Motricite Cerebrale最新文献

Objective

To assess the effect of superficial fibular transcutaneous neurostimulation as a treatment for hypertonic varus foot in children with unilateral cerebral palsy.

Method

We made a retrospective assessment of a transcutaneous electric stimulation protocol, applied on the superficial fibular nerve territory 3 hours per day during 3 months. We measured and compared maximum foot varus angle during swing phase and during stance, and fore-foot supination angle at initial contact and at mid-stance, on gait video captures before and after stimulation.

Results

Five children with unilateral cerebral palsy were included in this retrospective study. Their mean age was 8.5 years, and the average follow up after the end of the electric stimulation was 12 months. Statistical analysis was made with non-parametric Wilcoxon test. We found a significant decrease of fore-foot supination angle at initial contact (P = 0.042) and a significant decrease of rear-foot varus angle at mid-stance (P = 0.039), one month after the end of the electric stimulation, compared with the measures before electric stimulation. We found non-significant decrease of supination angle at mid-stance and maximal varus angle during swing phase.

Conclusion

Superficial fibular transcutaneous neurostimulation seams to be an effective treatment for hypertonic varus foot in children with unilateral cerebral palsy. Our findings are limited by the retrospective design of our study, and the small sample size. These encouraging results need to be confirmed by a bigger comparative prospective survey.

The people suffering multiple disabilities are surrounded by a lot of orthopedic appliance. Directly in contact with their body, they impact the psychomotor functions, the path to self-discovery, the exploration of the environment and of other people. Learning to be comfortable with this body is also crucial. This text, far from being comprehensive, brings a testimony and a reflection on the orthopedic appliance in light of the basic psychomotor functions.

Oral-facial motor disorders sometimes seem obvious in patients with cerebral palsy, but what about oral disorders? This question will lead us to discuss the act of eating, the meal and the development of the orofacial sphere in its various components: sucking – swallowing – chewing; sensoriality; ventilation; phonation – articulation (though the latter is not covered in this article). We will look at the issue of testing and referral.

Objective

The objective is to highlight the epidemiological, clinical and therapeutic profile of children with cerebral palsy followed in rehabilitation.

Methodology

This is a descriptive and retrospective study conducted on 1135 children with cerebral palsy followed in rehabilitation at the center “Shirika la Umoja” in Goma from 2010 to 2018. Information was collected from medical records and completed by parents.

Results

The predominance was male (57.4%), age 7–12 months was predominant. The deliveries were in 90% by vaginal delivery. The etiologies were perinatal asphyxia (41.9%), neonatal infections (13.7%), and neonatal jaundice (11.6%). They all consulted for a psychomotor development disorder associated with axial hypotonia (59.6%), seizures (27.4%), and limb spasticity (25.7%). The diagnosis was made by assessing the motor progression level. BMI children were spastic (47.8%), dyskinetic (24.4%), quadriplegic (55.8%), and hemiplegic (12.8%). The treatment consisted of neuromotor education, perceptive-motor facilitation, Le Métayer's “Niveau d’évolution mortice” (N.E.M), Bobath's method, respiratory physiotherapy, psychomotricity, parental awareness, and mobilisation. The evolution was marked by 53% abandonment of the treatment and 9.4% acquired or improved their walking.

Conclusion

Although the re-education and rehabilitation treatment was well administered, the therapeutic outcome was not favourable with a predominance of treatment abandonment.

Scoliosis is common in cerebral palsy. The higher the GMFCS (Gross Motor Function Classification System), the more severe the scoliosis. Depending on the degree of scoliosis, surgery may be required. The compensatory strategies put in place by the young person to perform certain acts of daily life frequently include the spine. We need to establish a predictive functional assessment in order to explain to the young person and his family the advantages and disadvantages of surgery, as well as the new strategies to be acquired to limit any functional restrictions. This assessment will be illustrated using a case study. This predictive assessment will enable us to anticipate certain problems and adapt our rehabilitation objectives.

Background

Children with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy.

Methods

Children with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy.

Results

Of 35 initial registrations, three studies met the inclusion criteria. Results showed that postural insoles are effective in improving foot biomechanics and posture. However, the quality of the evidence was generally low, and further high-quality studies are needed to confirm these results.

Conclusions

Postural insoles with corrective elements may be an effective treatment option for improving gait parameters in children with cerebral palsy. The use of these semelles can lead to an increase in cadence and speed, as well as an improvement in the range of motion of ankle dorsiflexion and a decrease in the range of motion of knee flexion and hip internal rotation.

Objective

This study determined which muscle tone assessment scale has the best psychometric properties in patients with acquired brain injury.

Methods

The systematic review included cross-sectional studies of diagnostic accuracy in which the sample consisted of adult patients with acquired brain injury of various etiologies, and the outcomes were the psychometric properties of muscle tone rating scales. The main databases consulted were PubMed, Cochrane Central Register of Controlled Trials and PEDro. Risk of bias and applicability were assessed using QUADAS-2, a specific tool for diagnostic studies. The characteristics of each study were presented in a synaptic table, and the results were described schematically and narratively.

Results

The search yielded 1056 results, of which only 13 were included in the systematic review after full-text analysis. The population of nine studies involved adult patients with upper motor neuron lesions of various etiologies, while in four studies the sample analyzed consisted of children with cerebral palsy. With regard to spasticity, the Ashworth scale and the modified Ashworth scale demonstrated low to moderate inter-operator reliability and low validity. The modified Ashworth scale, on the other hand, demonstrated high inter-operator reliability in the assessment of upper limb districts. The modified Tardieu scale was found to have low to moderate inter-operator reliability and moderate to high intra-operator reliability, with greater concordance of scores than the modified Ashworth scale. The Hypertonia Assessment Tool, the Barry-Albright Dystonia Scale, the Unified Dystonia Assessment Scale and the Burke-Fahn-Marsden Movement Scale, studied on samples of children with cerebral palsy, showed moderate to good inter-operator reliability and good internal consistency.

Conclusion

The systematic review identified a series of muscle tone assessment scales and analyzed the psychometric properties of each tool.