Neuromotor examination in unilateral cerebral palsy: Bilateral impairments in different levels of motor integration.

Unilateral cerebral palsy (UCP) usually results in damage to the unilateral pyramidal system. However, the clinical presentation of neuromotor deficits also suggests lesions to the extrapyramidal and cerebellar systems bilaterally. In this study, we developed and tested a behavioral neuromotor examination protocol assessing impairments at three levels of motor integration for children with UCP, also considering impairments of the non-paretic upper limb as well as the influences of the laterality of the lesion. We included 30 children with UCP (10.79 ± 2.61 years) and 60 healthy children (8.27 ± 1.57 years) in the study. All children were assessed on general cognitive ability and classified according to the manual ability classification system (MACS). Our neuromotor examination protocol incorporated specific tasks for each level of motor integration: pyramidal, extrapyramidal and cerebellar. Children with UCP and controls did not differ with respect to general cognitive abilities and sex but children with UCP were significantly older. Controls performed significantly better than children with UCP on neuromotor tasks at all levels of motor integration. Additionally, performance of the non-plegine hand in children with UCP was significantly inferior to controls. With the exception of fine motor skills (pyramidal level), children with right and left UCP did not differ. Our behavioral neuromotor examination was sensitive to reveal impairments at all three levels of motor integration bilaterally in children with UCP-although more subtle for the non-paretic limb.

Efectividad de la terapia robótica Armeo spring en la funcionalidad de extremidad superior de niños con parálisis cerebral unilateral espástica inyectados con toxina botulínica. Ensayo clínico aleatorio de grupos paralelos, simple ciego / Effectiveness of Armeo spring robotic therapy on upper limb functionality in children with spastic unilateral cerebral palsy injected with botulinum toxin. Randomized clinical trial of parallel groups, single blind

OBJETIVO: Comparar la efectividad de la terapia robótica Armeo spring (AS) con la Terapia Ocupacional (TO) para mejorar la funcionalidad de extremidad superior de niños/as entre 4-10 años con Parálisis cerebral (PC) unilateral e inyectados intramuscularmente con toxina botulínica tipo A en Instituto Teletón Concepción-Chile. PACIENTES Y MÉTODOS: Ensayo clínico controlado aleatorio de grupos paralelos AS y TO con una muestra de veinte niños clasificados con MACS I, II, III (10 paciente por grupo). Se realizaron 15 sesiones de tratamien­to, 3 veces/semana. Se aplicó escala QUEST y ABILHAND-kids, en tiempos basal, post intervención y seguimiento a 6 meses por Terapeuta Ocupacional que desconocía la asignación de los grupos. RESULTADOS: No hay diferencias significativas en subdimensiones y puntaje total QUEST en ambos grupos. En grupo TO se observan diferencias entre los tiempos T1 y T3 en las subdimen­siones movimiento disociado, agarre, carga de peso y puntaje total QUEST; y entre los tiempos T2 y T3 para movimiento disociado, carga de peso y puntaje total QUEST. En el grupo AS hubo diferencias entre T1 y T2 en movimiento disociado y puntaje total QUEST, y entre el T1 y T3 en puntaje disociado. En ABILHAND-kids no hay diferencias significativas entre ambos grupos y sólo en el grupo AS hay diferencias significativas entre los tiempos T1-T3 y T2-T3. DISCUSIÓN: La terapia robótica AS y la TO logran mejorar la funcionalidad de extremidad superior en niños con PC unilateral, no encontrándose diferencias entre ambos grupos.

OBJECTIVE: To evaluate the effectiveness of the robotic therapy Armeo spring (AS) in comparison with Occupational Therapy (OT) to improve the functio-nality of the upper limb of children between 4-10 years of age with unilateral cerebral palsy (CP) and injected with botulinum toxin type A in Instituto Teletón Concepción-Chile. PATIENTES AND METHODS: Randomised controlled clinical trial of parallel groups: conventional AS and OT. Twenty-three children classified with MACS I, II, III were randomised, twenty being analysed, corresponding to those who finished the intervention (10 from each group). Fifteen treatment sessions were carried out, three times per week. QUEST and ABILHAND-kids tests were applied at baseline (T1), post intervention (T2) and six-month follow-up (T3) by an Occupational Therapist who was unaware of the group assignment. RESULTS:In both groups there are no significant differences in their subdimensions and total QUEST score, however in the OT group differences are observed between T1-T3 in the subdimensions dissociated movement, grip, weight bearing and total QUEST score. There are also differences between T2-T3 for dissociated movement, weight bearing, and total QUEST score. In the AS group there were differences between T1 - T2 in dissociated movement and total QUEST score, and between T1-T3 only in dissociated movement. In ABILHAND-kids, there were no differences between both groups, only in AS group, there were only significant differences in evaluation in T1-T3 and T2 -T3. DISCUSSION: AS and OT robotic therapy can improve upper limb functionality in children with unilateral CP, not finding differences between both groups.