Motricite Cerebrale最新文献

Introduction

As part of the TOXSIALO-2 study (currently underway) on the drug treatment of drooling in children with cerebral palsy (CP), training material has been developed to intensify and standardize rehabilitation management.

Methods

A working group of experts (6 speech and language therapists, 1 occupational therapist, 2 rehabilitation doctors) in the care of CP children with persistent drooling has drawn up a booklet of exercises based on their clinical expertise, presented in an accessible and fun way, to be carried out daily at home as part of an approach based on individualized objectives.

Results

Using the Goal Attainment Scaling methodology, the booklet enables the functional goals to be defined with the child and his or her family (based on the difficulties encountered in daily life as a result of hypersialorrhoea). The therapist can then choose exercises that relate to the deficient skills and individualize them from among the 29 clearly illustrated exercises described in the booklet, divided into 4 key areas of swallowing: nasal breathing, oral sensory information, swallowing reflex and orofacial muscle strengthening. The booklet also enables therapists to monitor compliance with the rehabilitation program.

Discussion and conclusion

The booklet can help families to carry out self-rehabilitation or stimulation exercises at home to reduce sialorrhoea. In research, the booklet should also make it possible to better standardize oromotor rehabilitation associated with medical or surgical therapies in this indication, thereby improving the reliability of the therapy.

The text reviews the challenges faced by young people with cerebral palsy. We underline their suffering and its related aspects (suffering regarding pain, suffering regarding the gaze of others, suffering regarding the view of themselves). The article highlights the importance of communicating with these young people, to address these different issues. It aims to encourage healthcare prefessionals to listen to them carefully and to support them in expressing their emotions, even non-verbally. The author shares her experience of using hypnosis or relaxation to help young people suffering from cerebral palsy to overcome their pain. This work aims to take better account of the psychological needs of young people with cerebral palsy, such as the need for security, surroundings, affection, the need to be heard, the need to build their identity and to get positive feedback. It highlights the importance of an empathetic and holistic approach to meet these needs and to promote their well-being.

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.