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1.
Neurología (Barc., Ed. impr.) ; 34(8): 520-526, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186355

RESUMO

Introducción y objetivo: En la práctica clínica la evaluación del paciente con enfermedad de Parkinson (EP) es compleja y lleva tiempo. El presente estudio pretende comparar de forma rigurosa y objetiva la evaluación motora del paciente con EP realizada por el neurólogo experto frente a la enfermera especializada de la Unidad de Parkinson. Métodos: Estudio observacional, transversal, monocéntrico en el que se incluyó a 50 pacientes con EP (52% varones, 64,7±8,7 años), que fueron evaluados entre el 05 de enero del 2016 y el 20 de julio del 2016. El neurólogo y la enfermera evaluaron a los pacientes desde el punto de vista motor mediante el uso de las escalas de Hoehn&Yahr (H&Y) modificada, Unified Parkinson's Disease Rating Scalepart-III (UPDRS-III) y part-iv (UPDRS-IV) en el mismo estado motor (48 en OFF y 2 en ON) de forma protocolizada a primera hora de la mañana. Se utilizó el coeficiente de correlación intraclase (CCI) para medir la variabilidad. Resultados: El H&Y fue el mismo según ambos evaluadores en 49 de los 50 casos. No hubo grandes diferencias entre el tiempo empleado por ambos evaluadores. El CCI para la UPDRS-IV fue de 0,955 (p < 0,0001) y para la UPDRS-III de 0,954 (p < 0,0001). La mayor variabilidad en la UPDRS-III fue para el ítem 29 (marcha) con un CCI de 0,746 (p < 0,0001) y la menor para el ítem 30 (reflejos posturales) con un CCI de 0,918 (p < 0,0001).Conclusión: La evaluación motora de los pacientes con EP realizada por una enfermera entrenada es superponible a la del neurólogo experto y empleando un tiempo similar


Introduction and objective: In clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other. Methods: We conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7 ± 8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and Hoehn &Yahr (H&Y) scale. Tests were administered in the same PD periods (in 48 patients during the ‘off’ time and in 2 patients during the 'on' time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC).Results: Forty-nine patients (98%) were classified in the same H&Y stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P < .0001) and 0.954 (P < .0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC=0.746; P<.0001) and the lowest, for item 30 (postural stability; ICC = 0.918; P < .0001). Conclusions: Motor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transtornos Motores/diagnóstico , Transtornos Motores/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Estudos Transversais , Testes de Estado Mental e Demência , Neurologia , Enfermagem em Neurociência , Variações Dependentes do Observador
2.
J Neurol ; 266(8): 1980-1987, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31089860

RESUMO

OBJECTIVE: Amyotrophic lateral sclerosis type 8 (ALS8) is a familial form of motor neuron disease, with predominance of lower motor neuron degeneration, and is caused by mutation of the vesicle-associated membrane protein-associated protein B (VAPB). We aimed to compare the cognitive profile of patients with ALS8 and healthy controls (HC), and to screen for behavioural features in ALS8 patients. METHODS: The sample was composed of ALS8 patients (n = 22; 14 men; median age 48 years old; median disease duration 6.5 years) and HC (n = 33; 19 men; median age 48 years old). Patients and HC were matched for sex, age and educational level. Participants underwent behavioural, psychiatric (Hospital Anxiety and Depression Scale and Cambridge Behavioural Inventory-Revised) and neuropsychological assessments, focused on executive functions, visual memory, and facial emotion recognition. RESULTS: ALS8 patients exhibited subtle deficits in executive functions. Compared to controls, ALS8 patients were significantly impaired in measures of flexibility and inhibitory control. ALS8 patients and HC did not differ in scores of facial emotion recognition. There was clinically relevant anxiety and depression in 36% and 27% of ALS8 patients, respectively. Behavioural disorders such as stereotypic and motor behaviours were present in more than 30% of patients. CONCLUSIONS: ALS8 patients present mild executive dysfunction and behavioural changes such as mood disorders, apathy and stereotypic behaviour. Our findings suggest that ALS8 is not a pure motor disorder and it is associated with subtle cognitive and behavioural impairments.


Assuntos
Esclerose Amiotrófica Lateral/epidemiologia , Esclerose Amiotrófica Lateral/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Motores/epidemiologia , Transtornos Motores/psicologia , Adulto , Esclerose Amiotrófica Lateral/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos Motores/diagnóstico , Testes Neuropsicológicos
3.
Medicine (Baltimore) ; 98(8): e14667, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813213

RESUMO

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention.Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated.Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ±â€Š12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ±â€Š1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits.Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.


Assuntos
Tratamento Conservador , Discotomia , Deslocamento do Disco Intervertebral , Vértebras Lombares , Transtornos Motores , Adulto , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Discotomia/métodos , Discotomia/estatística & dados numéricos , Eletromiografia/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Transtornos Motores/diagnóstico , Transtornos Motores/etiologia , Transtornos Motores/cirurgia , Exame Neurológico/métodos , Núcleo Pulposo/diagnóstico por imagem , Medição da Dor/métodos , Radiografia/métodos , Remissão Espontânea , Resultado do Tratamento , Turquia
4.
Eur J Paediatr Neurol ; 23(3): 427-437, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30799092

RESUMO

OBJECTIVE: Non-progressive genetic disorders may present with motor dysfunction resembling cerebral palsy (CP). Such patients are often characterized as CP mimics. The purpose of this work was to delineate the clinical manifestations and molecular findings of CP mimic patients, with the ultimate goal to offer specific disease-modifying therapy and genetic counseling. METHODS: Retrospective study of 47 patients diagnosed with CP and no acquired etiology. Chart review of clinical, neuroradiological, biochemical and molecular data was performed. RESULTS: 31,91% of patients manifested with features resembling dyskinetic CP, 19,14% spastic CP, 10,63% ataxic CP and 38,30% mixed CP. In 23 patients molecular diagnosis was reached and included 5 hereditary spastic paraplegia genes (SPG) in spastic CP mimics; HPRT1, TH, QDPR, DDC in dystonic CP mimics; ADCY5 and NIKX2-1 in choreic CP mimics; CANA1A in ataxic CP mimics; and SPG, PDHA1, NIKX2-1, AT, SLC2A1 and SPR in mixed CP mimics. In 14 patients, the etiological diagnosis led to specific treatment. CONCLUSIONS: CP mimics show a number of features that differ from classic CP and can be used as diagnostic clues, including presence of mixed motor features, minor dysmorphic features, oculogyric movements, multiple features of autonomic dysfunction, and acquired microcephaly. A more stringent use of the concept of CP focused on acquired lesions during the perinatal and infancy periods, and excluding disorders that could be of genetic origin, could contribute to a purer use of the term. Identification of a specific genetic cause for CP mimics may in certain cases lead to etiologic treatment.


Assuntos
Transtornos Motores/diagnóstico , Transtornos Motores/genética , Transtornos Motores/fisiopatologia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Criança , Diagnóstico Diferencial , Feminino , Grécia , Humanos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
5.
Clin Drug Investig ; 39(4): 407-410, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810915

RESUMO

Oral antipsychotics are used to treat motor and behavioural disturbances in Huntington's disease (HD). However, patients with behavioural disturbances are often non-compliant, thus the oral route is inappropriate. The effects of antipsychotic long-acting injections (LAI) in HD are significantly underrepresented in literature. Paliperidone LAI (P-LAI), an atypical antipsychotic, has benefits over other antipsychotics LAI with its long dosing interval and no initial oral overlap, but has no documented cases for this indication. This case of a 45-year-old female highlights the use of P-LAI for severe aggression and chorea secondary to HD causing failed placement in assisted-care accommodation and mobility via an electronic-wheelchair. Three weeks after commencing treatment, she could walk unassisted, and displayed no aggression. After 10 months, she still had significant improvements and resided in the same accommodation for 6 months without any concern. Thus, this case suggests that P-LAI may be a treatment option for non-compliant HD patients.


Assuntos
Antipsicóticos/administração & dosagem , Doença de Huntington/tratamento farmacológico , Transtornos Mentais/tratamento farmacológico , Transtornos Motores/tratamento farmacológico , Palmitato de Paliperidona/administração & dosagem , Administração Oral , Preparações de Ação Retardada/administração & dosagem , Feminino , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/psicologia , Injeções Intramusculares , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos Motores/diagnóstico , Transtornos Motores/psicologia
6.
Invest Ophthalmol Vis Sci ; 60(1): 123-133, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30640976

RESUMO

Purpose: To investigate the temporal appearance of retinal, cognitive, and motor deficits in Goto-Kakizaki (GK) rats, a spontaneously occurring, polygenic model of type II diabetes. GK rats develop impaired insulin secretion at 2 weeks and fasting hyperglycemia at 4 weeks. Methods: In male and female GK rats and Wistar controls, glucose tolerance test (hyperglycemia) and electroretinogram (ERG, retinal function) were performed at 4 and 8 weeks of age. Spectral domain-optical coherence tomography (retinal structure) was assessed at 6 weeks. Spatial alternation (cognitive function) and number of entries (exploratory behavior) were assessed via Y-maze at 4, 5, 6, 7, and 8 weeks. Rotarod (motor function) was performed at 4, 6, and 8 weeks. Results: By 4 weeks, the GK rats exhibited significant glucose intolerance (P < 0.001) and retinal deficits, including delays in ERG implicit times (flicker, P < 0.01; oscillatory potentials, P < 0.001). In addition, the GK rats showed greater ERG amplitudes (P < 0.001) and thinner retinas (P < 0.001). At 7 weeks, the GK rats showed deficits in cognitive function (P < 0.001) and exploratory behavior (P < 0.01). However, no motor function deficits were observed by 8 weeks. Interestingly, the male GK rats showed greater hyperglycemia (P < 0.05), but the female rats showed greater ERG delays (P < 0.001). Conclusions: In GK rats, retinal function deficits developed prior to cognitive or motor deficits. Future studies will investigate common mechanistic links, long-term functional and vascular changes, and whether early retinal deficits can predict cognitive dysfunction or late-stage retinal disease.


Assuntos
Transtornos Cognitivos/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Modelos Animais de Doenças , Transtornos Motores/diagnóstico , Animais , Glicemia/metabolismo , Transtornos Cognitivos/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Eletrorretinografia , Comportamento Exploratório/fisiologia , Feminino , Teste de Tolerância a Glucose , Hiperglicemia/diagnóstico , Hiperglicemia/fisiopatologia , Masculino , Transtornos Motores/fisiopatologia , Ratos , Ratos Mutantes , Ratos Wistar , Retina/fisiopatologia , Tomografia de Coerência Óptica
7.
Neurologia ; 34(8): 520-526, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28549752

RESUMO

INTRODUCTION AND OBJECTIVE: In clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other. METHODS: We conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7 ± 8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and Hoehn & Yahr (H&Y) scale. Tests were administered in the same PD periods (in 48 patients during the 'off' time and in 2 patients during the 'on' time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC). RESULTS: Forty-nine patients (98%) were classified in the same H&Y stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P<.0001) and 0.954 (P<.0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC=0.746; P<.0001) and the lowest, for item 30 (postural stability; ICC=0.918; P<.0001). CONCLUSIONS: Motor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete.


Assuntos
Transtornos Motores/diagnóstico , Transtornos Motores/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Neurologia , Enfermagem em Neurociência , Variações Dependentes do Observador
8.
Arch Phys Med Rehabil ; 100(4): 613-619, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30193950

RESUMO

OBJECTIVES: (1) To determine the effects of concussion-related motor impairments at different task complexities in isolation and with a cognitive dual-task and (2) to determine if self-reported balance deficits after concussion are associated with gait, quiet stance, or cognitive dual-task impairments. DESIGN: Cross-sectional study. SETTING: Sports medicine clinic. PARTICIPANTS: Adolescent athletes clinically diagnosed with a sport-related concussion and those without concussion. Forty-nine patients with concussion (mean age=14.9±1.9y; 51% female; tested 7.0±3.0d postinjury) and 65 control participants (mean age=14.9±1.6y; 52% female) completed the study (N=114). INTERVENTIONS: Athletes with concussion completed a single-task and dual-task standing and walking protocol within 14 days of injury and were compared to those without concussion. MAIN OUTCOME MEASURES: Outcome measures included gait speed, quiet stance (root mean square [RMS] coronal/sagittal plane sway), and cognitive performance (accuracy). Dual-task costs were calculated as the percentage change between single-task and dual-task conditions. Participants with concussion were then stratified by those who did and did not report subjective balance problems at the time of testing and compared using objective balance and gait metrics. RESULTS: The concussion group walked slower during dual-task gait than controls (0.83±0.17 m/s vs 0.92±0.15 m/s; Cohen's d=0.53). Dual-task quiet stance RMS sway values were similar for concussion and control groups in coronal (1.20±0.52 m/s-2 vs 1.26±0.65 m/s-2; d=0.09) and sagittal (0.56±0.24 m/s-2 vs 0.73±0.44 m/s-2; d=0.20) movement planes. The concussion participants with subjectively-reported balance problems had significantly greater walking speed dual-task costs than concussion participants without self-reported balance problems (-25±10% vs -19±9%; P=.02). CONCLUSIONS: Following concussion, adolescents demonstrate slower gait speeds, but similar quiet stance values relative to those without concussion. The study results indicate that tasks requiring greater motor coordination may elicit greater alterations following a concussion.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Transtornos Motores/diagnóstico , Desempenho Psicomotor , Análise e Desempenho de Tarefas , Adolescente , Atletas/psicologia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/psicologia , Concussão Encefálica/complicações , Concussão Encefálica/psicologia , Cognição , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Motores/etiologia , Teste de Caminhada , Velocidade de Caminhada
10.
J Neurodev Disord ; 10(1): 41, 2018 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587102

RESUMO

BACKGROUND: Although autism spectrum disorder (ASD) is characterized by impairments in social communication and the presence of repetitive behavior and/or restricted interests, there is evidence that motor impairments may be a contributing factor to the ASD phenotype. The purpose of this study was to examine the motor act of reaching-to-grasp in children at high risk (HR; with an older sibling diagnosed with ASD) and low-risk (LR; no family history of ASD) for ASD. METHODS: Children were compared for differences in reaching-to-grasp based on sibling status and diagnostic outcome. Children were enrolled between 6 and 12 months of age and the reach-to-grasp movement was scored at 6, 9, (where available) 12, 15, 18, 24, and 36 months of age using the qualitative Skilled Reaching Rating Scale to determine the presence of any group-, age-, or sex-related differences in the mechanics of the reach-to-grasp movement using a Mixed Models analysis. At 36 months, all children underwent a gold-standard diagnostic assessment, which resulted in three outcome groups: HR children diagnosed with ASD (HR-ASD; n = 10), HR children not diagnosed with ASD (HR-N; n = 10), and low-risk children not diagnosed with ASD (LR; n = 10). RESULTS: The group of children who were later diagnosed with ASD (HR-ASD group) showed higher (worse) total scores on the reach-to-grasp movement, as well as higher scores on the components of Orient, Lift, and Pronate compared to children in the LR and HR-N groups. CONCLUSIONS: Our results support the growing literature indicating that children who are later diagnosed with ASD show impaired early motor performance. These results highlight the importance of early surveillance of children who are at elevated risk for ASD, and early initiatives should focus on early signs of the phenotype, including both movement and sensory differences (prodromal signs) prior to the emergence of diagnostic characteristics.


Assuntos
Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtornos Motores/complicações , Transtornos Motores/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Testes Neuropsicológicos , Desempenho Psicomotor , Fatores de Risco , Irmãos
11.
Taiwan J Obstet Gynecol ; 57(5): 692-695, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30342653

RESUMO

OBJECTIVE: Scorpion stings remain a serious health problem in many parts of the world. There is very limited information regarding the effects of therapies delivered for scorpion stings in pregnant women on the mother and fetus. They can cause acute conditions such as fetal loss, preterm delivery, or placental abnormalities and can also result in other conditions that may have an effect on the baby in the long term. MATERIALS AND METHODS: In this study the medical records of 24 pregnant women who were admitted to the emergency room at Suruç State Hospital due to scorpion stings between January 1, 2013 and January 1, 2014 were retrospectively reviewed. Age, gestational week, monthly distribution of the cases, type of delivery, status of the fetus, affected body sites, and local and systemic findings were evaluated. The clinical severity of each case was assessed using Abroug's classification. A fetal biophysical profile test was administered in pregnant women above 24 weeks of gestation. The newborns underwent follow-up for mental and motor functions in the pediatric department at three-month intervals for 12 months. RESULTS: 24 patients, with a mean age of 26.1 ± 2.4 years, were included in the study. The most common region stung by scorpions was Lower extremity (58.3%). The most common symptom occurred in cases was immediate localized pain (58%). In terms of gestational age, 41.6% of scorpion sting were within the third trimester. Biophysical profile scores were 8 and above. Only symptomatic treatment, without use of anti-venom, was done to all the patients in this study. And neither death nor major sequel happened. CONCLUSION: Scorpion stings during pregnancy may not have significant adverse effects on the fetus and the mother. Decisions regarding the use of anti-venom in pregnant women should be considered carefully when only limited safety information, especially in those patients with only local symptoms.


Assuntos
Complicações na Gravidez/terapia , Picadas de Escorpião/complicações , Picadas de Escorpião/terapia , Adulto , Antivenenos/efeitos adversos , Índice de Apgar , Fenômenos Biofísicos , Serviço Hospitalar de Emergência , Feminino , Feto/fisiologia , Idade Gestacional , Humanos , Recém-Nascido , Transtornos Mentais/diagnóstico , Transtornos Motores/diagnóstico , Dor , Gravidez , Estudos Retrospectivos , Picadas de Escorpião/fisiopatologia , Turquia
12.
BMC Pediatr ; 18(1): 326, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30322374

RESUMO

BACKGROUND: Late preterm infants, previously considered low risk, have been identified to be at risk of developmental problems in infancy and early childhood. There is limited information on the outcome of these infants in low and middle income countries. METHODS: Bayley scales of infant and toddler development, version III, were done on a group of late preterm infants in Johannesburg, South Africa. The mean composite cognitive, language and motor sub-scales were compared to those obtained from a group of typically developed control infants. Infants were considered to be "at risk" if the composite subscale score was below 85 and "disabled" if the composite subscale score was below 70. Infants identified with cerebral palsy were also reported. RESULTS: 56 of 73 (76.7%) late preterm infants enrolled in the study had at least one Bayley assessment at a mean age of 16.5 months (95% CI 15.2-17.6). The mean birth weight was 1.9 kg (95%CI 1.8-2.0) and mean gestational age 33.0 weeks (95% CI 32.56-33.51). There was no difference in the mean cognitive subscales between late preterm infants and controls (95.4 9, 95% CI 91.2-99.5 vs 91.9.95% CI 87.7-96.0). There was similarly no difference in mean language subscales (94.5, 95% CI 91.3-97.7 vs 95.9, 95% CI 92.9-99.0) or motor subscales (96.2, 95% CI 91.8-100.7 vs 97.6, 95% CI 94.7-100.5). There were four late preterm infants who were classified as disabled, two of whom had cerebral palsy. None of the control group was disabled. CONCLUSIONS: This study demonstrates that overall developmental outcome, as assessed by the Bayley scales of infant and toddler development, was not different between late preterm infants and a group of normal controls. However, 7.1% of the late preterm infants, had evidence of developmental disability. Thus late preterm infants in low and middle income countries require long term follow up to monitor developmental outcome. In a resource limited setting, this may best be achieved by including a parental screening questionnaire, such as the Ages and Stages Questionnaire, in the routine well baby clinic visits.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Disfunção Cognitiva/diagnóstico , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Masculino , Transtornos Motores/diagnóstico , Estudos Prospectivos , Fatores de Risco , África do Sul
13.
Rehabilitación (Madr., Ed. impr.) ; 52(3): 158-166, jul.-sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-175760

RESUMO

Introducción: La Escala de la Calidad del Desempeño Sensoriomotor (ECDSM2-15), desarrollada recientemente con metodología Delphi, realiza un diagnóstico de la calidad del desempeño sensoriomotor de los bebés desde los 2 a los 15 meses de edad, detectados previamente con retraso del desarrollo motor o parálisis cerebral. Clasifica las estrategias usadas por los bebés en típicas/normales, con retraso y atípicas/patológicas. Identifica la influencia de los componentes alineación, movimiento y base de soporte en el resultado funcional. Dada su importancia, es necesario evaluar sus características biométricas. Objetivo: Determinar fiabilidad y validez de constructo de la ECDSM2-15. Pacientes y método: Estudio descriptivo, prospectivo, en 454 bebés de ambos sexos, de 2 a 15 meses de edad, con retraso del desarrollo motor o parálisis cerebral, en Institutos Teletón-Chile, Hospital Nacional de Rehabilitación Pedro Aguirre Cerda y Centro de Rehabilitación Neurológica Amancay. Se realizó análisis de fiabilidad y validez de constructo. Resultados: Consistencia interna y variabilidad intraobservador evaluados con alpha Cronbach >0,80. Variabilidad de evaluadores versus grupo control medido con índice Kappa>0,60. El análisis factorial, mostró un índice de Kaiser-Meyer-Olkin>0,7 significativo con prueba de esfericidad de Bartlett (p<0,0001). El análisis de componentes principales con rotación varimax en las seis subescalas, explicó entre el 60 y 87% de la varianza. Conclusión: La ECDSM2-15 demuestra ser confiable, consistente y válida en su constructo; puede ser usada en evaluación, seguimiento clínico e investigación


Introduction: The Sensory Motor Performance Scale (ECDSM2-15), recently developed using Delphi methodology, is a scale to assess the sensory and motor development of infants aged 2 to 15 months previously diagnosed with motor delay or cerebral palsy. This scale classifies the strategies used by infants into typical/normal, delayed, and atypical/patology and identifies the influence of the components of alignment, movement, and support base on functional outcome. Given its importance, there is a need to analyse the biometric characteristics of this scale. Objective: To determine the reliability and construct validity of the ECDSM2-15 scale. Patients and methods: A descriptive and prospective study was conducted in 454 boys and girls aged 2 to 15 months who showed delayed motor development or were diagnosed with cerebral palsy at the Teletón-Chile Institutes, Pedro Aguirre Cerda National Rehabilitation Hospital, and Amancay Neurological Rehabilitation Center. Reliability and construct validity analyses were performed. Results: Internal consistency and intra-observer variability showed a Cronbach's alpha > 0.80. Variability of evaluators versus control group showed a Kappa index> 0.60. Factor analysis showed a significant Kaiser-Meyer-Olkin index > 0.7 with Bartlett's sphericity test (p <.0001). The analysis of principal components with varimax rotation in the six subscales explained between 60 and 87% of the variance. Conclusion: The scale is reliable, consistent and valid in its construct and can be used in assessment, clinical follow-up and research


Assuntos
Humanos , Masculino , Feminino , Lactente , Transtornos Motores/diagnóstico , Paralisia Cerebral/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Reprodutibilidade dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Modalidades de Fisioterapia
14.
Kurume Med J ; 65(1): 11-16, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30158356

RESUMO

Sudden death in patients with severe motor and intellectual disabilities (SMID) is sometimes caused in part by pulmonary thromboembolism (PTE), and deep venous thrombosis (DVT) has drawn attention as a possible embolic source. Warfarin, which is a conventional therapeutic agent, is not easy to control appropriately, and daily management can be especially difficult in SMID patients. On the other hand, edoxaban tosilate hydrate, which has been newly approved for insurance coverage for the treatment of DVT, is not listed in the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (DVT-PTE guidelines). The aim of this study is to evaluate the efficacy and safety of anticoagulation therapy (warfarin vs. edoxaban) in DVT treatment in SMID patients by means of an open-label, randomized controlled trial. The primary endpoint is the incidence of hemorrhagic events during 12 months of follow up.


Assuntos
Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Deficiência Intelectual/complicações , Inteligência , Pessoas com Deficiência Mental/psicologia , Atividade Motora , Transtornos Motores/complicações , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Trombose Venosa/tratamento farmacológico , Varfarina/uso terapêutico , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/fisiopatologia , Deficiência Intelectual/psicologia , Japão , Transtornos Motores/diagnóstico , Transtornos Motores/fisiopatologia , Transtornos Motores/psicologia , Estudos Multicêntricos como Assunto , Piridinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tiazóis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Varfarina/efeitos adversos
15.
Brain Struct Funct ; 223(8): 3665-3680, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29992470

RESUMO

Very preterm infants (≤ 31 weeks gestational age) are at high risk for brain injury and delayed development. Applying functional connectivity and graph theory methods to resting state MRI data (fcMRI), we tested the hypothesis that preterm infants would demonstrate alterations in connectivity measures both globally and in specific networks related to motor, language and cognitive function, even when there is no anatomical imaging evidence of injury. Fifty-one healthy full-term controls and 24 very preterm infants without significant neonatal brain injury, were evaluated at term-equivalent age with fcMRI. Preterm subjects showed lower functional connectivity from regions associated with motor, cognitive, language and executive function, than term controls. Examining brain networks using graph theory measures of functional connectivity, very preterm infants also exhibited lower rich-club coefficient and assortativity but higher small-worldness and no significant difference in modularity when compared to term infants. The findings provide evidence that functional connectivity exhibits deficits soon after birth in very preterm infants in key brain networks responsible for motor, language and executive functions, even in the absence of anatomical lesions. These functional network measures could serve as prognostic biomarkers for later developmental disabilities and guide decisions about early interventions.


Assuntos
Disfunção Cognitiva/etiologia , Conectoma , Recém-Nascido Prematuro/fisiologia , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiopatologia , Transtornos Motores/etiologia , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Cognição , Disfunção Cognitiva/diagnóstico , Estudos de Coortes , Estudos Transversais , Função Executiva , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Transtornos Motores/diagnóstico , Prognóstico , Análise de Regressão
16.
J Perinatol ; 38(10): 1398-1406, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30054588

RESUMO

OBJECTIVE: To assess the predictive value of trajectories and individual assessment of quality of general movements (AQGM) for identification of neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA) in infants <30 weeks gestational age and/or birth weight <1500 g. METHODS: In this retrospective cohort study, AQGM at 6 weeks and 3 months CA were scored and categorized as normal (N) or abnormal (A). AQGM measures were compared with degree of NDI and Bayley Scales of Infant Development, Third Edition (BSID-III) composite motor and cognitive scores. 'Persistently abnormal' AQGM included both mildly abnormal (MA) and definitely abnormal (DA) assessments. A "modified AQGM" where MA assessments were considered normal variant/transient injury was used to conduct post-hoc analysis. RESULTS: Across 244 cases, persistently abnormal AQGM trajectory predicted the level of NDI (OR 2.5, 95% CI 1.2, 5.1) compared to AQGM trajectory that normalized. However, using the "modified AQGM", persistently DA trajectories were associated with significantly lower BSID-III composite motor and cognitive scores (p < 0.001 and p = 0.039, respectively). CONCLUSION: Categorizing MA assessments as transient injury increased the predictive value of AQGM trajectories and significantly predicted lower cognitive and motor scores at 18-24 months CA.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Lactente Extremamente Prematuro , Paralisia Cerebral/diagnóstico , Desenvolvimento Infantil , Disfunção Cognitiva/diagnóstico , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Transtornos Motores/diagnóstico , Movimento , Exame Neurológico , Testes Neuropsicológicos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Transtornos das Sensações/diagnóstico , Sensibilidade e Especificidade , Índice de Gravidade de Doença
17.
Ther Umsch ; 75(1): 31-36, 2018 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-29909765

RESUMO

Diagnosis and treatment of motor phenomena in schizophrenia spectrum disorders Abstract. Motor abnormalities are intrinsic features of schizophrenia spectrum disorders. They may be spontaneous or antipsychotic drug-induced. The four most important symptom groups are abnormal involuntary movements or dyskinesia, Parkinsonism, catatonia and neurological soft signs. In addition, there are further motor abnormalities, which are less frequent and less operationalized. The suspected etiology of motor abnormalities is strongly associated with altered neurodevelopment. Delayed maturation in conjunction with environmental insults may give further rise to motor symptoms. For the four most relevant motor abnormalities clinical examination procedures and rating scales are available, aiding clinicians in both screening and evaluation of symptom severity. Besides these currently instrumental measures are being tested for wide spread and easy application. Treatment of motor abnormalities is necessary according to subjective well-being. Treatment options are few and remain symptomatic. The most important strategy is critical evaluation of antispychotic pharmacotherapy. Benefitial effects on motor phenomena have been noted with clozapine. Currently, specific substances against tardive dyskinesia and non-invasive brain stimulation techniques are being evaluated. However, the effeciacy of these approaches will only be available in the near future.


Assuntos
Transtornos Motores/terapia , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Criança , Terapia Combinada , Discinesia Induzida por Medicamentos/diagnóstico , Discinesia Induzida por Medicamentos/fisiopatologia , Discinesia Induzida por Medicamentos/terapia , Humanos , Transtornos Motores/diagnóstico , Transtornos Motores/fisiopatologia , Exame Neurológico , Sintomas Prodrômicos , Prognóstico , Fatores de Risco , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatologia
18.
J Bone Joint Surg Am ; 100(12): 1030-1038, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29916930

RESUMO

BACKGROUND: Spinal epidural abscess is a high-risk condition that can lead to paralysis or death. It would be of clinical and prognostic utility to identify which subset of patients with spinal epidural abscess is likely to develop a motor deficit or die within 90 days of discharge. METHODS: We identified all patients ≥18 years of age who were admitted to our hospital system with a diagnosis of spinal epidural abscess during the period of 1993 to 2016. Explanatory variables were collected retrospectively. Bivariate and multivariable logistic regression was performed using these variables to identify independent predictors of motor deficit and 90-day mortality. Nomograms were then constructed to quantify the risk of these outcomes. RESULTS: Of the 1,053 patients we identified with spinal epidural abscess, 362 presented with motor weakness. One hundred and thirty-four patients died within 90 days of discharge, inclusive of those who died during hospitalization. Multivariable logistic regression yielded 8 independent predictors of pre-treatment motor deficit and 8 independent predictors of 90-day mortality. We constructed nomograms that generated a probability of pre-treatment motor deficit or 90-day mortality on the basis of the presence of these factors. CONCLUSIONS: By quantifying the risk of pre-treatment motor deficit and 90-day mortality, our nomograms may provide useful prognostic information for the treatment team. Timely treatment of neurologically intact patients with a high risk of developing a motor deficit is necessary to avoid residual motor weakness and improve survival. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Abscesso Epidural/complicações , Abscesso Epidural/mortalidade , Transtornos Motores/diagnóstico , Adulto , Idoso , Algoritmos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Nomogramas , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
19.
Phys Ther ; 98(8): 691-704, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912447

RESUMO

Background: The World Health Organization's International Classification of Functioning, Disability, and Health framework, Children and Youth Version (ICF-CY), provides a valuable method of conceptualizing the multidomain difficulties experienced by children born very preterm (VP). Reviews investigating motor outcomes at preschool age across ICF-CY domains are lacking. Purpose: The purpose of this review is to identify and compare motor outcomes of 3- to 6-year-old children born VP and children born full-term (FT) within the ICF-CY framework. Data Sources: Four electronic databases and reference lists of included and key articles were searched. Study Selection: Studies comparing motor outcomes of 3- to 6-year-old children born VP (<32 weeks' gestation or birth weight <1500 g) with peers born FT were included. Data Extraction: Two independent authors extracted data and completed quality assessments. Data Synthesis: Thirty-six studies were included. Activity motor performance of children born VP was consistently poorer compared with peers born FT: standardized mean difference (SMD) was -0.71 (95% CI = -0.80 to -0.61; 14 studies, 2056 participants). Furthermore, children born VP had higher relative risk (RR) of motor impairment (RR = 3.39; 95% CI = 2.68 to 4.27; 9 studies, 3466 participants). Body structure and function outcomes were largely unable to be pooled because assessment tools varied too widely. However, children born VP had higher RR of any neurological dysfunction (Touwen Neurological Examination) (RR = 4.55; 95% CI = 1.20 to 17.17; 3 studies, 1363 participants). There were no participation outcome data. Limitations: Limitations include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence. Conclusions: Children born VP experience significant motor impairment across ICF-CY activity and body structure and function domains at preschool age compared with peers born FT. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.


Assuntos
Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/psicologia , Transtornos Motores/fisiopatologia , Transtornos Motores/psicologia , Tamanho Corporal , Criança , Pré-Escolar , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Atividade Motora , Transtornos Motores/diagnóstico , Participação Social
20.
Pediatrics ; 141(5)2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29666163

RESUMO

OBJECTIVES: Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time. METHODS: Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks' gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months' adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment. RESULTS: Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 (P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 (P = .67). CONCLUSIONS: Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Lactente Extremamente Prematuro , Paralisia Cerebral/diagnóstico , Disfunção Cognitiva/diagnóstico , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Transtornos Motores/diagnóstico , Exame Neurológico , Estudos Retrospectivos , Fatores de Risco , Transtornos das Sensações/diagnóstico , Índice de Gravidade de Doença , Fatores Socioeconômicos
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