Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation.

OBJECTIVE: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients' age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. METHOD: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. RESULTS: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. CONCLUSION: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth.

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation / Discrepâncias no crescimento dos dimídios em crianças com paralisia cerebral hemiplégica: associação com a função, atividades e participação social

Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth. .

Objetivo: Avaliar a discrepância entre o crescimento dos lados do corpo em crianças com paralisia cerebral hemiplégica (PCH), e investigar sua associação com a idade de início do tratamento de fisioterapia, função motora e cognitiva, grau de atividades e participação social. Método: Comparamos oito medidas obtidas de 24 crianças com PCH e com média de idade de 49,3±5,2 meses. Resultados: O início precoce da fisioterapia se relacionou à menor discrepância no comprimento da mão (p=0,037). A menor discrepância no comprimento do pé se relacionou à menor necessidade de ajuda do cuidador em atividades de mobilidade. A maior discrepância esteve relacionada à menor extensão de punho e à maior espasticidade. A discrepância foi mais importante em crianças com heminegligência e com envolvimento à direita. Conclusão: Crianças com PCH com maior discrepância apresentaram menor atividade/participação social. Os resultados sugerem associação entre o uso funcional da mão e o crescimento das extremidades. .

MRI findings in the painful hemiplegic shoulder.

AIM: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. MATERIALS AND METHODS: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. RESULTS: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. CONCLUSIONS: Adhesive capsulitis was found to be a possible cause of PHS.

Factors associated with pelvic asymmetry in transverse plane during gait in patients with cerebral palsy.

The purpose of this study was to describe the patterns of pelvic rotational asymmetry in the transverse plane and identify the possible factors related to this problem. One thousand and forty-five patients with cerebral palsy (CP) and complete documentation in the gait laboratory were reviewed in a retrospective study. Pelvic asymmetry in the transverse plane was observed in 52.7% of the patients; and to identify the possible causes of pelvic retraction, clinical (Thomas test, popliteal angle, and gastrocnemius tightness) and dynamic parameters (mean rotation of the hip in stance, minimum hip flexion, minimum knee flexion, and peak ankle dorsiflexion) were evaluated. The association between these parameters and pelvic retraction was assessed statistically. The results showed that 75.7% of patients with asymmetric pattern of the pelvis had clinical diagnosis of diplegic spastic CP. Among the patients with asymmetrical CP, the most common pattern was pelvic retraction on the affected side. The relationship between pelvic retraction and internal hip rotation was stronger in patients with asymmetrical diplegic CP than in those with hemiplegic (P<0.001) or symmetrical diplegic CP (P = 0.014). All of the patients exhibited a significant association among clinical parameters (Thomas test, popliteal angle, and gastrocnemius tightness) and pelvic retraction. In conclusion, pelvic retraction seems to be a multifactorial problem, and the etiology can change according to topographic classification, which must be taken into account during the decision-making process in patients with CP.

Comparative study of skin folding of dominant and nondominant hemibodies in spastic hemiplegic cerebral palsy.

OBJECTIVE: To compare skin folds in the dominant and nondominant halves of the body in a group (A) of 20 individuals with cerebral palsy and spastic hemiplegia and a group (B) of 30 normal volunteers. METHOD: Body mass, height and skin folds were measured, and the percentage of body fat was estimated by adipose tissue measurement and densitometry. The mean age in group (A) was 24.6 +/- 5.6 years (ranging from 16.1 to 38.1 years). The mean age in group (B) was 25.3 +/- 3.8 years (ranging from 19.0 to 34.11 years). RESULTS: Statistically significant differences were observed between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in group A; the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in group B; and the percentage fat obtained by adipose tissue measurement in both groups. Statistically significant differences were observed for the triceps skin fold when the dominant halves of the body in groups A and B were compared. Statistically significant differences were also observed for the biceps, triceps, thigh and midcalf skin folds as well as the adipose tissue measurements between the dominant and nondominant halves of the body in the two groups. The percentage fat as estimated by densitometry was significantly correlated with the adipose tissue measurement. CONCLUSION: There were statistically significant differences between the skin folds in the dominant and nondominant halves of the body, both in group A and in group B (greater in group A). There was a statistically significant correlation in the percentage fat as estimated by densitometry and as measured by adipose tissue in groups A and B.

Patrones del movimiento pélvico en pacientes con hemiplejía espástica / Pelvic movement patterns in patients with spastic hemiplegia

El tratamiento adecuado de patologías que alteran la marcha normal, como por ejemplo, encefalopatías estáticas tales como la parálisis cerebral infantil, requiere de la identificación precisa de los patrones de movimiento asociados y sus causas, con el propósito de seleccionar el tratamiento más apropiado en términos de efectividad. Identificar y caracterizar patrones cinemáticos de la pelvis en el plano transverso como respuesta compensatoria a deformidades de los miembros inferiores en pacientes pediátricos con hemiplejía espástica. La muestra utilizada fue de 66 pacientes con disfunción motora subtipo hemiplejia espástica secuela de parálisis cerebral infantil, del Hospital Ortopédico Infantil de Caracas, entre los años 1999 y 2004. A cada paciente se le realizó un análisis de marcha siguiendo el protocolo del Laboratorio de Marcha del Hospital Ortopédico Infantil. A los patrones de cinemática obtenidos se les midieron las desviaciones de los movimientos pélvicos en los tres planos así como también la progresión del pie y la rotación de cadera evidenciadas por el examen físico (anteversión femoral). Particular énfasis se realizó en el análisis de las desviaciones en el plano transverso. Se obtuvieron los patrones de movimiento con características propias para cada subgrupo: Tipo I, Tipo II, Tipo III y Tipo IV. Los hallazgos son consistentes con los reportados en la literatura en lo concerniente a los planos sagital y coronal. Sin embargo, en el plano transverso se demostraron patrones consistentes con deformidad ósea presente en el miembro ipsilateral. Las respuestas compensatorias observadas en pelvis en dicho plano tienen como objetivo mantener ambos pies en la línea de progresión.

Adequate treatment of pathologies that alter normal gait, for example, spastic encephalopaties such as cerebral palsy, require precise identification of their movement patterns and causes, in order to select the most effective treatment. To identify and characterize transverse plane kinematic patterns of the pelvis as a compensatory response to lower limb deformities in pediatric patients with spastic hemiplegias. 66 patients with spastic hemiplegia subtype motor dysfunction, from the Hospital Ortopédico Infantil (HOI) at Caracas,Venezuela, were studied between 1999 and 2004. A gait analysis was performed in each patient following the HOI’s protocol. Deviations of pelvic movements were measured on all three planes to the kinematics gait patterns obtained, Measurements of foot progression and hip rotation (femoral anteversion) were achieved via clinical examination. Movement patterns on spatial planes were obtained and characterized in terms of its deviations, then classified in four wellfeatured subtypes: Type I, Type II, Type III y Type IV. Special emphasis was placed on analysis of deviations in the transverse plane. Findings for sagital and coronal planes are consistent with those reported by the literature. However, movement patterns that are consistent with bone deformities in the ipsilateral limb were demonstrated for transverse plane, and the pelvic coping responses for that plane tend to maintain both feet aligned with the gait progression line.

Comparative study of skin folding of dominant and nondominant hemibodies in spastic hemiplegic cerebral palsy

OBJECTIVE: To compare skin folds in the dominant and nondominant halves of the body in a group (A) of 20 individuals with cerebral palsy and spastic hemiplegia and a group (B) of 30 normal volunteers. METHOD: Body mass, height and skin folds were measured, and the percentage of body fat was estimated by adipose tissue measurement and densitometry. The mean age in group (A) was 24.6 ± 5.6 years (ranging from 16.1 to 38.1 years). The mean age in group (B) was 25.3 ± 3.8 years (ranging from 19.0 to 34.11 years). RESULTS: Statistically significant differences were observed between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in group A; the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in group B; and the percentage fat obtained by adipose tissue measurement in both groups. Statistically significant differences were observed for the triceps skin fold when the dominant halves of the body in groups A and B were compared. Statistically significant differences were also observed for the biceps, triceps, thigh and midcalf skin folds as well as the adipose tissue measurements between the dominant and nondominant halves of the body in the two groups. The percentage fat as estimated by densitometry was significantly correlated with the adipose tissue measurement. CONCLUSION: There were statistically significant differences between the skin folds in the dominant and nondominant halves of the body, both in group A and in group B (greater in group A). There was a statistically significant correlation in the percentage fat as estimated by densitometry and as measured by adipose tissue in groups A and B.

The human pyramidal syndrome Redux.

Experimental studies in nonhuman primates have questioned the selectivity of pyramidal tract damage in giving rise to the classical pyramidal syndrome in humans, characterized by permanent spastic hemiplegia (PSH). According to this view, concomitant injury of extrapyramidal pathways is necessary for the development of both hemiplegia and spasticity. In this study we used conventional magnetic resonance imaging and diffusion tensor imaging tractography to characterize the anatomical correlates of PSH in a patient with a rare and discrete unilateral lesion of the medullary pyramid. Our findings support the hypothesis that damage confined to the medullary pyramid/pyramidal tract is sufficient to produce PSH. In contrast to nonhuman primates, the human 'pyramidal' and 'pyramid' syndromes are equivalent clinico-anatomic concepts.

[The fundus oculi in the hemiplegic patient]. / El fondo de ojo en el paciente hemipléjico.

INTRODUCTION AND OBJECTIVE: The fundus oculi is useful for observation of the interior of the eye and the retina. This study establishes a relationship between patients with established cerebral infarcts and the results observed in their fundi. PATIENTS AND METHODS: A retrospective study of the clinical histories of 177 patients seen in the rehabilitation department over a period of one year. RESULTS: The patients were aged between 29 and 85 years. The majority were men; 101 patients (57.06%) had systolic-diastolic arterial hypertension. On study of the fundus oculi there was a predominance of alterations of the blood vessels of the retina due to vascular sclerosis (93.1%) but only 24.4% had frank alterations caused by arterial hypertension. CONCLUSIONS: We found a slight relation between arterial hypertension and the alterations observed in the fundus oculi of these patients.

Hemiplegia por acidente vascular cerebral: tratamento da espasticidade de membros inferiores através de bloqueio com toxina botulítica do tipo - A e fenol / Hemiplegy by stroke: treatment of the spasticity in lowerlimbs blocked by Phenol an Botulinum Toxin A

O tratamento associado de bloqueios periféricos parece näo deixar dúvidas quanto a sua eficácia no que se refere à capacidade de provocar relaxamento da espasticidade. Devemos considerar contudo, a importância do processo de reabilitaçäo global, visto que a somatória de melhorias funcionais é o fator que realmente faz a diferença para a qualidade de vida do paciente. Assim sendo, o tratamento cinesioterápico de estimulaçäo funcional e de fortalecimento dos grupos musculares oponentes aos bloqueados säo fundamentais para o sucesso do procedimento. Também é importante a análise da relaçäo custo-benefício, considerando-se os custos dos bloqueios. Além disto, é necessário a continuaçäo das pesquisas e do intercâmbio de informaçöes no que se refere às dosagens, técnicas, indicaçöes e contra-indicaçöes. Nos parece ser este um caminho seguro para o aprimoramento e aumento das possibilidades reais de tratamento destes pacientes

Abordagem proprioceptiva no tratamento fisioterápico em paciente hemiplégico / Boarding receptive on treatment physiotherapic in hemiplegic patient

A hemiplegia é uma patologia que se caracteriza pela perda da motilidade voluntária em um hemicorpo, além de alterar o tônus muscular. O presente trabalho faz uma abordagem de tratamento fisioterápico através do método Bobath que propöe reeducar o "homem como um todo" para redescoberta dos movimentos que eram realizados antes da patologia

Childhood Degos disease with prominent neurological symptoms: report of a clinicopathological case.

Degos disease is a rare disorder, characterized by a vasculopathy of unknown origin that leads to typical skin lesions and involves other organ systems. It is frequently a lethal condition; death occurs as a consequence of intestinal perforation. In about 20% of cases, the central nervous system is involved and the neurological symptoms can be prominent. The incidence of the disease in children is very uncommon. We report the case of teenage girl who had Degos disease with prominent neurological involvement.