[Neurophysiological methods in evaliuation of neurorehabiltation in children]. / Przeslanki neuroelektrofizjologiczne dla rehabilitacji neurologicznej dzieci.

The authors reviewed neurophysiological methods, which are used in the evaluation of children referred for neurorehabilitation. Rehabilitation techniques which may stimulate or provoke pathological changes in EEG must be ruled out. Electrophysiological and clinical improvement allow for the extension and intensification of rehabilitation. Normal EEG pattern ensures the safe use of techniques consisting of neuromuscular re-education or passive verticalisation, electrotherapy and thermotherapy. Quantitative and qualitative assessment of cognitive impairment is based on neuropsychological tests and endogenous evoked potentials (most often P300). Presence of cognitive dysfunction needs the use of neuropsychological and neurologopedic therapy. Based on results of exogenous evoked potentials appropriate neurorehabilitation program (physiotherapy, kinezytherapy) can be determined and clinical outcome predicted. EMG allows appropriate usage of applications, patterns and principles in the PNF method (such as compression, stretching, resistance), adapting them optimally to the possibility of a child. ENG estimates conduction in motor and sensory nerves. Based on the results nerve impairment can be localized, severity and character of damage estimated (demyelinating, axonal or complex) and course of the disease and treatment monitored. Short characteristics of 37 children with Guillain-Barre syndrome referred for rehabilitation was presented. Special attention was drawn to floppy infants. Results of neuroelectrophysiological examinations determine suitable rehabilitation program adjusted to the course of central nervous system impairment.

[Rehabilitation outcome in children with cranial trauma and hypoxaemia of the brain]. / Wyniki usprawniania dzieci po ciezkich urazach czaszkowo-mózgowych i niedotlenieniu mózgu.

BACKGROUND: Traumatic brain injury is one of the most common causes of children's disability and death. AIM OF THE STUDY: The goal of this study was to present the effects of improvement treatment in patients who suffered various types of brain trauma, to discuss their motor functions as well as the emotional state and behavioural disturbances. One of the aims was also to present complications which took place reagardless of complex rehabilitation. MATERIAL AND METHODS: In this study we describe the state of 5 patients. The patients were assessed with the Ashworth and RLAS scales before and after the complex rehabilitation. The programme of rehabilitation was designed individually for each patient depending on his RLAS score. The complications developed after 6 months of treatment are described. RESULTS: In one case only- in a girl with hemiparesis- the state of nearly independent motor functioning was achieved. The other patients are bedridden or dependent on a second person when moving in a wheelchair. The girl with hempiparesis and another girl with spastic quadriparesis remain in the best verbal contact. Both of them however present with profound cognitive, emotional and behavioural deficits. The other patients are unable to reach any verbal communication. Because of swallowing problems some of the patients had feeding tube or tracheostomy performed. Each patient had an individually designed rehabilitation programme. CONCLUSIONS: The outcome of rehabilitation treatment in patients with profound traumatic brain injury is very individual. The best outcome was achieved in a girl with hemiparesis who suffered brain injury in a car accident, and worse in children after brain hypoxaemia.

[Neurorehabilitation in children with thoracic outlet syndrom and its assessment]. / Postepowanie neurorehabilitacyjne u dzieci z zespolem górnego otworu klatki piersiowej i ocena jego wyników.

OBJECTIVES: Thoracic outlet syndrome (TOS), a rare clinical condition develops as a consequence of compression of the brachial plexus and/or subclavian vessels in the thoracic outlet area. THE AIM: The aim of this research was the clinical and electrophysiological evaluation of results of therapeutic rehabilitation in female patients diagnosed with TOS. MATERIAL AND METHODS: 3 girls diagnosed in the Department of Pediatric Neurology and Neurophysiology Laboratory and treated in the Neurorehabilitation Division at the University Children's Hospital were evaluated. The TOS diagnosis was established in children aged 12-14 years with the use of doppler examination of subclavian vessels. Two girls underwent conservative management and in the third case surgical decompression and subsequent neurorehabilitation was provided. The methods of conservative management were addressed to relaxation of scalenic muscles, flexibility of cervical and thoracic vertebral column, stretching of pectoral smaller muscles, relaxation and relief of cervical vertebral column, and postural correction of shoulder girdle. The treatment plan assumed improvement of balance of muscle tone, postural correction and diaphragmatic mode of breathing. The first evaluation was conducted before rehabilitation, the control evaluation after 12 months of treatment using Lowet test, load tests, Doppler examination of subclavian vessels and electrophysiological tests (ENG, EMG and SEP) as well. RESULTS: Rehabilitation treatment increased the muscle strength, without significant proficiency improvement of patient upper extremities. The control electroneurography, electromyography and Doppler examinations did not reveal improvement after a conservative management. However, the surgical decompression led to deliberation of subclavian artery, stopped progress of muscle atrophy and normalization of SEP latencies as well. CONCLUSIONS: A 12-months of comprehensive rehabilitation treatment of children with TOS improved significantly a muscle mass and strength. Significant improvement of range of motions, however neurophysiological improvement was not observed. The surgical decompression combined with neurorehabilitation in 1 child caused normalization of somatosensory potentials.

[Assement of clumsiness in children with partial and generalized epilepsy]. / Ocena wystepowania niezgrabnosci ruchowej u dzieci z padaczka czesciowa i uogólniona.

THE AIM OF THE STUDY: Epilepsy in the developmental age is connected in some cases with disorders of gross motor dysfunction, but in the others every day motor activity is not disturbed. Although it does not mean that in children with epilepsy there are not diagnosed any different motor disorders. Aim of the study was to determined the differences between epilepsy with and without gross motor function disorders, the appearance of clumsiness in children with partial epilepsy and primary generalised. MATERIAL: The study was performed on a group of 40 children with idiopathic epilepsy, 23 with idiopathic partial seizures and 17 with generalised. In this group boys predominated (14/23 and 11/17). The average age of both groups was not significant different (12.5 and 13.4). The assessment of gross motor function and intellectual development was normal. METHODS: The assessment of clumsiness was performed by using 10 tests classifying 3 categories of movement: co-ordination, integration, balance. To diagnose the type of epilepsy the common used clinical, electrophisiological and neuroimaging procedures were done. The statistic assessment was performed by using T-test for independent probe. RESULTS: There were no differences between groups of children in 2 test evaluating balance, which were normal. Children with generalised epilepsy had normal results in other 5 test. The lower results were observed in children with partial epilepsy in 8 and with generalised in 3 tests, but this difference was not statistically significant (VAR2/VAR1 = 0.793 and AR3/VAR1 = 0.965). Results of children with partial seizures were lower in 8 tests, but it was not statistically significant(VAR3/ VAR2 = 0.827). The most expressive difference was seen in the test of balance with jumping. CONCLUSION: Children with partial epilepsy are a little more clumsy than children with primary generalised epilepsy.