Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22.858
Filtrar
1.
Clin Rehabil ; 37(1): 3-16, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35730135

RESUMO

OBJECTIVE: To investigate whether neuromuscular electrical stimulation improves mobility in children with spastic cerebral palsy. METHODS: PubMed, Cochrane, EMBASE, and Scopus were searched for randomized controlled trials studying the effects of NMES on the lower limbs in children with spastic CP. Randomized controlled trials comparing the effect of neuromuscular electrical stimulation with that of placebo or conventional therapy on mobility in children with cerebral palsy were eligible for inclusion. Two reviewers independently screened studies, extracted data, and examined the risk of bias and quality of evidence by using the revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2.0) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. The final search was conducted on May 23, 2022. RESULTS: A total of 14 randomized controlled trials (2 crossover studies and 12 parallel studies including 421 patients) were included in this meta-analysis. Compared with the control group (conventional physical therapy), the treatment group exhibited greater improvement in walking speed (standardized mean difference = 0.29; 95% confidence interval = 0.02-0.57) and the standing, walking, running, and jumping dimension of the Gross Motor Function Measure (standardized mean difference = 1.24; 95% confidence interval = 0.64-1.83). CONCLUSION: Neuromuscular electrical stimulation improved mobility in children with spastic cerebral palsy, particularly in standing, running, and jumping function, and it is safe for children with spastic cerebral palsy.


Assuntos
Paralisia Cerebral , Terapia por Estimulação Elétrica , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espasticidade Muscular/terapia , Caminhada , Estimulação Elétrica , Terapia por Estimulação Elétrica/métodos
2.
Clin Rehabil ; 37(1): 119-131, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36039504

RESUMO

OBJECTIVE: Rehabilitation may mitigate the high mortality rates and health declines post-fracture for adults with cerebral palsy, but this is understudied. The objectives were to characterize the post-fracture rehabilitation pathways and identify their association with 1-year survival among adults with cerebral palsy. METHODS: A retrospective cohort study of adults with cerebral palsy with a fragility fracture with continuous health plan enrollment ≥1-year prior to and ≥1 day after their fracture date was performed using a random 20% Medicare fee-for-service dataset. Participants were categorized as a home discharge or inpatient rehabilitation admission post-fracture. For the home discharge cohort, weekly exposure to outpatient physical/occupational therapy (PT/OT) was examined up to 6-month post-fracture. Cox regression examined the association between time-varying PT/OTuse within 6-month post-fracture and mortality from 30 days to 1-year post-fracture before and after adjusting for confounders (e.g. medical complexity). RESULTS: Of 3598 adults with cerebral palsy with an incident fragility fracture, 74% were discharged home without inpatient rehabilitation; they were younger, but more medically complex compared to the 26% admitted to inpatient rehabilitation. Among the home discharge cohort (n = 2662), 43.1% initiated PT/OTwithin 6-month post-fracture, and cumulative PT/OTexposure post-fracture was associated with improved survival; for example, per 3 weeks of PT/OTexposure, the adjusted mortality rate was 40% lower (95% confidence interval (CI) = 0.41-0.89). CONCLUSIONS: Most adults with cerebral palsy with a fragility fracture were discharged home rather than to inpatient rehabilitation, and only 43.1% of that group initiated outpatient PT/OTwithin 6 months post-fracture. Receiving outpatient PT/OTwas associated with improved 1-year survival.


Assuntos
Paralisia Cerebral , Fraturas Ósseas , Idoso , Adulto , Humanos , Estados Unidos , Medicare , Estudos Retrospectivos , Paralisia Cerebral/diagnóstico , Planos de Pagamento por Serviço Prestado , Alta do Paciente
3.
Turk J Med Sci ; 52(3): 803-808, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326319

RESUMO

BACKGROUND: Studies mostly focused on risk factors and clinical status in children with cerebral palsy (CP). Various antiinflammatory markers may help us in the early diagnosis and clinical classification of cerebral palsy patients. In this study, the relationship between antiinflammatory marker levels and clinical status in patients with CP is determined. It is the first time that Fetuin-A and Paraoxonase-1 (PON-1) are examined in children with CP. METHODS: The study is conducted on 79 children which are divided into two groups as CP and control. Gross motor function and spasticity are evaluated in addition to biochemical parameters. RESULTS: There is a statistically significant difference between CP and control group in terms of PON-1 activity, high sensitive C-Reactive Protein, HDL, and total cholesterol levels. There is no statistically significant difference in Fetuin A levels between the two groups. DISCUSSION: In suspected CP patients less than 24 months of age who possess prenatal and postnatal risk factors, the determination of PON-1 activity can be considered as a biomarker to support early diagnosis.


Assuntos
Paralisia Cerebral , Criança , Humanos , alfa-2-Glicoproteína-HS , Arildialquilfosfatase , Espasticidade Muscular
4.
Medicine (Baltimore) ; 101(46): e31404, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401482

RESUMO

RATIONALE: Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability. The treatment of patients diagnosed with spastic quadriplegia is complex and multidisciplinary. In this case report we described the positive effect of multisensory environment (MSEs) rehabilitation, and the strategies and technologies used to provide child who have to severe spastic quadriplegia and intellectual disability, palsy with playful and fun activities designed according to his abilities. PATIENT CONCERN: A 7-years-old boy diagnosed with spastic quadriplegia and severe intellectual disability began rehabilitation by MSEs. DIAGNOSES: Spastic quadriplegia is most severe form of Infantile Cerebral Palsy. Patients are unable to use their legs, arms and body and show language disorder and profound intellectual disability. INTERVENTIONS: Multisensory room is a large environment containing various elements where child can interact spontaneously and independently. OUTCOMES: The comparison scores between T0-T1 showed a reduction in self-harm and motor stereotypies (hand flapping). Sustained attention was improved and we observed a better therapeutic compliance by means of greater involvement in gaming activities. CONCLUSION: The stimuli within the MSEs provided the child opportunities to express himself with facilities more suited to his potential. Future research should project designed randomized controlled trials to examine the efficacy of multisensory on reduction disability.


Assuntos
Paralisia Cerebral , Deficiência Intelectual , Transtornos da Linguagem , Humanos , Criança , Masculino , Paralisia Cerebral/reabilitação , Quadriplegia
5.
BMJ Open ; 12(11): e063558, 2022 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-36410832

RESUMO

INTRODUCTION: Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12-24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research-practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control. METHODS AND ANALYSIS: This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost-consequence analysis from funders' and societal perspectives. ETHICS AND DISSEMINATION: Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.


Assuntos
Paralisia Cerebral , Médicos , Humanos , Criança , Paralisia Cerebral/diagnóstico , Austrália , Diagnóstico Precoce , Internet , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Exp Brain Res ; 240(12): 3315-3325, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36318317

RESUMO

Previous studies have revealed several deficits in anticipatory postural adjustments (APAs) during voluntary movements while standing in individuals with bilateral spastic cerebral palsy (BSCP). However, it remains unclear whether compensatory postural adjustments (CPAs) during movement increase to compensate for APA deficits. We investigated the anticipatory and compensatory activities of postural muscles during voluntary movement while standing in adolescents and young adults with BSCP. The study included seven participants with BSCP with level II on the Gross Motor Function Classification System (GMFCS), seven with BSCP with level III on the GMFCS, and fourteen healthy controls. The participants stood on a force platform and lifted a load under two weight conditions (light and heavy). The electromyographic activities of postural muscles were analyzed at time intervals typical for APAs and CPAs. The percentage of muscle activity in the CPA time epoch against the total muscle activity during the APA and CPA time epochs was higher in the two BSCP groups than in the control group. In the control group, a load-related modulation was observed only in the APA time epoch, whereas in the BSCP-II group, the load-related increase was observed in both the APA and CPA time epochs. No load-related modulations were observed in the BSCP-III group. These findings suggest that adolescents and young adults with BSCP exhibit an increase in the relative contribution of CPAs during voluntary movement and that there exist severity-related differences in the modulation of APAs and CPAs.


Assuntos
Paralisia Cerebral , Adulto Jovem , Adolescente , Humanos , Postura/fisiologia , Equilíbrio Postural/fisiologia , Movimento , Posição Ortostática , Eletromiografia , Músculo Esquelético/fisiologia
7.
Malawi Med J ; 34(3): 176-183, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36406099

RESUMO

Introduction: In Malawi, Primary Caregivers (PCGs) of children living with Cerebral Palsy report challenges such as physical strain and lack of resources that affect care giving. Although such experiences affect the PCGs' Quality of Life (QoL), there is paucity of data for Malawi. Understanding their QoL would inform establishment of holistic intervention(s) tailored to meet their needs. Therefore, the purposes of this study were to determine QoL of PCGs of the children who were receiving rehabilitation at Queen Elizabeth Central Hospital (QECH) and Feed the Children (FtC), to identify PCG's and children's socio-demographic factors that may attribute to the perceived QoL, and to compare the PCGs' QoL between the sites. Methods: A cross-sectional study was conducted from January to April 2019 on 142 PCGs of children aged between 2 and 18 years of age. All PCGs who were employed for the child-care, or had a chronic sickness were excluded. QoL was assessed using the World Health Organization Brief questionnaire, with a cut-off point of <60% for poor QoL. The severity of children's impairments was assessed using Gross Motor Function Classification System. Descriptive and inferential statistics were conducted to analyze the data. The PCGs' age, sex, marital status and level of education, and child's severity of impairment were compared with QoL. Results: The majority of PCGs (61.30%) had poor QoL, and there was no significant difference in overall QoL of the PCGs between the sites (p<0.31). The PCGs at QECH had significantly higher physical domain mean scores than at FtC (U=1906, p<0.01). The overall QoL differed significantly across the marital statuses of the PCGs (p<0.03). Conclusion: The study has established that most PCGs at both sites possess poor QoL. However, there is need to investigate how the rehabilitation institutions and workers influence the QoL of the PCGs within and between the facilities.


Assuntos
Paralisia Cerebral , Qualidade de Vida , Humanos , Pré-Escolar , Criança , Adolescente , Cuidadores , Estudos Transversais , Malaui
8.
Afr Health Sci ; 22(2): 565-572, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407341

RESUMO

Background: Gait speed and postural stability are indicators of community level ambulation and may be a valuable measure of disability. Objectives: to investigate the relation between the distribution of weight on both lower extremities and gait speed in children with spastic cerebral palsy. Methods: Evaluation for weight distribution on both lower limbs and speed during gait for sixty children with spastic diplegia and forty-five children with hemiplegia was carried out by the Biodex gait trainer. Pearson correlation test was conducted to determine the relation of the symmetry index and the percent of weight bearing to speed. Results: A significant weak positive correlation was found between speed and symmetry index in diplegic group, while there was a non-significant weak negative correlation between speed and symmetry index was noticed in hemiplegic group. Nonsignificant weak positive correlation between speed and weight on most affected side was recorded in diplegic group. While in hemiplegic group, there was significant weak negative correlation between weight on affected side and speed. Conclusion: Children with cerebral palsy demonstrate asymmetrical weight distribution during walking. Physical therapy training should be directed to enhance weight bearing distribution thus improving gait and postural stability.


Assuntos
Paralisia Cerebral , Humanos , Criança , Velocidade de Caminhada , Hemiplegia , Marcha , Caminhada
9.
Afr Health Sci ; 22(2): 573-580, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407377

RESUMO

Purpose: This study is aimed to identify factors influencing patient's adherence to treatment in a bid to characterize the extent to which these factors are considered while developing a treatment schedule for patients with cerebral palsy in Nigeria. Methods: Descriptive cross-sectional study of physiotherapists involved in the care of patients with cerebral palsy. Factors influencing treatment adherence were assessed using a pre-tested, self-administered questionnaire. Participants were sampled from physiotherapists working at University of Nigeria Teaching Hospital, Enugu State, Nigeria. The data were analyzed using descriptive statistics of percentage and frequencies. Results: A total of fifty three (31 males and 22 females) physiotherapists completed and returned the questionnaire. Participants (84.9%) agreed that patients occasionally forget to meet up with their appointment days; with majority of them agreeing that distance to the clinic and economic factor (cost of treatment and transportation) influence patient's adherence to treatment. Presence/absence of a caregiver and relationship between patients and their physiotherapist are also important factors influencing patient's treatment schedules. Conclusion: Distance to the clinic when compared to other (economic, patient-therapist relationship) factors is the major barrier to patient's adherence to treatment and therefore should be considered while developing treatment schedules for patients with cerebral palsy.


Assuntos
Paralisia Cerebral , Fisioterapeutas , Humanos , Masculino , Feminino , Paralisia Cerebral/terapia , Estudos Transversais , Nigéria , Modalidades de Fisioterapia
10.
Acta Med Okayama ; 76(5): 535-540, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36352800

RESUMO

The purpose of this study was to investigate the psychological impact of various positionings in subjects with cerebral palsy (CP). The participants were 17 individuals with severe motor and intellectual disability due to CP. They began in a sitting position in their wheelchair, and were placed consecutively in prone or supine positions, with no intervals between placements. Physiological observations were made in each position, and included salivary α-amylase activity, pulse, percutaneous oxygen saturation, respiratory rate, learance or not of airway secretions, and occurrence or not of adverse events. Salivary α-amylase activity values were higher in the prone position than in the baseline and supine positions (p<0.05). Clearance of airway secretions was significantly more prevalent in the prone position than in the baseline and supine positions (p <0.05). The participants' pulse was significantly lower in the supine and prone positions than in the baseline position (p<0.05). Greater prevalence of airway secretion clearance and significantly higher stress levels as indicated by saliva amylase were observed in the prone position than in the other two positions. Therefore, when such patients are placed in a prone position, close attention to airway management and the potential for psychological stress may be necessary.


Assuntos
Paralisia Cerebral , alfa-Amilases Salivares , Humanos , Decúbito Ventral/fisiologia , Posicionamento do Paciente/efeitos adversos , Estresse Psicológico/etiologia
11.
Medicine (Baltimore) ; 101(45): e30535, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397367

RESUMO

BACKGROUND: Over the past 30 years, treatments from different disciplines have been applied to spastic cerebral palsy (SCP). However, few bibliometric studies have been conducted to date. This study explored the knowledge base, emerging hotspots, and future trends related to SCP treatment research using bibliometric analysis. METHODS: Publications on SCP treatment included in the Web of Science Core Collection database between 1990 and 2020 were retrieved, and Medical Subject Headings terms were extracted from PubMed. Online bibliometric analysis website (http://bibliometric.com/), 2 pieces of software called "CiteSpace" and "VOSViewer" were used for quantitative analysis and knowledge map establishment. RESULTS: A total of 1668 papers were retrieved from 1990 to 2020. The number of publications has increased annually. Developmental Medicine and Child Neurology is the most productive and the highest co-cited journal. The United States has been the largest contributor. Vrije Universiteit Amsterdam ranked first in the number of papers published among institutions that have conducted correlational research. Becher JG and Graham HK should be considered scholars who have made outstanding contributions. The knowledge base of the SCP treatment research field is thoughtfully constructed to promote understanding of the field. CONCLUSION: This bibliometric study identified global achievements, research hotspots, and trends of SCP treatment. They provide insights into the research field and valuable information for future scientific research and clinical treatment.


Assuntos
Paralisia Cerebral , Criança , Humanos , Estados Unidos , Paralisia Cerebral/terapia , Bibliometria , Publicações , Bases de Dados Factuais , PubMed
13.
Medicine (Baltimore) ; 101(44): e31565, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343029

RESUMO

BACKGROUND: To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP). METHODS: A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software. RESULTS: A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group. CONCLUSIONS: Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.


Assuntos
Paralisia Cerebral , Criança , Humanos , Paralisia Cerebral/terapia , Atividades Cotidianas , China
14.
BMJ Open ; 12(11): e061988, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328390

RESUMO

INTRODUCTION: Treadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children's functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System. METHODS AND ANALYSIS: This study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic - Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30 min for each session. Assessments will be performed on three occasions: 1 week before the intervention, 1 week following the intervention and 1 month after the end of the intervention. The evaluations will involve the 6 min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used. ETHICS AND DISSEMINATION: The study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT05131724.


Assuntos
Paralisia Cerebral , Realidade Virtual , Criança , Humanos , Pré-Escolar , Método Simples-Cego , Qualidade de Vida , Terapia por Exercício/métodos
15.
Artigo em Inglês | MEDLINE | ID: mdl-36361083

RESUMO

Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0-3% GC (p < 0.017) and during the entire swing phase 31-100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to differ significantly both in absorption and generation 5-10%GC (p < 0.001); 21-27%GC (p < 0.001) with a reduction in both cases when the AFO was worn. No statistical differences were recorded in the GRF components, in the affected ankle torque and hip and knee kinematics and kinetics.


Assuntos
Paralisia Cerebral , Órtoses do Pé , Corrida , Criança , Humanos , Tornozelo , Marcha
16.
Artigo em Inglês | MEDLINE | ID: mdl-36361414

RESUMO

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.


Assuntos
Paralisia Cerebral , Terapia Assistida por Cavalos , Criança , Humanos , Paralisia Cerebral/reabilitação , Lacunas da Prática Profissional , Modalidades de Fisioterapia , Equilíbrio Postural
17.
JAMA Netw Open ; 5(11): e2240383, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36331502

RESUMO

Importance: There is no consensus on interventions to slow the progress of hip displacement in patients with cerebral palsy. Objective: To investigate the efficacy of a novel hip brace in preventing progressive hip displacement in patients with cerebral palsy. Design, Setting, and Participants: This 2-group randomized clinical trial was conducted at 4 tertiary hospitals in South Korea from July 2019 to November 2021. Participants included children aged 1 to 10 years with nonambulatory cerebral palsy (Gross Motor Function Classification System level IV or V). Block randomization was used to assign an equal number of patients to the study and control groups via computerized random allocation sequences. Data were analyzed from November to December 2021. Interventions: The intervention group wore the hip brace for at least 12 hours a day for the study duration (ie, 12 months). Follow-up evaluations were performed after 6 and 12 months of wearing the brace. Both groups proceeded with conventional rehabilitation therapy during the trial. Main Outcomes and Measures: The primary outcome was the Reimers migration index (MI) on radiography, as assessed by 3 blinded investigators. Primary outcome variables were analyzed using linear mixed models. Secondary outcomes include change in the Caregiver Priorities & Child Health Index of Life with Disabilities, on which lower scores indicate better quality of life. Results: A total of 66 patients were included, with 33 patients (mean [SD] age, 68.7 [31.6] months; 25 [75.8%] boys) randomized to the intervention group and 33 patients (mean [SD] age, 60.7 [24.9] months; 20 [60.6%] boys) randomized to the control group. The baseline mean (SD) MI was 37.4% (19.3%) in the intervention group and 30.6% (16.3%) in the control group. The mean difference of the MI between the intervention group and control group was -8.7 (95% CI, -10.2 to -7.1) percentage points at 6 months and -12.7 (95% CI, -14.7 to -10.7) percentage points at 12 months. The changes in the Caregiver Priorities & Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, -14.2; 95% CI, -25.2 to -3.3). Conclusions and Relevance: In this randomized clinical trial, the novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group. It effectively improved quality of life in patients with nonambulatory cerebral palsy. Therefore, hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy. Trial Registration: ClinicalTrials.gov Identifier: NCT04033289.


Assuntos
Paralisia Cerebral , Luxação do Quadril , Criança , Masculino , Humanos , Idoso , Pessoa de Meia-Idade , Feminino , Paralisia Cerebral/complicações , Paralisia Cerebral/terapia , Qualidade de Vida , Radiografia , República da Coreia
18.
Sensors (Basel) ; 22(22)2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36433532

RESUMO

Cerebral palsy is a neurological disorder with a variety of symptoms that can affect muscle coordination and movement. Crouch gait is one such symptom that is defined as excessive knee flexion accompanied by a crouched posture. This paper introduces a passive exoskeleton to support the knee joint during stance of individuals with cerebral palsy that are affected by crouch gait. The exoskeleton utilizes a hydraulic disc brake mechanism that is actuated only by the body weight and gait of the wearer to provide a braking torque at the knee joint. This passive, gait-based control method aims to offer a compact, lightweight, and simple alternative to existing exoskeletons. Preliminary experiments were conducted to verify the mechanics, safety, and braking capabilities of the device with healthy participants. A pilot study with an individual with cerebral palsy was then conducted. The individual with cerebral palsy showed a reduction in hip joint angle when using the device (18.8∘ and 21.7∘ for left and right sides, respectively). The muscle co-activation index was also reduced from 0.48 to 0.24 on the right side and from 0.17 to 0.017 on the left side. However, changes such as activation timing and device training need to be improved to better support the user.


Assuntos
Paralisia Cerebral , Exoesqueleto Energizado , Transtornos Neurológicos da Marcha , Humanos , Projetos Piloto , Fenômenos Biomecânicos , Marcha/fisiologia , Articulação do Joelho
19.
Artigo em Inglês | MEDLINE | ID: mdl-36429911

RESUMO

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.


Assuntos
Paralisia Cerebral , Deficiência Intelectual , Humanos , Feminino , Masculino , Dentição Permanente , Prevalência , Suscetibilidade à Cárie Dentária , Deficiência Intelectual/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-36429941

RESUMO

Cerebral palsy (CP) is a non-progressive neurologic pathology representing a leading cause of spasticity and concerning gait impairments in children. Robotic-assisted gait training (RAGT) is widely employed to treat this pathology to improve children's gait pattern. Importantly, the effectiveness of the therapy is strictly related to the engagement of the patient in the rehabilitation process, which depends on his/her psychophysiological state. The aim of the study is to evaluate the psychophysiological condition of children with CP during RAGT through infrared thermography (IRT), which was acquired during three sessions in one month. A repeated measure ANOVA was performed (i.e., mean value, standard deviation, and sample entropy) extracted from the temperature time course collected over the nose and corrugator, which are known to be indicative of the psychophysiological state of the individual. Concerning the corrugator, significant differences were found for the sample entropy (F (1.477, 5.907) = 6.888; p = 0.033) and for the mean value (F (1.425, 5.7) = 5.88; p = 0.047). Regarding the nose tip, the sample entropy showed significant differences (F (1.134, 4.536) = 11.5; p = 0.041). The findings from this study suggests that this approach can be used to evaluate in a contactless manner the psychophysiological condition of the children with CP during RAGT, allowing to monitor their engagement to the therapy, increasing the benefits of the treatment.


Assuntos
Paralisia Cerebral , Transtornos Neurológicos da Marcha , Procedimentos Cirúrgicos Robóticos , Humanos , Criança , Feminino , Masculino , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/reabilitação , Terapia por Exercício/métodos , Marcha/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...