Combined Therapy of Orthopedic Surgery after Deep Brain Stimulation in Cerebral Palsy Mixed Type: A Case Report

Dystonia is a symptom defined by involuntary and irregular contractions of the muscles, which cause movement disorders and postural problems. Deep brain stimulation (DBS) in globus pallidus interna (GPi) is a good option for controlling dystonia. DBS has already been shown to have significant effects on primary dystonia as well as Parkinson's disease. Dystonia is very difficult to manage, as seen in cerebral palsy (CP) mixed with spasticity. As CP patients grow, their musculoskeletal problems may require orthopedic surgery. However, the outcome of orthopedic surgery is not usually suitable due to dystonia. Therefore, we attempted to control dystonia through DBS initially and perform orthopedic surgery to correct musculoskeletal deformities after treatment of dystonia. Herein, we report a case that showed remarkable improvement in terms of the dystonia rating scale and gait pattern after combined therapy of DBS and orthopedic surgery.

Attenuation of Spinal Curvature and Pelvic Obliquity by Body Shape Molded Inner System in Cerebral Palsy with Non-Fixed Scoliosis

OBJECTIVE: To investigate the effect of the body shape molded inner system on attenuation of spinal curvature and pelvic obliquity in cerebral palsy (CP) with scoliosis. METHOD: Fifteen patients with CP who had fixed or non-fixed scoliosis were recruited. By radiographic studies, Cobb's angle and pelvic obliquity were measured with or without sitting in the body shape molded inner system. RESULTS: Spinal curvature assessed by Cobb's angle was significantly reduced when CP patients were seated in the body shape molded inner system rather than in conventional seats. Although pelvic obliquity was not improved in patients with fixed scoliosis, it was significantly ameliorated in patients with non-fixed scoliosis when seated in the body shape molded inner system. CONCLUSION: The body shape molded inner system attenuated spinal curvature and pelvic obliquity in CP patients with non-fixed scoliosis which had a flexible spinal curve.

Dopa-responsive Dystonia Misdiagnosed as Cerebral Palsy and Hereditary Spastic Paraplegia 2 Cases: Two cases report

Dystonia is a movement disorder caused by involuntary, sustained muscle contractions, frequently resulting in twitching and repetitive movements or abnormal postures. Dopa-responsive dystonia (DRD) is characterized by early childhood onset, marked diurnal fluctuation of symptoms and dramatic response to levodopa. The aim of this report is to present the two cases of DRD misdiagnosed respectively as cerebral palsy and hereditary spastic paraplegia. Proper understanding of this disease entity and its treatment options are necessary for comprehensive rehabilitative management of DRD.

Comparison of Energy Expenditure and Walking Performance by Arm Cycling and Leg Cycling Exercise

OBJECTIVE: To investigate the effect of cycling ergometry and to compare energy expenditure and walking performance after arm cycling with those after leg cycling in patients with brain diseases. METHOD: Twenty-two adults with brain diseases (6 stroke, 4 traumatic brain injury, 4 brain tumor, 4 parkinsonism, 4 cerebral palsy) were recruited as subjects. They were randomly assigned to disease-matched groups; arm cycling and leg cycling (n=11 each). VO2 (L/min), VCO2 (L/min), VE (L/min), O2 rate (ml/kg, min), O2 pulse (ml/kg, bpm), O2 cost (ml/kg, m) and VO2 peak (ml/kg, min) during cycling test or walking test, and walking performance were evaluated after cycling training for 4~6 weeks. RESULTS: Arm cycling exercise did not improve any parameters such as VO2, VCO2, O2 rate and O2 cost during walking test, whereas it increased VCO2, VE and O2 pulse during cycling test. In contrast, leg cycling significantly improved walking velocity and distance, and decreased O2 cost during walking test. It also increased all parameters including VO2 peak during cycling test (p<0.05). CONCLUSION: Leg cycling exercise improved walking performance and energy efficiency of walking as well as cardiorespiratory fitness relative to arm cycling. Therefore, leg cycling promoted lower-extremity task such as walking in patients with brain diseases.