Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.762
Filtrar
1.
Clin Podiatr Med Surg ; 39(1): 37-55, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809794

RESUMO

Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly observed foot and ankle segmental malalignment patterns include equinus, planovalgus, and equinovarus. Assessment of foot deformities is multifaceted, requiring the collection and integration of data from a combination of sources that include the clinical history, standardized physical examination, observational and quantitative gait analysis, GMFCS classification, and radiographic findings. Surgical procedures are determined by identifying all segmental malalignments and assessing the contribution of dynamic or flexible soft-tissue imbalance, fixed soft-tissue imbalance, and skeletal deformities.


Assuntos
Paralisia Cerebral , Pé Torto Equinovaro , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Paralisia Cerebral/complicações , Criança , Marcha , Humanos , Exame Físico
2.
Res Dev Disabil ; 119: 104110, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794115

RESUMO

AIMS: To describe the gross motor function of individuals with HNRNPH2-related disorder (OMIM 300986, Mental Retardation, X-linked, Syndrome, Bain Type; MRXSB) and determine the associations between clinician-measured motor function and caregiver-reported mobility scores. METHODS: Developmental histories of 17 female participants with HNRNPH2-related disorder (mean age 11.2 years, range 2.7-37.1 years) with various genotypes within and adjacent to the nuclear localization sequence (NLS) were analyzed. Participants performed the Gross Motor Function Measure-88 (GMFM-88) and caregivers completed developmental histories and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). RESULTS: All participants had measurable and quantifiable motor impairments. A strong positive correlation between the clinician-measured GMFM-88 total score and the caregiver-reported PEDI-CAT mobility domain score was established. Motor deficits were noted more often in individuals who were nonverbal. The 2 participants with genotypes adjacent to the NLS appear to have milder motor phenotypes. CONCLUSIONS: The GMFM-88 and PEDI-CAT are useful and feasible measures of mobility in individuals with HNRNPH2-related disorders. Convergent validity was established between the clinician-measured GMFM-88 raw scores and caregiver-reported PEDI-CAT mobility domain scores. Factors including verbal status and genotype may impact motor abilities.


Assuntos
Paralisia Cerebral , Deficiência Intelectual , Criança , Computadores , Estudos Transversais , Avaliação da Deficiência , Feminino , Ribonucleoproteínas Nucleares Heterogêneas Grupo F-H , Humanos , Deficiência Intelectual/genética , Destreza Motora
3.
J Healthc Eng ; 2021: 1822776, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804446

RESUMO

In this paper, we analyzed the application value and effect of deep learn-based image segmentation model of convolutional neural network (CNN) algorithm combined with 3D brain magnetic resonance imaging (MRI) in diagnosis of cerebral palsy in children. 3D brain model was segmented based on CNN algorithm to obtain the segmented MRI images of brain tissue, and the validity was verified. Then, 70 children with cerebral palsy were rolled into the observation group (n = 35), which received MRI for diagnosis after segmentation of brain tissue, and control group (n = 35), which were diagnosed by computed tomography (CT). The diagnosis results of the two groups were compared. The validity experiment verified that the image segmentation method based on CNN algorithm can obtain effective style graphics. In clinical trials, the diagnostic accuracy of 88.6% in the observation group was evidently superior to that of 80% in the control group (P < 0.05). In the observation group, one patient was diagnosed as normal, four patients had white matter lesions, 17 patients had corpus callosum lesions, and five patients had basal ganglia softening foci. In the control group, two patients were diagnosed as normal, two patients had white matter lesions, 19 patients had corpus callosum lesions, and four patients had basal ganglia softening foci. No notable difference was found between the two groups (P > 0.05). According to the research results, in the diagnosis of cerebral palsy in children, the image segmentation of brain 3D model based on CNN to obtain the MRI image of segmented brain tissue can effectively improve the detection accuracy. Moreover, the specific symptoms can be diagnosed clearly. It can provide the corresponding diagnostic basis for clinical diagnosis and treatment and was worthy of clinical promotion.


Assuntos
Paralisia Cerebral , Aprendizado Profundo , Paralisia Cerebral/diagnóstico por imagem , Criança , Computadores , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Redes Neurais de Computação
4.
Sensors (Basel) ; 21(22)2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34833666

RESUMO

Recumbent stationary cycling is a potential exercise modality for individuals with cerebral palsy (CP) that lack the postural control needed for upright exercises. Functional electrical stimulation (FES) of lower extremity muscles can help such individuals reach the cycling intensities that are required for aerobic benefits. The aim of this study was to examine the effect of cycling with and without FES assistance to that of a no-intervention control group on the cardiorespiratory fitness of children with CP. Thirty-nine participants were randomized to a FES group that underwent an 8-week FES-assisted cycling program, the volitional group (VOL), who cycled without FES, or a no-intervention control group (CON) (15 FES, 11 VOL, 13 CON). Cadence, peak VO2, and net rise in heart rate were assessed at baseline, end of training, and washout (8-weeks after cessation of training). Latent growth curve modeling was used for analysis. The FES group showed significantly higher cycling cadences than the VOL and CON groups at POST and WO. There were no differences in improvements in the peak VO2 and peak net HR between groups. FES-assisted cycling may help children with CP attain higher cycling cadences and to retain these gains after training cessation. Higher training intensities may be necessary to obtain improvements in peak VO2 and heart rate.


Assuntos
Paralisia Cerebral , Terapia por Estimulação Elétrica , Traumatismos da Medula Espinal , Criança , Estimulação Elétrica , Exercício Físico , Terapia por Exercício , Humanos
5.
Sensors (Basel) ; 21(22)2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34833737

RESUMO

Cerebral palsy (CP) is a non-progressive, neurological disorder often resulting in secondary musculoskeletal impairments affecting alignment and function which can result in orthopaedic surgery. Neuromuscular electrical stimulation (NMES) is a modality that can be used for rehabilitation; however, NMES immediately following orthopaedic surgery in children with CP using surface electrodes has not been previously reported. The purpose of this case series is to describe the novel use of NMES in the acute rehabilitation phase directly after orthopaedic surgery. This case series included three children with spastic diplegia CP, Gross Motor Function Classification System level II who underwent Single Event Multi-Level orthopaedic Surgery. Each long leg cast contained window cast cut-outs to allow for surface electrode placement for daily NMES intervention to the quadriceps muscles while immobilized. Children were assessed pre- and post-operatively using the Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM-66), and 6-Minute Walk Test (6MWT). All children demonstrated no adverse effects using NMES intervention and had improvements in the 6MWT. Most children demonstrated gains in the FMS and GMFM-66. Use of NMES through window cast-cuts in a long leg cast is a novel practice approach for delivery of early rehabilitation following lower extremity orthopaedic surgery.


Assuntos
Paralisia Cerebral , Terapia por Estimulação Elétrica , Procedimentos Ortopédicos , Criança , Estimulação Elétrica , Humanos , Extremidade Inferior
6.
Hum Mov Sci ; 80: 102875, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34736019

RESUMO

OBJECTIVE: Muscle clinical metrics are crucial for spastic cocontraction management in children with Cerebral Palsy (CP). We investigated whether the ankle plantar flexors cocontraction index (CCI) normalized with respect to the bipedal heel rise (BHR) approach provides more robust spastic cocontraction estimates during gait than those obtained through the widely accepted standard maximal isometric plantar flexion (IPF). METHODS: Ten control and 10 CP children with equinus gait pattern performed the BHR and IPF testing and walked barefoot 10-m distance. We compared agonist medial gastrocnemius EMG during both testing and CCIs obtained as the ratios of antagonist EMG during swing phase of gait and either BHR or IPF agonist EMG. RESULTS: Agonist EMG values from the BHR were: (i) internally reliable (Cronbach's α = 0.993), (ii) ~50 ± 0.4% larger than IPF, (iii) and positively correlated. Derived CCIs were significantly smaller (p < 0.05) in both populations. CONCLUSION: The bipedal heel rise approach may be accurate enough to reveal greater agonist activity of plantar flexors than the maximal isometric plantar flexion and seems to be more appropriate to obtain cocontraction estimates during swing of gait. SIGNIFICANCE: This modified biomarker may represent a step forward towards improved accuracy of spastic gait management in pediatric.


Assuntos
Paralisia Cerebral , Biomarcadores , Criança , Eletromiografia , Marcha , Humanos , Espasticidade Muscular
7.
NeuroRehabilitation ; 49(3): 375-389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34776432

RESUMO

BACKGROUND: No general recommendations are yet available for the application of robot-assisted treadmill therapy for children with cerebral palsy regarding the length and intensity of the intervention. OBJECTIVE: The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-assisted gait training (RAGT) in patients with bilateral spastic cerebral palsy. METHOD: During 12 months, the patients underwent 1-4 blocks of RAGT, representing 16-82 TUs. The following parameters were evaluated before (V0) and after each therapeutic block (V1-V4): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). We evaluated the change in motor functions in relation to the severity of disability, age, gender and number of therapeutic units. RESULTS: Ninety-seven patients aged between 3.7 and 27 years (mean age 10.02 years (SD±5.29); Gross Motor Function Classification System level I [n = 5], II [n = 25], III [n = 48], IV [n = 19]) underwent 16-82 TUs (overall average number 34.06 TUs, SD±16.41) of RAGT. In the patient group, we recorded clinically meaningful improvement and statistically significant improvement (p < 0.001) in gross motor functions with gradual increase in the effect size after each therapeutic block. Using correlation and regression analysis, we found a statistically significant associations between the number of therapeutic units, severity of disability, and improvement in motor functions after RAGT. CONCLUSION: We have identified two determinants -the severity of disability and the number of therapeutic units -which could have a decisive and predictive character in setting rehabilitation/designing programmes. The duration of the applied RAGT period, frequency and intensity could be a crucial factor for the potential of improvement in children with BS-CP.


Assuntos
Paralisia Cerebral , Robótica , Adolescente , Adulto , Criança , Pré-Escolar , Terapia por Exercício , Marcha , Humanos , Caminhada , Adulto Jovem
8.
Foot Ankle Clin ; 26(4): 639-653, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752232

RESUMO

Children with cerebral palsy frequently develop foot deformities, most commonly equinus contractures, which can be managed with orthotics up to age 5 to 7 years. Plantar flexor lengthening, typically around this age, should be restricted to the offending muscle only, usually with a fascia release of the gastrocnemius. Equinovarus, mainly a problem in children with unilateral cerebral palsy, often responds to plantar flexor lengthening. If further tendon transfers are needed, they should be done when the child is older to avoid overcorrection. Planovalgus mostly improves spontaneously up to age 5 years. Surgical correction is best done in adolescence.


Assuntos
Paralisia Cerebral , Pé Equino , Deformidades do Pé , Adolescente , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Pé Equino/etiologia , Pé Equino/cirurgia , , Deformidades do Pé/etiologia , Deformidades do Pé/cirurgia , Humanos , Músculo Esquelético
9.
Behav Neurol ; 2021: 6299462, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733374

RESUMO

This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.


Assuntos
Paralisia Cerebral , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Deglutição , Feminino , Humanos , Masculino , Destreza Motora
10.
Acta Clin Croat ; 60(2): 282-289, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34744279

RESUMO

The aim was to study functional abilities and to create functional classification of children with cerebral palsy (CP) in Krapina-Zagorje County, based on the classification of gross and fine motor skills and associated impairments. Classification was performed according to the SCPE (Surveillance of Cerebral Palsy in Europe) criteria. We used standardized and complementary functional classification systems for cerebral palsy to create a functional profile. Research included 44 children with CP in the age range of 4 to 18 years. The results showed that the majority of children had bilateral spastic CP (63.6%), followed by unilateral spastic (22.7%) while the representation of dyskinetic CP was 9.09% and ataxic CP 4.55%. Based on the classification of gross and fine motor skills, 43.2% of children had the ability to walk, 11% of children could walk with assistive mobility devices, while 45.4% of children had a low functional level. The study also analyzed the associated impairments where higher classification score of motor impairment correlated with the severity of impairment. The results showed that children with dyskinetic CP and severe motor impairment could have mild cognitive impairment. We systematically present the neuropsychological and functional profile according to the CP type.


Assuntos
Paralisia Cerebral , Doenças Genéticas Inatas , Adolescente , Ataxia , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Europa (Continente) , Humanos , Destreza Motora , Índice de Gravidade de Doença , Caminhada
11.
J Insur Med ; 49(s1): 1-31, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34788842

RESUMO

OBJECTIVE.­: To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. BACKGROUND.­: Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. METHOD.­: We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. RESULTS.­: We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. CONCLUSIONS.­: Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.


Assuntos
Paralisia Cerebral , Seguro Saúde , Criança , Pré-Escolar , Família , Humanos , Renda , Pais
12.
Neurophysiol Clin ; 51(5): 391-408, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34615605

RESUMO

Transcranial magnetic stimulation (TMS) can be a useful tool for the assessment of the brain functional reorganization in subjects with hemiplegic cerebral palsy (HCP). In this review, we performed a systematic search of all studies using TMS in order to explore the neuroplastic changes that occur in HCP patients. We aimed at investigating the usefulness of TMS to explore cortical excitability, plasticity and connectivity changes in HCP. Children with HCP due to unilateral lesions of the corticospinal system had ipsilateral motor evoked potentials (MEPs) similar to those recorded contralaterally. TMS studies demonstrated that occupational and constraint-induced movement therapy were associated with significant improvements in contralateral and ipsilateral corticomotor projection patterns. In addition, after intensive bimanual therapy, children with HCP showed increased activation and size of the motor areas controlling the affected hand. A TMS mapping study revealed a mediolateral location of the upper and lower extremity map motor cortical representations. Deficits in intracortical and interhemispheric inhibitory mechanisms were observed in HCP. Early hand function impairment correlated with the extension of brain damage, number of involved areas, and radiological signs of corticospinal tract (CST) degeneration. Clinical mirror movements (MMs) correlated with disability and CST organization in subjects with HCP and a positive relationship was found between MMs and MEPs strength. Therefore, TMS studies have shed light on important pathophysiological aspects of motor cortex and CST reorganization in HCP patients. Furthermore, repetitive TMS (rTMS) might have therapeutic effects on CST activities, functional connectivity and clinical status in children with HCP.


Assuntos
Paralisia Cerebral , Estimulação Magnética Transcraniana , Encéfalo , Paralisia Cerebral/complicações , Paralisia Cerebral/terapia , Criança , Potencial Evocado Motor , Hemiplegia/terapia , Humanos , Tratos Piramidais
13.
AJNR Am J Neuroradiol ; 42(11): 2054-2061, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34593378

RESUMO

BACKGROUND AND PURPOSE: Selective voluntary motor control is an important factor influencing gross motor function, interjoint coordination, and the outcome of hamstring-lengthening surgery in spastic cerebral palsy. Using DTI, we investigated whether selective voluntary motor control would show strong correlations with WM motor tract microstructure and whether selective voluntary motor control is more sensitive to global WM impairment than gross motor function. MATERIALS AND METHODS: Children with spastic bilateral cerebral palsy born preterm and typically developing children were recruited. The Selective Control Assessment of the Lower Extremity (SCALE) and Gross Motor Function Measure (GMFM) were assessed in participants with cerebral palsy. Participants underwent brain MR imaging to collect DWI data. Tract-Based Spatial Statistics was used to analyze the WM for between-group differences and correlations with SCALE and GMFM. ROI analyses compared motor regions. RESULTS: Twelve children with cerebral palsy (mean age, 11.5 years) and 12 typically developing children (mean age, 10.3 years) participated. Altered DTI outcomes were found throughout the whole brain for the cerebral palsy group. SCALE, developed to evaluate selective voluntary motor control in cerebral palsy, showed significant positive correlations with fractional anisotropy in more WM voxels throughout the whole brain and for motor regions, including the corticospinal tract and corpus callosum, compared with GMFM. A significant negative correlation between radial diffusivity and SCALE, but not GMFM, was found within the corpus callosum. CONCLUSIONS: SCALE was a more sensitive clinical correlate of motor and whole-brain WM tract impairment in children with spastic bilateral cerebral palsy, suggesting greater anisotropy and myelination in these regions for those with higher selective voluntary motor control.


Assuntos
Paralisia Cerebral , Substância Branca , Encéfalo/diagnóstico por imagem , Paralisia Cerebral/diagnóstico por imagem , Criança , Imagem de Tensor de Difusão , Humanos , Recém-Nascido , Espasticidade Muscular
14.
PLoS One ; 16(10): e0258650, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34705843

RESUMO

BACKGROUND: Research on cerebral palsy (CP) has lacked emphasis on knowledge and treatment practices among caregivers, particularly in low- and middle-income countries where socio-cultural contexts encourage a variety of treatment alternatives. In this study, we explored the beliefs and experiences that motivate care-seeking practices among caregivers of children with CP in Ghana. METHODS: Semi-structured interviews were conducted with 25 caregivers, 10 medical providers, and 5 alternative providers in the Greater Accra Region. Participant interviews were analyzed using principles adapted from grounded theory. A conceptual model was constructed to illustrate salient patterns and motivational factors influencing care-seeking practices. RESULTS: Participants' experiences showed that caregivers initially sought physiotherapy and prescription medications from medical providers. Many of them then transitioned to alternative methods to search for a cure or address specific CP symptoms. Over time, most caregivers discontinued both medical and alternative care in favor of at-home treatment. A few withdrew completely from all forms of care. Cost of treatment, caregiver burden, and stigma strongly inhibited care-seeking outside the home. CONCLUSION: Although caregivers were open to exploring a variety of treatment options, at-home treatment was preferred by long-time caregivers for its convenience, low cost, and adaptability to patient and caregiver needs.


Assuntos
Cuidadores/psicologia , Paralisia Cerebral/psicologia , Mães/psicologia , Adulto , Estudos de Avaliação como Assunto , Feminino , Gana , Teoria Fundamentada , Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Busca de Ajuda , Humanos , Masculino , Idade Materna , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estigma Social , Inquéritos e Questionários , Adulto Jovem
15.
J Neuroeng Rehabil ; 18(1): 151, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663392

RESUMO

BACKGROUND: As hyperactive muscle stretch reflexes hinder movement in patients with central nervous system disorders, they are a common target of treatment. To improve treatment evaluation, hyperactive reflexes should be assessed during activities as walking rather than passively. This study systematically explores the feasibility, reliability and validity of sudden treadmill perturbations to evoke and quantify calf muscle stretch reflexes during walking in children with neurological disorders. METHODS: We performed an observational cross-sectional study including 24 children with cerebral palsy (CP; 6-16 years) and 14 typically developing children (TD; 6-15 years). Short belt accelerations were applied at three different intensities while children walked at comfortable speed. Lower leg kinematics, musculo-tendon lengthening and velocity, muscle activity and spatiotemporal parameters were measured to analyze perturbation responses. RESULTS: We first demonstrated protocol feasibility: the protocol was completed by all but three children who ceased participation due to fatigue. All remaining children were able to maintain their gait pattern during perturbation trials without anticipatory adaptations in ankle kinematics, spatiotemporal parameters and muscle activity. Second, we showed the protocol's reliability: there was no systematic change in muscle response over time (P = 0.21-0.54) and a bootstrapping procedure indicated sufficient number of perturbations, as the last perturbation repetition only reduced variability by ~ 2%. Third, we evaluated construct validity by showing that responses comply with neurophysiological criteria for stretch reflexes: perturbations superimposed calf muscle lengthening (P < 0.001 for both CP and TD) in all but one participant. This elicited increased calf muscle activity (359 ± 190% for CP and 231 ± 68% for TD, both P < 0.001) in the gastrocnemius medialis muscle, which increased with perturbation intensity (P < 0.001), according to the velocity-dependent nature of stretch reflexes. Finally, construct validity was shown from a clinical perspective: stretch reflexes were 1.7 times higher for CP than TD for the gastrocnemius medialis muscle (P = 0.017). CONCLUSIONS: The feasibility and reliability of the protocol, as well as the construct validity-shown by the exaggerated velocity-dependent nature of the measured responses-strongly support the use of treadmill perturbations to quantify stretch hyperreflexia during gait. We therefore provided a framework which can be used to inform clinical decision making and treatment evaluation.


Assuntos
Paralisia Cerebral , Criança , Estudos Transversais , Humanos , Reflexo Anormal , Reflexo de Estiramento , Reprodutibilidade dos Testes
17.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34649982

RESUMO

OBJECTIVES: With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT). METHODS: CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures. RESULTS: Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment). CONCLUSIONS: CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.


Assuntos
Paralisia Cerebral/reabilitação , Técnicas de Exercício e de Movimento/métodos , Imobilização/métodos , Paresia/reabilitação , Criança , Pré-Escolar , Condicionamento Operante , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
18.
Am J Hum Genet ; 108(10): 2006-2016, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34626583

RESUMO

Spermatogenesis-associated 5 like 1 (SPATA5L1) represents an orphan gene encoding a protein of unknown function. We report 28 bi-allelic variants in SPATA5L1 associated with sensorineural hearing loss in 47 individuals from 28 (26 unrelated) families. In addition, 25/47 affected individuals (53%) presented with microcephaly, developmental delay/intellectual disability, cerebral palsy, and/or epilepsy. Modeling indicated damaging effect of variants on the protein, largely via destabilizing effects on protein domains. Brain imaging revealed diminished cerebral volume, thin corpus callosum, and periventricular leukomalacia, and quantitative volumetry demonstrated significantly diminished white matter volumes in several individuals. Immunofluorescent imaging in rat hippocampal neurons revealed localization of Spata5l1 in neuronal and glial cell nuclei and more prominent expression in neurons. In the rodent inner ear, Spata5l1 is expressed in the neurosensory hair cells and inner ear supporting cells. Transcriptomic analysis performed with fibroblasts from affected individuals was able to distinguish affected from controls by principal components. Analysis of differentially expressed genes and networks suggested a role for SPATA5L1 in cell surface adhesion receptor function, intracellular focal adhesions, and DNA replication and mitosis. Collectively, our results indicate that bi-allelic SPATA5L1 variants lead to a human disease characterized by sensorineural hearing loss (SNHL) with or without a nonprogressive mixed neurodevelopmental phenotype.


Assuntos
Paralisia Cerebral/patologia , Epilepsia/patologia , Predisposição Genética para Doença , Variação Genética , Perda Auditiva/patologia , Deficiência Intelectual/patologia , Espasticidade Muscular/patologia , ATPases Associadas a Diversas Atividades Celulares/genética , Adolescente , Adulto , Alelos , Animais , Paralisia Cerebral/etiologia , Paralisia Cerebral/metabolismo , Pré-Escolar , Epilepsia/etiologia , Epilepsia/metabolismo , Feminino , Perda Auditiva/etiologia , Perda Auditiva/metabolismo , Humanos , Lactente , Recém-Nascido , Deficiência Intelectual/etiologia , Deficiência Intelectual/metabolismo , Masculino , Espasticidade Muscular/etiologia , Espasticidade Muscular/metabolismo , Ratos , Adulto Jovem
19.
Geospat Health ; 16(2)2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34672180

RESUMO

Cerebral palsy (CP) is one of the most common causes of disability in childhood, leading to functional limitations and poor nutritional status. Families with CP children face challenges in providing proper care. Thus, accessibility of CP patients to health facilities is important to ensure that they can maintain regular visits to health facilities for proper treatment and care. The current study aimed to map the spatial distribution of CP in Johor, Malaysia and measure the accessibility of CP patients to nearby hospitals, health clinics and community-based rehabilitation centres. The study is based on CP cases in 2017 obtained from the Department of Social Welfare, Malaysia and analysed using the average nearest neighbour, buffer analysis and Kernel Density Estimation. Results indicate that there is generally good access to health care services for many of the CP children in Johor, but for 25% of those living more than 10 km away from the health clinics or community-based rehabilitation centres, regular visits can be a problem. This information should be used for targeted intervention and planning for health care strategies. Furthermore, information on hospital accessibility of CP children would allow for planning of proper and regular treatment for these patients. The study has shown that it is possible to improve the understanding of the distribution of CP cases by integrating spatial analysis using geographical information systems without relying on official information about the density of populations.


Assuntos
Paralisia Cerebral , Paralisia Cerebral/epidemiologia , Criança , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Malásia/epidemiologia , Análise Espacial
20.
Zhongguo Zhen Jiu ; 41(10): 1095-102, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34628741

RESUMO

OBJECTIVE: To observe the effect of acupuncture combined with rehabilitation training on cognitive function and amino acid metabolism in children with cerebral palsy. METHODS: Twenty children with cerebral palsy (cerebral palsy group) were randomly divided into an acupuncture and rehabilitation group (11 cases) and a rehabilitation group (9 cases), and 10 healthy children were included as the normal group. The rehabilitation group was treated with rehabilitation training, 30 min each time; on the basis of rehabilitation training, the acupuncture and rehabilitation group was treated with acupuncture at Sishenzhen, Zhisanzhen, Naosanzhen, Niesanzhen, Dazhui (GV 14), Shenzhu (GV 12), Mingmen (GV 4), etc. The Sishenzhen (left and right points) and the ipsilateral Niesanzhen were respectively connected with a group of electrodes, intermittent wave, frequency of 2 Hz for 30 min. Both groups were treated once every other day, three times a week, totaling for 3 months. The Gesell developmental diagnostic scale (GESELL) was used to evaluate the developmental quotient (DQ) scores before and after treatment, and the blood samples of children with cerebral palsy before and after treatment and normal children were collected for amino acid metabolomics. RESULTS: Compared before treatment, the DQ scores of adaptation, fine motor and social in the acupuncture and rehabilitation group was increased after treatment (P<0.05), and the DQ score of fine motor in the rehabilitation group was increased after treatment (P<0.05). Compared with the normal group, the serum L-glutamate, L-ornithine, L-tyrosine, L-methionine and L-arginine in the cerebral palsy group were down-regulated, and L-histidine, L-citrulline, 5-hydroxylysine and L-glutamine were up-regulated before treatment. The functional pathways mapped by different metabolites between the cerebral palsy group and the normal group included arginine biosynthesis, arginine and proline metabolism, etc. Compared with the cerebral palsy group, the serum L-histidine was decreased, and L-citrulline showed decreasing trend in the acupuncture and rehabilitation group after treatment. CONCLUSION: Acupuncture combined with rehabilitation training could improve cognitive function in children with cerebral palsy, and the effect may be related to the down-regulation of L-histidine and L-citrulline metabolism.


Assuntos
Terapia por Acupuntura , Paralisia Cerebral , Pontos de Acupuntura , Aminoácidos , Paralisia Cerebral/terapia , Criança , Cognição , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...