Efeito imediato, agudo e crônico da Kinesio taping® associada à Terapia Neuromotora Intensiva na postura sentada de crianças com paralisia cerebral / Immediate, acute and chronic effects of Kinesio taping® associated with Intensive Neuromotor Therapy on the sitting position of children with cerebral paralysis

A fisioterapia utiliza vários recursos e métodos para intervenções no tratamento da Encefalopatia Crônica Não Progressiva da Infância (ECNPI) ou paralisia cerebral (PC), entre eles a Kinesio Taping® (KT) e a Terapia Neuromotora Intensiva (TNMI). Esses métodos podem ser considerados relativamente novos, o que leva à necessidade do desenvolvimento de pesquisas para verificar seus efeitos em crianças com PC. O presente estudo objetivou verificar os efeitos da KT® e da TNMI na postura sentada de crianças com PC do tipo quadriparesia/quadriplegia espástica. Para isso, foram avaliadas 6 crianças, com uma média de idade de 6,25±2,69 anos. As avaliações aconteceram por meio do software SAPO, no qual os dados são obtidos em centímetros e a análise consiste na avaliação da vertical (eixo Y), comparando os lados esquerdo e direito, sendo assim possível a análise das assimetrias de maneira precisa. Com relação aos resultados, não foi identificada diferença significativa (p > 0,05) da aplicação de KT® na comparação entre efeitos imediato, agudo e crônico para os momentos pré e pós aplicação imediata da KT®. No entanto, de forma descritiva, o uso de KT® associado à TNMI favoreceu o alinhamento na postura sentada, principalmente para acrômios e Espinha ilíaca ânterossuperior (EIAS). Nota-se, portanto, que as evidências do uso de KT®, como coadjuvante durante a TNMI, ainda são inconclusivas em crianças com PC do tipo quadriparesia/plegia.

Physical therapy uses various resources and methods for intervention in the Chronic Non-Progressive Childhood Encephalopathy (CNPCE) or cerebral palsy (CP) interventions, including Kinesio Taping® (KT) and Intensive Neuromotor Therapy (INMT). These methods are relatively new, which leads to the need for the development of research to verify effects in children with CP. The present study analyzed the effects of KT® and INMT on the sitting posture of children with spastic quadriplegia. In order to do this, six (6) children (mean age 6.25±2.69 years) were evaluated. The evaluations took place through SAPO software, where data are obtained in centimeters and the analysis consists of the evaluation of the vertical (Y) axis, comparing the left and right side, thus being possible to precisely analyze any asymmetries. Regarding the results, no significant difference (p > 0.05) was observed with the application of KT® in the comparison between immediate, acute and chronic effect for the moments before and immediately after KT® application. However, descriptively, the use of KT® associated with INMT favored alignment in sitting posture, mainly for acromial and anterior superior iliac spine (ASIS). The results show that evidence of the use of KT® as an adjuvant during INMT is still inconclusive in children with CP quadriparesis/plegia.

A computer vision-based system for monitoring Vojta therapy.

A neurological illness is t he disorder in human nervous system that can result in various diseases including the motor disabilities. Neurological disorders may affect the motor neurons, which are associated with skeletal muscles and control the body movement. Consequently, they introduce some diseases in the human e.g. cerebral palsy, spinal scoliosis, peripheral paralysis of arms/legs, hip joint dysplasia and various myopathies. Vojta therapy is considered a useful technique to treat the motor disabilities. In Vojta therapy, a specific stimulation is given to the patient's body to perform certain reflexive pattern movements which the patient is unable to perform in a normal manner. The repetition of stimulation ultimately brings forth the previously blocked connections between the spinal cord and the brain. After few therapy sessions, the patient can perform these movements without external stimulation. In this paper, we propose a computer vision-based system to monitor the correct movements of the patient during the therapy treatment using the RGBD data. The proposed framework works in three steps. In the first step, patient's body is automatically detected and segmented and two novel techniques are proposed for this purpose. In the second step, a multi-dimensional feature vector is computed to define various movements of patient's body during the therapy. In the final step, a multi-class support vector machine is used to classify these movements. The experimental evaluation carried out on the large captured dataset shows that the proposed system is highly useful in monitoring the patient's body movements during Vojta therapy.

Early Physiotherapy by Passive Range of Motion Does Not Affect Partial Brain Tissue Oxygenation in Neurocritical Care Patients.

Background Studies investigating multimodal cerebral monitoring including partial brain tissue oxygen monitoring (ptiO2) in neuro-intensive care patients during physiotherapy are completely lacking in the literature. Materials and Methods We performed a post hoc analysis of prospectively collected data of patients on multimodal cerebral monitoring by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurement as well as ptiO2. Patients with severe brain diseases were treated with passive range of motion (PROM). We recorded ICP, CPP, and ptiO2 continuously every minute at baseline (15 minutes), during treatment (26 minutes), and 15 minutes after treatment with PROM. Results Overall, 25 treatment units with PROM in 10 patients with combined ICP/CPP and ptiO2 monitoring were evaluated. Median ICP, CPP, and ptiO2 at baseline were 12 ± 6.1 mm Hg, 86 ± 17.1 mm Hg, and 27 ± 14.3 mm Hg, respectively. Values for ICP, CPP, and ptiO2 did not change significantly when comparing mean values before, during, and after therapy. Conclusions Based on ptiO2 measurements, our data provide new information about the feasibility and safety of physiotherapy in patients with severe brain diseases.

Improving the motor skill of children with posterior fossa syndrome: a case series.

Children who receive treatment for medulloblastoma have a high survival rate, but also a high likelihood of developing posterior fossa syndrome, a condition that includes devastating balance and motor problems. This case series used 2 novel neuromodulation devices in conjunction with an intensive physical therapy intervention for 2 children who were 5 years post tumor treatment with a diagnosis of posterior fossa syndrome. Pre- and postclinical measures, in addition to magnetoencephalography brain imaging, describe positive behavioral and neuroplastic changes resulting from the intervention. The positive outcomes in these cases suggest that further study is needed using neuromodulatory devices and long-term rehabilitation in children with balance and movement disorders resulting from cancer treatment.

Older adults with acquired brain injury: outcomes after inpatient rehabilitation.

This study examined a population-based profile of older adults with acquired brain injury, and their functional outcomes, in in-patient rehabilitation. Older adults aged 65 and older admitted to in-patient rehabilitation from acute care with traumatic brain injury (TBI) (n = 1214) or non-traumatic brain injury (nTBI) (n = 1,530) from 2003/04 to 2009/10 in Ontario were identified. Demographic and clinical characteristics and the total function score from the FIM(™) Instrument were examined. The Discharge Abstract Database and National Rehabilitation Reporting System were used. Results indicated that older adults with TBI had significantly higher total function scores than those with nTBI at admission and at discharge (p < .001). However, both groups made significant (p < .001) and similar gains (p > .05) in total function scores. We conclude that older adults with TBI and nTBI make similar in-patient rehabilitation gains. Lower initial functional ability of nTBI patients on admission and patients' different clinical profiles have implications for clinical care and resources.

Semantic strategy training increases memory performance and brain activity in patients with prefrontal cortex lesions.

OBJECTIVE: Memory deficit is a frequent cognitive disorder following acquired prefrontal cortex lesions. In the present study, we investigated the brain correlates of a short semantic strategy training and memory performance of patients with distinct prefrontal cortex lesions using fMRI and cognitive tests. METHODS: Twenty-one adult patients with post-acute prefrontal cortex (PFC) lesions, twelve with left dorsolateral PFC (LPFC) and nine with bilateral orbitofrontal cortex (BOFC) were assessed before and after a short cognitive semantic training using a verbal memory encoding paradigm during scanning and neuropsychological tests outside the scanner. RESULTS: After the semantic strategy training both groups of patients showed significant behavioral improvement in verbal memory recall and use of semantic strategies. In the LPFC group, greater activity in left inferior and medial frontal gyrus, precentral gyrus and insula was found after training. For the BOFC group, a greater activation was found in the left parietal cortex, right cingulated and precuneus after training. CONCLUSION: The activation of these specific areas in the memory and executive networks following cognitive training was associated to compensatory brain mechanisms and application of the semantic strategy.

Multidisciplinary team care in rehabilitation: an overview of reviews.

OBJECTIVES: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems. DATA SOURCES: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research from existing systematic reviews was critically appraised and summarized. STUDY SELECTION: Using the search terms "rehabilitation", "multidisciplinary teams" or "team care", references were identified for existing studies published after 2000 that examined multidisciplinary rehabilitation team care for adults, without restrictions in terms of study population or outcomes. The most recent reviews examining a study population were selected. DATA EXTRACTION: Two reviewers independently extracted information about study populations, sample sizes, study designs, rehabilitation settings, the team, interventions, and findings. DATA SYNTHESIS: A total of 14 reviews were included to summarize the findings of 12 different study populations. Evidence was found to support improved functioning following multidisciplinary rehabilitation team care for 10 of 12 different study population: elderly people, elderly people with hip fracture, homeless people with mental illness, adults with multiple sclerosis, stroke, acquired brain injury, chronic arthropathy, chronic pain, low back pain, and fibromyalgia. Whereas evidence was not found for adults with amyetrophic lateral schlerosis, and neck and shoulder pain. CONCLUSION: Although these studies included heterogeneous patient groups the overall conclusion was that multidisciplinary rehabilitation team care effectively improves rehabilitation intervention. However, further research in this area is needed.

[Effect of home-based rehabilitation on functional independence measures in patients with heroin-associated encephalopathy].

OBJECTIVE: To investigate effect of home-based rehabilitation on performance in a functional independence measure (FIM) in patients with heroin-associated encephalopathy (HE). METHODS: A total of 56 patients with HE were divided into a family rehabilitation management group (treatment group, n=30) and a control group (n=26). The patients in the home-based rehabilitation management group were put on a rehabilitation program and then followed-up; those in the control group were only followed-up. Both groups were evaluated with FIM at discharge and 3, 6, and 12 months after discharge. RESULTS: FIM in the treatment group was remarkably better than that in the control group at 3, 6, 12 months after discharge (79.5±16.3 vs 62.3± 14.6, 88.2±20.0 vs 65.5±13.4, 99.6±21.2 vs 68.7±15.8; all P< 0.05). In the rehabilitation group, FIM of the patients receiving 3, 6, and 12 months of rehabilitation therapy was significantly higher than that at the time of discharge (P<0.01). CONCLUSION: Home-based rehabilitation management has significant effect on the FIM in patients with HE.

Korean Brain Rehabilitation Registry for rehabilitation of persons with brain disorders: annual report in 2009.

This first annual report provides a description of patients discharged from rehabilitation facilities in Korea based on secondary data analysis of Korean Brain Rehabilitation Registry V1.0 subscribed in 2009. The analysis included 1,697 records of patients with brain disorders including stroke, traumatic brain injury, brain tumor and other disorders from 24 rehabilitation facilities across Korea. The data comprised 1,380 cases of stroke, 104 cases of brain injury, 55 cases of brain tumor, and 58 cases of other brain diseases. The functional status of each patient was measured using the Korean version of the Modified Barthel Index (KMBI). The average change in the KMBI score was 15.9 for all patients in the inpatient rehabilitation facility. The average length of stay for inpatient rehabilitation was 36.9 days. The transfer rates to other hospitals were high, being 62.4% when all patients were considered. Patients with brain disorders of Korea in 2009 and measurable functional improvement was observed in patients. However, relatively high percentages of patients were not discharged to the community after inpatient rehabilitation. Based on the results of this study, consecutive reports of the status of rehabilitation need to be conducted in order to provide useful information to many practitioners.

Oncology and physical medicine and rehabilitation.

INTRODUCTION: Cancer patients are living longer with deficiencies and functional impairments requiring often typically a care in physical medicine and rehabilitation (PMR). OBJECTIVE: To examine the care of cancer patients in PMR. METHOD: Investigation made with a questionnaire diffused from the e-mail listing of the Société Française de Médecine Physique et de Réadaptation. RESULTS: Sixty-seven answers received. Fifty-seven centers take care of cancer patients. On average, 4% of cancer patients are hospitalised in PMR. Spinal cord injuries and hemiplegias are the most common impairments. Forty-two percent of the PMR units take the patients in all the stages of cancer treatment. Working relationships between PMR and oncology units are formalized only eight times out of 52. In case of health degradation, relationships with a palliative care unit are frequent but not generalized. Eighty-five percent of the centers think that PMR is not enough developed in oncology. CONCLUSIONS: In spite of its limited character, this investigation shows that the PMR units take these patients. Situations where PMR has an important role in the follow-up of cancer patients are multiple and publications have showed its interest, especially on the limitations of activities. It is important to make better known the interest of PMR in oncology units but also to develop specific care within PMR units.

[EYEMOVE. Standardized assessment and treatment of visual search disorders]. / EYEMOVE. Standardisierte Diagnostik und Therapie visueller Explorationsstörungen.

Disorders of visual search by coordinated eye and head movements are frequently encountered in patients with brain damage. Homonymous visual field disorders, impaired elementary visual capacities (e.g. acuity, contrast sensitivity, convergent fusion, oculomotor disorders), visual neglect, Balint-Holmes syndrome or dementia (e.g. Alzheimer's disease) are the most frequent causes of such disorders. Efficient visual search is necessary to select salient stimuli and bring them onto the fovea in order to perform an in-depth analysis. Visual search is not only an indispensible capacity for visual activities in vocational and private life but is also important for many motor and cognitive abilities such as reaching, grasping, standing, spatial perception, route navigation as well as mobility. Despite this importance no comprehensive system exists for the standardized assessment and treatment of visual search disorders in the German-speaking area. In this article, we describe the basic properties of such a system (EYEMOVE). After a short survey of the main causes of visual search disorders following brain damage, the diagnostic facilities, normative data as well as a variety of treatment techniques of this novel system are described. Selected results from on-going clinical studies highlight the practicability and effectiveness of this novel system which contributes to a better management of visual search disorders in neuro-visual rehabilitation.

Prevalence and risk factors of asymptomatic lower extremity deep venous thrombosis in Asian neurorehabilitation admissions in Singapore.

OBJECTIVE: To determine the local prevalence and risk factors of asymptomatic lower limb deep venous thrombosis (DVT) among neurorehabilitation admissions. DESIGN: A prospective observational single-center study. SETTING: Tertiary rehabilitation center affiliated to a public hospital. PARTICIPANTS: A total of 419 Asian neurorehabilitation admissions with a mean of 26 days to rehabilitation. INTERVENTION: Admission screening protocol included quantitative D-dimer assay within 24 to 48 hours of rehabilitation admission and targeted hemiplegic/weaker lower-extremity venous duplex ultrasonography was performed if D-dimer assay level was elevated at 0.34 microg/mL or higher. MAIN OUTCOME MEASURES: There were 251 (59.9%) men, and the subjects were predominantly Chinese (76.6%). Subjects had a mean age of 59+/-15 years. Admitting diagnoses included ischemic stroke (212), hemorrhagic stroke and subarachnoid hemorrhage (129), traumatic brain injury (59), and nontraumatic brain injury (19). The screening protocol included a quantitative D-dimer assay within 24 to 48 hours of rehabilitation admission, and hemiplegic/weaker lower-extremity venous duplex ultrasonography was performed if D-dimer assay level was elevated at 0.34 microg/mL or higher. RESULTS: Altogether, 247 (58.9%) patients had an elevated D-dimer assay, and all underwent venous duplex ultrasonography. The incidence of lower-limb DVT was 5.01% (21), including 11 proximal and 10 distal DVT. No patients had clinical pulmonary embolism. Using 247 venous duplex ultrasonography results for analyses of correlates with logistic regression analyses, no significant demographic or clinical predictive factors for DVT were found. CONCLUSIONS: This study confirms that asymptomatic lower limb DVT is indeed uncommon in Asian neurorehabilitation admissions. Possible reasons include genetic or ethnic protective factors, early walking initiated at rehabilitation, and timing of the admission protocol (median of 14 days postevent) when the maximal thrombotic risk was on the decline.

The ESDQ: a new method of assessing emotional and social dysfunction in patients following brain surgery.

The Emotional and Social Dysfunction Questionnaire (ESDQ) has been designed to overcome some of the difficulties of inappropriately applying psychiatric based questionnaires to brain-damaged populations. Two-hundred and twenty-five patients were assessed following brain surgery (BS) using a self-rating patient version of the ESDQ and 211 of these patients were rated by their partner. A factor analysis using a varimax rotation and principal components analysis found the partner results to show eight factors including, Anger, Helplessness, Emotional Dyscontrol, Indifference, Inappropriateness, Fatigue, Maladaptive behaviour, and Insight. The analysis of the Self-rating questions revealed a similar profile, Anger, Emotional Dyscontrol, Helplessness, Inertia, Fatigue, Indifference, Inappropriate, and Euphoria. The scales based on the factors were subjected to discriminant analysis in which the BS patients were compared with a combination control group of neurosurgical outpatients and terminally-ill cancer patients, all of which were without cerebral complaints. The brain surgery results for the partner-rated and the Self-rated version of the ESDQ were compared with control ratings of 42 partners and 54 self-ratings, respectively. The analysis showed a significant discrimination for the Partner-rated version on each of the eight scales individually with an overall significant overall separation (Wilks Lambda=.903, chi=21.1, df=8, p=<.005). The Self-rated version showed less separation on an individual scale basis the Emotional Dyscontrol scale failing to show a significant separation. The overall difference on the Self-rating version was significant [Wilks Lambda=.908, chi=26.2, df=8, p=<.001). The levels of internal consistency of the questionnaire scales were found to be satisfactory (Alpha,.78 -.94). Also the relationship between ESDQ scales and standardised measures of aggression, anxiety, depression, and vigour (STAXI, HADS, and POMS) gave an indication of acceptable levels of concurrent validity.

Ecology of development in children with brain impairment.

BACKGROUND: Many children with brain impairments develop well in spite of negative risk factors or prognoses. Most follow-up and review studies do not show uncontroversial effects of particular physiotherapy or activation programmes. Evidence is accumulating of environmental influence on brain plasticity, but it is not clear what exactly this means for human beings. This paper reports a qualitative study of the life histories of 20 children, with severe developmental disturbance of neurological origin, who showed marked functional improvements. METHODS: Qualitative analysis of a group of 20 children, heterogeneous in aetiology or severity of brain impairments (hydrocephalus, porencephalic brain cysts, cerebral palsy, Rubinstein-Taybi, Down's or other genetic syndromes), in methods of rehabilitation as well as in outcome. RESULTS: In these particular children, gross brain abnormalities apparent on initial imaging and early functional testing did not appear highly predictive of final outcome. There was no observed association between final functioning and any particular type of rehabilitation. The outcome rather seems to be the result of a complex process of interaction between the child and his/her human ecology; the way the child, as well as significant people in his/her environment, perceive problems and possible solutions; and the quality and quantity of activation and mediated learning experience. CONCLUSION: Development in children with brain impairment does not seem to happen spontaneously. It is not a linear but an unpredictable process. Both outer (a stimulating environment with lots of activities) as well inner aspects (will and interactive processes) constitute a child's rehabilitative ecology. The findings are also suggestive for a brain plasticity influenced by the ecology of the child.

Rehabilitation of cognitive and motor functions in younger and older patients with vascular brain damage, rheumatologic illness and in post-surgery patients.

This study presents results of inpatient rehabilitation (as monitored by Functional Independence Measure (FIM)) of patients with vascular brain damage (n = 78), post surgery patients (n = 62) and of patients with rheumatologic illness (n = 45). These patients were divided into two age groups (cut off point 65 years). There were significant differences in the FIM scores in all three diagnosis groups between the younger and the older patients at discharge, the younger patients reaching a higher FIM score. However, there were no substantial differences between the two age groups in FIM gains the length of stay in any of the diagnosis groups. This study indicates that although younger patients reach higher FIM score at admission and at discharge the patients older than 65 improved in a comparable way during the same length of stay thus requiring comparable financial resources.

Estimulacao magnetica transcraniana: uma nova ferrramenta para o tratamento da depressao? / Transcranial magnetic stimulation: a new tool in the treatment of depression?

Estimulacao magnetica transcraniana(EMT) e uma nova tecnica capaz de estimular o cerebro, com algumas vantagens sobre as ja existentes. AEMT e indolor, nao-invasiva, simples de ser aplicada e, mais importante ainda,e considerada de baixo risco para pesquisas em seres humanos. Essa nova ferramentatem sido proposta para ser usada no tratamento de ...

[A neuroepidemiological study in Beira, Mozambigue]. / Estudio neuroepidemiológico en Beira, Mozambique.

INTRODUCTION AND OBJECTIVE: The application of epidemiology to the field of neurology is relatively recent although it has become so relevant that it is currently recognized as a new specialty: Neuroepidemiology. The objective of our study was to study the morbid-mortality of neurological disorders. PATIENTS AND METHODS: We made a retrospective investigation of all the patients admitted to the Hospital Central de Beira, Mozambique, between 1 January 1996 and 30 June 1999. The source of information used was the clinical histories and data of the Statistics Department. The basis used for classification of the disorders was the International Classification of Diseases, Ninth Revision-1CD 9CM (3 digits). RESULTS: We found that neurological disorders were fifth in the classification of morbidity and third in mortality. Trauma, infections and vascular causes--in that order--were the most important factors in the morbidity of neurological diseases. The highest mortality rate was seen with infections, vascular and neoplastic etiologies. In our study we found disorders which several investigators consider to be almost nonexistent in Africa, such as multiple sclerosis, subacute combined degeneration of the cord and myasthenia gravis amongst others. The morbidity and mortality found for neurological diseases are similar, in general, to those described in Africa. CONCLUSION: The importance of neurological disorders in healthcare means that it is essential to have a specialist available for their management.

[Early rehabilitation after cerebral lesions: indications, methods, results]. / Frührehabilitation nach akuten zerebralen Läsionen. Indikationen, Methoden, Ergebnisse.

Early neurological and neurosurgical rehabilitation after severe brain injury of traumatic, hemorrhagic, ischemic, neoplastic, inflammatory, or hypoxic origin fills the gap between acute treatment and traditional rehabilitation services. During the last years, specific treatment modalities began to develop, directed at the key problems of severely brain injured patients: for example, stabilization of vegetative regulation, treatment of spasticity, swallowing disorders, disturbances of perception and communication, coping, and conditioning of the relatives. Procedures are gradually emerging to facilitate assessment, documentation of progress, and results. Prognosis is still very uncertain, especially in patients in a vegetative state. As a rule of thumb, about three out of four patients will improve substantially during the treatment.