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BMC Neurol ; 19(1): 317, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823743


BACKGROUND: Cerebral palsy (CP) is considered as the main cause of severe physical impairment and malnutrition in children. This cross-sectional study intended to survey the nutritional status of children cerebral palsy in Riyadh, Saudi Arabia. METHODS: We examined 74 children (age: 1-10 yrs) with CP, who attended Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh Saudi Arabia. Data on age, general demographics, nutritional status, and dietary intake were collected. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for his/her weight for age, weight for height, height for age and body mass index for age were ≤ -2.0 standard deviation (SD) using WHO growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. RESULTS: More than half (56.4%) of the children with cerebral palsy were malnourished as they had z-score below <-2 SD in at least one of the four indicators. Thinness (50%) was the most common form of malnutrition, followed by underweight, stunting, and wasting. Arm anthropometrics gave similar results on the percent number of malnourished children. Factors that were independently associated with malnutrition with an adjusted OR (aOR) were as follow: age ≤ 5 yrs. (aOR: 4.29); presence of cognitive impairment (aOR: 4.13); presence of anemia (aOR: 3.41) and inadequate energy intake (aOR: 4.86) (p, for all trends <0.05). CONCLUSION: Children with cerebral palsy of the current study have impaired growth and nutritional status as assessed by all four common nutritional status indicators. Further large-scale community-based studies for in-depth evaluation of nutritional status and growth patterns in children with CP are needed.

Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição do Lactente/epidemiologia , Estado Nutricional , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Masculino , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Magreza/epidemiologia
Sensors (Basel) ; 19(24)2019 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-31817941


The use of data logging systems for capturing wheelchair and user behavior has increased rapidly over the past few years. Wheelchairs ensure more independent mobility and better quality of life for people with motor disabilities. Especially, for people with complex movement disorders, such as dyskinetic cerebral palsy (DCP) who lack the ability to walk or to handle objects, wheelchairs offer a means of integration into daily life. The mobility of DCP patients is based on a head-foot wheelchair steering system. In this work, a data logging system is proposed to capture data from human-wheelchair interaction for the head-foot steering system. Additionally, the data logger provides an interface to multiple Inertial Measurement Units (IMUs) placed on the body of the wheelchair user. The system provides accurate and real-time information from head-foot navigation system pressure sensors on the wheelchair during driving. This system was used as a tool to obtain further insights into wheelchair control and steering behavior of people diagnosed with DCP in comparison with a healthy subject.

Interfaces Cérebro-Computador , Paralisia Cerebral/fisiopatologia , Robótica/métodos , Paralisia Cerebral/psicologia , Pessoas com Deficiência , Desenho de Equipamento , Humanos , Movimento , Robótica/instrumentação , Processamento de Sinais Assistido por Computador , Cadeiras de Rodas , Tecnologia sem Fio
J Musculoskelet Neuronal Interact ; 19(4): 500-506, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31789301


OBJECTIVE: To evaluate the effect of simultaneous proprioceptive - visual training on gait parameters in children with spastic diplegic cerebral palsy. METHOD: Gait parameters of 30 spastic diplegic children (age range 4-6 years) were evaluated before and after treatment by Tekscan's Walkway Pressure system. They were randomly and equally assigned into two groups (study and control). All children received regular therapeutic exercise program for one hour. In control group walked for 30 minutes without feedback, while those in study group walked for 30 minutes with proprioceptive-visual feedback. Duration of treatment was 3 times/week for 8 successive weeks. RESULTS: There were significant differences after treatment in spatial parameters and temporal parameters of both groups with more improvement in study group than control one, and insignificant difference in kinetic gait parameters. CONCLUSION: The simultaneous proprioceptive - visual training might improve spatial and temporal gait parameters with no effect on kinetic gait parameters of children with spastic diplegic cerebral palsy.

Paralisia Cerebral/reabilitação , Retroalimentação Sensorial/fisiologia , Marcha/fisiologia , Espasticidade Muscular/reabilitação , Modalidades de Fisioterapia , Propriocepção/fisiologia , Percepção Visual/fisiologia , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Espasticidade Muscular/fisiopatologia , Equilíbrio Postural/fisiologia , Resultado do Tratamento , Caminhada/fisiologia
J Musculoskelet Neuronal Interact ; 19(4): 507-515, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31789302


OBJECTIVE: To evaluate the subsequent effects of plyometric training on weight-bearing symmetry, muscle strength, and gait performance in children with unilateral cerebral palsy. METHODS: Thirty-nine children with spastic hemiplegia (age 8-12 years) were randomly divided into either the PLYO group (n=19, received a 30-minute plyometric exercise program plus the traditional physical rehabilitation, twice/week for eight consecutive weeks) or Non-PLYO group (n=20, received the traditional physical rehabilitation only). The weight-bearing symmetry index (WB-SI), maximum isometric muscle strength (MIMS) of quadriceps and hamstring muscles, and spatial-temporal gait parameters were assessed pre and post-intervention. RESULTS: From pre- to post-intervention, changes of WB-SI among PLYO and Non-PLYO groups did not differ significantly (P=.81; hindfoot and P=.23; forefoot). MIMS of quadriceps and hamstring muscles at 90° knee flexion (P=.008 and .013 respectively) increased significantly in PLYO compared to Non-PLYO group. Walking speed (P=.033), stride length (P=.002), and step time (P<.001) improved markedly in PLYO group more than in Non-PLYO group. The proportion of single leg support (P=.14) among PLYO and Non-PLYO groups did not differ significantly. CONCLUSION: Addition of plyometric exercises to the physical rehabilitation programs of children with unilateral CP could achieve greater improvement in muscles strength and walking performance, but not in WB-SI.

Paralisia Cerebral/reabilitação , Força Muscular/fisiologia , Exercício Pliométrico , Caminhada/fisiologia , Suporte de Carga/fisiologia , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Resultado do Tratamento
Rehabilitacion (Madr) ; 53(4): 276-283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31813423


INTRODUCTION AND OBJECTIVES: The study evaluated the effect of task-oriented training (TOT) on the motor function (MF) and balance of ambulant children with cerebral palsy (CP). MATERIALS AND METHODS: A total of 46 children were randomised into TOT group (n=23) and Control Group (CG [n=23]), but 39 children complete the study. Balance and MF were assessed at baseline, 6th and 12th weeks and 6 weeks post-intervention. Data were analysed with repeated measures ANOVA, Friedman's, Mann-Whitney U, Student's-t and post hoc tests at α≤0.05. RESULTS: The two groups were comparable in all baseline scores (P>0.05). At the 6th week, significant between-group difference was observed in MF only [TOT=81.9 (18.5); CG=72.8 (19.4)] (P<0.05). There were significant between-group differences in MF [TOT=88.8 (9.4); CG=75.5 (18.5); P<0.05] and balance (TOT=9.4±4.5; CG=13.6±6.9; P<0.05) at the 12th week (P<0.05) and 6 weeks post-intervention (P<0.05). CONCLUSION: TOT improved the balance and MF of ambulant children with CP.

Paralisia Cerebral/terapia , Terapia por Exercício/métodos , Destreza Motora/fisiologia , Equilíbrio Postural/fisiologia , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
Sensors (Basel) ; 19(23)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31816854


Although many methods have been developed to detect walking by using body-worn inertial sensors, their performances decline when gait patterns become abnormal, as seen in children with cerebral palsy (CP). The aim of this study was to evaluate if fine-tuning an existing walking bouts (WB) detection algorithm by various thresholds, customized at the individual or group level, could improve WB detection in children with CP and typical development (TD). Twenty children (10 CP, 10 TD) wore 4 inertial sensors on their lower limbs during laboratory and out-laboratory assessments. Features extracted from the gyroscope signals recorded in the laboratory were used to tune thresholds of an existing walking detection algorithm for each participant (individual-based personalization: Indiv) or for each group (population-based customization: Pop). Out-of-laboratory recordings were analyzed for WB detection with three versions of the algorithm (i.e., original fixed thresholds and adapted thresholds based on the Indiv and Pop methods), and the results were compared against video reference data. The clinical impact was assessed by quantifying the effect of WB detection error on the estimated walking speed distribution. The two customized Indiv and Pop methods both improved WB detection (higher, sensitivity, accuracy and precision), with the individual-based personalization showing the best results. Comparison of walking speed distribution obtained with the best of the two methods showed a significant difference for 8 out of 20 participants. The personalized Indiv method excluded non-walking activities that were initially wrongly interpreted as extremely slow walking with the initial method using fixed thresholds. Customized methods, particularly individual-based personalization, appear more efficient to detect WB in daily-life settings.

Paralisia Cerebral/diagnóstico , Paralisia Cerebral/reabilitação , Marcha , Monitorização Ambulatorial/instrumentação , Caminhada/fisiologia , Adolescente , Algoritmos , Fenômenos Biomecânicos , Criança , Estudos Transversais , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Masculino , Monitorização Ambulatorial/métodos , Reprodutibilidade dos Testes , Velocidade de Caminhada , Adulto Jovem
Rev. enferm. UERJ ; 27: e40274, jan.-dez. 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1049701


Objetivo: analisar a rede de apoio social utilizada pela família para cuidar a criança com paralisia cerebral. Método: pesquisa qualitativa, descritiva, realizada com 12 mães de crianças com paralisia cerebral atendidas em unidade de pediatria do Hospital Universitário de Rio Grande. Os dados foram coletados nos meses de agosto e setembro de 2018, por meio de entrevista semiestruturada, e submetidos à análise temática. Resultados: identificou-se a rede de apoio social formada pelos familiares, amigos, vizinhos, profissionais de saúde e ancorada pela fé em Deus. As mães foram protagonistas do cuidado e algumas não receberam nenhum tipo de apoio para os cuidados dos filhos. Conclusão: a rede de apoio social contribuiu para a superação de dificuldades da família e para o cuidado da criança, sendo fonte de apoio emocional, financeiro, ajuda com o transporte, remédios e orientação dos profissionais de saúde/enfermagem.

Objective: to know the social support network used by the family to care for children with cerebral palsy. Method: this qualitative and descriptive research was conducted with twelve mothers of children with cerebral palsy assisted at a pediatric unit of a University Hospital in Rio Grande. Data were collected in August and September 2018 through semi-structured interviews and submitted to thematic analysis. Results: we identified the social support network consisting of family, friends, neighbors, health professionals, and faith in God. Mothers were protagonists of care and some received no support for childcare. Conclusion: the social support network contributed to overcome family difficulties and childcare, being a source of emotional, financial support, help with transportation, medicine, and guidance from health/nursing professionals.

Objetivo: conocer la red de apoyo social utilizada por la familia para cuidar a niños con parálisis cerebral. Método: investigación cualitativa, descriptiva, realizada con doce madres de niños con parálisis cerebral atendidas en una unidad de pediatría de un Hospital Universitario de Río Grande. Los datos se recopilaron en agosto y septiembre de 2018 a través de entrevistas semiestructuradas y se sometieron a análisis temáticos. Resultados: identificamos que la red de apoyo social estaba formada por familiares, amigos, vecinos, profesionales de la salud y fe en Dios. Las madres fueron protagonistas de la atención y algunas no recibieron apoyo para el cuidado de los niños. Conclusión: la red de apoyo social contribuyó a superar las dificultades familiares y el cuidado de los niños, siendo una fuente de apoyo emocional y financiero, ayuda con el transporte, medicamentos y orientación de profesionales de la salud/enfermeros.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Apoio Social , Família , Paralisia Cerebral/prevenção & controle , Paralisia Cerebral/psicologia , Criança , Cuidado da Criança , Epidemiologia Descritiva , Pesquisa Qualitativa
Coluna/Columna ; 18(4): 272-275, Oct.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1055994


ABSTRACT Introduction: The effect of spinal fusion on gait in patients with neuromuscular scoliosis continues to be a controversial issue, especially in patients where the spinal fusion extends to the pelvis. Objective: To evaluate the effect of spinal instrumentation in these patients. Methods: We evaluated 34 patients in a retrospective study. The mean age at surgery was 14±3 years and only ambulatory patients who presented neuromuscular scoliosis and non-progressing neurogenic pathology were included. The patients were surgically treated by posterior spinal fusion with or without extension to the pelvis. Preoperative (PRE) and postoperative (POP) Rx were measured. Ambulatory potential was clinically examined in all the patients, and 10 patients were assessed by full-gait analysis. Results: The minimum POP follow-up was 2 years (2006-2016). Nine patients were instrumented to the pelvis when the obliquity was greater than 15°; the remaining patients were treated using the same fusion-level criteria as those applied for idiopathic scoliosis. All patients maintained their gait, with improvements in coronal and sagittal balance, transfers and sitting skills, physical appearance, and in some cases, gait speed. Conclusions: Spinal instrumentation in ambulatory patients with neuromuscular scoliosis, including procedures with extension to the pelvis, provides adequate correction and preserves ambulatory function. Level of evidence III; Retrospective case control study.

RESUMO Introdução: O impacto da fusão de coluna vertebral sobre a marcha de pacientes com escoliose neuromuscular continua sendo uma questão controversa, especialmente, em pacientes nos quais a fusão espinhal se estende até a pelve. Objetivo: Avaliar o efeito da instrumentação espinhal nesses pacientes. Métodos: Avaliamos 34 pacientes em estudo retrospectivo, com média de idade de 14±3 anos à cirurgia; somente pacientes deambulatórios com escoliose neuromuscular e patologia neurogênica não progressiva foram incluídos. Os pacientes foram tratados cirurgicamente com fusão posterior da coluna com ou sem extensão até a pelve. Foram feitas radiografias pré-operatórias (PRE) e pós-operatórias (POP). O potencial deambulatório foi clinicamente examinado em todos os pacientes e 10 pacientes foram avaliados com análise completa em laboratório de marcha. Resultados: O acompanhamento mínimo do POP foi de 2 anos (2006-2016). Em nove pacientes foi realizada a instrumentação até a pelve quando a obliquidade era maior que 15°; os demais pacientes foram tratados pelos mesmos critérios de nível de fusão aplicados à escoliose idiopática. Todos os pacientes mantiveram a marcha, com melhoras do balanço coronal e sagital, e transferências e capacidade para sentar, aparência física e, em alguns casos, na velocidade da marcha. Conclusões: A instrumentação da coluna vertebral em pacientes deambulatórios com escoliose neuromuscular, incluindo procedimentos com extensão até a pelve, proporciona correção adequada e preserva a função deambulatória. Nível de evidência III; Estudo retrospectivo de caso-controle.

RESUMEN Introducción: El impacto de la fusión de columna vertebral sobre la marcha de pacientes con escoliosis neuromuscular continúa siendo una cuestión controversia, especialmente, en pacientes en los que la fusión espinal se extiende hasta la pelvis. Objetivo: Evaluar el efecto de la instrumentación espinal en esos pacientes. Métodos: Evaluamos 34 pacientes en estudio retrospectivo, con promedio de edad de 14±3 años en el momento de la cirugía; fueron incluidos solamente pacientes ambulatorios con escoliosis neuromuscular y patología neurogénica no progresiva. Los pacientes fueron tratados quirúrgicamente con fusión posterior de la columna con o sin extensión hasta la pelvis. Fueron hechas radiografías preoperatorias (PRE) y postoperatorias (POP). El potencial ambulatorio fue clínicamente examinado en todos los pacientes y 10 pacientes fueron evaluados con análisis completo en laboratorio de marcha. Resultados: El acompañamiento mínimo del POP fue de 10 años (2006-2016). En nueve pacientes fue realizada la instrumentación hasta la pelvis cuando la oblicuidad era mayor que 15°; los demás pacientes fueron tratados por los mismos criterios de nivel de fusión aplicados a la escoliosis idiopática. Todos los pacientes mantuvieron la marcha, con mejoras del balance coronal y sagital, y transferencias y capacidad para sentarse, apariencia física y, en algunos casos, en la velocidad de la marcha. Conclusiones: La instrumentación de la columna vertebral en pacientes ambulatorios con escoliosis neuromuscular, incluyendo procedimientos con extensión hasta la pelvis, proporciona corrección adecuada y preserva la función ambulatoria. Nivel de evidencia III; Estudio retrospectivo de caso-controle.

Humanos , Escoliose , Encefalopatias , Paralisia Cerebral
Arch. Clin. Psychiatry (Impr.) ; 46(6): 145-150, Nov.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1054915


Abstract Background Caring for a child with cerebral palsy (CP) is an arduous task and the over-reliance on specific coping strategies may predispose caregivers to depression. Objective The aim of this study was to determine the relationship between the different types of coping strategies and presence of depression in caregivers of children with CP. Methods One hundred and thirty two participants were recruited into the study. Their coping styles were measured using the Brief COPE inventory while depression was assessed with Mini International Neuropsychiatric Interview. Results The prevalence of current depressive episodes among the participants was 20.5%. Depression had a strong negative correlation with active coping (r = -0.415), planning (r = -0.432), and positive reframing (r = -0.594), and a weak negative correlation with humor (r = -0.239). But a strong positive correlation with use of instrumental support (r = 0.421) and self-blame (r = 0.448), and a moderate positive correlation with denial (r = 0.313), and behavioral disengagement (r = 0.308). Both emotion-focused (r = -0.361) and problem-focused (r = -0.576) coping style had a strong negative correlation with depression. While dysfunctional coping style had a strong positive correlation with depression (r = 0.489). Discussion Emotional and problem focused coping style were found to more protective against depression than dysfunctional coping styles among care givers of children with CP.

Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adaptação Psicológica , Paralisia Cerebral , Cuidadores/psicologia , Depressão/epidemiologia , Escalas de Graduação Psiquiátrica , Características da População , Epidemiologia Descritiva , Prevalência , Estudos Transversais , Inquéritos e Questionários , Nigéria
Rev. méd. Urug ; 35(4): 281-288, dic. 2019. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1026148


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.

Humanos , Pré-Escolar , Criança , Paralisia Cerebral/complicações , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Radiografia/instrumentação
Rehabilitación (Madr., Ed. impr.) ; 53(4): 276-283, oct.-dic. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-192120


INTRODUCTION AND OBJECTIVES: The study evaluated the effect of task-oriented training (TOT) on the motor function (MF) and balance of ambulant children with cerebral palsy (CP). MATERIALS AND METHODS: A total of 46 children were randomised into TOT group (n=23) and Control Group (CG [n=23]), but 39 children complete the study. Balance and MF were assessed at baseline, 6th and 12th weeks and 6 weeks post-intervention. Data were analysed with repeated measures ANOVA, Friedman's, Mann-Whitney U, Student's-t and post hoc tests at alfa≤0.05. RESULTS: The two groups were comparable in all baseline scores (P>0.05). At the 6th week, significant between-group difference was observed in MF only [TOT=81.9 (18.5); CG=72.8 (19.4)] (P<0.05). There were significant between-group differences in MF [TOT=88.8 (9.4); CG=75.5 (18.5); P<0.05] and balance (TOT=9.4+/-4.5; CG=13.6+/-6.9; P<0.05) at the 12th week (P<0.05) and 6 weeks post-intervention (P<0.05). CONCLUSION: TOT improved the balance and MF of ambulant children with CP

INTRODUCCIÓN Y OBJETIVOS: El estudio evaluó el efecto de la formación orientada al cumplimiento de tareas (TOT) de la función motora (FM) y del equilibrio de los niños con parálisis cerebral (PC) capaces de caminar. MATERIALES Y MÉTODOS: Un total de 46 niños fueron distribuidos al azar entre el grupo TOT (n=23) y el grupo de control (GC [n=23]), pero solo 39 niños finalizaron el estudio. El equilibrio y la FM se evaluaron al inicio del estudio, en las semanas 6 y 12 y 6 semanas después de la intervención. Los datos se analizaron con medidas repetidas ANOVA, Friedman, la U de Mann-Whitney, la t de Student y pruebas post hoc a alfa≤0,05. RESULTADOS: Los 2 grupos fueron comparables en todas las puntuaciones iniciales (p > 0,05). En la sexta semana se observó una diferencia considerable entre los grupos de la FM sola (TOT=81,9 [18,5]; GC=72,8 [19,4]) (p < 0,05). Hubo diferencias considerables entre los grupos de la FM (TOT=88,8 [9,4]; GC=75,5 [18,5]; p < 0,05) y equilibrio (TOT=9,4+/-4,5; GC=13,6+/-6,9; p < 0,05) a las 12 semanas (p < 0,05) y 6 semanas después de la intervención (p < 0,05). CONCLUSIÓN: La formación TOT mejoró el equilibrio y la FM de los niños con PC capaces de caminar

Humanos , Masculino , Feminino , Pré-Escolar , Criança , Paralisia Cerebral/terapia , Terapia por Exercício/métodos , Destreza Motora/fisiologia , Equilíbrio Postural/fisiologia , Paralisia Cerebral/fisiopatologia
Res Dev Disabil ; 95: 103508, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31683246


BACKGROUND: An exacerbated systemic inflammatory response has been associated with the occurrence of central nervous system injuries that may determine, in long term, motor, sensorial and cognitive disabilities. Persistence of this exacerbated inflammatory response seems to be involved in the pathophysiology of cerebral palsy (CP). METHODS: A systematic search was conducted in Bireme, Embase, PubMed and Scopus including studies that were published until August 2019. The key words used were "cerebral palsy", "brain injury", "inflammation", "oxidative stress", "cytokines", "chemokines", "neuropsychomotor development", "neurodevelopment outcomes" and "child". The quality of the eligible studies was determined according to the criteria suggested by the Newcastle-Ottawa Scale (NOS). RESULTS: Fourteen eligible studies aimed to investigate the association between peripheral inflammatory molecules and neurodevelopment in infants. The studies differed regarding CP-related risk factors and its classification. Inflammatory proteins were measured in blood, plasma, serum, cerebrospinal fluid or urine. In ten studies, higher circulating levels of cytokines, including IL-1ß, IL-6, TNF and CXCL8/IL-8, were associated with abnormal neurological findings. CONCLUSION: The investigation of the potential association between inflammatory molecules and neurological development in children with CP requires further original studies in order to clarify the influence of prenatal and perinatal inflammation on neurological outcomes.

Paralisia Cerebral/metabolismo , Citocinas/metabolismo , Inflamação/metabolismo , Biomarcadores , Humanos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Estresse Oxidativo , Fator de Necrose Tumoral alfa/metabolismo
Int J Dev Neurosci ; 79: 54-64, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31722225


Simultaneous execution of motor and cognitive tasks is embedded in the daily life of children. 53 children of 7-12 years and 22 adults (study 1), 20 healthy children and 20 children of 7-12 years with cerebral palsy (study 2) performed a Stroop-animal task simultaneously with a standing or a walking task in order to determine the attentional demand of postural control and locomotion. Dual-task cost decreased with advancing age in healthy children during balance. CP and healthy children were similarly affected by dual-task constraints during standing and walking. Children with diplegia were more affected by the DT during the postural task than children with hemiplegia. We found that adults could benefit from dual-tasking for standing. The integrated model of task prioritization might explain our results regarding postural reserve of each population.

Atenção/fisiologia , Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Desempenho Psicomotor/fisiologia , Criança , Cognição/fisiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos
Can Fam Physician ; 65(11): 796-798, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31722910


Question As a family physician who provides care to a large pediatric population in the community, I see children with various neurologic impairments, many with cerebral palsy (CP), presenting with gastroesophageal reflux disease (GERD). What are the current recommendations to manage GERD in pediatric patients with CP?Answer A variety of lifestyle modifications can be used to manage GERD in pediatric patients with CP, including raising the head of the patient's bed, reducing patient weight, limiting exposure to smoke, and avoiding caffeine, spicy foods, fatty foods, and chocolate. The primary pharmacologic treatments currently recommended are histamine-2 receptor antagonists and proton pump inhibitors. Surgical treatments for GERD, like the Nissen fundoplication, might result in complications, so there is ongoing research looking at the benefits of using high-pectin diets, baclofen, and prokinetic agents like mosapride instead.

Paralisia Cerebral/complicações , Medicina de Família e Comunidade/métodos , Refluxo Gastroesofágico/terapia , Adolescente , Criança , Gerenciamento Clínico , Feminino , Refluxo Gastroesofágico/etiologia , Humanos , Masculino
Stem Cell Res ; 41: 101592, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31698189


The Renpenning syndrome spectrum is a rare X-linked mental retardation syndrome characterized by intellectual disability, microcephaly, low stature, lean body and hypogonadism. Mutations in the polyglutamine tract binding protein 1 (PQBP1) locus are causative for disease. Here, we describe the generation of an iPSC line from a patient mutated in the polar amino acid-rich domain of PQBP1 resulting in a C-terminal truncated protein (c.459_462 delAGAG, type p.R153fs193X).

Sequência de Bases , Paralisia Cerebral , Proteínas de Ligação a DNA , Células-Tronco Pluripotentes Induzidas/metabolismo , Retardo Mental Ligado ao Cromossomo X , Deleção de Sequência , Linhagem Celular , Paralisia Cerebral/genética , Paralisia Cerebral/metabolismo , Paralisia Cerebral/patologia , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Humanos , Células-Tronco Pluripotentes Induzidas/patologia , Masculino , Retardo Mental Ligado ao Cromossomo X/genética , Retardo Mental Ligado ao Cromossomo X/metabolismo , Retardo Mental Ligado ao Cromossomo X/patologia
Toxins (Basel) ; 11(11)2019 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-31717282


The aim of this study was to investigate the use of botulinum toxin type A (BoNT-A) injections and their efficacy on gross motor function for lower limb spasticity in children with spastic cerebral palsy (CP). This retrospective study included 919 injection occasions from 591 children with CP who received a lower limb BoNT-A injection between 2006 and 2016. The Gross Motor Function Measure (GMFM-88), the Modified Ashworth Scale, and the Modified Tardieu Scale were administered before and after injections. Injections were predominantly administered to children under the age of 6 years. The most common muscle injection site was the calf muscle for dynamic foot deformity. The second most commonly injected muscle was the hip adductor among 2-3 year olds and the hamstring muscle among 4-6 year olds. Distal injections were predominantly administered to high-functioning children, whereas proximal injections were typically administered to low-functioning children. Multilevel injections were mostly administered to midfunctioning children. GMFM-88 scores significantly increased post-injection for both high- and low-functioning groups. Younger age at injection and distal injection type were associated with larger improvements on the GMFM-88 at both short- and midterm follow-up. The target muscles for injection varied depending on gross motor functioning and age. Younger age at injection and distal injection type were significantly related with greater gain in gross motor function.

Toxinas Botulínicas Tipo A/toxicidade , Paralisia Cerebral/tratamento farmacológico , Extremidade Inferior/fisiopatologia , Atividade Motora/efeitos dos fármacos , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Injeções Intramusculares , Masculino , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Estudos Retrospectivos
Ophthalmic Genet ; 40(6): 534-540, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718390


Background: Patients with intellectual disability syndromes frequently have coexisting abnormalities of ocular structures and the visual pathway system. The microphthalmos, anophthalmos, and coloboma (MAC) spectrum represent structural developmental eye defects that occur as part of a syndrome in one-third of cases. Ophthalmic examination may provide important diagnostic clues in identifying these syndromes.Purpose: To provide a detailed and comprehensive description of the microphthalmos, anophthalmos, and coloboma (MAC) spectrum in two brothers with intellectual disability and dysmorphism.Methods: The two brothers underwent a detailed ophthalmic and systemic evaluation. A family pedigree was obtained and exome sequencing was performed in the proband.Results: The two brothers aged 4 and 7 years had intellectual disability, microcephaly, short stature, and characteristic dysmorphic features. Ophthalmic evaluation revealed the presence of the MAC spectrum in both boys. Genetic testing led to the detection of an X-linked hemizygous truncating mutation in the nuclear polyglutamine-binding protein 1 (PQBP1) gene confirming the diagnosis of X-linked recessive Renpenning syndrome.Conclusion: The presence of X-linked intellectual disability and characteristic dysmorphism, in a patient with the MAC spectrum should raise the suspicion of Renpenning syndrome. PQBP1 mutation testing is confirmatory. A comprehensive systemic evaluation is mandatory in all patients with the MAC spectrum and intellectual disability.

Anoftalmia/patologia , Paralisia Cerebral/complicações , Coloboma/patologia , Proteínas de Ligação a DNA/genética , Retardo Mental Ligado ao Cromossomo X/complicações , Microftalmia/patologia , Mutação , Anoftalmia/etiologia , Paralisia Cerebral/genética , Criança , Pré-Escolar , Coloboma/etiologia , Humanos , Masculino , Retardo Mental Ligado ao Cromossomo X/genética , Microftalmia/etiologia , Prognóstico , Síndrome