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1.
Rev. méd. Urug ; 35(4): 281-288, dic. 2019. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1026148

RESUMO

Introducción: la luxación de cadera es una complicación severa en pacientes con parálisis cerebral (PC), sobre todo en pacientes incluidos en el sistema de clasificación de la función motora gruesa (GMFCS, por su sigla en inglés) III-V. Para su identificación son necesarias radiografías de pelvis. Objetivos: evaluar el seguimiento radiográfico en estos pacientes y la detección precoz de esta complicación en nuestro hospital. Material y método: se revisaron historias clínicas y radiografías de 17 pacientes GMFCS III-V, entre 2 y 8 años de edad al momento de la radiografía de pelvis índice, midiendo el porcentaje de migración (PM) de cadera de acuerdo al índice de Reimer, el ángulo cérvico-diafisiario y calculando el CPUP Score de cada cadera. Evaluamos el control radiográfico al año o posteriormente a esa fecha, y de no haber sido así, se citaría a los pacientes a control radiológico para detectar las caderas con riesgo migratorio elevado. Resultados: de los 17 pacientes evaluados, 3 (18%) tuvieron una nueva radiografía de pelvis al año; 6 (35%) pacientes la tuvieron posteriormente al año, y antes de la fecha de control designada, 7 (41%) pacientes nunca fueron controlados, citándose para nueva radiografía en 2018. Un paciente (6%) se perdió en el seguimiento. Un paciente presentó una cadera con riesgo alto (CPUP Score 50%-60%), el resto tuvo PM dentro de rangos normales. Conclusiones: pocos pacientes con PC GMFCS III-V tuvieron un seguimiento radiográfico anual. Los monitoreados posteriormente no mostraron progresión de esta condición. El resultado de este estudio y la literatura respaldan la introducción de un programa de vigilancia en nuestro hospital.


Introduction: hip luxation is a severe complication in patients with cerebral palsy (CP), especially in gross motor functional classification system (GMFCS) III-V patients. Pelvic x-rays are necessary to identify this condition. Objectives: to assess the x-ray follow-up in these patients and the early detection of this complication in our hospital. Method: the medical records and x-rays of 17 GMFCS III-V patients who were between 2 and 8 years old at the time of index pelvic x-ray were reviewed, measurement of the hip migration percentage according to Reimer´s index, the cervical-diaphyseal angle and calculation of the CPUP hip score for each hip. We assessed the follow-up x-ray a year later or later than that date, and in the even this had not happened, we would call the patients in for a control x-ray to identify the hips with an increase migration risk. Results: 3 (18%) out of 17 patients assessed underwent a new pelvic x-ray a year later. 6 patients (35%) underwent one later than one year after and prior to the control visit planned, 7 (41%) patients were never controlled and they were called for a new x-ray in 2018. One patient (6%) was lost during follow-up. One patient had an increased risk hip (CPUP Score 50-60%), the rest had normal migration percentages. Conclusions: few patients with PC GMFCS III-V underwent annual follow-up. Those monitored did not evidence progression of this condition. This study and the relevant literature back up the introduction of a surveillance program in our hospital.


Introdução: a luxação de quadril é uma complicação grave nos pacientes com paralisia cerebral (PC), principalmente nos pacientes "Gross motor funcional classificativo system (GMFCS) III-V". Para sua identificação é necessário realizar radiografias de pélvis. Objetivos: avaliar o seguimento radiográfico nesses pacientes e realizar a detecção precoce desta complicação no hospital. Material e método: foram estudados os prontuários e radiografias de 17 pacientes GMFCS III-V, com idades entre 2 e 8 anos no momento da radiografia de pélvis índice, medindo a porcentagem de migração (PM) de quadril de acordo com o índice de Reimer, o ângulo cervico-diafisiario e calculando o CPUP Score de cada quadril. Foi feito o controle radiográfico um ano ou mais depois da data da realização da radiografia; quando não foi possível os pacientes foram convocados para a realização de controle radiológico para detectar os quadris com risco migratório elevado. Resultados: dos 17 pacientes avaliados, 3 (18%) realizaram uma nova radiografia de pélvis um ano depois da primeira, 6 (35%) pacientes depois de um ano mas antes de ser convocados para controle, 7 (41%) pacientes nunca foram controlados, sendo convocados para uma nova radiografia em 2018. Um paciente (6%) foi perdido. Um paciente apresentou um quadril com risco alto (CPUP Score 50-60%), os demais tinham PM dentro de intervalos normais. Conclusões: poucos pacientes com PC GMFCS III-V tiveram um seguimento radiográfico anual. Os que foram monitorados posteriormente não mostraram progressão desta condição. O resultado deste estudo e a literatura respaldam a introdução de um programa de vigilância no nosso hospital.


Assuntos
Humanos , Pré-Escolar , Criança , Paralisia Cerebral/complicações , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Radiografia/instrumentação
2.
Isr Med Assoc J ; 21(11): 752-755, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713365

RESUMO

BACKGROUND: In non-ambulatory patients with cerebral palsy, the presence of scoliosis has a major impact on health and quality of life. The aim of this review is to raise awareness of caregivers from various professions to the extent of the problem, to explain the natural history of neuromuscular scoliosis and its pathophysiology, and to describe up-to-date optional conservative and surgical treatments.


Assuntos
Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Escoliose/complicações , Escoliose/fisiopatologia , Pessoas com Deficiência , Humanos , Limitação da Mobilidade , Qualidade de Vida
3.
Arch Esp Urol ; 72(7): 634-640, 2019 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-31475673

RESUMO

OBJECTIVES: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child's urinary tract infection and CP and its degree of independence. METHOD: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico. RESULTS: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control. CONCLUSIONS: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection.


Assuntos
Paralisia Cerebral/complicações , Doenças Urológicas/patologia , Adolescente , Paralisia Cerebral/enfermagem , Criança , Pré-Escolar , Humanos , Masculino , Papel do Profissional de Enfermagem , Estudos Retrospectivos , Infecções Urinárias , Doenças Urológicas/complicações , Doenças Urológicas/enfermagem
4.
Fisioterapia (Madr., Ed. impr.) ; 41(4): 242-246, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183102

RESUMO

Antecedentes y objetivos: La parálisis cerebral es el trastorno neurológico más frecuente en la edad infantil que afecta el cerebro inmaduro o en desarrollo ocasionando retraso en el desarrollo psicomotor. El objetivo de este estudio de caso fue identificar los efectos del concepto Bobath en la función motora en un niño con parálisis cerebral espástica nivel v según la clasificación de la función motora gruesa. Descripción del caso: Niño de 9 años de edad con diagnóstico médico de parálisis cerebral de tipo cuadriplejia espástica nivel v según el Gross Motor Function Classification System. Intervención: Se aplicó el concepto Bobath 5 veces a la semana con una duración de 45min cada sesión para un total de 16 semanas de tratamiento. Resultados: Se muestran cambios en las puntuaciones de la función motora gruesa, que en preintervención fue de 0,0, a las 12 semanas de intervención se evidencia un puntaje de 14,8 y en la semana 16 de intervención los cambios a nivel de la función motora son de 20,5, con una diferencia entre la segunda y la tercera intervención de un 5,7%. Discusión: Los resultados obtenidos evidencian que el concepto enfoque Bobath genera cambios positivos en la función motora y el manejo de la espasticidad. Los autores han encontrado resultados similares que confirman los beneficios que se lograron en el caso clínico planteado


Background and objectives: Cerebral palsy is the most frequent neurological disorder in childhood that affects the immature or developing brain, causing a delay in psychomotor development. The objective of this study was to identify the effects of the Bobath concept on motor function in a child with spastic cerebral palsy level v according to the of gross motor function classification. Case description: A 9 year-old boy with a medical diagnosis of spastic cerebral palsy level v according to the Gross Motor Function Classification System. Intervention: The Bobath concept was applied 5 times a week, with a duration of 45min each session for a total of 16 weeks of treatment. Results: Changes were seen in the gross motor function scores in pre-intervention of 0.0. A change of 14.8 was observed at 12 weeks of intervention. At week 16 of intervention the changes in the level of the motor function was 20.5, with a difference between the second and third intervention of 5.7%. Discussion: The results obtained suggest that the Bobath approach generates positive changes in motor function, and in the management of spasticity. The authors have found similar results that confirm the benefits that were achieved in this clinical case


Assuntos
Humanos , Masculino , Criança , Paralisia Cerebral/terapia , Espasticidade Muscular/terapia , Modalidades de Fisioterapia , Paralisia Cerebral/reabilitação , Paralisia Cerebral/complicações , Avaliação da Deficiência , Destreza Motora/fisiologia
5.
Artigo em Russo | MEDLINE | ID: mdl-31407681

RESUMO

AIM: To study the efficacy of the developed approach to the specialized Spa-rehabilitation of motor disorders in patients with cerebral palsy (spastic diplegia). MATERIAL AND METHODS: The study included 86 patients (45 (52,33%) women and 41 (47.67%) men), aged from 10 to 16-years, mean 13,02±2,13. All patients were divided into 2 groups depending on the method of treatment. RESULTS AND CONCLUSION: Administration of minimally invasive procedures during the course of rehabilitation can effectively restore the volume of movements in the limbs, stimulate motor development in children and form a new stereotype of walking. An analysis of the follow-up data one year after the treatment confirms the efficacy of the proposed approach to rehabilitation.


Assuntos
Paralisia Cerebral , Espasticidade Muscular , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/reabilitação , Criança , Feminino , Humanos , Masculino , Espasticidade Muscular/reabilitação , Amplitude de Movimento Articular , Caminhada
6.
Eklem Hastalik Cerrahisi ; 30(2): 155-62, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291865

RESUMO

OBJECTIVES: This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes. PATIENTS AND METHODS: Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement. RESULTS: Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures. CONCLUSION: Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/complicações , Contratura/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adolescente , Articulação do Tornozelo/fisiopatologia , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Pré-Escolar , Contratura/etiologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Fármacos Neuromusculares/administração & dosagem , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
7.
Artigo em Russo | MEDLINE | ID: mdl-31317899

RESUMO

This lecture presents general information about children cerebral palsy concerning current views on its causes and pathogenesis as well as the data on different classifications of speech disorders (localization of lesions, clinical presentations) and their prevalence, which are important for general practitioners. Special attention is drawn to the principles and tasks of diagnostics of speech disorders, organization of treatment-correction measures considering all possible approaches to the care of patients.


Assuntos
Paralisia Cerebral , Distúrbios da Fala , Paralisia Cerebral/complicações , Criança , Humanos , Prevalência , Fala , Distúrbios da Fala/complicações
8.
J Pediatr Orthop ; 39(7): 366-371, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305380

RESUMO

BACKGROUND: Surgical lengthening of the hamstrings is often performed to correct crouch gait in children with cerebral palsy (CP). Previous studies have demonstrated the effectiveness of open hamstring lengthening (oHSL) in improving knee extension static and dynamic range of motion; however, literature regarding percutaneous hamstring lengthening (pHSL) is limited. The purpose of this study was to investigate the effect of open versus pHSL for improving crouch gait and knee function in children with CP. METHODS: This retrospective cohort study included 87 ambulatory children with CP who underwent HLS surgery with both preoperative and postoperative gait analysis (mean time, 29.4±19.9 mo after surgery) testing between 1997 and 2015. In total, 65 patients underwent oHLS surgery (mean age, 8.5±2.5 y) and 22 patients underwent pHSL surgery (mean age, 8.3±2.3 y). Lower extremity three-dimensional kinematic data were collected while subjects walked at a self-selected speed. Outcome variables for operative limbs were compared within and between groups using t tests, χ tests, and multiple regression analysis. RESULTS: Significant postoperative decreases in knee flexion at initial contact were seen for both open (Δ12.7±13.4 degrees; P<0.001) and percutaneous (Δ19.1±13.1 degrees; P<0.001) groups. Increased postoperative maximum knee extension in stance was found for both open (Δ8.2±16.8 degrees; P=0.001) and percutaneous (Δ14.4±16.5 degrees; P=0.001) groups. No significant differences between open and percutaneous groups were found when comparing postoperative changes in kinematic variables between groups after adjusting for covariates. Postoperative changes in static range of motion were similar between lengthening groups. CONCLUSIONS: pHSL is as effective as open lengthening in improving stance phase knee kinematics during gait in children with CP. This is the first study to compare the kinematic effects of open versus pHSL in the pediatric population. Percutaneous lengthening is tolerated well by patients, and as it allows for rapid rehabilitation it may be preferable to the open procedure. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Paralisia Cerebral/cirurgia , Transtornos Neurológicos da Marcha/cirurgia , Músculos Isquiotibiais/cirurgia , Articulação do Joelho/fisiopatologia , Tenotomia/métodos , Adolescente , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Caminhada
9.
J Rehabil Med ; 51(8): 575-581, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31282980

RESUMO

OBJECTIVE: Adults with cerebral palsy have an increased risk of developing osteoarthritis. However, little is known about the epidemiology of osteoarthritis among this vulnerable population. The objectives of this study were to compare the prevalence of osteoarthritis between adults with and without cerebral palsy, and to determine how the prevalence of osteoarthritis changes throughout adulthood for each group. DESIGN: Data were extracted from the 2016 Optum Clinformatics® Data Mart, a nationwide database of de-identified US insurance claims, containing medical and pharmacy information on beneficiaries. SUBJECTS: International Classification of Diseases 10th revision (ICD-10) codes were used to identify adults (18+ years) with (n = 7,348) and without (n = 8.7 million) cerebral palsy. METHODS: ICD-10 codes were used to identify osteoarthritis. Prevalence of osteoarthritis was compared between adults with and without cerebral palsy before and after adjusting for age and sex. The prevalence of any type of osteoarthritis was compared between men and women with and without cerebral palsy, stratified by the following age groups: 18-30, 31-40, 41-50, 51-60, 61-70, and > 70 years. RESULTS: Adults with cerebral palsy had higher prevalence and adjusted odds of any, poly, hip, knee, and other/unspecified osteoarthritis (odds ratio (OR): 1.3-2.1; p < 0.001), but not hand osteoarthritis (OR: 0.86; p = 0.46). Men and women with cerebral palsy had a higher prevalence of any osteoarthritis compared with adults without cerebral palsy across all age groups (all p < 0.05). CONCLUSION: Privately-insured adults with cerebral palsy had a higher prevalence of osteoarthritis compared with adults without cerebral palsy across the adult lifespan.


Assuntos
Paralisia Cerebral/complicações , Adolescente , Adulto , Idoso , Paralisia Cerebral/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite , Prevalência , Adulto Jovem
10.
Braz Oral Res ; 33: e033, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31269113

RESUMO

The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1ß, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1ß levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1ß and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1ß, IL-6 and IL-8.


Assuntos
Biomarcadores/análise , Paralisia Cerebral/complicações , Gengivite/complicações , Gengivite/reabilitação , Periodontite/terapia , Saliva/química , Adolescente , Criança , Citocinas/análise , Profilaxia Dentária/métodos , Feminino , Gengivite/microbiologia , Humanos , Interleucina-10 , Interleucina-1beta/análise , Interleucina-6/análise , Masculino , Concentração Osmolar , Índice Periodontal , Distribuição de Poisson , Saliva/imunologia , Saliva/microbiologia , Fator de Necrose Tumoral alfa/análise
11.
Rehabil. integral (Impr.) ; 1(14): 8-15, jul. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1015950

RESUMO

Introducción: Los trastornos de la alimentación y deglución (TAD) acompañan frecuentemente a la parálisis cerebral (PC). Su diagnóstico oportuno previene numerosas complicaciones. La evaluación clínica es el primer acercamiento a los TAD, pero resulta insuficiente para identificar situaciones de riesgo (penetración laríngea o aspiración). Para ello, es necesaria una evaluación instrumental como la videofluoroscopía (VFC). Objetivo: Describir y cuantificar los hallazgos de VFC en un grupo de niños con PC, entre 3 años y 6 años 11 meses, GMFCS I-V. Pacientes y Métodos: Se practicó una VFC a 50 pacientes con PC, previa determinación del nivel Gross Motor Functional Classification System (GMFCS) e inexistencia de contraindicaciones para dicho examen. Además, se determinaron signos de incompetencia e inseguridad deglutoria, consistencias toleradas y requerimientos de posicionamiento, para facilitar el procedimiento. Resultados: Población predominantemente masculina, edad promedio de 5 años, 78% GMFCS III-V. Hasta el 94% tuvo una o más alteraciones videofluoroscópicas en alguna etapa del examen. El 28% no presentó capacidad de masticación, siendo todos GMFCS V. En eficacia deglutoria la alteración más frecuente fue el residuo vallecular (86%). En seguridad deglutoria fue el derrame posterior en la fase oral (68%). El 26% tuvo aspiración traqueal silente. En la fase esofágica, el 30% presentó tránsito esofágico lento y el 8% reflujo gastroesofágico. Conclusión: La VFC identificó alteraciones potencialmente riesgosas en todos los niveles GMFCS en niños portadores de PC, algunas de ellas silentes, incluso en casos de compromiso motor leve.


Introduction: Cerebral palsy (CP) is frequently accompanied by feeding and swallowing disorders (FSD). An early diagnosis of FSD prevents numerous complications. Clinical assessment stands as the first approach to FSD, although it is insufficient to identify risk factors (laryngeal penetration and aspiration). For this purpose, a videofluoroscopic (VFC) evaluation is required. Objective: To describe and quantify VFC findings in a group of children with CP, aged 3 to 6 years, GMFCS I to V. Patients and Methods: 50 patients underwent a VFC after their Gross Motor Functional Classification System (GMFCS) level was determined and no contraindications for the exam were identified. In addition, the researchers conducted an assessment to establish the presence of signs of unsafe and incompetent swallowing, food consistency tolerance, and mealtime positioning requirements, in order to allow a more comfortable VFC procedure. Results: There was male predominance, average age of 5 years, 78% GMFCS III-V. Up to 94% had one or more VFC alterations at some point of the exam. 28% had no chewing ability, being all the cases GMFCS V. Considering the deglutition efficacy, the commonest alteration was residue in the vallecula (86%), while the most frequent for swallowing safety was posterior spillage in the oral phase (68%). 26% presented silent tracheal aspiration. In the esophageal phase the findings were poor esophageal transit (30%) and gastroesophageal reflux (8%). Conclusions: VFC identified potentially risks in every GMFCS level of children with CP. Some of the VFC alterations are silent, even in mild motor impairment cases.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Fluoroscopia/métodos , Transtornos de Deglutição/diagnóstico por imagem , Paralisia Cerebral/complicações , Fluoroscopia/efeitos adversos
12.
J Clin Neurosci ; 66: 77-82, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31164264

RESUMO

OBJECTIVE: The present study aimed to identify certain acoustic parameters for speech evaluation in cerebral palsy children with dysarthria. METHODS: The subject included 30 native Mandarin-Speaking children with cerebral palsy, who were 5-15 years old, and 13 healthy children in a similar age range. Each subject was recorded while producing a list of 12 Mandarin words, which included three syllables ('ba', 'bi' and 'du'), in all four Mandarin tones. The formants (F1 and F2) of monophthong vowels /a, i, u/ were extracted from each vowel token. Based on F1 and F2, the vowel acoustic indexes VSA, VAI and FCR were calculated and analyzed. RESULTS: Compared with the control group, the cerebral palsy group had significantly low F1 and F2 in vowel /a/ (P < 0.05), and F2 in vowel /i/ (P < 0.05), while F1 and F2 in vowel /u/ and F1 in vowel /i/ had no significant difference. Between the healthy group and cerebral palsy group, the differences in VSA, VAI and FCR were all statistically significant. CONCLUSION: Children with cerebral palsy have reduced vowel space and speech articulation. The significant difference in vowel acoustic indexes (VSA, VAI and FCR) among the two groups revealed that the three indexes were sensitive to the variation of the vowels production in children with cerebral palsy, and that these may be used as an evaluation method of speech intelligibility caused by impaired vowel pronunciation in children with cerebral palsy, and the effect of rehabilitation therapy.


Assuntos
Paralisia Cerebral/complicações , Disartria/fisiopatologia , Acústica da Fala , Adolescente , Criança , Disartria/etiologia , Feminino , Humanos , Masculino , Fonética , Inteligibilidade da Fala
13.
Int J Pediatr Otorhinolaryngol ; 124: 124-128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31185343

RESUMO

OBJECTIVE: To describe the effects of salivary gland Botulinum Toxin-A (SG BoNT-A) on children with drooling due to neurological dysfunction. METHODS: This was a 3½-year prospective observational case series design of children referred for SG BoNT-A injections at a pediatric hospital (2010-2014). Outcomes were parent-reported severity, frequency, impact of drooling, and respiratory morbidity; and, from hospital records, number of respiratory hospital admissions. RESULTS: Out of 17 children treated, complete data were available for 15 (including 8 boys) aged 3-14 years (Mean = 9.9 years; SD = 3.4), with a combined total of 71 injections. Most had cerebral palsy (n = 11), classified as Level V (n = 10) or IV (n = 1) on the Gross Motor Function Classification Scale (GMFCS). In almost all instances, parents reported reductions in severity, frequency, and impact of drooling, and parent-reported respiratory morbidity. Among those with posterior drooling (n = 12), most children (n = 10) did not have advanced respiratory disease. A trend towards reduced respiratory-related hospital admissions was observed during SG BoNT-A treatment periods. CONCLUSION: SG BoNT-A can improve severity, frequency, and impact of drooling. It can also reduce respiratory-related hospital admissions in children with posterior drooling without advanced respiratory disease. For children with advanced respiratory disease, it may reduce severity and impact of drooling.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Paralisia Cerebral/complicações , Fármacos Neuromusculares/administração & dosagem , Glândulas Salivares , Sialorreia/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Injeções , Masculino , Estudos Prospectivos , Sialorreia/etiologia , Resultado do Tratamento
14.
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S33-S37, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169645

RESUMO

BACKGROUND: Hip displacement in children with cerebral palsy is common and related to a child's gross motor function. Progressive lateral hip displacement can result in severe pain, impaired function and quality of life. The purpose of this paper is to review the literature to identify the natural history of untreated spastic hip displacement in children with cerebral palsy. METHODS: A search of the literature was carried out using PubMed to identify papers describing the natural history of spastic hip displacement in children with cerebral palsy. Population-based studies, large retrospective cohort series, and randomized trials were included when available; expert opinion and case series were excluded. RESULTS: A total of 79 articles were reviewed. Articles were then subdivided into 4 main categories: epidemiology, pathophysiology, outcome, and prevention. The prevalence of hip displacement as defined as a migration percentage >30% was found to be 33% in pooled population-based studies. The risk of hip displacement was found to be linked to a child's gross motor function. Hip surveillance programs have been shown to be sustainable and capable of preventing hip dislocation. The majority of children with hip dislocation do develop pain, decreased function, and impaired health-related quality of life (HRQOL). CONCLUSIONS: Children with cerebral palsy are at risk of progressive lateral hip displacement proportional to their gross motor function. Untreated progressive lateral hip displacement has been shown to negatively impact a child's HRQOL and hip surveillance can decrease the incidence of hip dislocation.


Assuntos
Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Luxação do Quadril/etiologia , Dor Musculoesquelética/etiologia , Adolescente , Criança , Pré-Escolar , Luxação do Quadril/epidemiologia , Luxação do Quadril/fisiopatologia , Luxação do Quadril/prevenção & controle , Humanos , Incidência , Espasticidade Muscular/complicações , Prevalência , Qualidade de Vida
15.
Int J Mol Sci ; 20(10)2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31100943

RESUMO

The aim of this narrative review is to report on the current knowledge regarding the clinical use of umbilical cord blood (CB) based on articles from PubMed and clinical trials registered on ClinicalTrials.gov. An increasing amount of evidence suggests that CB may be used for both early diagnostics and treatment of cerebral palsy. The acidity of CB and its biochemical parameters, including dozens of cytokines, growth factors, and other metabolites (such as amino acids, acylcarnitines, phosphatidylcholines, succinate, glycerol, 3-hydroxybutyrate, and O-phosphocholine) are predictors of future neurodevelopment. In addition, several clinical studies confirmed the safety and efficacy of CB administration in both autologous and allogeneic models, including a meta-analysis of five clinical trials involving a total of 328 participants. Currently, nine clinical trials assessing the use of autologous umbilical CB in children diagnosed with hypoxic-ischemic encephalopathy or cerebral palsy are in progress. The total population assessed in these trials exceeds 2500 patients.


Assuntos
Paralisia Cerebral/diagnóstico , Paralisia Cerebral/terapia , Sangue Fetal/metabolismo , Ácido 3-Hidroxibutírico/metabolismo , Aminoácidos/metabolismo , Animais , Encefalopatias , Lesões Encefálicas , Carnitina/análogos & derivados , Carnitina/metabolismo , Paralisia Cerebral/complicações , Criança , Citocinas/metabolismo , Bases de Dados Factuais , Glicerol/metabolismo , Humanos , Hipóxia , Hipóxia-Isquemia Encefálica/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Fosfatidilcolinas/metabolismo , Fosforilcolina/metabolismo , Células-Tronco , Ácido Succínico/metabolismo
16.
Tidsskr Nor Laegeforen ; 139(8)2019 May 07.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31062563

RESUMO

BACKGROUND: For more than 20 years, intramuscular injections of botulinum toxin A have been an established treatment for spasticity in children with cerebral palsy. We investigated the proportion of children with cerebral palsy who receive such treatment in Norway and the guidelines that apply to the treatment. MATERIAL AND METHOD: Data from the five-year registration in the Cerebral Palsy Registry of Norway were used to investigate the proportion of children with cerebral palsy born in the period 1999-2010 treated with botulinum toxin A, and whether there were any variations in the proportion of children treated between the habilitation centres. We conducted an online survey to identify the treatment guidelines that were applied in all of the 21 habilitation centres. RESULTS: A total of 1 414 children (average age 6.3 years) were included, of whom 775 (55 %) had been treated with botulinum toxin A. The proportion of children who received treatment varied considerably between the habilitation centres (38-80 %; p < 0.001). The maximum dose of botulinum toxin A per treatment per patient was 200-600 units of Botox. Five centres reported to have written guidelines for the treatment indication. INTERPRETATION: The proportion of children with cerebral palsy who are treated with botulinum toxin A varies considerably between Norwegian habilitation centres.


Assuntos
Toxinas Botulínicas Tipo A , Paralisia Cerebral/tratamento farmacológico , Fármacos Neuromusculares , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/uso terapêutico , Noruega/epidemiologia , Procedimentos Ortopédicos , Guias de Prática Clínica como Assunto , Sistema de Registros , Centros de Reabilitação , Inquéritos e Questionários
17.
Int J Pediatr Otorhinolaryngol ; 123: 132-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102967

RESUMO

OBJECTIVES: To evaluate if drooling recurrence after surgery of the submandibular ducts is due to surgical failure or other variables. METHODS: Historic cohort with prospective collected data of all patients with severe drooling who underwent unsuccessful submandibular duct surgery with subsequent re-intervention between 2003 and 2018. A reference cohort was used for comparison of clinical variables. RESULTS: Six males and 4 females were included (cerebral palsy n = 8, neurodevelopmental disorders n = 2). All patients underwent submandibular gland surgery as a primary intervention (duct ligation n = 8, submandibular duct relocation n = 2) followed by re-intervention (submandibular gland excision n = 7, parotid duct ligation n = 3). One patient underwent tertiary surgery (parotid duct ligation after re-intervention by submandibular gland excision). Three patients were successful after re-intervention. No difference was found between both re-intervention techniques. There was significantly more severe dental malocclusion (50% vs. 21%, P value = 0.047) and severe speech disorders (80% vs. 42%, P value = 0.042) in the current cohort when compared to the reference cohort. CONCLUSION: Recurrence of drooling surgery is most likely not caused by surgical failure of the primary intervention, because re-intervention (submandibular gland excision) did not lead to more success. Dysarthria and dental malocclusion might negatively influence treatment outcome.


Assuntos
Glândula Parótida/cirurgia , Ductos Salivares/cirurgia , Sialorreia/cirurgia , Glândula Submandibular/cirurgia , Adolescente , Paralisia Cerebral/complicações , Criança , Estudos de Coortes , Feminino , Humanos , Ligadura , Masculino , Recidiva , Salivação , Sialorreia/etiologia , Resultado do Tratamento , Adulto Jovem
18.
J Rehabil Med ; 51(7): 525-531, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31120542

RESUMO

OBJECTIVE: To examine longitudinal changes in traditional and non-traditional risk factors for cardiovascular disease in individuals with cerebral palsy and to investigate relationships between age, Gross Motor Function Classification System (GMFCS) and risk of cardiovascular disease. METHODS: Individuals with cerebral palsy (n = 28 of 53 eligible participants; GMFCS levels I-V; follow-up mean age 35.1 years (standard deviation (SD) 14.4) participated in a longitudinal cohort study with 4.0 years (SD 1.2) follow-up. Traditional risk factors included waist circumference and systolic blood pressure. Non-traditional risk factors included carotid artery intima media thickness and distensibility, carotid-femoral pulse wave velocity, and flow-mediated dilation. RESULTS: Absolute (0.31 mm (SD 0.13) vs 0.22 mm (SD 0.08) , p = 0.045, 95% confidence interval (95% CI) 0.040, 0.151) and relative flow-mediated dilation (9.9 % (SD 4.7) vs 7.5 % (SD 2.6), p = 0.049, 95% CI 0.464, 4.42) decreased, while carotid artery intima media thickness (0.52 mm (SD 0.17) vs 0.67 mm (SD 0.33), p = 0.041, 95% CI -0.242, -0.074) increased from baseline to follow-up. No other risk factor changed significantly. Age at baseline was a significant independent predictor of carotid artery intima media thickness change (R-squared = 0.261, p = 0.031). CONCLUSION: Individuals with cerebral palsy experience significant changes in non-traditional risk factors for cardiovascular disease over 4 years, in the face of no changes in traditional risk factors. Compared with findings in the literature from the general population, these risk factors progress at a faster rate and at a younger age in individuals with cerebral palsy.


Assuntos
Envelhecimento/fisiologia , Doenças Cardiovasculares/etiologia , Paralisia Cerebral/complicações , Adulto , Doenças Cardiovasculares/patologia , Paralisia Cerebral/patologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco
20.
Med. oral patol. oral cir. bucal (Internet) ; 24(2): e204-e210, mar. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180644

RESUMO

Background: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. Material and Methods: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. Study design: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. Results: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). Conclusions: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality


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Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Paralisia Cerebral/complicações , Cárie Dentária/epidemiologia , Sialorreia/tratamento farmacológico , Antagonistas Colinérgicos/efeitos adversos , Saliva/química , Concentração Osmolar , Suscetibilidade à Cárie Dentária , Estudos Transversais , Toxinas Botulínicas/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico
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