Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review.

OBJECTIVE: To conduct a systematic review of the impact of different injection-guiding techniques on the effectiveness of botulinum toxin type A (BoNT-A) for the treatment of focal spasticity and dystonia. DATA SOURCES: MEDLINE via PubMed, Academic Search Premier, PASCAL, The Cochrane Library, Scopus, SpringerLink, Web of Science, EM Premium, and PsycINFO. STUDY SELECTION: Two reviewers independently selected studies based on predetermined inclusion criteria. DATA EXTRACTION: Data relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale. DATA SYNTHESIS: Ten studies were included. Seven were randomized. There was strong evidence (level 1) that instrumented guiding (ultrasonography [US], electrical stimulation [ES], electromyogram [EMG]) was more effective than manual needle placement for the treatment of spasmodic torticollis, upper limb spasticity, and spastic equinus in patients with stroke, and spastic equinus in children with cerebral palsy. Three studies provided strong evidence (level 1) of similar effectiveness of US and ES for upper and lower limb spasticity in patients with stroke, and spastic equinus in children with cerebral palsy, but there was poor evidence or no available evidence for EMG or other instrumented techniques. CONCLUSIONS: These results strongly recommend instrumented guidance of BoNT-A injection for the treatment of spasticity in adults and children (ES or US), and of focal dystonia such as spasmodic torticollis (EMG). No specific recommendations can be made regarding the choice of instrumented guiding technique, except that US appears to be more effective than ES for spastic equinus in adults with stroke.

Digital technologies for motor rehabilitation in children: protocol for a cross-sectional European survey.

INTRODUCTION: Digital technologies can be used as part of paediatric motor rehabilitation to remediate impairment, promote recovery and improve function. However, the uptake of digital technologies in this clinical field may be limited.The aim of this study is to describe and explain digital technology use for paediatric motor rehabilitation. The specific objectives will be: (1) to describe the access to, acceptance of and use of digital technologies as a function of individual factors related to professionals practicing motor rehabilitation with children, and of environmental factors related to paediatric rehabilitation practice and (2) to explain digital technology use with a causal model based on the 'unified theory of acceptance and use of technology'. METHODS AND ANALYSIS: RehaTech4child (Rehabilitation Technologies For children) is a cross-sectional study involving an online survey, that is sponsored by the European Academy of Childhood Disability (EACD). The survey protocol follows the Strengthening the Reporting of Observational Studies in Epidemiology and CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines. The survey includes 43 questions about (1) respondents' individual and environmental characteristics; (2) the ease of access to digital technologies, and the frequency, type and purpose of use of those technologies and (3) acceptance of technologies and barriers to their use. The survey is intended for professionals involved in paediatric motor rehabilitation. It is disseminated across Europe by the EACD network in 20 languages. Participation is anonymous and voluntary. We aim to include 500 respondents to ensure sufficient precision for the description of study outcomes and to perform stratified analyses by the main determinants. ETHICS AND DISSEMINATION: Ethics approval was waived by the Brest CHRU Institutional Review Board. The study is conducted according to current French legislation (loi Jardé (n°2012-300)) and the survey is GDPR compliant. Study findings will be presented at national and international meetings and submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05176522.

Characteristics of newly acquired gait in toddlers with unilateral cerebral palsy: Implications for early rehabilitation.

BACKGROUND: Knowledge of the characteristics of newly acquired gait in toddlers with cerebral palsy (CP) is limited. OBJECTIVES: This study compared gait characteristics (spatiotemporal parameters, kinematics and lower-limb muscle activation) within the first 6 months of independent walking in toddlers with unilateral cerebral palsy (UCP) and typically developing (TD) children. METHODS: The gait of 28 TD toddlers and 13 toddlers with UCP, all up to 3 years old with maximum walking experience of 6 months, was recorded by using a 3-D optoelectronic system and surface electromyography (EMG). Statistical parametric mapping was used to compare the kinematic parameters and EMG envelopes. Mann-Whitney U test was used to compare spatiotemporal parameters between groups. Principal component analysis was used to determine whether the main kinematic results were related to the clinical measures. RESULTS: Toddlers with UCP had bilateral modifications of the spatiotemporal parameters during gait as compared with TD toddlers and temporal asymmetry. The largest kinematic difference between the UCP and TD groups was external pelvic rotation on the affected side (13.3°). Foot progression angle was external during swing phase on the affected side. The groups did not differ in muscle activation for the set of muscles recorded. Pelvic rotation was not associated with any of the clinical measures on the affected or non-affected sides of toddlers with UCP. CONCLUSIONS: Alterations in kinematic gait parameters were mostly found at the pelvis in toddlers with UCP and newly acquired gait. At that age, the external pelvic rotation on the affected side is more likely due to primary motor control disorders than compensatory mechanisms. These findings suggest that early rehabilitation should focus on proximal motor control, balance and symmetry to optimize gait development from the early stages in children with UCP.

Reliability and sources of variability of 3D kinematics and electromyography measurements to assess newly-acquired gait in toddlers with typical development and unilateral cerebral palsy.

The aim was to 1) determine intersession and intertrial reliability and 2) assess three sources of variability (intersubject, intersession and intertrial) of lower limb kinematic and electromyographic (EMG) variables during gait in toddlers with typical development (TD) and unilateral cerebral palsy (UCP) (age <3 years, independent walking experience ≤6 months). Gait kinematics and surface EMG were recorded in 30 toddlers (19 TD and 11 UCP), during two, 3D-motion capture sessions. Standard error of measurement (SEM) between trials (gait cycles) of the same session and between sessions was calculated to assess reliability. Standard deviations (SD) between subjects, sessions and trials were calculated to estimate sources of variability. Sixty-four percent of kinematic SEM-values were acceptable (2°-5°). Frontal plane measurements were most reliable (SEM 2°-4.6°). In toddlers with UCP, EMG variables were most reliable for affected side, distal muscles. Intrinsic (intertrial and intersubject) variability was high, reflecting both motor immaturity and the high variability of toddler gait patterns. In toddlers with UCP, variability was amplified by motor impairment and delayed motor development. 3D gait analysis and surface EMG are partially reliable tools to study individual gait patterns in toddlers in clinical practice and research, although some variables must be interpreted with caution.

Cardiovascular Risk Factors in Chronic Inflammatory Rheumatic Diseases: Modern Assessment and Diagnosis.

The current view is that systemic inflammation, which is specific to all chronic inflammatory rheumatic diseases (CIRD), accelerates atherogenesis; this hypothesis is supported by the high cardiovascular (CV) morbidity and mortality rates and the high prevalence of all atherosclerosis stages and complications in CIRD patients. The assessment of traditional CV risk factors underestimates the actual risk in patients with CIRD. A comprehensive evaluation and follow-up of both traditional and non-traditional CV risk factors, as well as the correct classification of risk reduction categories are necessary. Imaging techniques (e.g. carotid intima-media thickness and flow-mediated vasodilation) can be used for the early diagnosis of endothelial dysfunction. Immunologic and metabolic markers (anti-cyclic citrullinated peptide (CCP) antibodies, IgM rheumatoid factor, circulating immune complexes, proinflammatory cytokines, TH0/TH1 lymphocytes and homocysteine) may be involved in the atherosclerotic disease development specific to CIRD. A modern therapeutic approach should include the early diagnosis of endothelial dysfunction and atherosclerosis, treatment of CIRD, specific medication designed to control atherosclerosis, changes in patient lifestyle and periodic follow-ups. The assessment and diagnosis of traditional and non-traditional CV risk factors, followed by aggressive prevention and therapy, are necessary to achieve efficient control over the inflammation, immunologic and metabolic disorders specific to CIRD.

[Aggressive nature of rheumatic arthritis with citrullinated cyclic peptide antibodies]. / Caracterul agresiv al artritei reumatoide cu anticorpi anti peptid ciclic citrulinat prezenti.

UNLABELLED: Numerous studies demonstrate the high specificity (90-98%) of the anticyclic citrullinated antibodies (antiCCP) in rheumatoid arthritis (RA) and their correlation with the erosive arthritis, these antibodies being a disease activity marker and a prognostic factor. MATERIAL AND METHODS: A total of 53 RA patients (48 women, 5 men), mean age 47.3 years old, diagnosed according to the ACR criteria were evaluated. The clinical evaluation was centered upon: tender joint count, swollen joint count, patient pain (VAS), morning stiffness and disease activity score (DAS28). The laboratory tests had in view: the inflammatory syndrome, blood count, immunological syndrome (antinuclear antibodies, rheumatoid factor, antiCCP antibodies), radiographs of the hands and feet. RESULTS: The high levels of the anti-CCP antibodies founded in 28 patients with RA were correlated with severity of the inflammatory syndrome, the immunological abnormalities and with the precocity appearance of the joint erosions. CONCLUSIONS: The presence of the anti-CCP antibodies at patients with RA are correlated with severe joint destruction and it represents a marker of the disease activity and progression.