Motricite Cerebrale最新文献

Hip eccentricity (EH) is a common musculoskeletal deformity in children with cerebral palsy (CP), with severe and multiple consequences. The risk of EH increases with young age, functional limitation, spasticity, and if the condition is quadriplegic. Prevention of EH is therefore a public health issue from an early age. The standing program with hip abduction (VAH) is commonly used for this purpose, but it is highly controversial. Based on a review of the literature and external sources, only seven clinical trials in relation to the subject were found. There is a great disparity in methodology between the articles. VAH may have an effect on EH in children with CP, both preventively and after soft tissue surgery, but the level of evidence is moderate. This device seems to be more effective if the management is more comprehensive. Younger age and less advanced CP are indications where VAH seems to be effective, especially when started early. Confirming this effect with larger numbers is necessary as well as studying the long-term effect, especially in adolescence.

Literature about the use of intermittent positive pressure breathing is scarce, mainly old and with a low evidence level. There is no specific study about the use of this therapy in severe cerebral palsy. This literature review doesn’t allow clear-cut conclusions but let us think that, in severe cerebral palsy, the use of Intermittent Positive Pressure Breathing at suitable pressure levels could improve and maintain over time lung compliance. It could also mobilize the patient's rib cage, ventilating poorly ventilated lung areas and even removing atelectasis caused by spinal deformities in particular. This therapy could also facilitate bronchial drainage by increasing the volume of air mobilized when using chest physiotherapy techniques. Expert's reports and clinical practice also point in this direction.

Objective

The objective of this work is to research, from the literature, whether there is an interest of bimanual training compared unimanual training in improving the upper limb function in children with unilateral spastic cerebral palsy.

Method

PubMed and Science Direct databases have been consulted to find articles since 2000 discussing the intensive bimanual therapy and the constraint induced movement therapy in these patients.

Results

Five articles were selected between 2011 and 2017, including two systematic reviews, a multisite clinical trial, a secondary analysis of a randomized controlled trial and a literature review.

Conclusion

The literature shows a strong but nonspecific recommendation for one or the other approach in improving the hemiparetic upper limb function. However, constraint induced movement therapy appears to be more effective in improving grip in the injured hand and there is a weak recommendation for intensive bimanual therapy in improving coordination between limbs and for bimanual activities. The conclusion would be to approach these two therapies by making them complementary and to link unimanual training and bimanual training in the rehabilitation of children with unilateral spastic cerebral palsy.

Although the current definition of cerebral palsy requires us to make a classification of children based on their motor abilities, other associated disorders, such as perceptual disturbances, may be the source of the main problem of our patients. These perceptual disturbances include the "startle response", commonly known in France as "Factor E". This reaction is a sudden and involuntary movement characterized by an opening motor pattern, although other autonomous and emotional components may be present. As the "Factor E" can directly impact on the autonomy and activities of the daily lives of our patients, the following problem arises: What neurophysiological and motor characteristics of factor E allow it to be modulated in children with cerebral palsy? A literature review on seven different databases was performed, finding five articles that meet the eligibility criteria. In general, we can affirm that "Factor E" has a motor pattern which is similar to that of the startle reflex found in lambda subjects and that it is habituated which can be rapid in patients with cerebral palsy.

The admission of children with disabilities to a dedicated nursery in Côte d’Ivoire has made it possible to respond to the fight against infanticide or neglect without care. The aim of this work was to define the profile of disabled children abandoned and admitted to the Dabou nursery in Côte d’Ivoire.

Material and methods

Descriptive cross-sectional study carried out over a 9-month period in the Dabou nursery in Côte d’Ivoire and including 74 children and adolescents with disabilities. The epidemiological, clinical and functional data and the treatment needs of infants were described.

Results

Children aged 0 to 3 and 6 to 10 years were the most numerous (45% of cases) with a predominance of males (sex ratio = 1.31). They came mainly from the capital of the country. The infants’ clinical aspects were polymorphic, sometimes associated with limb malformations (68.9%), various motor impairments, neuro-orthopaedic deformities (59.46%), and psychomotor acquisition delays. The therapeutic needs expressed were varied and superimposed on the clinical aspects of the children and were broken down into rehabilitation activities, orthopaedic devices and care.

Conclusion

The implementation of an adapted rehabilitation care strategy is necessary to support disabled children who have been abandoned and admitted to a dedicated nursery.

Objective

Identify and evaluate the severity of post-neuropaludism motor and sensory sequelae in children in Kinshasa, the scales used to quantify them, and the effective rehabilitation techniques used to manage them.

Methodology

This is a multicenter, transversal and descriptive study, carried out in Kinshasa, during the period from July to September 2019. It consisted in evaluating the frequency and severity of motor and sensory sequelae in children aged 0 to 15 years, within three weeks of an episode of neuropaludism with sequelae. Prior informed consent had been obtained from their parents.

Results

The frequency of post-neuropaludism motor and sensory sequelae in Kinshasa was 33%. Spastic hypertonia was the most objective tone disorder in 78.8% of patients. Dysarthria and aphasia were the most objective language disorders in 42.4 and 24.2% of cases. Late consultation (87.0%) and convulsions (78.3%) significantly influenced the severity of hypertonia and severity of sequelae. In 93.9% of the cases, no evaluation scale was applied in patients undergoing rehabilitation. Only in patients of the university hospital of Kinshasa (6.1%), the scales were realized and benefited from the protocol including all other rehabilitation techniques according to our perspectives, with a satisfactory evolution.

Conclusion

Post-neuropaludism motor and sensory sequelae are present in Kinshasa but are very insufficiently evaluated, with inadequate management increasing their severity. So, the need for a standard protocol, advocating prior assessments through specific measurement scales as well as early and multidisciplinary management.

Disability is a complex subject. The conception of disability is constantly changing over the years. Since antiquity, there has been an intimate relationship between art and human development. The perception of the artist is always influenced by the patient, sometimes by the illness, and artistic works bear witness to this. Art is a powerful means to rehabilitate the image of people with disabilities in a society, the stigma they suffer from inspires art. Artistic manifestations abound, responding to all the discomforts of this society. In recent years, studies have focused on art as a therapeutic means for neurological disorders. Through its creative, playful and participatory action, it improves physical fitness and empowerment. To improve this art-handicap relationship, we must act in a transversal way between the different intervening parties (doctors, patients, artists, civil society, authorities…etc.). Disability is not the prerogative of health professionals but of everyone.