison with neonatal cranial echography and correlation with neurological sequelae

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Yamashita, Yushiro; Horikawa, Mizuho; Matsuishi, Toyojiro (Kurume Univ., Fukuoka (Japan). School of Medicine); Utsunomiya, Hidetsuna; Okudera, Toshio; Fukuda, Seiichi; Hashimoto, Takeo; Nakamura, Yasuhiro

1994-08-01

Fourteen patients with bilateral spastic paralysis (an average age of 2 years and 5 months) were examined using magnetic resonance imaging (MRI). Common MRI findings were an enlarged cerebral ventricle, irregular wall, abnormal signal area in the vicinity of the cerebral ventricle, decrease in the content of white matter, and thickening of the callosum. These findings seemed to reflect pathological lesions in periventricular leukomalacia (PVL). Of 3 patients who had been diagnosed as having cystic PVL on neonatal ultrasonography, 2 had cystic lesions in the corresponding areas on MRI. In the other patient with cystic PVL, membrane-like wall between the cyst and the enlarged cerebral ventricle was different from that seen definitely in porencephalie on spin density images. In patients in whom PVL was missed on neonatal ultrasonography, MRI demonstrated PVL. There was correlation between MRI findings and neurological sequelae: the severity of exercise function tended to correlate with the degree of decreased white matter; however, there was no correlation between spread of abnormal signal areas and the severity of exercise function. (N.K.).

Correlation of cerebrovascular reserve as measured by acetazolamide-challenged perfusion CT with collateral circulation in unilateral high grade carotid stenosis

International Nuclear Information System (INIS)

Hong, Doran; Lee, Young Hen; Seo, Hyung Suk; Je, Bo Kyoung; Suh, Sang Il; Seol, Hae Young; Kim, Jung Hyuk; Lee, Nam Joon; Yang, Kyung Sook

2014-01-01

We correlated cerebrovascular reserve in unilateral high grade carotid artery stenosis or occlusion with a type of collateral circulation using acetazolamide-challenged perfusion CT (ACZ-PCT). Among the patients who underwent ACZ-PCT in our institution, we retrospectively selected the patients with unilateral high grade internal carotid artery or middle cerebral artery stenosis (> 70%) or occlusion; we verified the types of their dominant collateral circulation by digital subtraction angiography or 3T MR-angiography; first, the primary collaterals flow through the circle of Willis; second, the secondary collaterals that flow through the opthalmic artery, the basal artery or other external carotid artery. Using ACZ-PCT, we measured the difference in percentage change of cerebral blood flow of the stenotic hemisphere against contralateral normal hemisphere and compared cerebrovascular reserves of lesional hemisphere, according to the type of collaterals. A total of 28 patients were included. The percentage changes of cerebral blood flow were significantly lower in the stenotic hemisphere than the contralateral hemisphere (14.34 ± 36.43% and 34.53 ± 47.82%, p < 0.001), and in the hemisphere predominantly supplied by secondary collaterals than primary (7.03 ± 32.71% and 24.37 ± 42.03%, p < 0.05), respectively. Cerebrovascular reserves in the ipsilateral hemisphere predominantly supplied by secondary collaterals were more impaired than primary collaterals in patients with unilateral high grade carotid stenosis or occlusion.

The Effects of a Music and Movement Program on Gait, Balance and Psychological Parametres of Adults with Cerebral Palsy

Science.gov (United States)

Efraimidou, Vasiliki; Sidiropoulou, Maria; Giagazoglou, Paraskevi; Proios, Miltiadis; Tsimaras, Vasileios; Orologas, Anastasios

2016-01-01

The purpose of this investigation was to examine the effect of a music and movement intervention program on gait, balance and psychological parameters of 10 male athletes in throwing events (ball and disc) with Cerebral Palsy (CP) (spastic hemiplegia), all coming from a sport club in Thessaloniki. Participants were divided randomly by methodical…

MR imaging of spastic diplegia. The importance of corpus callosum

International Nuclear Information System (INIS)

Hayakawa, K.; Kanda, T.; Hashimoto, K.; Okuno, Y.; Yamori, Y.; Yuge, M.; Ando, R.; Ozaki, N.; Tamamoto, A.

1996-01-01

Purpose: The MR findings in patients with spastic diplegia were investigated and the role of MR imaging in assessing the extent of brain injury was evaluated. Material and Methods: 39 male and 24 female patients (preterm/term 43/20) were imaged using a 0.5 T MR system. Results: The MR findings in term patients were quite different from those in preterm patients; 55% of the term patients showed normal and minimal changes on MR, whereas 90.7% of the 43 preterm children had periventricular leucomalacia. The deep cerebral white matter was the most frequently involved site. Objective measurements revealed significant reductions of the entire sagittal area of corpus callosum in diplegic patients in comparison with normal controls. The motor plasy severity correlated well with the extent of corpus callosum involvement. Conclusion: The corpus callosum appears to be a sensitive marker site for the assessment of the extent of white matter injury. (orig.)

Mania associated with complicated hereditary spastic paraparesis

OpenAIRE

Raghavendra B Nayak; Govind S Bhogale; Nanasaheb M Patil; Aditya A Pandurangi

2011-01-01

Hereditary spastic paraparesis (HSP) is an inherited group of neurological disorders with progressive lower limb spasticity. HSP can be clinically grouped into pure and complicated forms. Pure HSP is one without any associated neurological/psychiatric comorbidity. Depression is the most common psychiatric comorbidity. Presence of mania or bipolar affective illness with HSP is a rare phenomenon. We report a case of a 17-year-old boy who presented with classical features of HSP with complaints ...

UNILATERAL ACTINOMYCOTIC TUBO-OVARIAN ABSCESS COMPLICATED WITH CEREBRITIS – A CASE REPORT

OpenAIRE

Marina Jakimovska; Borut Kobal

2018-01-01

Background: Tuboovarian abscess is a serious complication of pelvic inflammatory disease. Pelvic ac- tinomycosis may correlate with long term use of intra-uterine device (IUD), but is uncom- mon cause of inflammation, except in postmenopausal IUD users.1, 2 Tuboovarian abscess complicated with cerebritis is relatively uncommon condition. Methods: We present a rare case of a 56-years-old woman with IUD, developing tuboovarian abscess that complicated with cerebritis. Twenty days before adm...

The prevalence of depression in hereditary spastic paraplegia.

Science.gov (United States)

Vahter, L; Braschinsky, M; Haldre, S; Gross-Paju, K

2009-09-01

To evaluate the prevalence of depression and sensitivity and specificity of the single-item interview 'Are you depressed?' for people with hereditary spastic paraplegia in Estonia. Single-item interview 'Are you depressed?' was used as a screening question for depression; all participants then completed the Beck Depression Inventory. People with hereditary spastic paraplegia identified from the epidemiological database who agreed to participate in the study. Beck Depression Inventory, clinical interview. The epidemiological database consisted of 59 patients with clinically confirmed diagnosis of hereditary spastic paraplegia. Forty-eight of these consented to participate in the study. The Beck Depression Inventory score was higher than cut-off point in 58% (28/48) and lower in 42% (20/48). Of the study group, 44% (21/48) had mild, 13% (6/48) moderate and one person revealed severe depression. There was a statistically significant correlation between Beck Depression Inventory score and level of mobility; no other significant correlations with other measures were detected. Of the participants, 54% (26/48) had subjective complaints about depression and answered 'Yes' to the single-item interview 'Are you depressed?'. The sensitivity of the one-item interview in the hereditary spastic paraplegia group was 75% and specificity 75%. Our results show that mild depression is prevalent among people with hereditary spastic paraplegia. Although the single question may be helpful, it cannot be relied upon entirely when assessing a person for depression.

Genetic and phenotypic characterization of complex hereditary spastic paraplegia

Science.gov (United States)

Kara, Eleanna; Tucci, Arianna; Manzoni, Claudia; Lynch, David S.; Elpidorou, Marilena; Bettencourt, Conceicao; Chelban, Viorica; Manole, Andreea; Hamed, Sherifa A.; Haridy, Nourelhoda A.; Federoff, Monica; Preza, Elisavet; Hughes, Deborah; Pittman, Alan; Jaunmuktane, Zane; Brandner, Sebastian; Xiromerisiou, Georgia; Wiethoff, Sarah; Schottlaender, Lucia; Proukakis, Christos; Morris, Huw; Warner, Tom; Bhatia, Kailash P.; Korlipara, L.V. Prasad; Singleton, Andrew B.; Hardy, John; Wood, Nicholas W.; Lewis, Patrick A.

2016-01-01

Abstract The hereditary spastic paraplegias are a heterogeneous group of degenerative disorders that are clinically classified as either pure with predominant lower limb spasticity, or complex where spastic paraplegia is complicated with additional neurological features, and are inherited in autosomal dominant, autosomal recessive or X-linked patterns. Genetic defects have been identified in over 40 different genes, with more than 70 loci in total. Complex recessive spastic paraplegias have in the past been frequently associated with mutations in SPG11 (spatacsin), ZFYVE26/SPG15 , SPG7 (paraplegin) and a handful of other rare genes, but many cases remain genetically undefined. The overlap with other neurodegenerative disorders has been implied in a small number of reports, but not in larger disease series. This deficiency has been largely due to the lack of suitable high throughput techniques to investigate the genetic basis of disease, but the recent availability of next generation sequencing can facilitate the identification of disease-causing mutations even in extremely heterogeneous disorders. We investigated a series of 97 index cases with complex spastic paraplegia referred to a tertiary referral neurology centre in London for diagnosis or management. The mean age of onset was 16 years (range 3 to 39). The SPG11 gene was first analysed, revealing homozygous or compound heterozygous mutations in 30/97 (30.9%) of probands, the largest SPG11 series reported to date, and by far the most common cause of complex spastic paraplegia in the UK, with severe and progressive clinical features and other neurological manifestations, linked with magnetic resonance imaging defects. Given the high frequency of SPG11 mutations, we studied the autophagic response to starvation in eight affected SPG11 cases and control fibroblast cell lines, but in our restricted study we did not observe correlations between disease status and autophagic or lysosomal markers. In the remaining

Self-care and mobility skills in children with cerebral palsy, related to their manual ability and gross motor function classifications.

Science.gov (United States)

Öhrvall, Ann-Marie; Eliasson, Ann-Christin; Löwing, Kristina; Ödman, Pia; Krumlinde-Sundholm, Lena

2010-11-01

The aim of this study was to investigate the acquisition of self-care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function. Data from the Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8 y 1 mo; SD 3 y 11 mo; range 3-15 y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively. Children classified as MACS and GMFCS levels I or II scored higher than children in MACS and GMFCS levels III to V on both the self-care and mobility domains of the PEDI, with significant differences between all classification levels (pskills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self-care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age. Knowledge of a child's MACS and GMFCS level can be useful when discussing expectations of, and goals for, the development of functional skills. © The Authors. Journal compilation © Mac Keith Press 2010.

Evaluation of regional cerebral circulation and metabolism in moyamoya disease using positron emission computed tomography

International Nuclear Information System (INIS)

Kuwabara, Yasuo

1986-01-01

Regional cerebral blood flow, oxygen extraction fraction, metabolic rate of oxygen, blood volume and transit time were evaluated in 11 patients with moyamoya disease and 3 with suspected moyamoya disease using positron emission computed tomography. Eight of them were examined before and after EC-IC bypass surgery. Moyamoya patients were classified into four groups, namely, pediatric bilateral chronic type (over 5 years from onset), pediatric bilateral early type (within 5 years from onset), pediatric unilateral early type and adult type, according to age, duration of disease from onset and angiographic findings. These four groups showed different patterns on PET images; diffusely decreased CBF and CMRO2 in pediatric bilateral chronic type, decreased CBF and increased OEF in the frontal or temporoparietal region in pediatric bilateral early type, diffusely decreased CBF and increased OEF in the unilateral cerebral hemisphere in pediatric unilateral cerebral hemisphere in pediatric unilateral early type, and decreased CBF and CMRO2 in adult type. An increase of rCBV was demonstrated in frontal regions or basal ganglia in all groups, more prominently in pediatric patients. This was thought to be a common finding in moyamoya disease, corresponding to moyamoya vessels. Staging of moyamoya disease by PET was presented and compared to the angiographic staging. They were significantly correlated, and the stage 3 on PET image with decreased CMRO2 corresponded to the stage 3 or 4 on angiography, the most active stage of moyamoya disease. PET revealed increased CBF in the cortical area around EC-IC bypass but no remarkable changes in mean values of rCBF, OEF, CMRO2 and CBV in cerebral hemisphere. Some patients showed decreased rCBV in the basal ganglia. (J.P.N.)

Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study.

Science.gov (United States)

Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G; Maas, Huub; Buizer, Annemieke I

2018-01-01

To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.

Sit-to-Stand Movement in Children with Hemiplegic Cerebral Palsy: Relationship with Knee Extensor Torque and Social Participation

Science.gov (United States)

dos Santos, Adriana Neves; Pavao, Silvia Leticia; Santiago, Paulo Roberto Pereira; Salvini, Tania de Fatima; Rocha, Nelci Adriana Cicuto Ferreira

2013-01-01

This study aimed to investigate the relationship between sit-to-stand (STS) movement, knee extensor torque and social participation in children with cerebral palsy (CP). Seven spastic hemiplegic CP patients (8.0 plus or minus 2.2 years), classified by the Gross Motor Function Classification System as I and II, and 18 typical children (8.4 plus or…

Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study

Science.gov (United States)

Grøholt, Else-Karin; Eskild, Anne

2010-01-01

Objectives To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. Design Population based cohort study. Setting The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data were linked to the Norwegian Registry of Cerebral Palsy in Children born 1986-95, which was established on the basis of discharge diagnoses at all paediatric departments in Norway. Population All singletons without malformations born in Norway during 1986-95 and who survived the first year of life (n=543 064). Main outcome measure Cerebral palsy diagnosed before the age of 5 years. Results 988 children (1.8 in 1000) were diagnosed with cerebral palsy before the age of 5 years. In total, 11% (39/369) of the children with Apgar score of less than 3 at birth were diagnosed with cerebral palsy, compared with only 0.1% (162/179 515) of the children with Apgar score of 10 (odds ratio (OR) 53, 95% CI 35 to 80 after adjustment for birth weight). In children with a birth weight of 2500 g or more, those with an Apgar score of less than 4 were much more likely to have cerebral palsy than those who had an Apgar score of more than 8 (OR 125, 95% confidence interval 91 to 170). The corresponding OR in children weighing less than 1500 g was 5 (95% CI 2 to 9). Among children with Apgar score of less than 4, 10-17% in all birthweight groups developed cerebral palsy. Low Apgar score was strongly associated with each of the three subgroups of spastic cerebral palsy, although the association was strongest for quadriplegia (adjusted OR 137 for Apgar score 8, 95% CI 77 to 244). Conclusions Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the

OPTIMIZATION OF EARLY PHYSICAL REHABILITATION OF PATIENTS WITH SPASTIC INFANTILE CEREBRAL PALSIES

Directory of Open Access Journals (Sweden)

G. S. Lupandina-Bolotova

2014-01-01

Full Text Available Infantile cerebral palsy is an urgent issue of pediatric neurology all over the world. Adequate choice of the term and methods of rehabilitation helps children with this pathology to adapt to the society and improves prognosis of motor and mental development thereof. The article presents the optimal methods of physical rehabilitation at early stages of a child’s development based on the current understanding of neuroplasticity, reserve capabilities of a developing brain, as well as of pathophysiological aspects of recovery and compensation of the damaged structures of the central nervous system. The authors demonstrate crucial differences between approaches to rehabilitation of children under and over 2 years of age. Despite the selected methods of rehabilitation of children with infantile cerebral palsy, successful results of the therapy require a multidisciplinary approach characterized by early onset, balanced combination of methods of physical rehabilitation and drug therapy, physiotherapy and psychological-pedagogic support. 

Comparative study of muscular tonus in spastic tetra paretic cerebral palsy in children with predominantly cortical and subcortical lesions in computerized tomography of the skull; Estudo comparativo do tono muscular na paralisia cerebral tetraparetica em criancas com lesoes predominantemente corticais ou subcorticais na tomografia computadorizada de cranio

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Iwabe, Cristina [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Neurologia; Piovesana, Ana Maria Sedrez Gonzaga [Universidade Estadual de Campinas, SP (Brazil). Ambulatorio Multidisciplinar de Paralisia Cerebral e Neurologia Infantil

2003-09-01

The objective was to compare distribution and intensity of muscular tonus in spastic tetra paretic cerebral palsy (CP), correlating the clinical data with lesion location in the central nervous system. Twelve children aged two to four years old with predominantly cortical lesions (six children) and subcortical lesions (six children) were included. The tonus was analyzed in the upper (UULL) and lower limbs (LLLL) based on Durigon and Piemonte protocol. The result showed that there was no significant difference regarding tonus intensity and distribution in the UULL and LLLL in both groups. Comparing the upper and lower limbs of subjects in the same group, the LLLL presented more asymmetry and higher tonus intensity than the UULL. It was concluded that in this study children with CP as a result of predominantly cortical or subcortical lesions present a similar deficit in tonus modulation, causing a symmetric and homogeneous distribution of hypertonicity, which is predominant in the LLLL. (author)

Technologically-advanced assessment of upper-limb spasticity

DEFF Research Database (Denmark)

Posteraro, Federico; Crea, Simona; Mazzoleni, Stefano

2018-01-01

post stroke patients. METHODS: A new robotic device able to automatically assess upper-limb spasticity during passive and active mobilization has been developed. The elbow spasticity of five post stroke patients has been assessed by using the new device and by means of the Modified Ashworth Scale (MAS......). After the first assessment, subjects were treated with botulin toxin injections, and then underwent 10 sessions of robotic treatments. After the treatment, subjects spasticity was assessed by using the robotic device and the MAS score. RESULTS: In four out of five patients, the botulin toxin injection...... and robotic treatment resulted in the improvement of the MAS score; in three patients the robotic measures were able to detect the MAS changes. In one subject botulin toxin was not effective and the robotic device was able to detect the lack of effectiveness. CONCLUSIONS: By using the robotic device some...

The Effect of Hydrotherapy on Health of Cerebral Palsy Patients: An Integrative Review

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Masoud Khalaji

2017-06-01

Discussion: The results of the review showed that hydrotherapy when applied along with other conventional methods of rehabilitation, exerts positive effects on all areas of ICF. Hydrotherapy can be used in children and adolescents with spastic diplegia cerebral palsy, but the exercises chosen must be in accordance with the physical and cognitive conditions of the patients. However, studies in some areas of ICF are limited and further studies in this field are felt.

Correlations between computerized tomography of the head and motor developmental disturbances of children with cerebral palsy

International Nuclear Information System (INIS)

Chen, Yu-Herng

1981-01-01

Two hundred and eighty-two children with cerebral palsy (C.P.) and thirty-seven normal children were studied by computerized tomography (C.T.) of the head for finding out the correlations between the organic damage of the brain and the motor developmental disturbance. The abnormal findings of C.T. were: enlargement of the ventricular system, high density area, low density area and porencephalus, enlargement of the sulcus and anomaly of the medial structure. Enlargement of the ventricular system seemed to have correlation with spasticity; the portion and the extent of the enlargement corresponded to the affected extremities and the severity of the spasticity. Children of other types also showed various abnormal C.T. findings but, in general, less than that of spastic types. The prognosis of the motor development of C.P. children cannot be predicted by serial C.T. examinations strictly, because early treatment could cause improvement to that of these children. However, it is of worthy notice that C.T. is an effective method of helping to diagnose the motor developmental disturbance in earlier childhood. (author)

Quantitative analysis of the corpus callosum in children with cerebral palsy and developmental delay: correlation with cerebral white matter volume

International Nuclear Information System (INIS)

Panigrahy, Ashok; Barnes, Patrick D.; Robertson, Robert L.; Sleeper, Lynn A.; Sayre, James W.

2005-01-01

This study was conducted to quantitatively correlate the thickness of the corpus callosum with the volume of cerebral white matter in children with cerebral palsy and developmental delay. Material and methods: A clinical database of 70 children with cerebral palsy and developmental delay was established with children between the ages of 1 and 5 years. These children also demonstrated abnormal periventricular T2 hyperintensities associated with and without ventriculomegaly. Mid-sagittal T1-weighted images were used to measure the thickness (genu, mid-body, and splenium) and length of the corpus callosum. Volumes of interest were digitized based on gray-scale densities to define the hemispheric cerebral white matter on axial T2-weighted and FLAIR images. The thickness of the mid-body of the corpus callosum was correlated with cerebral white matter volume. Subgroup analysis was also performed to examine the relationship of this correlation with both gestational age and neuromotor outcome. Statistical analysis was performed using analysis of variance and Pearson correlation coefficients. There was a positive correlation between the thickness of the mid-body of the corpus callosum and the volume of cerebral white matter across all children studied (R=0.665, P=0.0001). This correlation was not dependent on gestational age. The thickness of the mid-body of the corpus callosum was decreased in the spastic diplegia group compared to the two other groups (hypotonia and developmental delay only; P<0.0001). Within each neuromotor subgroup, there was a positive correlation between thickness of the mid-body of the corpus callosum and volume of the cerebral white matter. (orig.)

Quantitative analysis of the corpus callosum in children with cerebral palsy and developmental delay: correlation with cerebral white matter volume

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Panigrahy, Ashok [Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA (United States); Barnes, Patrick D. [Stanford University Medical Center, Department of Radiology, Lucile Salter Packard Children' s Hospital, Palo Alto, CA (United States); Robertson, Robert L. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States); Sleeper, Lynn A. [New England Research Institute, Watertown, MA (United States); Sayre, James W. [UCLA Medical Center, Departments of Radiology and Biostatistics, Los Angeles, CA (United States)

2005-12-01

This study was conducted to quantitatively correlate the thickness of the corpus callosum with the volume of cerebral white matter in children with cerebral palsy and developmental delay. Material and methods: A clinical database of 70 children with cerebral palsy and developmental delay was established with children between the ages of 1 and 5 years. These children also demonstrated abnormal periventricular T2 hyperintensities associated with and without ventriculomegaly. Mid-sagittal T1-weighted images were used to measure the thickness (genu, mid-body, and splenium) and length of the corpus callosum. Volumes of interest were digitized based on gray-scale densities to define the hemispheric cerebral white matter on axial T2-weighted and FLAIR images. The thickness of the mid-body of the corpus callosum was correlated with cerebral white matter volume. Subgroup analysis was also performed to examine the relationship of this correlation with both gestational age and neuromotor outcome. Statistical analysis was performed using analysis of variance and Pearson correlation coefficients. There was a positive correlation between the thickness of the mid-body of the corpus callosum and the volume of cerebral white matter across all children studied (R=0.665, P=0.0001). This correlation was not dependent on gestational age. The thickness of the mid-body of the corpus callosum was decreased in the spastic diplegia group compared to the two other groups (hypotonia and developmental delay only; P<0.0001). Within each neuromotor subgroup, there was a positive correlation between thickness of the mid-body of the corpus callosum and volume of the cerebral white matter. (orig.)

Efficacy of T2*-Weighted Gradient-Echo MRI in Early Diagnosis of Cerebral Venous Thrombosis with Unilateral Thalamic Lesion

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Shingo Mitaki

2013-01-01

Full Text Available Cerebral venous thrombosis (CVT is an uncommon cause of stroke with diverse etiologies and varied clinical presentations. Because of variability in clinical presentation and neuroimaging, CVT remains a diagnostic challenge. Recently, some studies have highlighted the value of T2*-weighted gradient-echo MRI (T2*WI in the diagnosis of CVT. We report the case of a 79-year-old woman with CVT due to a hypercoagulable state associated with cancer. On the initial T2-weighted image (T2WI, there was a diffuse high-intensity lesion in the right thalamus, extending into the posterior limb of the internal capsule and midbrain. T2*WI showed diminished signal and enlargement of the right basilar vein and the vein of Galen. Even though there is a wide range of differential diagnoses in unilateral thalamic lesions, and a single thalamus lesion is a rare entity of CVT, based on T2*WI findings we could make an early diagnosis and perform treatment. Our case report suggests that T2*WI could detect thrombosed veins and be a useful method of early diagnosis in CVT.

Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study.

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Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2009-12-01

Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data. We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %). In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images. Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia. Level 4.

The Efficacy of Botulinum Toxin A Intramuscular Injections in After-Stroke Spasticity

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Melek Karaçam

2010-09-01

Full Text Available OBJECTIVE: Spasticity is a common dysfunction in stroke patients. It hinders the performance of everyday living activities and lowers the quality of life. In this study, it was aimed to investigate the effects of botulinum toxin A therapy on various aspects, such as muscle tone, pain, daily living activities and disability. METHODS: Fifteen patients with stroke presenting with focal spasticity in the botulinum toxin outpatient unit were evaluated. Results before and after treatment were evaluated by applying different scales. Modified Ashworth Scale was applied for the severity of spasticity. The Medical Council Research Scale was used to test muscle power, and the disability scoring scale, Visual Analogue Pain Scale and Barthel index were the other measures tested. RESULTS: It was found that therapy with botulinum toxin A was effective in spasticity. The increased muscle tone and the disability scores decreased prominently after the treatment (p< 0.05. Lower values in pain scores (p< 0.05 also contributed to better functional outcome (p< 0.01. Along with the significantly good outcome according to the scales, the higher scores in quality of life, feeling of well-being, good performance during the physiotherapy sessions, and less medications needed for spasticity were also indications in commencing the therapy of botulinum toxin A in spasticity. CONCLUSION: Spasticity is a complicated condition causing serious disability. Botulinum toxin A is a preferred therapy when there is an increased motor activity. The effects of the agent are reversible and reliable. The duration of the treatment is long-lasting. Since botulinum toxin A is easily applied and the outcome in focal spasticity is favorable, it is recommended as the first-line choice in the treatment of focal spasticity

Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy

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Hong, Wei-Hsien; Chen, Hseih-Ching; Shen, I-Hsuan; Chen, Chung-Yao; Chen, Chia-Ling; Chung, Chia-Ying

2012-01-01

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n =…

Planning of surgical treatment of upper extremity in patients with cerebral palsy

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V. V. Umnov

2013-01-01

Full Text Available The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1, as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.

Spinal Cord Stimulation for Spasticity: Historical Approaches, Current Status, and Future Directions.

Science.gov (United States)

Nagel, Sean J; Wilson, Saul; Johnson, Michael D; Machado, Andre; Frizon, Leonardo; Chardon, Matthieu K; Reddy, Chandan G; Gillies, George T; Howard, Matthew A

2017-06-01

Millions of people worldwide suffer with spasticity related to irreversible damage to the brain or spinal cord. Typical antecedent events include stroke, traumatic brain injury, and spinal cord injury, although insidious onset is also common. Regardless of the cause, the resulting spasticity leads to years of disability and reduced quality of life. Many treatments are available to manage spasticity; yet each is fraught with drawbacks including incomplete response, high cost, limited duration, dose-limiting side effects, and periodic maintenance. Spinal cord stimulation (SCS), a once promising therapy for spasticity, has largely been relegated to permanent experimental status. In this review, our goal is to document and critique the history and assess the development of SCS as a treatment of lower limb spasticity. By incorporating recent discoveries with the insights gained from the early pioneers in this field, we intend to lay the groundwork needed to propose testable hypotheses for future studies. SCS has been tested in over 25 different conditions since a potentially beneficial effect was first reported in 1973. However, the lack of a fully formed understanding of the pathophysiology of spasticity, archaic study methodology, and the early technological limitations of implantable hardware limit the validity of many studies. SCS offers a measure of control for spasticity that cannot be duplicated with other interventions. With improved energy-source miniaturization, tailored control algorithms, novel implant design, and a clearer picture of the pathophysiology of spasticity, we are poised to reintroduce and test SCS in this population. © 2017 International Neuromodulation Society.

Early results of surgical intervention for elbow deformity in cerebral palsy based on degree of contracture.

Science.gov (United States)

Carlson, Michelle G; Hearns, Krystle A; Inkellis, Elizabeth; Leach, Michelle E

2012-08-01

Elbow flexion posture, caused by spasticity of the muscles on the anterior surface of the elbow, is the most common elbow deformity seen in patients with cerebral palsy. This study retrospectively evaluated early results of 2 surgical interventions for elbow flexion deformities based on degree of contracture. We hypothesized that by guiding surgical treatment to degree of preoperative contracture, elbow extension and flexion posture angle at ambulation could be improved while preserving maximum flexion. Eighty-six patients (90 elbows) were treated for elbow spasticity due to cerebral palsy. Seventy-one patients (74 elbows) were available for follow-up. Fifty-seven patients with fixed elbow contractures less than 45° were surgically treated with a partial elbow muscle lengthening, which included partial lengthening of the biceps and brachialis and proximal release of the brachioradialis. Fourteen patients (17 elbows) with fixed elbow contractures ≥ 45° had a more extensive full elbow release, with biceps z-lengthening, partial brachialis myotomy, and brachioradialis proximal release. Age at surgery averaged 10 years (range, 3-20 y) for partial lengthening and 14 years (range, 5-20 y) for full elbow release. Follow-up averaged 22 months (range, 7-144 mo) for partial lengthening and 18 months (range, 6-51 mo) for full elbow release. Both groups achieved meaningful improvement in flexion posture angle at ambulation, active and passive extension, and total range of motion. Elbow flexion posture angle at ambulation improved by 57° and active extension increased 17° in the partial lengthening group, with a 4° loss of active flexion. In the full elbow release group, elbow flexion posture angle at ambulation improved 51° and active extension improved 38°, with a loss of 19° of active flexion. Surgical treatment of spastic elbow flexion in cerebral palsy can improve deformity. We obtained excellent results by guiding the surgical intervention by the amount of

Effect of whole-body vibration on muscle strength, spasticity, and ...

African Journals Online (AJOL)

CP) and is characterized by spasticity and muscle weakness of both lower limbs resulting in decreased walking ability. The purpose of this study was to evaluate the effect of whole body vibration (WBV) training on muscle strength, spasticity, and ...

Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis.

Science.gov (United States)

Tintoré, Mar

2015-01-01

Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.

Spasticity, an impairment that is poorly defined and poorly measured

NARCIS (Netherlands)

Malhotra, S.; Malhotra, S.; Pandyan, A.D.; Day, C.R.; Jones, Valerie M.; Hermens, Hermanus J.

Objective: To explore, following a literature review, whether there is a consistent definition and a unified assessment framework for the term 'spasticity'. The congruence between the definitions of spasticity and the corresponding methods of measurement were also explored. Data sources: The search

Does botulinum toxin improve the function of the patient with spasticity after stroke? Toxina botulínica proporciona melhora funcional em pacientes com espasticidade secundária a acidente vascular cerebral?

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Eduardo Cardoso

2007-09-01

Full Text Available Post-stroke spasticity is an important cause of disability in adults, due to muscle hyperactivity, which results in limb stiffness and muscle spasm. The prognosis for these patients depends on several features such as early management and adequate physical therapy to avoid muscle shortening, pain, and their consequences. Although several papers have shown that intramuscular injections of botulinum toxin type A (BT-A decreases spasticity in post-stroke patients, few authors have demonstrated functional improvement after this therapy. In order to assess if individualized BT-A injections improves upper limb function in post-stroke spastic patients, we prospectively followed 20 consecutive patients of 18 years of age or more with spastic hemiparesis secondary to stroke. Fulg-Meyer scale modified for upper limbs, measure of functional independence (MFI, Ashworth modified scale, and goniometry were applied in the beginning of the investigation and in the 16th and 32nd weeks. BT-A was applied at baseline and in the 16th week. All subjects were submitted to rehabilitation therapy. All patients showed improvement according to Ashworth modified scale and increase in the range of motion, which were sustained until the 32nd week (pEspasticidade secundária a acidente vascular cerebral (AVC é importante causa de incapacidade em adultos. O prognóstico para estes pacientes depende de vários fatores como tratamento precoce e terapia física adequada, evitando encurtamento muscular, dor e outras conseqüências. Vários estudos têm demonstrado que aplicacões intramusculares de toxina botulínica do tipo A (TxB-A reduzem a espasticidade após AVC, entretanto poucos autores observaram melhora funcional de membros superiores com esta terapêutica. Para determinar se aplicações individualizadas de TxB-A melhoram a função no membro superior espástico de pacientes com hemiparesia secundária a AVC, acompanhamos 20 pacientes com história de AVC entre 6 meses

The use of instrumented gait analysis for individually tailored interdisciplinary interventions in children with cerebral palsy

DEFF Research Database (Denmark)

Rasmussen, Helle Mätzke; Pedersen, Niels Wisbech; Overgaard, Søren

2015-01-01

in gait following individually tailored interventions when IGA is used are superior to those following ‘care as usual’. Methods/Design A prospective, single blind, randomised, parallel group study will be conducted. Children aged 5 to 8 years with spastic CP, classified at Gross Motor Function...... Classification System levels I or II, will be included. The interventions under investigation are: 1) individually tailored interdisciplinary interventions based on the use of IGA, and 2) ‘care as usual’. The primary outcome is gait measured by the Gait Deviation Index. Secondary outcome measures are: walking......Abstract Background Children with cerebral palsy (CP) often have an altered gait. Orthopaedic surgery, spasticity management, physical therapy and orthotics are used to improve the gait. Interventions are individually tailored and are planned on the basis of clinical examinations and standardised...

Threshold values of ankle dorsiflexion and gross motor function in 60 children with cerebral palsy

DEFF Research Database (Denmark)

Rasmussen, Helle M; Svensson, Joachim; Thorning, Maria

2018-01-01

Background and purpose - Threshold values defining 3 categories of passive range of motion are used in the Cerebral Palsy follow-Up Program to guide clinical decisions. The aim of this study was to investigate the threshold values by testing the hypothesis that passive range of motion in ankle...... dorsiflexion is associated with gross motor function and that function differs between the groups of participants in each category. Patients and methods - We analyzed data from 60 ambulatory children (aged 5-9 years) with spastic cerebral palsy. Outcomes were passive range of motion in ankle dorsiflexion...... with flexed and extended knee and gross motor function (Gait Deviation Index, Gait Variable Score of the ankle, peak dorsiflexion during gait, 1-minute walk, Gross Motor Function Measure, the Pediatric Quality of Life Inventory Cerebral Palsy Module, and Pediatric Outcomes Data Collection Instrument). Results...

Etiologic profile of spastic quadriplegia in children.

Science.gov (United States)

Venkateswaran, Sunita; Shevell, Michael I

2007-09-01

The etiologic profile and possible predictors of etiology in children with spastic quadriplegia were assessed in a consecutive cohort of children with this motor impairment. Medical records from a single pediatric neurology practice over a 14-year interval were retrospectively and systematically reviewed. Variables comprised possible demographic, prenatal, perinatal, and postnatal risk factors. Of the 99 patients included in the study, 39 were premature (quadriplegia was 83%, with differing underlying etiologies depending on gestational age. These results should help guide physicians in investigating possible underlying etiologies in patients with spastic quadriplegia.

Can turned inward patella predict an excess of femoral anteversion during gait in spastic diplegic children?

Science.gov (United States)

Simon, Anne-Laure; Presedo, Ana; Ilharreborde, Brice; Mallet, Cindy; Mazda, Keyvan; Penneçot, Georges-François

2014-06-01

Determining patellar orientation in the transverse plane during observational gait analysis is a fundamental aspect of physical examinations. Many physicians consider that an abnormal position of the patella in the transverse planes is only explained by a rotational abnormality of the proximal femur. A total of 188 spastic diplegic children with cerebral palsy were reviewed (376 lower limbs). The physical examination included observation of patellar orientation at midstride and measuring femoral anteversion (FA). All patients also underwent 3-dimensional (3D) computerized gait analysis of pelvic and hip rotation kinematics. Observational gait analysis and videotapes found 103 children (206 lower limbs) with inturned patella at midstance. Kinematic data from 3D gait analysis showed that the visual impression of turned inward patella was erroneous in 48 limbs. Of the remaining 158 lower limbs, 117 (74%) exhibited excessive FA and 41 (26%) did not. Of the 117 with excessive FA, kinematics showed only 66 (56%) with excessive internal hip rotation (with or without excessive internal pelvic rotation). Of the 41 lower limbs without excessive FA, 25 were explained by excessive internal pelvic rotation and 16 were explained by excessive internal hip rotation (isolated spasticity and/or contracture of internal rotator muscles). Turned inward patella was caused by isolated excessive internal pelvic rotation in 48%, excessive internal hip rotation in 35% (including 44 cases with excessive FA and 12 cases with isolated spasticity and/or contracture of internal hip rotators), and excessive internal hip rotation combined with excessive internal pelvic rotation in 17%. Excessive FA was not the only cause of turned inward patella gait and could not explain this gait anomaly by itself. Excessive internal pelvic rotation was the most frequent cause of turned inward patella gait. Level IV.

The meaning of spasticity to people with multiple sclerosis: what can health professionals learn?

Science.gov (United States)

Morley, Alex; Tod, Angela; Cramp, Mary; Mawson, Sue

2013-07-01

Multiple sclerosis (MS) is the most common disabling neurological condition affecting young adults. One third of people on an American registry of people with MS (PWMS) reported having activities affected by spasticity. The psychosocial effects of spasticity in people with MS have been shown to be distressing and detrimental to emotional and social relationships when investigated from a psychology perspective. This paper investigates the impact of spasticity on the lives of people living with MS from a physiotherapeutic perspective. This study involved 12 semi-structured interviews with individuals experiencing MS-related spasticity. Ten sets of data were analyzed following framework analysis principles. Results suggest spasticity effects life experience of these PWMS in diverse and complex ways. Physical, psychological and social consequences of spasticity are closely linked and can be far reaching. Therapists need to be aware of links between specific physical symptoms and their psychosocial consequences if they want to improve peoples' quality of life. This paper provides in depth qualitative research evidence for the complexity of the spasticity experience for each individual, strengthening the argument for a patient-centred approach to treatment. These results also support the case for targeted interventions with effectiveness recorded in a patient-centred way. • Spasticity is suggested here to affect the lives of individuals with multiple sclerosis in diverse and far reaching ways. Therapists need to investigate this fully in subjective assessment to impact on people's quality of life. • Direct links were identified between treatable physical symptoms and far reaching consequences of spasticity. • Knowledge about the complexity of the spasticity experience for each individual will allow therapists to target interventions appropriately and accurately record effectiveness in a patient-centred way.

Hip dislocation in cerebral palsy: evolution of the contralateral side after reconstructive surgery

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João Caetano Munhoz Abdo

2016-06-01

Full Text Available ABSTRACT OBJECTIVE: To evaluate the progression of the contralateral hip after unilateral reconstruction of hip dislocation in patients classified as GMFCS IV-V; and to identify potential prognostic factors for their evolution. METHODS: This was a retrospective study on 17 patients with spastic cerebral palsy, who were classified on the GMFCS scale (Gross Motor Functional Classification System as degrees IV and V, and who underwent unilateral reconstruction surgery to treat hip dislocation (adductor release, femoral varus osteotomy and acetabuloplasty. The minimum postoperative follow-up was 30 months. The clinical parameters evaluated were sex, age at time of surgery, length of follow-up after surgery and range of abduction. The treatment parameters were use/nonuse of femoral shortening, application of botulinum toxin and any previous muscle releases. The radiographic parameters were Reimer's extrusion index (REI, acetabular angle (AA and the continuity of Shenton's line. RESULTS: Among the 17 patients evaluated, eight presented dislocation (group I and nine did not (group II. Group I comprised three males and five females; group II comprised one male and eight females. The mean age at the time of surgery among the group I patients was 62 months and the mean follow-up was 62 months. In group II, these were 98 and 83 months, respectively. There was a trend in which patients of greater age did not evolve with contralateral dislocation. Among the nine patients with the combination of REI < 30% and AA < 25°, only one presented dislocation during the follow-up. Contralateral subluxation occurred within the first two years after the surgery. CONCLUSION: Hips presenting REI < 30° and AA < 25° do not tend to evolve to subluxation and can be kept under observation. Preoperative clinical and radiographic measurements alone are not useful for indicating the natural evolution of non- operated hips. The critical period for subluxation is the first two

Orthopedic surgery in cerebral palsy: Instructional course lecture

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Deepak Sharan

2017-01-01

Full Text Available Orthopedic surgery (OS plays an important role in the management of cerebral palsy (CP. The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS, orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a “last resort” intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.

The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

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S. R. Belagaje

2014-01-01

Full Text Available Several devices and medications have been used to address poststroke spasticity. Yet, spasticity’s impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question “Did you have spasticity following your stroke?” on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n=30 or did not have spasticity data available (n=102 were excluded. Spasticity affected the 3-month functional status (β=0.420, 95 CI=0.194 to 0.645 after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model’s R2 changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors.

Effects on the Treatments in Physical Therapy with the Wii Fit Plus Balance Board Concerning the Postural Changes on Children Suffering Spastics Hemiparesis. Case Report

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Luisa Fernanda Córdoba Castillo

2015-05-01

Full Text Available Introduction: This study tried to determine the effects on the treatments in physical therapy with the Wii Balance Board and Wii Fit Plus __both of Wii, Nintendo Company Limited__ concerning the postural changes on children suffering spastics hemiparesis. Material and methods: Longitudinal cohort case studies done with two children, from the municipality of Popayán, suffering cerebral palsy type spastic hemiparesis. This children had a test on static posture with the software APIC v. 2.0, previously, It was executed an exercises program using Wii Fit plus Balance Board for 20 sessions. Results: Both of the patients had remarkable changes on lateralization of the center of gravity. This change can subserve the postural changes later. Conclusions: The application of the game with Wii Fit Plus with Wii Balance Board in physical therapy is a useful alternative in rehabilitation of hemi paretic patients related to a better distribution of the center of gravity. It is advisable to avoid weight overload and compensations.

Optimising Ankle Foot Orthoses for children with Cerebral Palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

NARCIS (Netherlands)

Kerkum, Y.L.; Harlaar, J.; Buizer, A.I.; van den Noort, J.C.; Becher, J.G.; Brehm, M.A.

2013-01-01

Background: Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of

Optimising Ankle Foot Orthoses for children with cerebral palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

NARCIS (Netherlands)

Kerkum, Yvette L.; Harlaar, Jaap; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Brehm, Merel-Anne

2013-01-01

Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of walking energy

The cranial MRI in severe cerebral palsy

International Nuclear Information System (INIS)

Yamada, Kazutaka; Itoh, Masahiro; Fueki, Noboru; Hirasawa, Kyoko; Suzuki, Noriko; Kurata, Kiyoko; Sato, Junichi; Morimatsu, Yoshio; Yagishita, Akira.

1993-01-01

The magnetic resonance examination was performed in 38 patients with severe cerebral palsy (CP; 15 males and 23 females) who had both motor delay (unable to move anywhere) and mental retardation (I.Q. or D.Q. below 30). Neuroimaging findings were compared with the CP type, etiology, and grade of understanding of language. Cranial magnetic resonance imagings (MRI) in CP were divided into five types. In type 1, nine predominantly showed cyst-liked ventricles and periventricular hyperintensity on T 2 -weighted imaging (PVH) and only scarred basal ganglia and thalamus were visible. All suffered from neonatal asphyxia and the clinical type was rigospastic tetraplegia (RST). In type 2, eleven predominantly showed PVH and hyperintensity on T 2 -weighted (HT2) in basal ganglia and thalamus. All suffered from neonatal asphyxia and the clinical type was RST or rigospastic diplegia. In type 3, five showed PVH and three had cortical atrophy. All suffered from neonatal asphyxia and the clinical type was spastic diplegia. In type 4, four predominantly showed HT2 in putamen and thalamus. Three had cortical atrophy. All suffered from neonatal asphyxia. The clinical type was athetotic CP (ATH). In type 5, nine predominantly showed HT2 in globus pallidus. Four had cortical atrophy and two had hippocampal atrophy. All suffered from neonatal jaundice and the clinical type was ATH. All patients who suffered from neonatal asphyxia and spastic CP had MRI in PVH. All patients who suffered from neonatal asphyxia and ATH showed HT2 in putamen and thalamus. Almost patients who suffered from neonatal jaundice and ATH showed HT2 in globus pallidus. With athetotic CP, cases with atrophy of the cerebral cortex and/or hippocampus were lower grade of understanding of language than no atrophy of both. The results of studies of MRI are in agreement with neuropathological findings. (author)

Validity of Modified Ashworth Scale as a Measure of Wrist Spasticity in Stroke Patients

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Mohammad Heidari

2011-04-01

Full Text Available Objectives: There are some controversies about the value of modified Ashworth Scale (MAS for assessing spasticity. The goal of this study was to investigate if there is any correlation between scores obtained from MAS for wrist spasticity and electrophysiological recordings as the objective measure of spasticity. Methods: In this cross-sectional study, 34 stroke patients were employed. Wrist spasticity was clinically measured by means of MAS. Also, an electromyogram (EMG machine was used to elicit Hmax and Mmax from the flexor carpi radialis muscle. Spearman’s correlation coefficient test was used to investigate potential correlation between clinically and electrophysiologically measures of spasticity. Results: The observed relation between MAS and EMG recordings was not statistically significant (rho=0.183, P>0.05. Discussion: Our findings suggest that MAS may be a useful tool for grading hypertonia, but it is not a valid measure of spasticity in selected patients.

Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy.

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Stark, C; Nikopoulou-Smyrni, P; Stabrey, A; Semler, O; Schoenau, E

2010-06-01

The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children. In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training. Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training. The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

Judesių ribojimo ir veidrodinio аtspindžio terаpijų poveikis vаikų, turinčių cerebrinį pаrаlyžių, rаnkos funkcijаi ir аpsitаrnаvimui.

OpenAIRE

Stasiulienė, Ksenija

2017-01-01

The aim of the research: Identification of constraint-induced movement therapy and mirror therapy effects for children with cerebral palsy (spastic hemiplegic) to hand function and self-care. The tasks of the research: 1. To evaluate constraint-induced movement therapy effects for children with cerebral palsy (spastic hemiplegic) to hand function and self-care. 2. To evaluate mirror therаpy effects on children with cerebral palsy (spastic hemiplegic) for hand function and self-care. 3. Ide...

Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS – a randomized controlled trial protocol for a stationary cycling intervention

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Simms Victoria

2007-03-01

Full Text Available Abstract Background In the past, effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns. Current scientific evidence indicates that these concerns were unfounded and that therapeutic interventions focused on muscle strengthening can lead to improved functional ability. However, few studies have examined the potential benefits of cardiorespiratory fitness exercises in this patient population. Methods/design The rationale and design of a randomized controlled trial examining the effects of a stationary cycling intervention for children with CP are outlined here. Sixty children with spastic diplegic CP between the ages of 7 and 18 years and Gross Motor Function Classification System (GMFCS levels of I, II, or III will be recruited for this study. Participants will be randomly assigned to either an intervention (cycling or a control (no cycling group. The cycling intervention will be divided into strengthening and cardiorespiratory endurance exercise phases. During the strengthening phase, the resistance to lower extremity cycling will be progressively increased using a uniquely designed limb-loaded mechanism. The cardiorespiratory endurance phase will focus on increasing the intensity and duration of cycling. Children will be encouraged to exercise within a target heart rate (HR range (70 – 80% maximum HR. Thirty sessions will take place over a 10–12 week period. All children will be evaluated before (baseline and after (follow-up the intervention period. Primary outcome measures are: knee joint extensor and flexor moments, or torque; the Gross Motor Function Measure (GMFM; the 600 Yard Walk-Run test and the Thirty-Second Walk test (30 sec WT. Discussion This paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS; a Phase I randomized controlled trial

Validity and Inter-Rater Reliability of a Novel Bedside Referral Tool for Spasticity

Science.gov (United States)

2018-02-20

Spasticity, Muscle; Muscular Diseases; Musculoskeletal Disease; Muscle Hypertonia; Muscle Spasticity; Neuromuscular Manifestations; Signs and Symptoms; Nervous System Diseases; Neurologic Manifestations

Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by 99mTc-HMPAO SPECT

International Nuclear Information System (INIS)

Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru; Aburano, Tamio

2000-01-01

Cerebral blood flow (CBF) measured by 99m Tc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the

Clinical features and management of hereditary spastic paraplegia

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Ingrid Faber

2014-03-01

Full Text Available Hereditary spastic paraplegia (HSP is a group of genetically-determined disorders characterized by progressive spasticity and weakness of lower limbs. An apparently sporadic case of adult-onset spastic paraplegia is a frequent clinical problem and a significant proportion of cases are likely to be of genetic origin. HSP is clinically divided into pure and complicated forms. The later present with a wide range of additional neurological and systemic features. To date, there are up to 60 genetic subtypes described. All modes of monogenic inheritance have been described: autosomal dominant, autosomal recessive, X-linked and mitochondrial traits. Recent advances point to abnormal axonal transport as a key mechanism leading to the degeneration of the long motor neuron axons in the central nervous system in HSP. In this review we aim to address recent advances in the field, placing emphasis on key diagnostic features that will help practicing neurologists to identify and manage these conditions.

Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy

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Jae Meen Lee

2016-02-01

Full Text Available Neuroleptic malignant syndrome (NMS is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS surgery in a cerebral palsy (CP patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Use of paracetamol, ibuprofen or aspirin in pregnancy and risk of cerebral palsy in the child

DEFF Research Database (Denmark)

Petersen, Tanja Gram; Liew, Zeyan; Nybo Andersen, Anne-Marie

2018-01-01

Background: It has been debated whether mild analgesics, mainly paracetamol, adversely affect aspects of neurodevelopment. We examined whether mother's use of paracetamol, aspirin or ibuprofen in pregnancy is associated with increased risk of cerebral palsy (CP) in the child. Method: We included...... registers. We estimated the average causal effect of analgesics on risk of CP using marginal structural models with stabilized inverse probability weights. Results: Paracetamol use was reported in 49% of all pregnancies, aspirin in 3% and ibuprofen in 4%. Prenatal exposure to paracetamol ever in pregnancy......% CI: 1.0-2.5). Children ever prenatally exposed to aspirin in pregnancy had an elevated risk of bilateral spastic CP (aOR 2.4, 95% CI: 1.1-5.3) compared with unexposed. Conclusion: We observed an increased risk of spastic CP in children prenatally exposed to paracetamol and aspirin. Although we...

Hereditary spastic paraplegia with cerebellar ataxia

DEFF Research Database (Denmark)

Nielsen, J E; Johnsen, B; Koefoed, P

2004-01-01

Complex forms of hereditary spastic paraplegia (HSP) are rare and usually transmitted in an autosomal recessive pattern. A family of four generations with autosomal dominant hereditary spastic paraplegia (AD-HSP) and a complex phenotype with variably expressed co-existing ataxia, dysarthria......, unipolar depression, epilepsy, migraine, and cognitive impairment was investigated. Genetic linkage analysis and sequencing of the SPG4 gene was performed and electrophysiologic investigations were carried out in six individuals and positron emission tomography (PET) in one patient. The disease was linked...... in those individuals who were clinically affected by a complex phenotype consisting of HSP and cerebellar ataxia. Other features noted in this kindred including epilepsy, cognitive impairment, depression, and migraine did not segregate with the HSP phenotype or mutation, and therefore the significance...

Effect of nutritional support in children with spastic quadriplegia.

Science.gov (United States)

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

2008-11-01

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.

[Management of symptoms associated with spasticity in patients with multiple sclerosis].

Science.gov (United States)

Fernández-Pablos, María Asunción; Costa-Frossard, Lucienne; García-Hernández, Carlos; García-Montes, Inmaculada; Escutia-Roig, Matilde

To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). A descriptive study was developed based on a questionnaire on spasticity in MS patients. The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these patients. Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain. Participants thought that it is important that nursing takes: 1) a role in identifying these symptoms, 2) should focus on the detection of the triggering or aggravating factors, and 3) on providing support in the assessment of the level of spasticity. It is important to inform about the correct use of anti-spasticity drugs, how to adjust the dosage and side effects of treatments, including cannabinoids via an oromucosal spray, titrating its doses according to each patient, and monitoring its tolerability, efficacy and adherence. Although there are usually resources to follow up these patients, there are still important gaps, including the lack of a specific follow-up protocol. Although all the participants are experts in the management of patients with MS, there is still diversity in the functions they perform, and the available resources they have in their hospitals. Nurses act as a key element in the process of identification of symptoms, training and monitoring of these patients with spasticity in EM. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors

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Svetlana Pundik

2014-01-01

Full Text Available Background. Arm spasticity is a challenge in the care of chronic stroke survivors with motor deficits. In order to advance spasticity treatments, a better understanding of the mechanism of spasticity-related neuroplasticity is needed. Objective. To investigate brain function correlates of spasticity in chronic stroke and to identify specific regional functional brain changes related to rehabilitation-induced mitigation of spasticity. Methods. 23 stroke survivors (>6 months were treated with an arm motor learning and spasticity therapy (5 d/wk for 12 weeks. Outcome measures included Modified Ashworth scale, sensory tests, and functional magnetic resonance imaging (fMRI for wrist and hand movement. Results. First, at baseline, greater spasticity correlated with poorer motor function (P=0.001 and greater sensory deficits (P=0.003. Second, rehabilitation produced improvement in upper limb spasticity and motor function (P<0.0001. Third, at baseline, greater spasticity correlated with higher fMRI activation in the ipsilesional thalamus (rho=0.49, P=0.03. Fourth, following rehabilitation, greater mitigation of spasticity correlated with enhanced fMRI activation in the contralesional primary motor (r=-0.755, P=0.003, premotor (r=−0.565, P=0.04, primary sensory (r=−0.614, P=0.03, and associative sensory (r=−0.597, P=0.03 regions while controlling for changes in motor function. Conclusions. Contralesional motor regions may contribute to restoring control of muscle tone in chronic stroke.

The effects of a 12-week program of static upper extremity weight bearing exercises on weight bearing in children with hemiplegic type of cerebral palsy

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P. Jayaraman

2010-01-01

Full Text Available The  major  objective  of  this  study  was  to  quantify  the  effects  of a  12-week  program  of  weight  bearing  exercises  on  weight  borne  through  the hand and grip pressures in children with hemiplegic cerebral palsy. This study also sought to monitor the change in spasticity immediately following weight-bearing  exercises.  A  quasi-experimental,  one  group  pre-test,  post-test  study  was used. Eleven children with hemiplegic type of cerebral palsy from a special school in KwaZulu Natal participated after fully informed written consent. The intervention consisted of a 12-week program of weight bearing. The Tekscan Grip system was used to quantify weight borne through the hand during extended arm prone and quadruped positions and whilst holding a pencil and a tumbler. The modified Ashworth grading of spasticity was used to monitor spasticity. The data was analysed using the random effects GLS model Wald Chi Square test. Significant increases in contact pressure in extended arms prone (p=0,012 and quadruped (p=0,002 and when holding a pencil (p=0,045 was noted post-test compared to pre-test. Significant increases in contact area of the hand was also noted in prone (p=0,000, quadruped (p=0, 03 at assessment 7 and when holding a pencil (p=0,035.  A significant decrease in spasticity during elbow extension (p=0,004, and wrist flexion (p=0,026 and extension (p=0,004 was noted. An overall significant effect of static weight bearing exercises on weight borne through the hands, grip strength and spasticity justifies the use of static weight-bearing in therapy.

Percutaneous epidural neurostimulation in modulation of paraplegic spasticity. Six case reports.

Science.gov (United States)

Richardson, R R; Cerullo, L J; McLone, D G; Gutierrez, F A; Lewis, V

1979-01-01

Six cases of paraplegic, post-traumatic spasticity, alleviated by percutaneous epidural neurostimulation with temporary or permanent implanted neuroelectrodes from the L1 to L4 intervertebral levels are presented. Modulation of this spasticity and secondary beneficial physiological effects were achieved, including regulation of bowel regimens, production of sweating and piloerection below the level of the lesion, and morning erections. The main advantages of percutaneous epidural neurostimulation in modulating spasticity are the avoidance of destructive neurosurgical procedures, the regulation of secondary physiological and autonomic responses, the avoidance of antispasticity medications, and the reversibility of the neurostimulation procedure.

O uso de técnicas para auxiliar a flexibilidade e equilíbrio em adolescentes portadores de paralisia cerebral: o relato de três casos Use of techniques to increase flexibility and equilibrium in adolescents with cerebral palsy: report of three case studies

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Katia Carpetieri Ferrarezi

2000-05-01

Full Text Available Esta pesquisa teve por objetivo descrever os testes e o tratamento pediátrico de paralisia cerebral espástica em fase de independência motora para a flexibilidade dos membros inferiores e para o desenvolvimento do aumento no tempo de equilíbrio. Foram selecionados, para participar deste estudo, 3 sujeitos com paralisia cerebral em fase de independência motora. Sujeito 1 do sexo masculino, 12 anos, diplégico espástico; sujeito 2 do sexo masculino, 13 anos, hemiplegia direita espástica; sujeito 3 do sexo feminino, 10 anos, hemiplegia espástica esquerda. A metodologia usada para a avaliação foi o teste de “sentar e alcançar”, a goniometria e o teste de equilíbrio. O procedimento é composto em 16 semanas, com sessões individuais de 30 minutos, duas vezes por semana. Para conseguir flexibilidade dos membros inferiores, foi usado o método de facilitação neuromuscular proprioceptiva, e para estímulos proprioceptivos e vestibulares (equilíbrio foram usados saltos no mini-trampolim. O resultado obtido com o tratamento proposto foi um ganho na flexibilidade, medido pelo teste de "sentar e alcançar" de 30% para o sujeito 1, 40% para o sujeito 2 e 40 % para o sujeito 3, e o ganho obtido com o tempo de equilíbrio foi de 160% para o sujeito 1, 100% para o sujeito 2 e 500% para o sujeito 3The aim of this paper is to describe the tests and pediatric treatment of motor-independent spastic cerebral palsy to increase lower-limbs flexibility and equilibrium time. Three subjects were selected for the experiment: a twelve-year-old boy with spastic diplegia, a thirteen-year-old boy with right spastic hemiplegia and a ten-year-old girl with left spastic hemiplegia. The evaluation methodology consisted of sit-and-reach test, goniometry and equilibrium test. The treatment procedure consisted of two weekly individual 30-minute sessions covering a period of 16 weeks. Proprioceptive neuromuscular facilitation method was used to increase lower

Crossed cerebellar atrophy in children: a neurologic sequela of extreme prematurity

International Nuclear Information System (INIS)

Rollins, N.K.; Wen, T.S.; Dominguez, R.

1995-01-01

We retrospectively identified eight children, aged 8 months to 13 years, in whom cerebellar atrophy associated with cerebral injury was diagnosed on MR or CT, and reviewed their past medical history, neurologic findings, and neuroimaging studies. Seven patients were born extremely premature, EGA 25-28 weeks, and had severe perinatal intracranial hemorrhage. Neurologic problems include severe developmental delay in seven, spastic paresis in six, and seizures in five. Neuroimaging showed severe unilaterial holohemispheric atrophy in four, bilateral asymmetric holohemispheric atrophy in two, and left temporoparietal atrophy in one. Cerebellar atrophy was unilateral in five and bilateral but asymmetric in two. Gliosis of the atrophic cerebellum occurred in one patient. Sequential neuroimaging in one patient showed evolution of crossed cerebellar atrophy at 8 months of age. The final patient, a term infant, had an idiopathic perinatal left cerebral infarct. (orig./MG)

Evaluation of cerebral metabolism in patients with unilateral carotid stenosis by proton MR spectroscopy: a correlative study with cerebral hemodynamics by acetazolamide stress brain perfusion SPECT (acz-SPECT)

International Nuclear Information System (INIS)

Kim, Jae Seung; Kim, Geun Eun; Lee, Jeong Hee; Kim, Do Gyun; Kim, Sang Tae; Lee, Hee Kyung

2001-01-01

Carotid stenosis may lead not only to cerebral hemodynamic compromise but also cerebral metabolic changes without overt infarction. To investigate the brain metabolic changes as a result of hemodynamic compromise in pts with carotid stenosis, we compared the changes in metabolism of the gray and white matter detected by proton MRS with cortical hemodynamics measured by Acz-SPECT. We prospectively studied symptomatic 18 pts (M/F=15/3, mean ages: 64.4y) with unilateral carotid stenosis. All pts underwent Acz-SPECT and MRS with 3 days. rCBF and rCVR of MCA territory were assessed by Acz-SPECT. Hemodynamic compromise was graded as stage 0 (normal rCBF and rCVR), stage 1 (normal rCBF and reduced rCVR), and stage 2( reduced rCBF and rCVR). Brain metabolism was assessed by measuring the peaks of N-acetyl aspartate (NAA), choline (Cho), and the sum of creatine and phosphocreatine (Cr) from noninfarcted white matter in the both centrum semiovales and gray matter in both MCA territories. On Acz-SPECT, 7 pts showed stage 2 were significantly lower than in pts with stage 0 (p<0.01). The asymmetric ratio of NAA/Cr in pts with state 2 was also significantly lower than in pts with stage 1(p<0.05). The asymmetric ratio of Cho/Cr was increased as hemodynamic stage increased but the differences were not statistically significant among 3 stages. In cortical gray matter, the asymmetric ratios of NAA/Cho and NAA/Cr were decreased statistically significant among 3 stages. In cortical gray matter, the asymmetric ratios of NAA/Cho and NAA/Cr were decreased and that of Cho/Cr was increased as hemodynamic stage increased. However, these differences were not statistically significant among 3 stages. The asymmetric ratios of NAA/Cho of centrum semiovale in pts with reduced rCBF and/or reduced rCVR were lower than in pts with normal perfusion. Our results indicate the metabolic changes detected by proton MRS in patients with carotid stenosis reflect a hemodynamic compromised state

Converging cellular themes for the hereditary spastic paraplegias.

Science.gov (United States)

Blackstone, Craig

2018-05-10

Hereditary spastic paraplegias (HSPs) are neurologic disorders characterized by prominent lower-extremity spasticity, resulting from a length-dependent axonopathy of corticospinal upper motor neurons. They are among the most genetically-diverse neurologic disorders, with >80 distinct genetic loci and over 60 identified genes. Studies investigating the molecular pathogenesis underlying HSPs have emphasized the importance of converging cellular pathogenic themes in the most common forms of HSP, providing compelling targets for therapy. Most notably, these include organelle shaping and biogenesis as well as membrane and cargo trafficking. Published by Elsevier Ltd.

Botulinum therapy for poststroke spasticity of the lower extremity (clinical cases

Directory of Open Access Journals (Sweden)

L. V. Krylova

2014-01-01

Full Text Available The paper deals with the topical problem – the medical rehabilitation of patients with poststroke spasticity. It describes clinical cases of patients with poststroke spasticity of the upper and lower extremities who have received combined therapy using botulinum toxin type A (Botox injections.

Tropical spastic paraparesis in Northeastern Brazil

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C. M. de Castro Costa

1989-06-01

Full Text Available Ten possible cases of tropical spastic paraparesis (TSP in Northeastern Brazil (Ceará are presented. They show the typical symptoms and signs of TSP consisting of weakness of the lower limbs, spastic gait, hiperreflexia, bladder dysfunction and variable signs of posterior columns impairment. The laboratory examinations excluded other compressive, infective, degenerative or demyelinating lesions of their spinal cord. Our patients age ranged from 21 to 59 years, all were of black origin and all were of lower social class. There was a slight preponderance of females. An etiological implication of a retrovirus (HTLV-I has been shown for TSP, but for lack of technical conditions we could not determine it in our patients, and that stands as our subsequent step in those and further cases.

Videofluoroscopic assessment in children with severe cerebral palsy presenting with dysphagia

International Nuclear Information System (INIS)

Wright, R.E.R.; Wright, F.R.; Carson, C.A.

1996-01-01

In this study 16 patients with severe spastic cerebral palsy with an age range between 6 months and 16 years were examined using videofluoroscopy and a modified barium meal. All patients were slow, inefficient eaters. Silent aspiration was demonstrated in five cases. The latter five patients demonstrated a delayed swallow reflex but there was little correlation between aspiration and the oral phase of deglutition. Our data confirms the impression that early diagnostic workup including videofluoroscopy is helpful in managing the feeding difficulties in these children, and may prevent chronic aspiration and malnutrition. (orig.). With 2 tabs

Videofluoroscopic assessment in children with severe cerebral palsy presenting with dysphagia

Energy Technology Data Exchange (ETDEWEB)

Wright, R.E.R. [Ulster Hospital, Belfast (United Kingdom); Wright, F.R. [Ulster Hospital, Belfast (United Kingdom); Carson, C.A. [Ulster Hospital, Belfast (United Kingdom)

1996-10-01

In this study 16 patients with severe spastic cerebral palsy with an age range between 6 months and 16 years were examined using videofluoroscopy and a modified barium meal. All patients were slow, inefficient eaters. Silent aspiration was demonstrated in five cases. The latter five patients demonstrated a delayed swallow reflex but there was little correlation between aspiration and the oral phase of deglutition. Our data confirms the impression that early diagnostic workup including videofluoroscopy is helpful in managing the feeding difficulties in these children, and may prevent chronic aspiration and malnutrition. (orig.). With 2 tabs.

Symmetry of fMRI activation in the primary sensorimotor cortex during unilateral chewing.

Science.gov (United States)

Lotze, M; Domin, M; Kordass, B

2017-05-01

Functional magnetic resonance imaging (fMRI) is one of the most advanced techniques to analyze the cerebral effects on many behavior aspects of the oral system such as chewing and mastication. Studies on imaging of the cerebral representation of chewing demonstrated differential results with respect to cortical lateralization during unilateral chewing. The aim of our study is to clarify the effects of cerebral responses during unilateral chewing. We used fMRI to compare brain activities during occlusal function in centric occlusion on natural teeth and chewing on a gum located on the right or the left teeth in 15 healthy subjects. Group data were performed by Talairach normalization and in addition by an assignment of activation maxima to individual anatomical landmarks in order to avoid possible loss of spatial preciseness of activation sites by normalization procedures. Evaluation of group data by Talairach normalization revealed representation sites for occlusal movements in bilateral primary (S1) and secondary (S2) somatosensory cortices, primary motor (M1) and premotor cortices, supplementary motor area (SMA) and medial cingulate gyrus, bilateral anterior cerebellar hemispheres and vermis, insula, orbitofrontal cortex, thalamus, and left pallidum. Right-sided chewing showed no differential activation to left-sided chewing, and both showed activation in areas also involved in bilateral occlusion. Both techniques, the one based on group normalization and the one based on an individual evaluation method, revealed remarkable low differences in activation maximum location in the primary motor, the primary and secondary somatosensory cortices, and the anterior cerebellar lobe. All chewing movements tested involved bilateral sensorimotor activation without a significant lateralization of activation intensities. Overall, a general lateralization of occlusion movements to the dominant side could not be verified in the present study. Chewing on the left or on the right

Biomechanical analysis of countermovement jump in people with cerebral palsy Análisis biomecánico del salto vertical con contramovimiento en personas con parálisis cerebral

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K. Gianikellis

2010-09-01

Full Text Available

The main purpose of the study was to evaluate the patterns of the developed ground reaction forces in the two – legged countermovement jumping, performed by persons affected by tetraparesis with ataxia, tetraparesis with athetosis, tetraparesis with spasticity, diplegia with spasticity, right and left hemiplegia and, finally, right and left hemiparesis. After twenty subjects jumped on the surface of a force plate analysis of the ground reaction force – time trend took place. The obtained results confirm the accomplishment of the biomechanical principle of the initial force as in the case of persons not affected by neurological disorders. Finally the calculated ratio between the breaking impulse and the acceleration impulse is very near to optimum values.
KEY WORDS: cerebral palsy, biomechanics, countermovement jump.

El valor óptimo del impulso de aceleración en el salto vertical con contra -movimiento, es aproximadamente tres veces superior al impulso de “frenaje”. El objetivo de este estudio ha sido investigar el modo de actuación de la cadena biocinemática del tren inferior en el salto vertical con contra -movimiento para personas afectadas por parálisis cerebral, concretamente, tetraparesia con ataxia, tetraparesia con atetosis, tetraparesia con espasticidad, diplegia con espasticidad, hemiplegia izquierda y derecha, y finalmente, hemiparesia izquierda y derecha. Para ello, se han analizado las fuerzas de reacción de veintitrés sujetos que han realizado saltos con contramovimiento sobre una plataforma de fuerzas. El hallazgo de un valor medio de la ratio entre el impulso de “frenaje” y el de aceleración muy próximo al valor teórico para los veintitrés sujetos con diferentes síntomas de parálisis cerebral, confirma el principio de la fuerza inicial mientras que el alto coeficiente de variación de los parámetros utilizados en este estudio confirma la esperada

Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study.

Science.gov (United States)

Krewer, Carmen; Hartl, Sandra; Müller, Friedemann; Koenig, Eberhard

2014-06-01

To investigate short-term and long-term effects of repetitive peripheral magnetic stimulation (rpMS) on spasticity and motor function. Monocentric, randomized, double-blind, sham-controlled trial. Neurologic rehabilitation hospital. Patients (N=66) with severe hemiparesis and mild to moderate spasticity resulting from a stroke or a traumatic brain injury. The average time ± SD since injury for the intervention groups was 26 ± 71 weeks or 37 ± 82 weeks. rpMS for 20 minutes or sham stimulation with subsequent occupational therapy for 20 minutes, 2 times a day, over a 2-week period. Modified Tardieu Scale and Fugl-Meyer Assessment (arm score), assessed before therapy, at the end of the 2-week treatment period, and 2 weeks after study treatment. Additionally, the Tardieu Scale was assessed after the first and before the third therapy session to determine any short-term effects. Spasticity (Tardieu >0) was present in 83% of wrist flexors, 62% of elbow flexors, 44% of elbow extensors, and 10% of wrist extensors. Compared with the sham stimulation group, the rpMS group showed short-term effects on spasticity for wrist flexors (P=.048), and long-term effects for elbow extensors (P<.045). Arm motor function (rpMS group: median 5 [4-27]; sham group: median 4 [4-9]) did not significantly change over the study period in either group, whereas rpMS had a positive effect on sensory function. Therapy with rpMS increases sensory function in patients with severe limb paresis. The magnetic stimulation, however, has limited effect on spasticity and no effect on motor function. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The nature of arm movement in children with cerebral palsy when using computer-generated exercise games.

Science.gov (United States)

Weightman, Andrew; Preston, Nick; Levesley, Martin; Bhakta, Bipin; Holt, Raymond; Mon-Williams, Mark

2014-05-01

To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices. A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick's end point and the participant's shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group. Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants. Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems. A kinematic analysis of upper limb function of children with CP when using joystick devices is presented. Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement. The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the

Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by {sup 99m}Tc-HMPAO SPECT

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Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru [Kushiro Neurosurgical Hospital, Hokkaido (Japan); Aburano, Tamio

2000-02-01

Cerebral blood flow (CBF) measured by {sup 99m}Tc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in

Positron emission tomographic localization of left-sided unilateral spatial agnosia

International Nuclear Information System (INIS)

Tagawa, Koichi; Nagata, Ken; Shishido, Fumio; Uemura, Kazuo

1986-01-01

Positron emission tomography (PET) was used to clarify the localization and the underlying mechanisms of left-sided unilateral spatial agnosia (LUSA). Eleven right-handed patients with cerebral infarction in the territory of the right middle cerebral artery who had LUSA were included in this study. Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO 2 ) were measured with PET using 15 O steady state method. Sixteen right-handed patients with cerebral infarction who did not exhibit LUSA served as a control group. The mean local values of CBF and CMRO 2 in the control group were 37.4 ml/100 ml tissue/min and 2.66 ml/100 ml tissue/min, respectively. By contrast, those values of CBF and CMRO 2 in the patients with LUSA were 21.7 ml/100 ml tissue/min and 1.43 ml/100 ml tissue/min, respectively. Both CBF and CMRO 2 in the right posterior parietal region were significantly lower in the patients with LUSA as compared with the control group (p 2 between 1.8 and 2.2 ml/100 ml tissue/min. These ranges of CBF and CMRO 2 in the right parietal region were considered to include the threshold level producing LUSA. The CMRO 2 values were more stabilized in the course of cerebral infarction as compared with the CBF values which may be variable on account of luxury perfusion syndrome. The right posterior parietal CMRO 2 values less than 2.0 ml/100 ml tissue/min was considered to be critical in causing LUSA. The above results may suggest that severe damages of CBF and metabolism in the posterior part of the right parietal lobe play an important role in the occurrence of LUSA. (J.P.N.)

Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation.

Science.gov (United States)

Rose, Jessica; Cahill-Rowley, Katelyn; Butler, Erin E

2017-11-01

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait. © 2017 International Center for Artificial Organs and

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

Directory of Open Access Journals (Sweden)

Fernando Farcetta Junior

2010-01-01

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.

Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy.

Science.gov (United States)

Tseng, Sung-Hui; Chen, Hung-Chou; Tam, Ka-Wai

2013-01-01

To evaluate the literature on the efficacy of equine assisted activities and therapies (EAAT) on gross motor outcomes representing the ICF component of body functions and activity in children with cerebral palsy (CP). We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies of hippotherapy (HPOT) and therapeutic horseback riding (TR) for children with spastic CP. Gross motor outcomes, assessed via muscle activity and muscle tone, gait, posture and Gross Motor Function Measures (GMFM) were evaluated. Five TR studies and nine HPOT studies were included. Our meta-analysis indicated that short-term HPOT (total riding time 8-10 min) significantly reduced asymmetrical activity of the hip adductor muscles. HPOT could improve postural control in children with spastic CP, GMFCS level < 5. However, the evidence did not show a statistically significant effect on GMFM after long-term HPOT or TR (total riding time, 8-22 h) in children with spastic CP. This systematic review found insufficient evidence to support the claim that long-term TR or HPOT provide a significant benefit to children with spastic CP. We found no statistically significant evidence of either therapeutic effect or maintenance effects on the gross motor activity status in CP children.

Co-60 and Ca-45 autoradiography in cerebral ischemia in the rat

NARCIS (Netherlands)

Stevens, H; Krop-van Gastel, W; Korf, J

1998-01-01

Radioisotopes of divalent Co (Co-57 in Single photon emission tomography (SPECT)and Co-55 in positron emission tomography (PET) have clinically been applied to visualize Ca related brain damage. The cerebral uptake of Ca-45 and Co-60 in a unilateral stroke model in the rat was compared; 100 mu Ci

The effect of Sativex in neuropathic pain and spasticity in spinal cord injury

DEFF Research Database (Denmark)

Andresen, Sven Robert; Hansen, Rikke Bod Middelhede; Johansen, Inger Lauge

2014-01-01

Introduction: Neuropathic pain and spasticity after spinal cord injury represent significant but still unresolved problems, which cause considerable suffering and reduced quality of life for patients with spinal cord injury. Treatment of neuropathic pain and spasticity is complicated and patients...... often receive incomplete relief from present available and recommended treatment. Cannabinoids has shown efficacy on both neuropathic pain and spasticity in patients with spinal cord injury, but the studies one the topic has been too small to make a general conclusion for patients with spinal cord...... injury. Aims: To investigate the effect of Sativex (cannabinoid agonist given as an oral mucosal spray), on neuropathic pain and spasticity in patients with spinal cord injury. Methods: A randomized, double-blind, placebo-controlled crossover study. We will include 30 patients with neuropathic pain...

Decreased contribution from afferent feedback to the soleus muscle during walking in patients with spastic stroke

DEFF Research Database (Denmark)

Mazzaro, Nazarena; Nielsen, Jørgen Feldbæk; Grey, Michael James

2007-01-01

We investigated the contribution of afferent feedback to the soleus (SOL) muscle activity during the stance phase of walking in patients with spastic stroke. A total of 24 patients with hemiparetic spastic stroke and age-matched healthy volunteers participated in the study. A robotic actuator...... by the Ashworth score. These results indicate that although the stretch reflex response is facilitated during spastic gait, the contribution of afferent feedback to the ongoing locomotor SOL activity is depressed in patients with spastic stroke....

Hereditary spastic paraplegia and amyotrophy associated with a novel locus on chromosome 19

Science.gov (United States)

Meilleur, K.G.; Traoré, M.; Sangaré, M.; Britton, A.; Landouré, G.; Coulibaly, S.; Niaré, B.; Mochel, F.; La Pean, A.; Rafferty, I.; Watts, C.; Littleton-Kearney, M. T.; Blackstone, C.; Singleton, A.; Fischbeck, K.H.

2010-01-01

We identified a family in Mali with two sisters affected by spastic paraplegia. In addition to spasticity and weakness of the lower limbs, the patients had marked atrophy of the distal upper extremities. Homozygosity mapping using single nucleotide polymorphism arrays showed that the sisters shared a region of extended homozygosity at chromosome 19p13.11-q12 that was not shared by controls. These findings indicate a clinically and genetically distinct form of hereditary spastic paraplegia with amyotrophy, designated SPG43. PMID:20039086

Acetazolamide stimulation test in patients with unilateral internal carotid artery stenosis using Tc-99m HMPAO SPECT and transcranial doppler sonography

Energy Technology Data Exchange (ETDEWEB)

Hyun, I. Y.; Na, J. H. [Inha University Hospital, Incheon (Korea, Republic of)

2007-07-01

We compared perfusion reserve by acetazolamide (ACZ) challenged brain perfusion SPECT and cerebral vasoreactivity (CVR) by transcranial Doppler sonography (TCD) in patients with unilateral internal carotid artery stenosis. This study was conducted prospectively in 37 consecutive patients with angiographically proven unilateral internal carotid artery stenosis (stenosis> 50%). We estimated % CVR (100? {l_brace}post-ACZ mean velocity (cm/sec) - Pre-ACZ mean velocity (cm/sec){r_brace} / pre-ACZ mean velocity) by TCD. The % CVR was compared with perfusion reserve of SPECT. The % CVR of MCA and ICA was significantly decreased in the ipsilateral side to the carotid stenosis (p<0.05). The CVR impairment was more severe when cerebral infarct is already developed (p<0.01). There was a significant correlation between the degree of carotid stenosis and the CVR (p<0.01). In the area of impaired perfusion reserve on the SPECT, the estimated CVR by TCD was significantly lower (p<0.05), even to the negative value, implying that there is actually steal phenomenon in that area. ACZ challenge can actually decrease cerebral blood flow in the area of impaired perfusion reserve on brain SPECT. So we should be very cautiously performing in ACZ challenge especially when there is a severe carotid stenosis because there is a possibility of developing hemodynamic stroke.

Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture.

Science.gov (United States)

Thibaut, A; Wannez, S; Deltombe, T; Martens, G; Laureys, S; Chatelle, C

2018-01-01

Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC). 109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT = 0-3 and high PT = 4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake. We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4 sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On

Cerebral palsy in eastern Denmark: declining birth prevalence but increasing numbers of unilateral cerebral palsy in birth year period 1986-1998

DEFF Research Database (Denmark)

Ravn, Susanne Holst; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data...... are registered. The total cerebral palsy birth prevalence has been significantly decreasing since the birth period 1983-1986 with 3.0 per 1000 live births until the period 1995-1998 with 2.1 per 1000 live births. The overall decrease was seen in preterm infants (...

Cerebral palsy in eastern Denmark: declining birth prevalence but increasing numbers of unilateral cerebral palsy in birth year period 1986-1998

DEFF Research Database (Denmark)

Ravn, Susanne Holst; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data are regis......The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data...

Treating cerebral palsy with aculaser therapy

Science.gov (United States)

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

2008-03-01

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

Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Science.gov (United States)

Delabastita, Tijs; Desloovere, Kaat; Meyns, Pieter

2016-01-01

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in

Fetal MRI demonstrates glioependymal cyst in a case of sonographic unilateral ventriculomegaly

International Nuclear Information System (INIS)

Muehler, Matthias R.; Hartmann, Christian; Werner, Walter; Meyer, Oliver; Bollmann, Rainer; Klingebiel, Randolf

2007-01-01

We report a fetus of 28 weeks' gestation in which ultrasonography demonstrated unilateral ventriculomegaly and microcephaly. Fetal MRI demonstrated a simple, left paramedian occipital cyst with rarefaction of the corpus callosum and thinning of the adjacent cortical mantle. Ischaemia was suggested as the underlying pathogenesis, but autopsy after termination of pregnancy revealed a glioependymal cyst. This case highlights consideration of the rare diagnosis of glioependymal cyst when a cystic lesion associated with cerebral malformations, particularly dysgenesis of the corpus callosum, is demonstrated and fetal MRI suggests an ischaemic origin. (orig.)

Metabolite changes in the ipsilateral and contralateral cerebral hemispheres in rats with middle cerebral artery occlusion

Directory of Open Access Journals (Sweden)

Lei Ruan

2017-01-01

Full Text Available Cerebral ischemia not only causes pathological changes in the ischemic areas but also induces a series of secondary changes in more distal brain regions (such as the contralateral cerebral hemisphere. The impact of supratentorial lesions, which are the most common type of lesion, on the contralateral cerebellum has been studied in patients by positron emission tomography, single photon emission computed tomography, magnetic resonance imaging and diffusion tensor imaging. In the present study, we investigated metabolite changes in the contralateral cerebral hemisphere after supratentorial unilateral ischemia using nuclear magnetic resonance spectroscopy-based metabonomics. The permanent middle cerebral artery occlusion model of ischemic stroke was established in rats. Rats were randomly divided into the middle cerebral artery occlusion 1-, 3-, 9- and 24-hour groups and the sham group. 1H nuclear magnetic resonance spectroscopy was used to detect metabolites in the left and right cerebral hemispheres. Compared with the sham group, the concentrations of lactate, alanine, γ-aminobutyric acid, choline and glycine in the ischemic cerebral hemisphere were increased in the acute stage, while the concentrations of N-acetyl aspartate, creatinine, glutamate and aspartate were decreased. This demonstrates that there is an upregulation of anaerobic glycolysis (shown by the increase in lactate, a perturbation of choline metabolism (suggested by the increase in choline, neuronal cell damage (shown by the decrease in N-acetyl aspartate and neurotransmitter imbalance (evidenced by the increase in γ-aminobutyric acid and glycine and by the decrease in glutamate and aspartate in the acute stage of cerebral ischemia. In the contralateral hemisphere, the concentrations of lactate, alanine, glycine, choline and aspartate were increased, while the concentrations of γ-aminobutyric acid, glutamate and creatinine were decreased. This suggests that there is a

Muscle specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

DEFF Research Database (Denmark)

Olesen, Annesofie Thorup; Jensen, Bente Rona; Uhlendorf, Toni L

2014-01-01

length, passive stiffness and passive force of spastic GA were decreased whereas those of spastic SO were increased. No mechanical interaction between the calf muscles and TA was found. As GA was lengthened, force from SO and PL declined despite a constant muscle-tendon unit length of SO and PL. However......, the extent of this interaction was not different in the spastic rats. In conclusion, the effects of spasticity on length-force characteristics were muscle specific. The changes seen for GA and PL muscles are consistent with the changes in limb mechanics reported for human patients. Our results indicate......The purpose of the present study was to investigate muscle mechanical properties and mechanical interaction between muscles in the lower hindlimb of the spastic mutant rat. Length-force characteristics of gastrocnemius (GA), soleus (SO) and plantaris (PL) were assessed in anesthetized spastic...

The Transcranial Doppler Sonography for Optimal Monitoring and Optimization of Cerebral Perfusion in Aortic Arch Surgery: A Case Series.

Science.gov (United States)

Ghazy, Tamer; Darwisch, Ayham; Schmidt, Torsten; Nguyen, Phong; Elmihy, Sohaila; Fajfrova, Zuzana; Zickmüller, Claudia; Matschke, Klaus; Kappert, Utz

2017-06-16

To analyze the feasibility and advantages of transcranial doppler sonography (TCD) for monitoring and optimization of selective cerebral perfusion (SCP) in aortic arch surgery. From April 2013 to April 2014, nine patients with extensive aortic pathology underwent surgery under moderate hypothermic cardiac arrest with unilateral antegrade SCP under TCD monitoring in our institution. Adequate sonographic window and visualization of circle of Willis were to be confirmed. Intraoperatively, a cerebral cross-filling of the contralateral cerebral arteries on the unilateral SCP was to be confirmed with TCD. If no cross-filling was confirmed, an optimization of the SCP was performed via increasing cerebral flow and increasing PCO2. If not successful, the SCP was to be switched to bilateral perfusion. Air bubble hits were recorded at the termination of SCP. A sonographic window was confirmed in all patients. Procedural success was 100%. The mean operative time was 298 ± 89 minutes. Adequate cross-filling was confirmed in 8 patients. In 1 patient, inadequate cross-filling was detected by TCD and an optimization of cerebral flow was necessary, which was successfully confirmed by TCD. There was no conversion to bilateral perfusion. Extensive air bubble hits were confirmed in 1 patient, who suffered a postoperative stroke. The 30-day mortality rate was 0. Conclusion: The TCD is feasible for cerebral perfusion monitoring in aortic surgery. It enables a confirmation of adequacy of cerebral perfusion strategy or the need for its optimization. Documentation of calcific or air-bubble hits might add insight into patients suffering postoperative neurological deficits.

SPECT measurements of cerebral blood volume before and after acetazolamide in occlusive cerebrovascular diseases

International Nuclear Information System (INIS)

Inoue, Yusuke; Momose, Toshimitsu; Machida, Kikuo; Honda, Norinari; Nishikawa, Junichi; Sasaki, Yasuhito.

1994-01-01

Cerebral blood volume before and after acetazolamide was measured by SPECT to evaluate cerebral vasodilatory capacity in eight patients with cerebrovascular disease and five control subjects. Two SPECT measurements were performed serially, and acetazolamide was administered between them. The ratio of increase in hemispheric blood volume was calculated, and it was compared with the results of cerebral blood flow and cerebral blood volume measurements. A cerebral vasodilatory capacity map, the image after acetazolamide minus the baseline image, was also produced. Acetazolamide increased hemispheric blood volume in all subjects. The ratio of increase was lower in the involved hemispheres of the patients with unilateral carotid disease than in the uninvolved hemispheres of the patients and control subjects. The ratio of concordance with blood flow and blood volume measurements was approximated at 80%. Cerebral vasodilatory capacity mapping revealed three defects compatible with the clinical data. SPECT measurements of cerebral blood volume after acetazolamide can be performed following baseline SPECT with no additional radiotracer, and may be helpful to assess hemodynamic status. (author)

Unilateral delayed opercularization in a case of Sotos' syndrome (cerebral gigantism)

International Nuclear Information System (INIS)

Barth, P.G.; Vlasveld, L.; Valk, J.

1980-01-01

A case of Sotos' syndrome (cerebral gigantism) is described. Pneumencephalography, performed at the age of 15 days, revealed abnormal separation of the opercula on the right. By comparing the contours with developmental anatomical features of this area it agreed with a foetal development of 24 weeks gestational age. Bilateral carotid angiography was normal. CT showed normal development of the Sylvian area at the age of 27 months. (orig.)

Cerebral Palsy: Comprehensive Review and Update

International Nuclear Information System (INIS)

Jan, Mohammed M.S.

2006-01-01

Cerebral palsy (CP) is a common pediatric disorder occurring in about 2 to 2.5 per 1000 live births. It is a chronic motor disorder resulting from a nonprogressive (static) insult to the developing brain. CP is the clinical presentation of a wide variety of cerebral cortical or sub-cortical insults occurring during the first year of life. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the commonest risk factor. Children with CP suffer multiple problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Screening for those conditions should be part of the initial assessment. The child with CP is best cared for with an individualized treatment plan that provides a combination of interventions. This requires the provision of a number of family-centered services that make a difference in the lives of these children and their families. Management of spasticity can be challenging with a wide variety of possible therapeutic interventions. The treatment must be goal oriented, such as to assist with mobility, reduce or prevent contractures, improve positioning and hygiene, and provide comfort. Each member of the child's multidisciplinary team, including the child and both parents, should participate in the serial evaluations and treatment planning. (author)

Neglect-like characteristics of developmental disregard in children with cerebral palsy revealed by event related potentials

NARCIS (Netherlands)

Zielinski, I.M.; Steenbergen, B.; Baas, C.M.; Aarts, P.B.M.; Jongsma, M.L.A.

2014-01-01

Background Children with unilateral Cerebral Palsy (CP) often show diminished awareness of the remaining capacity of their affected upper limb. This phenomenon is known as Developmental Disregard (DD). DD has been explained by operant conditioning. Alternatively, DD can be described as a

Genetics Home Reference: spastic paraplegia type 7

Science.gov (United States)

... in the arms; speech difficulties (dysarthria); difficulty swallowing (dysphagia); involuntary movements of the eyes (nystagmus); mild hearing ... AH, Warner TT. A clinical, genetic and biochemical study of SPG7 mutations in hereditary spastic paraplegia. Brain. ...

How to Perfuse: Concepts of Cerebral Protection during Arch Replacement

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Andreas Habertheuer

2015-01-01

Full Text Available Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP and retrograde cerebral perfusion (RCP. Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data.

How to Perfuse: Concepts of Cerebral Protection during Arch Replacement

Science.gov (United States)

Habertheuer, Andreas; Wiedemann, Dominik; Kocher, Alfred; Laufer, Guenther; Vallabhajosyula, Prashanth

2015-01-01

Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA) or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data. PMID:26713319

Cerebral Myiasis Associated with Artificial Cranioplasty Flap: A Case Report.

Science.gov (United States)

Giri, Sachin Ashok; Kotecha, Nitin; Giri, Deepali; Diyora, Batuk; Nayak, Naren; Sharma, Alok

2016-03-01

Cranioplasty is a commonly performed procedure for the repair of cranial defects. Various materials have been used for this procedure and have a good safety profile. Human cerebral myiasis is an exceedingly rare condition. It involves the invasion of live or dead human tissues by larvae of the insect species dipterous. We describe the first case of cerebral myiasis associated with an artificial cranioplasty bone flap. There was delayed cerebral cortex infestation of the species dipterous after cranioplasty with polymethyl methacrylate bone flap. The patient initially presented with an acute subdural hematoma and contaminated, comminuted frontal bone fracture that required craniectomy with interval cranioplasty at 3 months. Two years after the index procedure, the patient presented for neurosurgical follow-up because of 2 months of nonhealing ulcers and a foul smell emanating from the cranioplasty site, as well as acute onset of unilateral arm and leg weakness. Surgical exploration found live larvae invading the dura and cerebral cortex, an area that was thoroughly debrided with good outcomes for the patient. Cerebral myiasis can be managed via surgical and antibiotic therapy to obtain a good clinical outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review

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Rowland Marie

2009-12-01

Full Text Available Abstract Background Cannabis therapy has been considered an effective treatment for spasticity, although clinical reports of symptom reduction in multiple sclerosis (MS describe mixed outcomes. Recently introduced therapies of combined Δ9-tetrahydrocannabinol (THC and cannabidiol (CBD extracts have potential for symptom relief with the possibility of reducing intoxication and other side effects. Although several past reviews have suggested that cannabinoid therapy provides a therapeutic benefit for symptoms of MS, none have presented a methodical investigation of newer cannabinoid treatments in MS-related spasticity. The purpose of the present review was to systematically evaluate the effectiveness of combined THC and CBD extracts on MS-related spasticity in order to increase understanding of the treatment's potential effectiveness, safety and limitations. Methods We reviewed MEDLINE/PubMed, Ovid, and CENTRAL electronic databases for relevant studies using randomized controlled trials. Studies were included only if a combination of THC and CBD extracts was used, and if pre- and post-treatment assessments of spasticity were reported. Results Six studies were systematically reviewed for treatment dosage and duration, objective and subjective measures of spasticity, and reports of adverse events. Although there was variation in the outcome measures reported in these studies, a trend of reduced spasticity in treated patients was noted. Adverse events were reported in each study, however combined TCH and CBD extracts were generally considered to be well-tolerated. Conclusion We found evidence that combined THC and CBD extracts may provide therapeutic benefit for MS spasticity symptoms. Although some objective measures of spasticity noted improvement trends, there were no changes found to be significant in post-treatment assessments. However, subjective assessment of symptom relief did often show significant improvement post-treatment. Differences in

Reduction in spasticity in stroke patient with paraffin therapy.

Science.gov (United States)

Wang, Jing; Yu, Peng; Zeng, Ming; Gu, Xudong; Liu, Yan; Xiao, Mingyue

2017-01-01

The aim of the study was to confirm whether paraffin therapy offer clinical value in the treatment of spasticity due to stroke. Fifty-two patients with spasticity in the upper limb were included. The patients were randomized into the experimental group with paraffin therapy (n = 27) and the control group with placebo therapy (n = 25). The outcome measures besides temperature examination were undertaken at time points of 0 (T0), 2 (T1) and 4 weeks (T2) following therapy treatment. The extent of spasticity was measured using Modified Ashworth Score (MAS) during passive movement at the shoulder, elbow, wrist and finger joints. Visual analogue scale (VAS) was used to evaluate the hemiplegic upper limb pain and functional activity of the upper limb motor function was evaluated by Brunnstrom recovery stage. All adverse events were recorded. MAS decreased significantly in Exp group compared with Con group, at the time points of T1 and T2, both before and immediately after paraffin therapy. Paraffin treatment failed to show remarkable improvement in pain compared with placebo-treated patient at movement at any time point. But VAS in Exp exhibited a tendency to decrease over time in shoulder, elbow, wrist and hand. With regard to the Brunnstrom score, patients in Exp showed significant improvement at the end of trial compared to the beginning. The values of temperature showed significant increment immediately after paraffin therapy at each time point in Exp group. Paraffin therapy may be a kind of noninvasive, promising method to reduce spasticity of stroke patients.

Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial.

Science.gov (United States)

Kirkpatrick, Emma; Pearse, Janice; James, Peter; Basu, Anna

2016-10-01

To determine whether home-based, parent-delivered therapy comprising action observation (AO) and repeated practice (RP) improves upper limb function more than RP alone in children with unilateral cerebral palsy (UCP). single-blinded parallel-group randomized controlled trial with 1:1 allocation comparing AO+RP (intervention) with RP alone (control). computer-generated, with allocation concealment by opaque sequentially-numbered envelopes. northern England, August 2011 to September 2013. 70 children with UCP; mean age 5.6 years (SD 2.1), 31 female. home-based activities were provided, tailored to interests and abilities. 15 minutes/day, 5 days/week for 3 months. Assisting Hand Assessment (AHA; primary outcome measure), Melbourne Assessment 2 (MA2), and ABILHAND-Kids at baseline, 3 months, and 6 months. Outcome data was available at 3 months for 28 children in the AO+RP group and 31 controls, and at 6 months for 26 and 28 children respectively. There were no between-group differences in AHA, MA2, or ABILHAND-Kids at 3 or 6 months versus baseline (all p>0.05). Combined-group improvements (pMA2 at 3 months, were maintained at 6 months. ABILHAND-Kids also showed improvement at 3 months (p=0.003), maintained at 6 months. Parent-delivered RP (with or without AO) improves upper limb function and could supplement therapist input. © 2016 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Postural Muscle Dyscoordination in Children With Cerebral Palsy

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Jolanda C. van der Heide

2005-01-01

Full Text Available The present paper gives an overview of the knowledge currently available on muscular dyscoordination underlying postural problems in children with cerebral palsy (CP. Such information is a prerequisite for developing successful therapeutic interventions in children with CP. Until now, three children with CP functioning at GMFCS (Gross Motor Function Classification System level V have been documented. The children totally or partially lacked direction specificity in their postural adjustments and could not sit independently for more than 3 seconds. Some children functioning at GMFCS level IV have intact direction-specific adjustments, whereas others have problems in generating consistently direction-specific adjustments. Children at GMFCS levels I to III have an intact basic level of control but have difficulties in fine-tuning the degree of postural muscle contraction to the task-specific conditions, a dysfunction more prominently present in children with bilateral spastic CP than in children with spastic hemiplegia. The problems in the adaptation of the degree of muscle contraction might be the reason that children with CP, more often than typically developing children, show an excess of antagonistic coactivation during difficult balancing tasks and a preference for cranial-caudal recruitment during reaching. This might imply that both stereotypies might be regarded as functional strategies to compensate for the dysfunctional capacity to modulate subtly postural activity.

Cerebral hematocrit decreases with hemodynamic compromise in carotid artery occlusion: a PET study.

Science.gov (United States)

Yamauchi, H; Fukuyama, H; Nagahama, Y; Katsumi, Y; Okazawa, H

1998-01-01

This study investigated whether in patients with internal carotid artery occlusion the regional cerebral hematocrit correlates with cerebral hemodynamics or metabolic state and, if so, how the regional cerebral hematocrit changes in the hemodynamically compromised region. We used positron emission tomography to study seven patients with unilateral internal carotid artery occlusion and no cortical infarction in the chronic stage. The distributions of red blood cell and plasma volumes were assessed using oxygen-15-labeled carbon monoxide and copper-62-labeled human serum albumin-dithiosemicarbazone tracers, respectively. The calculated hematocrit value was compared with the hemodynamic and metabolic parameters measured with the oxygen-15 steady-state technique. In the cerebral cortex, the value of the cerebral hematocrit varied but was correlated with the hemodynamic and metabolic status. Stepwise regression analysis revealed that the large vessel hematocrit, the cerebral metabolic rate of oxygen, and the cerebral blood flow or the oxygen extraction fraction accounted for a significant proportion of variance of the cerebral hematocrit. The oxygen extraction fraction and the cerebral metabolic rate of oxygen negatively correlated with the cerebral hematocrit, whereas the cerebral blood flow correlated positively: patients with reduced blood supply relative to metabolic demand (decreased blood flow with increased oxygen extraction fraction) showed low hematocrit values. In carotid artery occlusion in the chronic stage, regional cerebral hematocrit may vary according to cerebral hemodynamics and metabolic status. Regional cerebral hematocrit may decrease with hemodynamic compromise unless oxygen metabolism concomitantly decreases.

Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy.

Science.gov (United States)

de Gooijer-van de Groep, Karin L; de Vlugt, Erwin; de Groot, Jurriaan H; van der Heijden-Maessen, Hélène C M; Wielheesen, Dennis H M; van Wijlen-Hempel, Rietje M S; Arendzen, J Hans; Meskers, Carel G M

2013-07-23

Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: "spasticity" vs. "contracture"). Differentiation between these components is hard to achieve by common manual tests. We applied an assessment instrument to obtain quantitative measures of neural and non-neural contributions to ankle joint stiffness in CP. Twenty-three adolescents with CP and eleven healthy subjects were seated with their foot fixated to an electrically powered single axis footplate. Passive ramp-and-hold rotations were applied over full ankle range of motion (RoM) at low and high velocities. Subject specific tissue stiffness, viscosity and reflexive torque were estimated from ankle angle, torque and triceps surae EMG activity using a neuromuscular model. In CP, triceps surae reflexive torque was on average 5.7 times larger (p = .002) and tissue stiffness 2.1 times larger (p = .018) compared to controls. High tissue stiffness was associated with reduced RoM (p therapy.

Influence of post-stroke spasticity on EMG-force coupling and force steadiness in biceps brachii.

Science.gov (United States)

Carlyle, Jennilee K; Mochizuki, George

2018-02-01

Individuals with spasticity after stroke experience a decrease in force steadiness which can impact function. Alterations in the strength of EMG-force coupling may contribute to the reduction in force steadiness observed in spasticity. The aim was to determine the extent to which force steadiness and EMG-force coupling is affected by post-stroke spasticity. This cross-sectional study involved individuals with upper limb spasticity after stroke. Participants were required to generate and maintain isometric contractions of the elbow flexors at varying force levels. Coefficient of variation of force, absolute force, EMG-force cross-correlation function peak and peak latency was measured from both limbs with surface electromyography and isometric dynamometry. Statistically significant differences were observed between the affected and less affected limbs for all outcome measures. Significant main effects of force level were also observed. Force steadiness was not statistically significantly correlated with EMG-force coupling; however, both force steadiness and absolute force were associated with the level of impairment as measured by the Chedoke McMaster Stroke Assessment Scale. Spasticity after stroke uncouples the relationship between EMG and force and is associated with reduced force steadiness during isometric contractions; however, these features of control are not associated in individuals with spasticity. Copyright © 2017 Elsevier Ltd. All rights reserved.

NIPA1 mutation in complex hereditary spastic paraplegia with epilepsy

DEFF Research Database (Denmark)

Svenstrup, K; Møller, R S; Christensen, J

2011-01-01

or signs are found. Mutations in the NIPA1 gene have been reported to cause spastic paraplegia type 6 (SPG6) in 10 families. SPG6 is a rare form of autosomal dominantly inherited HSP associated with a pure phenotype; however, in one complex SPG6 family, idiopathic generalized epilepsy (IGE) has been...... described and in addition, recurrent microdeletions at 15q11.2 including NIPA1 have been identified in patients with IGE. The purpose was to identify NIPA1 mutations in patients with pure and complex HSP. Methods: Fifty-two patients with HSP were screened for mutations in NIPA1. Results: One previously...... reported missense mutation c.316G>A, p.Gly106Arg, was identified in a complex HSP patient with spastic dysarthria, facial dystonia, atrophy of the small hand muscles, upper limb spasticity, and presumably IGE. The epilepsy co-segregated with HSP in the family. Conclusion: NIPA1 mutations were rare in our...

1-------------------------_ editorial i van die redaksie

African Journals Online (AJOL)

Spasticity as a clinical phenomenon is generally con- ... 159 cases, including 88 of spastic diplegia treated by .... Intra-operative monitoring of nerve root function by ... the management of cerebral palsy spasticity: a 10-year experience.

A literature review on the efficacy and safety of botulinum toxin: An injection in post-stroke spasticity

Directory of Open Access Journals (Sweden)

Majid Ghasemi

2013-01-01

Full Text Available Background: A variety of techniques for the management of spasticity have been suggested, including positioning, cryotherapy, splinting and casting, biofeedback, electrical stimulation, and medical management by pharmacological agents, Botulinum toxin A (BTA is now the pharmacological treatment of choice in focal spasticity. BTA by blocking acetylcholine release at neuromuscular junctions accounts for its therapeutic action to relieve spasticity. Methods: A computerized search of Pub Med was carried out to find the latest result about efficacy of BTA in management of post stroke spasticity. Result: Among 84 articles were found, frothy of them included in this review and divided to lower and upper extremity. Conclusions: BTA is a treatment choice in reducing tone and managing post stroke spasticity .

Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy.

Science.gov (United States)

El-Shamy, Shamekh Mohamed; Abd El Kafy, Ehab Mohamed

2014-01-01

The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Thirty spastic diplegic cerebral palsied children (10-12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30 min/d, 3 d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p control group (p postural balance control in children with diplegic cerebral palsy.

Dental trauma in individuals with severe cerebral palsy: prevalence and associated factors

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Cristina Batista Miamoto

2011-08-01

Full Text Available The aim of the present study was to determine the prevalence of dental trauma and associated factors among a sample of patients with severe cerebral palsy. The sample was made up of 120 individuals equally divided into two groups. The group with cerebral palsy was made up of 60 patients diagnosed with the spastic form of the disease. The control group was made up of 60 individuals with no mental impairment. Questionnaires were used to collect information on individual, socioeconomic and behavioral characteristics. Dental trauma was assessed based on the clinical chart of each participant, on a questionnaire and on a clinical evaluation to determine past injuries. Mouth mirrors and millimeter periodontal probes (Community Periodontal Index probe were used to measure overjet. Lip seal and breathing type were determined during the clinical exams and interviews. Statistical analysis involved the chi-square test (p < 0.05 and multivariate logistic regression (forward stepwise procedure. The prevalence of dental trauma was greater among individuals with cerebral palsy (18% than in the control group (5%, with the difference achieving statistical significance (p = 0.023. Individuals with lip incompetence had a greater chance of exhibiting dental trauma (OR [CI 95%] = 3.81 [1.19-12.24]. The prevalence of dental trauma among individuals with cerebral palsy was high. A lack of lip seal was identified as a factor directly associated to this prevalence.

Structural Brain Damage and Upper Limb Kinematics in Children with Unilateral Cerebral Palsy

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Lisa Mailleux

2017-12-01

Full Text Available Background: In children with unilateral cerebral palsy (uCP virtually nothing is known on the relation between structural brain damage and upper limb (UL kinematics quantified with three-dimensional movement analysis (3DMA. This explorative study aimed to (1 investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM vs. cortical and deep gray matter (CDGM lesions and (2 to explore the relation between UL kinematics and lesion location and extent within each lesion timing group.Methods: Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of maximum velocity, trajectory straightness], the Arm Profile Score (APS and Arm Variable Scores (AVS were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale.Results: Children with CDGM lesions showed more aberrant spatiotemporal parameters (p < 0.03 and more movement pathology (APS, p = 0.003 compared to the PWM group, mostly characterized by increased wrist flexion (p = 0.01. In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness (r = 0.53–0.90. Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; r = 0.50–0.65 and with the APS (r = 0.51–0.63. In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation (r = 0.35–0.42. Regression analysis

Mania associated with complicated hereditary spastic paraparesis

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Raghavendra B Nayak

2011-01-01

Full Text Available Hereditary spastic paraparesis (HSP is an inherited group of neurological disorders with progressive lower limb spasticity. HSP can be clinically grouped into pure and complicated forms. Pure HSP is one without any associated neurological/psychiatric comorbidity. Depression is the most common psychiatric comorbidity. Presence of mania or bipolar affective illness with HSP is a rare phenomenon. We report a case of a 17-year-old boy who presented with classical features of HSP with complaints of excessive happiness, irritability, increased self-esteem and decreased sleep since 1 month. The patient also had complex partial seizure ever since he had features of HSP. The patient′s father and younger sister suffer from pure HSP. The patient was diagnosed to have first episode mania with complicated HSP. The details of treatment and possible neurobiology are discussed in this case report.

Mania associated with complicated hereditary spastic paraparesis.

Science.gov (United States)

Nayak, Raghavendra B; Bhogale, Govind S; Patil, Nanasaheb M; Pandurangi, Aditya A

2011-07-01

Hereditary spastic paraparesis (HSP) is an inherited group of neurological disorders with progressive lower limb spasticity. HSP can be clinically grouped into pure and complicated forms. Pure HSP is one without any associated neurological/psychiatric comorbidity. Depression is the most common psychiatric comorbidity. Presence of mania or bipolar affective illness with HSP is a rare phenomenon. We report a case of a 17-year-old boy who presented with classical features of HSP with complaints of excessive happiness, irritability, increased self-esteem and decreased sleep since 1 month. The patient also had complex partial seizure ever since he had features of HSP. The patient's father and younger sister suffer from pure HSP. The patient was diagnosed to have first episode mania with complicated HSP. The details of treatment and possible neurobiology are discussed in this case report.

SPG20 mutation in three siblings with familial hereditary spastic paraplegia.

Science.gov (United States)

Dardour, Leila; Roelens, Filip; Race, Valerie; Souche, Erika; Holvoet, Maureen; Devriendt, Koen

2017-07-01

Troyer syndrome (MIM#275900) is an autosomal recessive form of complicated hereditary spastic paraplegia. It is characterized by progressive lower extremity spasticity and weakness, dysarthria, distal amyotrophy, developmental delay, short stature, and subtle skeletal abnormalities. It is caused by deleterious mutations in the SPG20 gene, encoding spartin, on Chromosome 13q13. Until now, six unrelated families with a genetically confirmed diagnosis have been reported. Here we report the clinical findings in three brothers of a consanguineous Moroccan family, aged 24, 17, and 7 yr old, with spastic paraplegia, short stature, motor and cognitive delay, and severe intellectual disability. Targeted exon capture and sequencing showed a homozygous nonsense mutation in the SPG20 gene, c.1369C>T (p.Arg457*), in the three affected boys. © 2017 Dardour et al.; Published by Cold Spring Harbor Laboratory Press.

Flexion synergy overshadows flexor spasticity during reaching in chronic moderate to severe hemiparetic stroke.

Science.gov (United States)

Ellis, Michael D; Schut, Ingrid; Dewald, Julius P A

2017-07-01

Pharmaceutical intervention targets arm flexor spasticity with an often-unsuccessful goal of improving function. Flexion synergy is a related motor impairment that may be inadvertently neglected. Here, flexor spasticity and flexion synergy are disentangled to determine their contributions to reaching dysfunction. Twenty-six individuals participated. A robotic device systematically modulated shoulder abduction loading during ballistic reaching. Elbow muscle electromyography data were partitioned into windows delineated by elbow joint velocity allowing for the separation of synergy- and spasticity-related activation. Reaching velocity decreased with abduction loading (psynergy increased with abduction loading (psynergy is the predominant contributor to reaching dysfunction while flexor spasticity appears only relevant during unnaturally occurring passively supported movement. Interventions targeting flexion synergy should be leveraged in future stroke recovery trials. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Post-activation depression of soleus stretch reflexes in healthy and spastic humans

DEFF Research Database (Denmark)

Grey, Michael James; Klinge, Klaus; Crone, Clarissa

2007-01-01

Reduced depression of transmitter release from Ia afferents following previous activation (post-activation depression) has been suggested to be involved in the pathophysiology of spasticity. However, the effect of this mechanism on the myotatic reflex and its possible contribution to increased...... reflex excitability in spastic participants has not been tested. To investigate these effects, we examined post-activation depression in Soleus H-reflex responses and in mechanically evoked Soleus stretch reflex responses. Stretch reflex responses were evoked with consecutive dorsiflexion perturbations...... of the soleus stretch reflex and H-reflex decreased as the interval between the stimulus/perturbation was decreased. Similarly, the stretch-evoked torque decreased. In the spastic participants, the post-activation depression of both reflexes and the stretch-evoked torque was significantly smaller than...

SACS gene-related autosomal recessive spastic ataxia of Charlevoix-Saguenay from South India

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M Suraj Menon

2016-01-01

Full Text Available Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS is a neurodegenerative disorder characterized by late infantile onset spastic ataxia and other neurological features. Initially described in the Charlevoix-Saguenay region of Quebec, Canada, it is being increasingly reported from many other countries. Here, we present the case of a 20-year-old male from South India, who presented with progressive ataxia, spasticity, and peripheral neuropathy with imaging features and genetic testing suggestive of SACS gene-related ARSACS. The phenotypic variability from other cases and occurrence in a geographically distinct region is stressed upon to alert the clinicians to consider ARSACS in progressive ataxias.

Rehabilitation of teenagers of patients by a cerebral paralysis by facilities of physical culture

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Vindiuk P.A.

2012-08-01

Full Text Available Influence of physical exercises is investigated in combination with mobile games on power supply of organism of teenagers of patients by a cerebral paralysis. In research took part 16 schoolchildren of teens with the spastic cerebral paralysis. For determination of their functional preparedness multivariable express diagnostics of S.A. Dushanin was utillized. It is recommended in the lessons of physical culture to include the specially organized mobile games, elements of cross-country race preparation and employment on exercise bicycle. It is set that an early and successive rehabilitation and physical education is instrumental in maximally complete renewal of the lost functions. It is marked that the index of maximal consumption of oxygen was increased on 7,4%, to the aerobic economy - on 3,1%. It is set that the lessons of physical culture in growth of indexes of functional preparation were instrumental.

Twenty weeks of computer-training improves sense of agency in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Ritterband-Rosenbaum, Anina; Christensen, Mark Schram; Nielsen, Jens Bo

2012-01-01

Children with cerebral palsy (CP) show alteration of perceptual and cognitive abilities in addition to motor and sensory deficits, which may include altered sense of agency. The aim of this study was to evaluate whether 20 weeks of internet-based motor, perceptual and cognitive training enhances...

Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment : A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

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Salavati, M.; Rameckers, E. A. A.; Waninge, A.; Krijnen, W. P.; Steenbergen, B.; van der Schans, C. P.

Purpose: To investigate whether the adapted version of the Gross Motor Function Measure 88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result

[Efficacy of dynamic magnetotherapy with modulation frequency 10Hz in the complex of spa rehabilitation of children with cerebral palsy].

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Gurova, N Iu; Babina, L M

2007-01-01

Two groups of children with cerebral paralysis received combined therapy. Treatment of one of the groups included a course of magnetotherapy (AMO-ATOS unit, 10 Hz) according to the suboccipital-lumbar method, the other group was control (no magnetotherapy). The study of cliniconeurophysiological indices showed significantly higher efficacy of the therapeutic complex with a course of magnetotherapy. The highest beneficial effect was observed on bioelectrogenesis of the brain, rheoencephalographic parameters and clinical manifestation of muscular spasticity.

Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions.

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Rasmussen, Helle Mätzke; Nielsen, Dennis Brandborg; Pedersen, Niels Wisbech; Overgaard, Søren; Holsgaard-Larsen, Anders

2015-07-01

The Gait Deviation Index (GDI) and Gait Profile Score (GPS) are the most used summary measures of gait in children with cerebral palsy (CP). However, the reliability and agreement of these indices have not been investigated, limiting their clinimetric quality for research and clinical practice. The aim of this study was to investigate the intra-rater reliability and agreement of summary measures of gait (GDI; GPS; and the Gait Variable Score (GVS) derived from the GPS). The intra-rater reliability and agreement were investigated across two repeated sessions in 18 children aged 5-12 years diagnosed with spastic CP. No systematic bias was observed between the sessions and no heteroscedasticity was observed in Bland-Altman plots. For the GDI and GPS, excellent reliability with intraclass correlation coefficient (ICC) values of 0.8-0.9 was found, while the GVS was found to have fair to good reliability with ICCs of 0.4-0.7. The agreement for the GDI and the logarithmically transformed GPS, in terms of the standard error of measurement as a percentage of the grand mean (SEM%) varied from 4.1 to 6.7%, whilst the smallest detectable change in percent (SDC%) ranged from 11.3 to 18.5%. For the logarithmically transformed GVS, we found a fair to large variation in SEM% from 7 to 29% and in SDC% from 18 to 81%. The GDI and GPS demonstrated excellent reliability and acceptable agreement proving that they can both be used in research and clinical practice. However, the observed large variability for some of the GVS requires cautious consideration when selecting outcome measures. Copyright © 2015 Elsevier B.V. All rights reserved.

Cautious Use of Intrathecal Baclofen in Walking Spastic Patients: Results on Long-term Follow-up.

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Dones, Ivano; Nazzi, Vittoria; Tringali, Giovanni; Broggi, Giovanni

2006-04-01

Intrathecal baclofen is presently the most effective treatment for diffuse spasticity whatever the cause. The fact that both spasticity is always accompanied by a degree of muscle weakness and that any antispastic treatment causes a decrease in muscle strength indicate that major attention must be paid in treating spasticity in ambulant patients. Methods.  We present here a retrospective study, approved by the insitutional ethics committee, of 22 ambulant spastic patients, selected as homogeneous for disease and disease duration, who were treated with intrathecal baclofen at the Istituto Nazionale Neurologico "C.Besta" in Milan. These patients were followed-up for to 15 years of treatment and their clinical assessment was enriched by the evaluation of their functional independence measurement (FIM) before and during treatment. Results.  There was improvement in quality of life as measured by the FIM scale; however, an increase in the patient's motor performance could not be detected. Conclusion.  Although we did not show any improvement in muscle performance, intrathecal baclofen did improve daily quality of life, even in spastic patients who were able to walk.

HTLV-I associated myelopathy with multiple spotty areas in cerebral white matter and brain stem by MRI

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Hara, Yasuo; Takahashi, Mitsuo; Yoshikawa, Hiroo; Yorifuji, Shirou; Tarui, Seiichiro

1988-01-01

A 48-year-old woman was admitted with complaints of urinary incontinence and gait disturbance, both of which had progressed slowly without any sign of remission. Family history was not contributory. Neurologically, extreme spasticity was recoginized in the lower limbs. Babinski sign was positive bilaterally. Flower-like atypical lymphocytes were seen in blood. Positive anti-HTLV-I antibody was confirmed in serum and spinal fluid by western blot. She was diagnosed as having HTLV-I associated myelopathy (HAM). CT reveald calcification in bilateral globus pallidus, and MRI revealed multiple spotty areas in cerebral white matter and brain stem, but no spinal cord lesion was detectable. Electrophysiologically, brain stem auditory evoked potential (BAEP) suggested the presence of bilateral brain stem lesions. Neither median nor posterior tibial nerve somatosensory evoked potentials were evoked, a finding suggesting the existence of spinal cord lesion. In this case, the lesion was not confined to spinal cord, it was also observed in brain stem and cerebral white matter. Such distinct lesions in cerebral white matter and brain stem have not been reported in patients with HAM. It is suggested that HTLV-I is probably associated with cerebral white matter and brain stem.

Treatment diary for botulinum toxin spasticity treatment

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Biering-Sørensen, Bo; Iversen, Helle K; Frederiksen, Inge M S

2017-01-01

The aim of this study is to develop a treatment diary for patients receiving spasticity treatment including botulinum toxin injection and physiotherapy and/or occupational therapy. The diary focuses on problems triggered by skeletal muscle overactivity; agreed goals for treatment and the patient...

To report a case of unilateral proliferative retinopathy following noncerebral malaria with Plasmodium falciparum in Southern India

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Aditya Verma

2015-01-01

Full Text Available The retinopathy in association with malaria fever described so far includes retinal hemorrhages, vessel changes, retinal discoloration/whitening and papilledema. Malaria retinopathy has been mostly described in severe cases, associated with Plasmodium falciparum, correlating the patho-physiology of retinal and cerebral manifestations. We report an unusual case of proliferative retinopathy as a manifestation of malaria fever, caused by P. falciparum with no cerebral involvement. The patient had features of unilateral retinal vascular occlusion with proliferative changes and vitreous hemorrhage. To the best of our knowledge, such a case has never been reported so far in the literature. This report highlights the possible occurrence of severe proliferative changes associated with malaria fever, which if diagnosed early can prevent possible blindness.

[H reflex in patients with spastic quadriplegia].

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Miyama, Sahoko; Arimoto, Kiyoshi; Kimiya, Satoshi

2009-01-01

Hoffmann reflex (H reflex) is an electrically elicited spinal monosynaptic reflex. H reflex was examined in 18 patients with spastic quadriplegia who had perinatal or postnatal problems. H reflex was elicitable in 11 patients for the abductor pollicis brevis (61.1%), 10 for the abductor digiti minimi (55.6%) and 16 for the abductor hallucis (88.9%). Because the abductor pollicis brevis and the abductor digiti minimi do not exhibit H reflex in normal subjects, it was suggested that the excitability of alpha motor neurons innervating these muscles was increased. H reflex was not detected for the extensor digitorum brevis in any patients, indicating the difference in the excitability among alpha motor neurons. In some patients, H reflex did not disappear under supramaximal stimuli. We conclude that the mechanism of evolution of H reflex in patients with spastic quadriplegia is different from that in normal subjects.

Quantitative perfusion computed tomography measurements of cerebral hemodynamics: Correlation with digital subtraction angiography identified primary and secondary cerebral collaterals in internal carotid artery occlusive disease

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Cheng Xiaoqing; Tian Jianming; Zuo Changjing; Liu Jia; Zhang Qi; Lu Guangming

2012-01-01

Background: The aim of the present study was to assess hemodynamic variations in symptomatic unilateral internal carotid artery occlusion (ICAO) patients with primary collateral flow via circle of Willis or secondary collateral flow via ophthalmic artery and/or leptomeningeal collaterals. Methods: Thirty-eight patients with a symptomatic unilateral ICAO were enrolled in the study. Based on digital subtraction angiography (DSA) findings, patients were classified into 2 groups: primary collateral (n = 14) and secondary collateral (n = 24) groups. Collateral flow hemodynamics were investigated with perfusion computed tomography (PCT) by measuring the cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) in the hemispheres ipsilateral and contralateral to ICAO. Based on the measurements, the ipsilateral to contralateral ratio for each parameter was calculated and compared. Results: Irrespective of the collateral patterns, ipsilateral CBF was not significantly different from that of the contralateral hemisphere (P = 0.285); ipsilateral CBV and TTP was significantly increased compared with those of the contralateral hemisphere (P = 0.000 and P = 0.000 for CBV and TTP, respectively). Furthermore, patients with secondary collaterals had significantly larger ipsilateral-to-contralateral ratios for both CBV (rCBV, P = 0.0197) and TTP (rTTP, P = 0.000) than those of patients with only primary collaterals. These two groups showed no difference in ipsilateral-to-contralateral ratio for CBF (rCBF, P = 0.312). Conclusion: Patients with symptomatic unilateral ICAO in our study were in an autoregulatory vasodilatation status. Moreover, secondary collaterals in ICAO patients were correlated with ipsilateral CBV and delayed TTP that suggested severe hemodynamic impairment, presumably increasing the risk of ischemic events.

Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children.

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Smith, Sabrina E; Vargas, Gray; Cucchiara, Andrew J; Zelonis, Sarah J; Beslow, Lauren A

2015-04-01

Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage. Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared. Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory. Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information. Copyright © 2015 Elsevier Inc. All rights reserved.

Development of postural adjustments during reaching in infants with CP

NARCIS (Netherlands)

Hadders-Algra, M; van der Fits, IBM; Stremmelaar, EF; Touwen, BCL

1999-01-01

The development of postural adjustments during reaching movements was longitudinally studied in seven infants with cerebral palsy (CP) between 4 and 18 months of age. Five infants developed spastic hemiplegia, one spastic tetraplegia, and one spastic tetraplegia with athetosis. Each assessment

Cannabinoids in the management of spasticity associated with multiple sclerosis

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Anna Maria Malfitano

2008-08-01

Full Text Available Anna Maria Malfitano, Maria Chiara Proto, Maurizio BifulcoDipartimento di Scienze Farmaceutiche, Università degli Studi di SalernoAbstract: The endocannabinoid system and cannabinoid-based treatments have been involved in a wide number of diseases. In particular, several studies suggest that cannabinoids and endocannabinoids may have a key role in the pathogenesis and therapy of multiple sclerosis (MS. In this study we highlight the main findings reported in literature about the relevance of cannabinoid drugs in the management and treatment of MS. An increasing body of evidence suggests that cannabinoids have beneficial effects on the symptoms of MS, including spasticity and pain. In this report we focus on the effects of cannabinoids in the relief of spasticity describing the main findings in vivo, in the mouse experimental allergic encephalomyelitis model of MS. We report on the current treatments used to control MS symptoms and the most recent clinical studies based on cannabinoid treatments, although long-term studies are required to establish whether cannabinoids may have a role beyond symptom amelioration in MS.Keywords: cannabinoids, multiple sclerosis, spasticity

Vibration therapy in patients with cerebral palsy: a systematic review

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Ritzmann, Ramona; Stark, Christina; Krause, Anne

2018-01-01

The neurological disorder cerebral palsy (CP) is caused by unprogressive lesions of the immature brain and affects movement, posture, and the musculoskeletal system. Vibration therapy (VT) is increasingly used to reduce the signs and symptoms associated with this developmental disability. The purpose of this narrative review was systematically to appraise published research regarding acute and long-term effects of VT on functional, neuromuscular, and structural parameters. Systematic searches of three electronic databases identified 28 studies that fulfilled the inclusion criteria. Studies were analyzed to determine participant characteristics, VT-treatment protocols, effect on gross motor function (GMF), strength, gait, posture, mobility, spasticity, reflex excitability, muscle tone, mass, and bone strength within this population, and outcome measures used to evaluate effects. The results revealed that one acute session of VT reduces reflex excitability, spasticity, and coordination deficits. Subsequently, VT has a positive effect on the ability to move, manifested for GMF, strength, gait, and mobility in patients with CP. Effects persist up to 30 minutes after VT. Long-term effects of VT manifest as reduced muscle tone and spasticity occurring concomitantly with improved movement ability in regard to GMF, strength, gait, and mobility, as well as increased muscle mass and bone-mineral density. Posture control remained unaffected by VT. In conclusion, the acute and chronic application of VT as a nonpharmacological approach has the potential to ameliorate CP symptoms, achieving functional and structural adaptations associated with significant improvements in daily living. Even though further studies including adult populations validating the neuromuscular mechanisms underlying the aforementioned adaptations should be fostered, growing scientific evidence supports the effectiveness of VT in regard to supplementing conventional treatments (physiotherapy and drugs

Windmill-task as a New Quantitative and Objective Assessment for Mirror Movements in Unilateral Cerebral Palsy: A Pilot Study.

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Zielinski, Ingar Marie; Steenbergen, Bert; Schmidt, Anna; Klingels, Katrijn; Simon Martinez, Cristina; de Water, Pascal; Hoare, Brian

2018-03-23

To introduce the Windmill-task, a new objective assessment tool to quantify the presence of mirror movements (MMs) in children with unilateral cerebral palsy (UCP), which are typically assessed with the observation-based Woods and Teuber scale (W&T). Prospective, observational, cohort pilot study. Children's hospital. Prospective cohort of children (N=23) with UCP (age range, 6-15y, mean age, 10.5±2.7y). Not applicable. The concurrent validity of the Windmill-task is assessed, and the sensitivity and specificity for MM detection are compared between both assessments. To assess the concurrent validity, Windmill-task data are compared with W&T data using Spearman rank correlations (ρ) for 2 conditions: affected hand moving vs less affected hand moving. Sensitivity and specificity are compared by measuring the mean percentage of children being assessed inconsistently across both assessments. Outcomes of both assessments correlated significantly (affected hand moving: ρ=.520; P=.005; less affected hand moving: ρ=.488; P=.009). However, many children displayed MMs on the Windmill-task, but not on the W&T (sensitivity: affected hand moving: 27.5%; less affected hand moving: 40.6%). Only 2 children displayed MMs on the W&T, but not on the Windmill-task (specificity: affected hand moving: 2.9%; less affected hand moving: 1.4%). The Windmill-task seems to be a valid tool to assess MMs in children with UCP and has an additional advantage of sensitivity to detect MMs. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Overview of Four Functional Classification Systems Commonly Used in Cerebral Palsy

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Andrea Paulson

2017-04-01

Full Text Available Cerebral palsy (CP is the most common physical disability in childhood. CP comprises a heterogeneous group of disorders that can result in spasticity, dystonia, muscle contractures, weakness and coordination difficulty that ultimately affects the ability to control movements. Traditionally, CP has been classified using a combination of the motor type and the topographical distribution, as well as subjective severity level. Imprecise terms such as these tell very little about what a person is able to do functionally and can impair clear communication between providers. More recently, classification systems have been created employing a simple ordinal grading system of functional performance. These systems allow a more precise discussion between providers, as well as better subject stratification for research. The goal of this review is to describe four common functional classification systems for cerebral palsy: the Gross Motor Function Classification System (GMFCS, the Manual Ability Classification System (MACS, the Communication Function Classification System (CFCS, and the Eating and Drinking Ability Classification System (EDACS. These measures are all standardized, reliable, and complementary to one another.

Cirurgia da catarata infantil unilateral Unilateral pediatric cataract surgery

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Adriana Maria Drummond Brandão

2008-04-01

Full Text Available OBJETIVO: Analisar os resultados visuais de uma série de crianças operadas de catarata unilateral. MÉTODOS: Um estudo retrospectivo foi realizado através da análise de 35 prontuários médicos do Serviço de Catarata Congênita da UNIFESP/EPM. RESULTADOS: Quanto à etiologia, a primeira causa de catarata foi idiopática, a segunda causa foi o trauma e a terceira foi a rubéola congênita. Em 51,4% dos olhos tinham acuidade visual pré-operatória de ausência de fixação. E em 42,8% dos casos operados a acuidade visual final foi igual ou melhor que 20/200. DISCUSSÃO: Embora a cirurgia em catarata unilateral seja motivo de controvérsias entre os oftalmologistas, obteve-se melhora de acuidade visual em número significativo de casos.PURPOSE: To analyze the results in a series of children submitted to unilateral cataract surgery. METHODS: A retrospective study was conducted through the analysis of 35 patient files from the Congenital Cataract Service of UNIFESP/EPM. RESULTS: The main cause of unilateral cataract was idiopathic, the second cause was ocular trauma and the third cause was congenital rubella. Initial visual acuity was very poor in 51.4% of the cases (did not fix or follow, and the best corrected final visual acuity was better than 20/200 in 42.8% of the eyes. DISCUSSION: Although controversial, the surgical treatment of unilateral cataract, in this study, showed improvement in many cases.

Neuroimpairment, activity limitation, and participation restriction among children with cerebral palsy in Hong Kong.

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Chan, H S S; Lau, P H B; Fong, K H; Poon, D; Lam, C C C

2005-10-01

To study children with cerebral palsy in Hong Kong, their neuroimpairment, activity limitation, and participation restriction in society. Parents' opinion on current medical and rehabilitation services was also sought. Systematic survey using questionnaires. Four associations in Hong Kong: Child Assessment Service, Hong Kong Association for Parents of Children with Physical Disabilities, Association of Parents of the Severely Mentally Handicapped, and Hong Kong Physically Handicapped and Able-Bodied Association. Parents of children with cerebral palsy. Neuroimpairment, activity limitation, and participation restriction. Information from 181 children with cerebral palsy was analysed. Among them, 56% were boys. The mean age was 7 years 6 months (standard deviation, 3 years 11 months). The most common diagnostic type was spastic cerebral palsy. Co-morbidities in children with cerebral palsy were common. Limitation in daily activities including mobility and self-care tasks was considerable and this posed great stress to parents when taking care of their children. Children's participation in both social and leisure activities was regarded as a low priority. A high percentage (70%) of parents reported difficulty in travelling. The reasons involved problems in transportation, building access (entry and exit), and attitudes of the general public. These environmental factors restricted the social participation of the children and their families. Over 75% of parents were satisfied with the current medical and rehabilitation services. Children with cerebral palsy have multiple and complex needs. The findings of this study may serve as a reference for parents, service providers, and policy makers to work in partnership to achieve a more comprehensive health-care service for children with cerebral palsy and to facilitate better integration into the community.

Sport-specific fitness testing and intervention for an adolescent with cerebral palsy: a case report.

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Kenyon, Lisa K; Sleeper, Mark D; Tovin, Melissa M

2010-01-01

This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy. The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling. Scores on all tests and measures were higher after the intervention. The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy.

Use of Hybrid Assistive Limb (HAL®) for a postoperative patient with cerebral palsy: a case report.

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Mataki, Yuki; Kamada, Hiroshi; Mutsuzaki, Hirotaka; Shimizu, Yukiyo; Takeuchi, Ryoko; Mizukami, Masafumi; Yoshikawa, Kenichi; Takahashi, Kazushi; Matsuda, Mayumi; Iwasaki, Nobuaki; Kawamoto, Hiroaki; Wadano, Yasuyoshi; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-03-27

The Hybrid Assistive Limb (HAL ® ) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery. We report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased. Hybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting.

[The optimization of an early rehabilitation program for cerebral stroke patients: the use of different methods of magneto- and laser therapy].

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Kochetkov, A V; Gorbunov, F E; Minenkov, A A; Strel'tsova, E N; Filina, T F; Krupennikov, A I

2000-01-01

Magnetotherapy and laser therapy were used in complex and complex-combined regimens in 75 patients after cerebral ischemic or hemorrhagic stroke starting on the poststroke week 4-5. Clinico-neurologic, neurophysiological and cerebrohemodynamic findings evidence for the highest effectiveness of neurorehabilitation including complex magneto-laser therapy in hemispheric ischemic and hemorrhagic stroke of subcortical location in the absence of marked clinico-tomographic signs of dyscirculatory encephalopathy. Complex-combined magneto-laser therapy is more effective for correction of spastic dystonia. Mutual potentiation of magnetotherapy and laser therapy results in maximal development of collateral circulation and cerebral hemodynamic reserve (84% of the patients). Complex effects manifest in arteriodilating and venotonic effects. Complex magneto-laser therapy is accompanied by reduction of hyperthrombocythemia and hyperfibrinogenemia.

Co-segregation of Huntington disease and hereditary spastic paraplegia in 4 generations.

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Panas, Marios; Karadima, Georgia; Kalfakis, Nikolaos; Vassilopoulos, Dimitris

2011-07-01

Huntington disease (HD) is an autosomal dominant neurodegenerative disease characterized by choreic hyperkinesias, cognitive decline, and psychiatric manifestations, caused by an increased number of CAG repeats in the IT15 gene on chromosome 4p16.3. Silver syndrome is a rare autosomal dominant form of complicated hereditary spastic paraplegia, characterized by lower limb spasticity in addition to amyotrophy of the small muscles of the hands. In addition to the previously identified locus SPG17 on chromosome 11q12-q14, a new locus (SPG38) on chromosome 4p16-p15 has been recently identified, a region that includes the HD gene. We present a Greek family with 5 members diagnosed with HD in 4 generations. All affected members also presented with clinical features of Silver syndrome showing severe spastic paraplegia and prominent atrophy of all small hand muscles bilaterally. None of the other family members showed features of either HD or spastic paraplegia. The reported coexistence of Silver syndrome with HD in 4 generations is not fortuitous, suggesting that these 2 distinct genetic disorders are in linkage disequilibrium. Although rare, it is reasonable to expect additional similar cases. Clinical neurologists should perhaps investigate this possibility in cases combining features of HD and involvement of the upper and lower motor neurons.

Unilateral delayed opercularization in a case of Sotos' syndrome (cerebral gigantism)

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Barth, P.G.; Vlasveld, L.; Valk, J.

1980-08-01

A case of Sotos' syndrome (cerebral gigantism) is described. Pneumencephalography, performed at the age of 15 days, revealed abnormal separation of the opercula on the right. By comparing the contours with developmental anatomical features of this area it agreed with a foetal development of 24 weeks gestational age. Bilateral carotid angiography was normal. CT showed normal development of the Sylvian area at the age of 27 months.

Aculaser therapy for the treatment of cerebral palsy

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

2012-03-01

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

Effects of Nintendo Wii™ Training on Occupational Performance, Balance, and Daily Living Activities in Children with Spastic Hemiplegic Cerebral Palsy: A Single-Blind and Randomized Trial.

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Atasavun Uysal, Songül; Baltaci, Gül

2016-10-05

This study aimed at assessing how the addition of Nintendo Wii ™ (NW) system to the traditional therapy influences occupational performance, balance, and daily living activities in children with spastic hemiplegic Cerebral Palsy (CP). The present study is a single-blind and randomized trial involving 24 children aged 6-14 years, classified as level I or II on the Gross Motor Function Classification System. The children were allocated into two groups: an intervention and a control group, and their families participated in the study. The activity performance analysis of the children was undertaken by using the Canadian Occupational Performance Measure (COPM), functional balance was measured with the Pediatric Balance Scale (PBS), and activities of daily living were assessed with Pediatric Evaluation of Disability Inventory (PEDI). Twenty-four children with CP were randomly divided into two groups: intervention (n = 12) and control group (n = 12). All children in both groups continued their traditional physiotherapy program twice a week, 45 minutes per session, whereas the participants in the intervention group, additionally, were trained with NW, two other days of the week for 12 weeks, with each session lasting for 30 minutes. Self-care, mobility, PEDI total, PBS, and performance of COPM scores increased in the NW group after intervention. Self-care, mobility, and total PEDI increased in the control group as well. However, there was no statistically significant difference found between the groups, except for PBS (P < 0.05). NW contributed to the implementation of occupational performance, daily living activities, and functional balance. We recommend that NW could be used in the rehabilitation program to engage play-based activities with fun.

A preliminary study of the effect of restricted gastrocnemius length on foot kinematics and plantar pressure patterns during gait in children with Cerebral Palsy

DEFF Research Database (Denmark)

Curtis, Derek

2008-01-01

  Summary/conclusion Kinematic foot modelling and pedobarography are complementary measurement methods for measuring foot biomechanics in children with cerebral palsy (CP). Pedobarography appears to be the most sensitive instrument measuring significantly decreased hindfoot and increased lateral......, range, 9-18 yrs) was tested twice using an EMED pedobarograph and a Vicon motion analysis system using the Oxford kinematic foot model to test the repeatability of the measurement methods and generate normal data. 8 children (4 girls, 4 boys, mean ± SD, 12 ± 2 yrs, range 8-15yr) with spastic CP...... forefoot mean plantar pressure and force in the children with gastrocnemius contracture, whilst the corresponding changes in foot kinematics were non-significant.   Introduction Foot deformity is common in CP and is often due to hypertonia and contracture in spastic muscles. The aim of this study...

Transcranial and spinal cord magnetic stimulation in treatment of spasticity: a literature review and meta-analysis.

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Korzhova, Julia; Sinitsyn, Dmitry; Chervyakov, Alexander; Poydasheva, Alexandra; Zakharova, Maria; Suponeva, Natalia; Chernikova, Lyudmila; Piradov, Michael

2018-02-01

Spasticity is associated with various diseases of the nervous system. Current treatments such as drug therapy, botulinum toxin injections, kinesitherapy, and physiotherapy are not sufficiently effective in a large number of patients. Transcranial magnetic stimulation (TMS) can be considered as an alternative method of treatment. The purpose of this article was to conduct a systematic review and meta-analysis of all available publications assessing the efficacy of repetitive TMS in treatment of spasticity. Search for articles was conducted in databases PubMed, Willey, and Google. Keywords included "TMS", "spasticity", "TMS and spasticity", "non-invasive brain stimulation", and "non-invasive spinal cord stimulation". The difference in scores according to the Modified Ashworth Scale (MAS) for one joint before and after treatment was taken as the effect size. We found 26 articles that examined the TMS efficacy in treatment of spasticity. Meta-analysis included 6 trials comprising 149 patients who underwent real stimulation or simulation. No statistically significant difference in the effect of real and simulated stimulation was found in stroke patients. In patients with spinal cord injury and spasticity, the mean effect size value and the 95% confidence interval were -0.80 and (-1.12, -0.49), respectively, in a group of real stimulation; in the case of simulated stimulation, these parameters were 0.15 and (-0.30, -0.00), respectively. Statistically significant differences between groups of real stimulation and simulation were demonstrated for using high-frequency repetitive TMS or iTBS mode for the M1 area of the spastic leg (P=0.0002). According to the meta-analysis, the statistically significant effect of TMS in the form of reduced spasticity was demonstrated only for the developed due to lesions at the brain stem and spinal cord level. To clarify the amount of the antispasmodic effect of repetitive TMS at other lesion levels, in particular in patients with

Neural tension technique is no different from random passive movements in reducing spasticity in patients with traumatic brain injury

DEFF Research Database (Denmark)

Lorentzen, Jakob; Nielsen, Dorthe; Holm, Karl

2012-01-01

Purpose: Neural tension technique (NTT) is a therapy believed to reduce spasticity and to increase range of motion (ROM). This study compared the ability of NTT and random passive movements (RPMs) to reduce spasticity in the knee flexors in 10 spastic patients with brain injury. Methods: An RCT...

Effects on locomotion and memory in 2 models of cerebral hypoperfusion in male Wistar rats.

Science.gov (United States)

Martínez-Díaz, J A; García, L I; Hernández, M E; Aranda-Abreu, G E

2015-09-01

Cerebral ischaemia is one of the most common neurological diseases worldwide. Its many sequelae range from motor and sensory symptoms to cognitive decline and dementia. Animal models of cerebral ischaemia/hypoperfusion elicit effects on long term memory; however, the effects of these procedures on short term memory are not clearly understood and effects induced by alternative hypoperfusion models are completely unknown. We evaluated the effects of 2 cerebral hyperperfusion models on memory in 3-month-old male rats. Episodic memory and working memory were assessed using the new object recognition test and the spontaneous alteration test, respectively. Neurological assessment was also performed, along with an open field test to evaluate locomotor activity. Rats in both hyperperfusion models displayed no cognitive changes. Rats with unilateral left-sided ligation plus temporary ligation of the right carotid tended to show slightly impaired performance on the new object recognition test on the second day after the procedure. In contrast, the group with permanent unilateral ligation tended to display alterations in working and episodic memory 9 days after the procedure, but they subsequently recovered. Despite these differences, both hypoperfusion groups displayed clear signs of motor impairment 2 days after the procedure, as reflected by their decreased locomotor activity during the open field test. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

Science.gov (United States)

Mailleux, Lisa; Klingels, Katrijn; Fiori, Simona; Simon-Martinez, Cristina; Demaerel, Philippe; Locus, Marlies; Fosseprez, Eva; Boyd, Roslyn N; Guzzetta, Andrea; Ortibus, Els; Feys, Hilde

2017-09-01

Upper limb (UL) function in children with unilateral cerebral palsy (CP) vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assessed whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N = 2), periventricular white matter (PWM, N = 42) and cortical and deep grey matter (CDGM, N = 29) lesions. Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at body function and activity level. CDGM lesions were more pronounced compared to PWM lesions (p = 0.0003). Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (r s  = -0.39 to r s  = -0.84) compared to the PWM group (r rb  = -0.42 to r s  = -0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p < 0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p < 0.03) in the PWM group. In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like corticospinal tract (re)organization and structural connectivity may play an additional role. Copyright © 2017 European Paediatric Neurology Society. All rights reserved.

Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

Directory of Open Access Journals (Sweden)

Egen-Lappe V

2013-03-01

Full Text Available Veronika Egen-Lappe, Ingrid Köster, Ingrid SchubertPMV Research Group, Department of Child and Adolescence Psychiatry and Psychotherapy, University of Cologne, Cologne, GermanyBackground: Spasticity after stroke has been internationally recognized as an important health problem causing impairment of mobility, deformity, and pain. The aim of this study was to assess the frequency of first-ever and recurrent stroke and of subsequent spastic and flaccid paresis. Factors influencing the development of spasticity were analyzed. A further major aim was to provide a "real-life" assessment of the treatment of spasticity in Germany and to discuss this in view of the treatment recommended by German and international clinical guidelines.Methods: The database used in this study comprised a cohort of 242,090 insurants from a large statutory health insurance fund in the federal state of Hesse, Germany. A first hospital discharge diagnosis in 2009 with any of the International Classification of Diseases, Tenth Revision (ICD-10 codes I60–I64 was used to identify patients with acute stroke (hemorrhage and ischemic. These patients were followed up six months after stroke to monitor whether they developed spastic or flaccid paresis (hospital or ambulatory care diagnoses ICD-10 code G81–G83 [excluding G82.6/G83.4/G83.8]. For patients with spastic paresis after stroke the spasticity treatment was analyzed for a six-month period (physiotherapy, oral muscle relaxants, intrathecal baclofen, and botulinum toxin.Results: Standardized to the population of Germany, 3.7 per 1000 persons suffered a stroke in 2009 (raw 5.2/1000. Of all surviving patients, 10.2% developed spasticity within 6 months. Cox regression revealed no significant influence of patient age, gender, morbidity (diabetes, hypertensive diseases, ischemic heart diseases or type of stroke on development of spasticity. 97% of surviving patients with spasticity received physiotherapy (inpatient care 89

No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy.

Science.gov (United States)

Alhusaini, Adel A A; Crosbie, Jack; Shepherd, Roberta B; Dean, Catherine M; Scheinberg, Adam

2011-06-01

Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function. The aim of this study was to investigate non-neurally mediated calf-muscle tightness in children with cerebral palsy (CP) before and after botulinum toxin type A (BoNT-A) injection. Sixteen children with spastic CP (seven females, nine males; eight at Gross Motor Function Classification System level I, eight at level II; age range 4-10 y) and calf muscle spasticity were tested before and during the pharmaceutically active phase after injection of BoNT-A. Measures of passive muscle compliance and viscoelastic responses, hysteresis, and the gradient of the torque-angle curve were computed and compared before and after injection. Although there was a slight, but significant increase in ankle range of motion after BoNT-A injection and a small, significant decrease in the torque required to achieve plantigrade and 5° of dorsiflexion, no significant difference in myotendinous stiffness or hysteresis were detected after BoNT-A injection. Despite any effect on neurally mediated responses, the compliance of the calf muscle was not changed and the muscle continued to offer significant resistance to passive motion of the ankle. These findings suggest that additional treatment approaches are required to supplement the effects of BoNT-A injections when managing children with calf muscle spasticity. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

UNILATERAL ACTINOMYCOTIC TUBO-OVARIAN ABSCESS COMPLICATED WITH CEREBRITIS – A CASE REPORT

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Marina Jakimovska

2018-02-01

Full Text Available Background: Tuboovarian abscess is a serious complication of pelvic inflammatory disease. Pelvic ac- tinomycosis may correlate with long term use of intra-uterine device (IUD, but is uncom- mon cause of inflammation, except in postmenopausal IUD users.1, 2 Tuboovarian abscess complicated with cerebritis is relatively uncommon condition. Methods: We present a rare case of a 56-years-old woman with IUD, developing tuboovarian abscess that complicated with cerebritis. Twenty days before admittance to the Gynecologic clinic, she complained of fatigue and nausea, anorexia, vomiting and diarrhea. After an initial improvement for 5 days her symptoms recurred, profounded with sweating and fever up to 40 °C, leg weakness and walking difficulties, and weight loss. In that condition she was presented to our emergency room. There was no history of chronic disease. The patient had an IUD for the past 30 years. On physical examination the abdomen was tender, but without signs of peritoneal irritation. Laboratory studies revealed elevated CRP (107 mg/L, ESR (65mm/h and normal number of leukocytes (7.8 × 109/L. Ultrasound showed 8x4 cm left infraumbilical septated mass suspect for tubo-ovarian abscess.. She was hospitalized, IUD was removed and Metronidazol, Ciprofloxacin and Gentamycin were started parenterally. Tumor markers were negative. On the next day she developed neurologic symptoms with blindness and left-hemiparesis. MR angiography and CT of the head revealed local brain edema, suspect for cerebritis. Although the laboratory findings of inflammation were de- creasing, we changed the antimicrobial therapy with Cefotaxime and Kloksacilin (Orbenin instead of Metronidazol and Ciprofloxacin because of better blood-brain barrier transport. Cerebrospinal fluid tests for HSV, neurotropic viruses, malignant cells, TBC, echinoccocus, toxoplasmosis, cysticercosis, pathogenic bacteria, fungi, TILR2, and TNF alfa were nega- tive. A brain biopsy was preformed and

Congenital Cytomegalovirus among Children with Cerebral Palsy.

Science.gov (United States)

Smithers-Sheedy, Hayley; Raynes-Greenow, Camille; Badawi, Nadia; Fernandez, Marian A; Kesson, Alison; McIntyre, Sarah; Leung, Kin-Chuen; Jones, Cheryl A

2017-02-01

To determine the proportion of children with cerebral palsy (CP) and cytomegalovirus (CMV) DNA detected retrospectively in their newborn screening cards (NBSC), to compare the proportion of children with CMV DNA in their NBSC across spastic subtypes of CP, and to compare the sex and other characteristics of children with CP and CMV detected on their NSBC with those in whom CMV DNA was not detected. Retrospective observational study. Data were extracted from patient records on children with CP (birth years 1996-2014) from 2 Australian state CP registers and state-wide paediatric rehabilitation services with consent. NBSCs were retrospectively analyzed for CMV DNA by nested polymerase chain reaction (PCR) using primers against gB. Positive samples were validated using real time PCR for CMV UL83. Of 401 children recruited, 323 (80.5%) had an available NBSC. Of these, 31 (9.6%; 95% CI, 6.8-13.3) tested positive for CMV DNA by nested PCR for CMV gB, of whom 28 (8.7%; 95% CI, 6.1-12.2) also had CMV DNA detected by real-time PCR for CMV UL83. Detection of CMV DNA was significantly associated with epilepsy, but not with clinical or epidemiologic characteristics, including sex and pattern of spasticity. CMV viremia in the newborn period, indicating congenital CMV infection, is highly prevalent among children with CP. Further research is needed to investigate the mechanisms and contribution of congenital CMV to the causal pathways to CP. Copyright © 2016 Elsevier Inc. All rights reserved.

Flexed-knee gait in children with cerebral palsy.

Science.gov (United States)

Church, C; Ge, J; Hager, S; Haumont, T; Lennon, N; Niiler, T; Hulbert, R; Miller, F

2018-04-01

Aims The purpose of this study was to evaluate the long-term outcome of adolescents with cerebral palsy who have undergone single-event multilevel surgery for a flexed-knee gait, followed into young adulthood using 3D motion analysis. Patients and Methods A total of 59 young adults with spastic cerebral palsy, with a mean age of 26 years (sd 3), were enrolled into the study in which their gait was compared with an evaluation that had taken place a mean of 12 years (sd 2) previously. At their visits during adolescence, the children walked with excessive flexion of the knee at initial contact and surgical or therapeutic interventions were not controlled between visits. Results Based on the change in flexed-knee gait over approximately ten years, improvements were seen in increased Gait Deviation Index (p gait (p = 0.007) suggested a mild decline in function. Quality-of-life measures showed that these patients fell within normal limits compared with typical young adults in areas other than physical function. Conclusion While some small significant changes were noted, little clinically significant change was seen in function and gait, with gross motor function maintained between adolescence and young adulthood. Cite this article: Bone Joint J 2018;100-B:549-56.

Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

Science.gov (United States)

Lorente Fernández, L; Monte Boquet, E; Pérez-Miralles, F; Gil Gómez, I; Escutia Roig, M; Boscá Blasco, I; Poveda Andrés, J L; Casanova-Estruch, B

2014-06-01

Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children

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Tugumisirize Joshua

2010-04-01

Full Text Available Abstract Background Cerebral malaria is the most severe neurological complication of falciparum malaria and a leading cause of death and neuro-disability in sub-Saharan Africa. This study aimed to describe functional deficits and behaviour problems in children who survived cerebral malaria with severe neurological sequelae and identify patterns of brain injury. Findings Records of children attending a specialist child neurology clinic in Uganda with severe neurological sequelae following cerebral malaria between January 2007 and December 2008 were examined to describe deficits in gross motor function, speech, vision and hearing, behaviour problems or epilepsy. Deficits were classified according to the time of development and whether their distribution suggested a focal or generalized injury. Any resolution during the observation period was also documented. Thirty children with probable exposure to cerebral malaria attended the clinic. Referral information was inadequate to exclude other diagnoses in 7 children and these were excluded. In the remaining 23 patients, the commonest severe deficits were spastic motor weakness (14, loss of speech (14, hearing deficit (9, behaviour problems (11, epilepsy (12, blindness (12 and severe cognitive impairment (9. Behaviour problems included hyperactivity, impulsiveness and inattentiveness as in attention deficit hyperactivity disorder (ADHD and conduct disorders with aggressive, self injurious or destructive behaviour. Two patterns were observed; a immediate onset deficits present on discharge and b late onset deficits. Some deficits e.g. blindness, resolved within 6 months while others e.g. speech, showed little improvement over the 6-months follow-up. Conclusions In addition to previously described neurological and cognitive sequelae, severe behaviour problems may follow cerebral malaria in children. The observed differences in patterns of sequelae may be due to different pathogenic mechanisms, brain

[A case of medulla oblongata compression by tortuous vertebral arteries presenting with spastic quadriplegia].

Science.gov (United States)

Kamada, Takashi; Tateishi, Takahisa; Yamashita, Tamayo; Nagata, Shinji; Ohyagi, Yasumasa; Kira, Jun-Ichi

2013-01-01

We report a 58-year-old man showing spastic paraparesis due to medulla oblongata compression by tortuous vertebral arteries. He noticed weakness of both legs and gait disturbance at the age of 58 years and his symptoms progressively worsened during the following several months. General physical findings were normal. Blood pressure was normal and there were no signs of arteriosclerosis. Neurological examination on admission revealed lower-limb-dominant spasticity in all four extremities, lower-limb weakness, hyperreflexia in all extremities with positive Wartenberg's, Babinski's and Chaddock's signs, mild hypesthesia and hypopallesthesia in both lower limbs, and spastic gait. Cranial nerves were all normal. Serum was negative for antibodies against human T-cell lymphotropic virus-1 antibody. Nerve conduction and needle electromyographic studies of all four limbs revealed normal findings. Cervical, thoracic and lumbo-sacral magnetic resonance imaging (MRI) findings were all normal. Brain MRI and magnetic resonance angiography demonstrated bilateral tortuous vertebral arteries compressing the medulla oblongata. Neurovascular decompression of the right vertebral artery was performed because compression of the right side was more severe than that of the left side. Post-operative MRI revealed outward translocation of the right vertebral artery and relieved compression of the medulla oblongata on the right side. The patient's symptoms and neurological findings improved gradually after the operation. Bilateral pyramidal tract signs without cranial nerve dysfunction due to compression of the medulla oblongata by tortuous vertebral arteries are extremely rare and clinically indistinguishable from hereditary spastic paraplegia (HSP). Although we did not perform a genetic test for HSP, we consider that the spastic paraparesis and mild lower-limb hypesthesia were caused by compression of the medulla oblongata by bilateral tortuous vertebral arteries based on the post

Skeletal Maturation and Mineralisation of Children with Moderate to Severe Spastic Quadriplegia

Science.gov (United States)

Sitaraman, Sadasivan

2016-01-01

Introduction Diminished bone mineral density and delayed skeletal maturation are common in children with spastic quadriplegia. Aim The purpose of our study was to evaluate the Bone Mineral Density (BMD) of children with moderate to severe spastic quadriplegia and its relationship with other variables like nutrition and growth. Materials and Methods This was a hospital based, cross- sectional, case-control study. Forty-two (28 males, 14 females) children with spastic quadriplegia and 42 (24 males, 18 females) healthy children were included in the study. BMD of cases and control were measured by Dual Energy X-ray Absorptiometry (DEXA). Radiographs of left hand and wrist of cases and controls were taken and bone age was determined. Results BMD values of upper extremity, lower extremity, thoraco-lumbar spine and pelvis in cases were lower than those of controls (p quadriplegia and nutritional status is an important contributing factor. PMID:27504366

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma.

Science.gov (United States)

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer-specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer-specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p =0.11). Bilateral mastectomy did not provide a clinically or statistically significant breast cancer-specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy.

Modified Ashworth Scale (MAS) Model based on Clinical Data Measurement towards Quantitative Evaluation of Upper Limb Spasticity

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Puzi, A. Ahmad; Sidek, S. N.; Mat Rosly, H.; Daud, N.; Yusof, H. Md

2017-11-01

Spasticity is common symptom presented amongst people with sensorimotor disabilities. Imbalanced signals from the central nervous systems (CNS) which are composed of the brain and spinal cord to the muscles ultimately leading to the injury and death of motor neurons. In clinical practice, the therapist assesses muscle spasticity using a standard assessment tool like Modified Ashworth Scale (MAS), Modified Tardiue Scale (MTS) or Fugl-Meyer Assessment (FMA). This is done subjectively based on the experience and perception of the therapist subjected to the patient fatigue level and body posture. However, the inconsistency in the assessment is prevalent and could affect the efficacy of the rehabilitation process. Thus, the aim of this paper is to describe the methodology of data collection and the quantitative model of MAS developed to satisfy its description. Two subjects with MAS of 2 and 3 spasticity levels were involved in the clinical data measurement. Their level of spasticity was verified by expert therapist using current practice. Data collection was established using mechanical system equipped with data acquisition system and LABVIEW software. The procedure engaged repeated series of flexion of the affected arm that was moved against the platform using a lever mechanism and performed by the therapist. The data was then analyzed to investigate the characteristics of spasticity signal in correspondence to the MAS description. Experimental results revealed that the methodology used to quantify spasticity satisfied the MAS tool requirement according to the description. Therefore, the result is crucial and useful towards the development of formal spasticity quantification model.

Tilt table standing for reducing spasticity after spinal cord injury.

Science.gov (United States)

Bohannon, R W

1993-10-01

A patient with a T12 spinal cord injury and intractable extensor spasms of the lower extremities participated in tilt table standing trial on 5 nonconsecutive days to determine if the intervention would affect his spasticity and spasms. Each day's standing trial was followed by an immediate reduction in lower extremity spasticity (measured using the modified Ashworth scale and pendulum testing). Standing was also accompanied by a reduction in spasms that lasted until the following morning. The reduction of spasms was particularly advantageous to the performance of car transfers. Tilt table standing merits further examination as a physical treatment of spasms that accompany central nervous system lesions.

Fitzsimmons Syndrome: Spastic Paraplegia, Brachydactyly, and Cognitive Impairment

NARCIS (Netherlands)

Armour, Christine M.; Humphreys, Peter; Hennekam, Raoul C. M.; Boycott, Kym M.

2009-01-01

Fitzsimmons syndrome is an infrequently described entity comprising slowly progressive spastic paraplegia, brachydactyly, and cone-shaped epiphyses, dysarthria, and low-normal intelligence. Five patients with this syndrome have been reported. The cause remains unknown. Here we describe a 16-year-old

Comparison of the Effect of Neuromuscular Electrical Stimulation ...

African Journals Online (AJOL)

Children with cerebral palsy (CP) often demonstrate poor hand function due to spasticity. Thus spasticity in the wrist and finger flexors poses a great deal of functional limitations. This study was therefore designed to compare the effectiveness of Cryotherapy and Neuromuscular Electrical Stimulation (NMES) on spasticity ...

The use of transcutaneous electrical nerve stimulation (tens in the treatment of the spasticity - a review

Directory of Open Access Journals (Sweden)

Dahyan Wagner da Silva Silveira

2008-01-01

Full Text Available This study it has as objective to argue the job of TENS in the spasticity, observing the main parameters, form of application and the mechanism for which TENS it acts in the spasticity. One is about a bibliographical revision based in the literature specialized selected scientific articles through search in the data base of scielo and of bireme, from the sources Medline and Lilacs. The studies found on the job of TENS in the spasticity, had pointed mainly that this chain reduces the spasticity significantly, in lower degrees. The stimulation electrical parameters had disclosed that TENS it (about 100Hz of raised frequency provides one better effect in the reduction of the spasticity. The types of TENS more used had been the conventional and the soon-intense one, however some studies had not presented the used duration of pulse, limit the determination of one better modality of TENS. Few studies had explained the mechanism of performance of the current related one. The ones that had made it, had pointed the release of opioid endogenous (Dynorphins for the central nervous system as main mechanism of performance, however this contrasts with the neurophysiologic bases of the high-frequency stimulation, that demonstrated better resulted in the joined studies. Still it is necessary more studies on the job of this modality of stimulation electrical in the spasticity, since important parameters as duration of pulse, time of application, numbers of attendance and performance mechanism remains without scientific evidence.

Effects of intrathecal baclofen therapy on motor and cognitive functions in a rat model of cerebral palsy.

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Nomura, Sadahiro; Kagawa, Yoshiteru; Kida, Hiroyuki; Maruta, Yuichi; Imoto, Hirochika; Fujii, Masami; Suzuki, Michiyasu

2012-02-01

Cerebral palsy (CP) arises in the early stages of brain development and manifests as spastic paresis that is often associated with cognitive dysfunction. Available CP treatments are aimed at the management of spasticity and include botulinum toxin administration, selective dorsal rhizotomy, and intrathecal baclofen (ITB). In this study, the authors investigated whether the management of spasticity with ITB therapy affected motor function and whether the release of spasticity was associated with an improvement in intellectual function. Newborn Sprague-Dawley rats were divided into the following groups: control, CP model, and CP model with ITB therapy. For the CP model, postnatal Day 7 (P7) rats were exposed to hypoxic conditions (8% O(2)) for 150 minutes after ligation of the right common carotid artery. In the groups receiving ITB therapy, a spinal catheter was connected to an osmotic pump filled with baclofen and placed in the spinal subarachnoid space on P21 in the early group and on P35 in the late group. A daily dose of 12 μg of baclofen was continuously administered until P49, resulting in 28 days of therapy in the early group and 14 days in the late group. Changes in spasticity in the CP and CP with ITB treatment groups were confirmed by assessing the motor evoked potential in the plantar muscle. In the CP group, the time required to complete a beam-walking test on P49 was significantly longer than that in the control and ITB treatment groups (4.15 ± 0.60 vs 2.10 ± 0.18 and 2.22 ± 0.22 seconds, respectively). Results of the beam-walking test are expressed as the mean ± SD. Radial arm maze performance on P49 indicated that spatial reference memory had significantly deteriorated in the CP group compared with controls (2.33 ± 0.87 vs 0.86 ± 0.90 points); moreover, working memory was also negatively affected by CP (0.78 ± 1.09 vs 0.14 ± 0.38 points). Results of the memory tests are expressed as the mean ± SE. These memory functions did not recover after

Unilateral initiatives

International Nuclear Information System (INIS)

Anon.

1988-01-01

This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

Variations and Anomalies of the circle of Willis in Korean: Cerebral digital subtraction angiogram studies in 200 case

International Nuclear Information System (INIS)

Lee, Ouk; Chung, Gyoo Sik; Kim, So Sun; Huh, Jin Do; Kim, Ho Joon; Joh, Young Duk

1989-01-01

In order to evaluate the variations of the circle of Willis in Korean population, digital subtraction angiograms in 200 cases were retrospectively analyzed. There was non-visualization of the anterior communicating artery and the posterior communicating artery in 41 cases and this was the most common type 4 vessel cerebral angiogram (20.5%). Unilateral or bilateral non-visualization of the posterior communicating artery was noted in 40 case (20%). The fetal origin of the posterior cerebral artery from the internal carotid artery was seen in 22 cases (11%). In 20 out of 22 cases, there were non-visualization of either the anterior communicating or posterior communicating artery. Visualization of the anterior communicating artery was noted in 102 cases (51%) and of the posterior communicating artery in 87 cases (43.5%). Hypoplasia of the anterior cerebral artery was noted in 24 cases (12%). Non- visualization of the anterior communicating artery or unilateral posterior communicating artery is noted in 16 cases (8%). Non- visualization of the anterior communicating artery was seen in 14 cases (7%). The most common type in appearance of the basilar artery variation was straight type (Type 1: 51%) and the bifurcation of the basilar artery was most commonly located above the posterior clinoid process of the dorsum sellae (58%) on vertebral angiogram

The cranial MRI in severe cerebral palsy; A comparative study with clinical data

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Yamada, Kazutaka; Itoh, Masahiro; Fueki, Noboru; Hirasawa, Kyoko; Suzuki, Noriko; Kurata, Kiyoko (Metropolitan Medical Center of the Severely Handicapped, Tokyo (Japan)); Sato, Junichi; Morimatsu, Yoshio; Yagishita, Akira

1993-09-01

The magnetic resonance examination was performed in 38 patients with severe cerebral palsy (CP; 15 males and 23 females) who had both motor delay (unable to move anywhere) and mental retardation (I.Q. or D.Q. below 30). Neuroimaging findings were compared with the CP type, etiology, and grade of understanding of language. Cranial magnetic resonance imagings (MRI) in CP were divided into five types. In type 1, nine predominantly showed cyst-liked ventricles and periventricular hyperintensity on T[sub 2]-weighted imaging (PVH) and only scarred basal ganglia and thalamus were visible. All suffered from neonatal asphyxia and the clinical type was rigospastic tetraplegia (RST). In type 2, eleven predominantly showed PVH and hyperintensity on T[sub 2]-weighted (HT2) in basal ganglia and thalamus. All suffered from neonatal asphyxia and the clinical type was RST or rigospastic diplegia. In type 3, five showed PVH and three had cortical atrophy. All suffered from neonatal asphyxia and the clinical type was spastic diplegia. In type 4, four predominantly showed HT2 in putamen and thalamus. Three had cortical atrophy. All suffered from neonatal asphyxia. The clinical type was athetotic CP (ATH). In type 5, nine predominantly showed HT2 in globus pallidus. Four had cortical atrophy and two had hippocampal atrophy. All suffered from neonatal jaundice and the clinical type was ATH. All patients who suffered from neonatal asphyxia and spastic CP had MRI in PVH. All patients who suffered from neonatal asphyxia and ATH showed HT2 in putamen and thalamus. Almost patients who suffered from neonatal jaundice and ATH showed HT2 in globus pallidus. With athetotic CP, cases with atrophy of the cerebral cortex and/or hippocampus were lower grade of understanding of language than no atrophy of both. The results of studies of MRI are in agreement with neuropathological findings. (author).

[Vegetative disorders in children with cerebral palsy. Results of an inquiry of parents].

Science.gov (United States)

Feldkamp, M; Bartmann, D; Süreth, H; Steinhausen, D

1976-08-01

Many of the disturbances resulting from dysregulations in the autonomous nervous system of children with cerebral palsy are rarely discussed in the doctor's praxis. Nevertheless, they are causes of trouble and worry for the parents. For this reason we started an inquiry into this matter. Questionnaires were sent to the parents of 452 C.P. patients. 374 were answered with sufficient care. The following factors were evaluated: sleep, bladder and bowel activity, temperature regulation, vomiting, sweating, blood circulation, growth. The C.P. children were compared to their own siblings especially to the next younger ones. The diagnoses were as follows: Spastic tetraplegia 197 patients. Spastic hemiplegia 44 patients, Athetosis 33 patients, Mixed cases of spasticity and athetosis 82 patients, Other 15 patients. The degrees of handicap in terms of motor development were: severe (unability to sit unsupported) 166 cases, moderate (unability to kneel or walk unsupported) 118 cases, mild (ability to kneel and/or walk unsupported) 87 cases. Summarized, the statements of the parents gave the following results: sleep disturbances: 169 cases (46%), constipation: 145 cases (39%), tendency towards temperature dysregulation: 112 cases (30%) , tendency towards increased vomiting: 91 cases (25%), sweating increased or decreased: 110 cases (30%), irregular and frequent voiding of bladder: 92 cases (25%), unstable regulation of blood circulation: 101 cases (27%), cold skin: 264 cases (71%), body-length deficit: 119 cases (32%), low-weight: 177 cases (48%), feet too small for age: 252 cases (68%). Results are related to diagnosis and severeness of handicap. In addition, it is discussed, whether there are relations between several of the investigated factors. The influence of the patients sex is discussed.

Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force.

Science.gov (United States)

Dressler, Dirk; Bhidayasiri, Roongroj; Bohlega, Saeed; Chahidi, Abderrahmane; Chung, Tae Mo; Ebke, Markus; Jacinto, L Jorge; Kaji, Ryuji; Koçer, Serdar; Kanovsky, Petr; Micheli, Federico; Orlova, Olga; Paus, Sebastian; Pirtosek, Zvezdan; Relja, Maja; Rosales, Raymond L; Sagástegui-Rodríguez, José Alberto; Schoenle, Paul W; Shahidi, Gholam Ali; Timerbaeva, Sofia; Walter, Uwe; Saberi, Fereshte Adib

2017-01-01

Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.

Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy.

Science.gov (United States)

Park, Eun Sook; Rha, Dong Wook; Shin, Jung Soon; Kim, Soohyeon; Jung, Soojin

2014-11-01

The purpose of our study was to investigate the effects of hippotherapy on gross motor function and functional performance in children with spastic cerebral palsy (CP). We recruited 34 children (M:F=15:19, age: 3-12 years) with spastic CP who underwent hippotherapy for 45 minutes twice a week for 8 weeks. Twenty-one children with spastic CP were recruited for control group. The distribution of gross motor function classification system level and mean age were not significantly different between the two groups. Outcome measures, including the Gross Motor Function Measure (GMFM)-66, GMFM-88 and the Pediatric Evaluation of Disability Inventory: Functional Skills Scale (PEDI-FSS), were assessed before therapy and after the 8-weeks intervention as outcome measures. There were no significant differences between intervention and control groups in mean baseline total scores of GMFM-66, GMFM-88 or PEDI-FSS. After the 8-weeks intervention, mean GMFM-66 and GMFM-88 scores were significantly improved in both groups. However, the hippotherapy group had significantly greater improvement in dimension E and GMFM-66 total score than the control group. The total PEDI-FSS score and the sub-scores of its 3 domains were significantly improved in the hippotherapy group, but not in the control group. The results of our study demonstrate the beneficial effects of hippotherapy on gross motor function and functional performance in children with CP compared to control group. The significant improvement in PEDI-FSS scores suggests that hippotherapy may be useful to maximize the functional performance of children with CP.

Somatosensory inputs by application of KinesioTaping: Effects on spasticity, balance, and gait in chronic spinal cord injury

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Federica eTamburella

2014-05-01

Full Text Available Introduction: Leg paralysis, spasticity, reduced inter limb coordination and impaired balance are considered the chief limitations to overground ambulation in subjects with incomplete spinal cord injury (SCI. In the last years KinesioTaping (KT application has been proposed for enhancing sensory inputs, decreasing spasticity via proprioception feedback and relieving abnormal muscle tension. No studies addressed KT technique on SCI subjects: our goal was to analyze effects of ankle joint KT application on spasticity, balance and gait. Material and Methods: A randomized cross-over case control design was used to compare KT and conventional non-elastic silk tape (ST application’s effects in 11 chronic SCI subjects, AIS level D, with soleus/gastrocnemius (S/G muscles’ spasticity , balance and gait impairments. Treatment: 48 hours of either KT or ST treatment was followed after 1 week interval by a reverse protocol. Patient treated with KT were subjected to 48 hours of ST treatment and viceversa. Single Y-stripe of Cure©tape (KT and ST were applied to S and G with 0% stretch. Before and after 48 hours of KT and ST application, clinical data of range of motion (ROM, spasticity, clonus, pain, balance and gait were collected. Stabilometric platform assessment of Centre of Pressure (COP movements, bi-dimensional gait analysis and electromyograpich (EMG activity of S, G, Tibialis Anterior and Extensor Hallicus Lungus muscles were also collected. Results: Only After KT treatment significant effects on spasticity, clonus and COP movements, kinematic gait parameters and EMG activities were recorded. Comparison between KT and ST improvements pointed out significant differences for ROM, spasticity, clonus, pain, COP parameters and most of all kinematic gait data. Discussion: KT short term application reduces spasticity and pain and improves balance and gait performances in chronic incomplete SCI subjects.

Supplemental Stimulation Improves Swing Phase Kinematics During Exoskeleton Assisted Gait of SCI Subjects With Severe Muscle Spasticity

Science.gov (United States)

Ekelem, Andrew; Goldfarb, Michael

2018-01-01

Spasticity is a common comorbidity associated with spinal cord injury (SCI). Robotic exoskeletons have recently emerged to facilitate legged mobility in people with motor complete SCI. Involuntary muscle activity attributed to spasticity, however, can prevent such individuals from using an exoskeleton. Specifically, although most exoskeleton technologies can accommodate low to moderate spasticity, the presence of moderate to severe spasticity can significantly impair gait kinematics when using an exoskeleton. In an effort to potentially enable individuals with moderate to severe spasticity to use exoskeletons more effectively, this study investigates the use of common peroneal stimulation in conjunction with exoskeleton gait assistance. The electrical stimulation is timed with the exoskeleton swing phase, and is intended to acutely suppress extensor spasticity through recruitment of the flexion withdrawal reflex (i.e., while the stimulation is activated) to enable improved exoskeletal walking. In order to examine the potential efficacy of this approach, two SCI subjects with severe extensor spasticity (i.e., modified Ashworth ratings of three to four) walked in an exoskeleton with and without supplemental stimulation while knee and hip motion was measured during swing phase. Stimulation was alternated on and off every ten steps to eliminate transient therapeutic effects, enabling the acute effects of stimulation to be isolated. These experiments indicated that common peroneal stimulation on average increased peak hip flexion during the swing phase of walking by 21.1° (236%) and peak knee flexion by 14.4° (56%). Additionally, use of the stimulation decreased the swing phase RMS motor current by 228 mA (15%) at the hip motors and 734 mA (38%) at the knee motors, indicating improved kinematics were achieved with reduced effort from the exoskeleton. Walking with the exoskeleton did not have a significant effect on modified Ashworth scores, indicating the common

Supplemental Stimulation Improves Swing Phase Kinematics During Exoskeleton Assisted Gait of SCI Subjects With Severe Muscle Spasticity.

Science.gov (United States)

Ekelem, Andrew; Goldfarb, Michael

2018-01-01

Spasticity is a common comorbidity associated with spinal cord injury (SCI). Robotic exoskeletons have recently emerged to facilitate legged mobility in people with motor complete SCI. Involuntary muscle activity attributed to spasticity, however, can prevent such individuals from using an exoskeleton. Specifically, although most exoskeleton technologies can accommodate low to moderate spasticity, the presence of moderate to severe spasticity can significantly impair gait kinematics when using an exoskeleton. In an effort to potentially enable individuals with moderate to severe spasticity to use exoskeletons more effectively, this study investigates the use of common peroneal stimulation in conjunction with exoskeleton gait assistance. The electrical stimulation is timed with the exoskeleton swing phase, and is intended to acutely suppress extensor spasticity through recruitment of the flexion withdrawal reflex (i.e., while the stimulation is activated) to enable improved exoskeletal walking. In order to examine the potential efficacy of this approach, two SCI subjects with severe extensor spasticity (i.e., modified Ashworth ratings of three to four) walked in an exoskeleton with and without supplemental stimulation while knee and hip motion was measured during swing phase. Stimulation was alternated on and off every ten steps to eliminate transient therapeutic effects, enabling the acute effects of stimulation to be isolated. These experiments indicated that common peroneal stimulation on average increased peak hip flexion during the swing phase of walking by 21.1° (236%) and peak knee flexion by 14.4° (56%). Additionally, use of the stimulation decreased the swing phase RMS motor current by 228 mA (15%) at the hip motors and 734 mA (38%) at the knee motors, indicating improved kinematics were achieved with reduced effort from the exoskeleton. Walking with the exoskeleton did not have a significant effect on modified Ashworth scores, indicating the common

Supplemental Stimulation Improves Swing Phase Kinematics During Exoskeleton Assisted Gait of SCI Subjects With Severe Muscle Spasticity

Directory of Open Access Journals (Sweden)

Andrew Ekelem

2018-06-01

Full Text Available Spasticity is a common comorbidity associated with spinal cord injury (SCI. Robotic exoskeletons have recently emerged to facilitate legged mobility in people with motor complete SCI. Involuntary muscle activity attributed to spasticity, however, can prevent such individuals from using an exoskeleton. Specifically, although most exoskeleton technologies can accommodate low to moderate spasticity, the presence of moderate to severe spasticity can significantly impair gait kinematics when using an exoskeleton. In an effort to potentially enable individuals with moderate to severe spasticity to use exoskeletons more effectively, this study investigates the use of common peroneal stimulation in conjunction with exoskeleton gait assistance. The electrical stimulation is timed with the exoskeleton swing phase, and is intended to acutely suppress extensor spasticity through recruitment of the flexion withdrawal reflex (i.e., while the stimulation is activated to enable improved exoskeletal walking. In order to examine the potential efficacy of this approach, two SCI subjects with severe extensor spasticity (i.e., modified Ashworth ratings of three to four walked in an exoskeleton with and without supplemental stimulation while knee and hip motion was measured during swing phase. Stimulation was alternated on and off every ten steps to eliminate transient therapeutic effects, enabling the acute effects of stimulation to be isolated. These experiments indicated that common peroneal stimulation on average increased peak hip flexion during the swing phase of walking by 21.1° (236% and peak knee flexion by 14.4° (56%. Additionally, use of the stimulation decreased the swing phase RMS motor current by 228 mA (15% at the hip motors and 734 mA (38% at the knee motors, indicating improved kinematics were achieved with reduced effort from the exoskeleton. Walking with the exoskeleton did not have a significant effect on modified Ashworth scores, indicating the

Invasive rhino-orbito-cerebral mucormycosis in a diabetic patient – the need for prompt treatment

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Vanessa Chow

2015-06-01

Full Text Available Mucormycosis is a rare life threatening fungal infection predominately seen in immunocompromised or diabetic patients. The following case is of a known type II diabetic patient who presented with sepsis and sudden unilateral loss of vision secondary to infective rhino-orbito-cerebral mucormycosis. Treatment of the condition required extensive surgical intervention and medical management for a life saving outcome.

Personal and environmental factors contributing to participation in romantic relationships and sexual activity of young adults with cerebral palsy

NARCIS (Netherlands)

Wiegerink, D.J.H.G.; Stam, H.J.; Ketelaar, M.; Cohen-Kettenis, P.T.; Roebroeck, M.E.

2012-01-01

Purpose: To study determinants of romantic relationships and sexual activity of young adults with cerebral palsy (CP), focusing on personal and environmental factors. Method: A cohort study was performed with 74 young adults (46 men; 28 women) aged 20-25 years (SD 1.4) with CP (49% unilateral CP,

Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke.

Science.gov (United States)

Chon, Seung Chul; Oh, Duck Won; Shim, Jae Hun

2009-06-01

This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. All patients showed decreased scores in the TAS and RVGA after Watsu application. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis.

Post-operative Hypertension following Correction of Flexion Deformity of the Knees in a Spastic Diplegic Child: A Case Report

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Vipin Mohan

2016-11-01

Full Text Available An adolescent boy with spastic diplegic cerebral palsy presented with crouch gait. He had bilateral severe flexion deformities of knees and hips. He was treated with single event multilevel surgery for the correction of deformities. Surgical procedures included bilateral adductor release, iliopsoas lengthening, bilateral femoral shortening and patella plication. Persistent hypertension was noted in the post-operative period. All causes of secondary hypertension were ruled out. Having persistent hypertension following the femoral shortening procedure is unusual. Antihypertensive medication controlled his blood pressure 15 months after surgery. Hypertension following correction of knee flexion deformity and limb lengthening is well known. Hypertension has not been described with the shortening osteotomy of the femur. Hypertension is a rare complication following the corrective surgery for the treatment of crouch gait. Blood pressure should be monitored during the post-operative period to detect such a rare complication.

Asterixis in the leg induced by anterior cerebral artery infarction.

Science.gov (United States)

Sunwoo, Mun Kyung; Jang, Hyun-Soon; Roh, Sook Young; Yoo, Hyun Jung; Jeong, Eun Hye; Kim, Byung-Su; Choe, Yeo Reum; Lee, Ko-Eun

2016-06-01

Asterixis commonly occurs in a patient with metabolic encephalopathy, whereas focal brain lesions such as thalamus, cerebellum, or frontal area also cause focal or unilateral asterixis in the arms. We report a novel case of asterixis in the leg after unilateral anterior cerebral artery territory infarction. A 76-year-old man was admitted with sudden-onset mild right leg weakness and postural instability due to knee buckling. He was diagnosed with ischemic stroke in the left prefrontal area and cingulated gyrus by brain magnetic imaging. Needle electromyography of the right vastus lateralis muscle while standing showed intermittent periods of EMG silence, consistent with asterixis. There were no abnormal involuntary movements in the upper extremities. This case suggests that gait disturbance or postural instability after structural lesions in the prefrontal area may be directly related to asterixis in the leg, not in the arm associated with postural failure.

Sensory Barrage Stimulation in the Treatment of Elbow Spasticity: A Crossover Double Blind Randomized Pilot Trial.

Science.gov (United States)

Slovak, Martin; Chindo, Joseph; Nair, Krishnan Padmakumari Sivaraman; Reeves, Mark L; Heller, Ben; Barker, Anthony T