Hemiplegic Group Research Articles

The Evaluation of 10 week Urinary Tract Function Promotion Program for the Elderly Women in the Community

Purpose: This study was accomplished to apply and to evaluate the 10-week Urinary tract Function Promotion for the Elderly Women (UFPE), and to suggest guideline and to be utilized on the community level. Method: Subjects were 30 persons of 16 healthy elderly and 14 hemiplegic elderly. This UFPE was composed of diagnosis of incontinence & evaluation of physical condition, understanding of urogenital system & urinary incontinence management. UFPE was evaluated by subjective urinary condition, intra-vaginal contraction power, continence self-efficacy (CSE), incontinence stress, geriatric depression. The collected data was analyzed using Wilcoxon Matched Signed-Ranks test by SPSS/WIN program. Result: 5 subjects (31.2%) in healthy group and 2 subjects(14.3%) in hemiplegic group have a daytime frequency, 14 subjects(87.5%) in healthy- group and 14 subjects(100%) have a nocturia. After program, subjective urinary condition was increased just only healthy elderly (Z=-2.545, p

Cerebral palsy in preterm infants: a population‐based case‐control study of antenatal and intrapartal risk factors

Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection‐related risk factors for spastic CP in preterm infants. A population‐based series of preterm infants with spastic CP, 91 very preterm (>32wk) and 57 moderately preterm (32–36 wk), born in 1983–90, were included and matched with a control group (n= 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission‐delivery interval >4 h and Apgar scores of >7 at 1 min just significantly increased the risk of CP, and Apgar scores of >7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores >7 at 1 min and pathological non‐stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group. Conclusion: Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.

Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors.

Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection-related risk factors for spastic CP in preterm infants. A population-based series of preterm infants with spastic CP, 91 very preterm (<32 wk) and 57 moderately preterm (32-36 wk), born in 1983-90, were included and matched with a control group (n = 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission-delivery interval <4 h and Apgar scores of <7 at 1 min just significantly increased the risk of CP, and Apgar scores of <7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores <7 at 1 min and pathological non-stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group. Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.

Modificaciones de la amplitud articular de tobillo durante la marcha en niños afectos de PCI y pie equino tratados con TBA

El objetivo de este estudio fue comprobar el efecto de la TBA (BOTOXâ) en la amplitud articular&#x0D; del tobillo durante la marcha en pacientes afectos de PCI. La muestra estuvo formada por 9 niños&#x0D; con una media de 6 años de edad distribuyéndose en 4 grupos de estudio: control, hemipléjico,&#x0D; dipléjico I y dipléjico II. Las variables cuantificadas fueron la máxima flexión dorsal y plantar&#x0D; realizadas durante la marcha (calzados y descalzos) así como los porcentajes del CM en el que se&#x0D; alcanzaron estos máximos. La técnica instrumental utilizada fue un sistema de fotogrametría vídeo&#x0D; 3D con el software Kinescan-IBV. Interrelacionando las cuatro variables sometidas a estudio, los&#x0D; resultados obtenidos demostraron que cada grupo evolucionó de forma distinta. Mientras que el&#x0D; grupo hemipléjico alcanzó los mejores resultados entre los 3 meses y 5 meses dependiendo de la&#x0D; condición, el grupo dipléjico I lo consiguió a los 5 meses y 3 semanas el dipléjico II a los 9 meses y&#x0D; 3 semanas. La TBA permitió una mayor movilidad en la articulación del tobillo, sin embargo para&#x0D; que también mejorara la marcha fue necesario que transcurriera un cierto tiempo para reeducarla,&#x0D; necesitando un incremento de este periodo y del número de dosis de TBA cuanto mayor es la&#x0D; alteración de la marcha.

The Locus of Control of Japanese Senior Citizens with Hemiplegia.

The aim of this study was to assess the effects of living circumstances on the locus of control of senior citizens with hemiplegia, and to research the factors that control the locus of control from among the 10 items (activities of daily living, quality of life, degrees of paralysis, age, sex, diagnosis, type of disorder, length of living at home/institution, whether or not s/he has hobbies, whether or not s/he has friends). The subjects of this study were senior citizens with hemiplegia who were living at home (n=31) or resided in the nursing homes (n=30), and elderly able bodied people who were living at home (n=35). The results showed that there were no significant differences in the locus of control between the hemiplegia group and able bodied people group, but in the stroke patients group, patients who were living at home got a high score in the locus of control which was significantly more than that of these who resided in nursing homes. The items which controlled the locus of control were abilities of activities of daily living among the senior citizens with hemiplegia who were living at home and quality of life among these who resided in nursing homes. The results suggest that a sensitive indicator of locus of control is not physical disability but place of living. The living at home group requires the formation of an environment in which activities of daily living ability can be drawn out to the maximum, and the institution group requires the offer of a lifestyle that is high in quality and which matches the individual preferences of the people entering the institution.

BONE MINERAL DENSITY OF METATARSUS IN HEMIPLEGIC SUBJECTS1

The cortical bone mineral density (BMD) of the first metatarsus was measured using computed x-ray densitometry in 84 hemiplegic subjects (35 men and 49 postmenopausal women) and 49 healthy age-matched controls (23 men and 26 postmenopausal women), and the determinants of paralysis-induced cortical osteopenia were investigated. In the hemiplegia group, ages were 63.9 +/- 9.8 yr (mean +/- standard deviation) for men and 66.6 +/- 11.0 yr for women. The duration of hemiplegia was 25.3 +/- 19.8 mo for men and 26.0 +/- 26.3 mo for women. The Brunnstrom stage (lower limb) was 4.0 +/- 1.1 for men and 3.8 +/- 1.4 for women. The walking ability, evaluated by walking score, was 3.6 +/- 1.3 (range, 1-5) for men and 3.2 +/- 1.5 (range, 1-5) for women. The time since menopause was 14.8 +/- 10.0 yr. The age and time since menopause were similar in the hemiplegia and control groups. On the paralyzed side, the BMD of men and women in the hemiplegia group was significantly lower than that of the control group on the nondominant side (by 6.1% and 11.6%, respectively). In hemiplegic men, Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.418 and r = 0.349, respectively). In hemiplegic women, on the other hand, age, duration of hemiplegia, and years since menopause showed a significant negative correlation to the BMD (r = -0.260, r = -0.478, and r = -0.506, respectively), and Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.526 and r = 0.406, respectively). These findings suggest that the determinant of metatarsal cortical BMD loss on the paralyzed side of the hemiplegic subject might be different according to gender. That is, although the degree of paralysis and walking ability could be a determinant of metatarsal cortical BMD loss on the paralyzed side of hemiplegic men, additional factors such as age, duration of hemiplegia, and years since menopause could play an important role in the determination of metatarsal cortical BMD loss in postmenopausal hemiplegic women.

THE ORGANIZATION OF LATERALIZED CEREBRAL FUNCTIONS IN CONGENITAL HEMIPLEGIA. II. INTELLIGENCE &amp; III PSYCHOMETRIC DATA

Abstract This study describes the results of the assessment of 51 children with congenital hemiplegia, 28 right and 23 left hemiplegics, on the Wechsler Intelligence Scales (WISC-R). These two groups were compared to a Control group of thirty non-hemiplegic children who were chosen to match the subjects on age at testing, full scale IQ, socioeconomic status and sex distribution. Hemiplegic subjects showed significantly greater differences between Verbal and Performance IQ scores compared to Controls, while the scores on the Object Assembly subscale and the Performance IQ compared to Controls. The left-right maturation gradient of the two hemispheres as a possible explanation for the unexpected results in the right hemiplegics is discussed, although lack of differences between the hemiplegic groups may be the more striking feature. Children with congenital hemiplegia may have fewer cognitive deficits due to early reorganization of lateralized cerebral functions, or the WISC-R may not be sensitive enough to demonstrate specific cognitive deficits. No effect of gender or extent of brain damage as measured on brain scan could be demonstrated. There was an effect of seizures, familial sinistrality, treatment and birth asphyxia on Performance IQ and VIQ/PIQ differences only. It is possible that these variables are markers of early brain damage.

Unilateral neglect in children with hemiplegic cerebral palsy.

The purpose of this study was to examine the pattern of attentional deficits in children with right and left hemiplegic cerebral palsy. Unilateral neglect and visuospatial deficits are common findings following right brain injury in adults. It has been suggested by some that children may show a similar pattern. Children were tested on several paper-and-pencil measures of neglect. It was hypothesized that (a) on the left side of the page, children with left hemiplegia (right hemispheric damage) will score significantly lower than both the control group and the right hemiplegia group and (b) on the right side of the page, there will be no significant difference between the control group and the right and left hemiplegic groups. Participants included 32 children with cerebral palsy, 15 with left hemiplegia, 17 with right hemiplegia, and 32 matched controls. The ages ranged from 5 years 10 months to 12 years 6 months; all had normal intelligence. Inventories included 3 subtests of the Conventional part of the Behavioral Inattention Test, the Mesulam Symbol Cancellations tests, and the Rey Osterrieth Complex Figure, copy and recall. Analysis indicated that children with left hemiplegia scored significantly more poorly than controls on seven of the eight measures on the left side of the page, but they did not consistently score more poorly than children with right hemiplegia. Moreover, the poorer performance of the children with left hemiplegia was not specific only to the left side of the page; they also scored significantly lower than the controls on five of the eight measures on the right side. These findings suggest that children with left hemiplegia may have relatively greater attentional and perceptual problems than children with right hemiplegia, but they do not clearly indicate a left unilateral neglect. Results also indicate that children with right hemiplegia have attentional and perceptual problems relative to controls, particularly on the more complex tasks of high demand.

THE ORGANIZATION OF LATERALIZED CEREBRAL FUNCTIONS IN CONGENITAL HEMIPLEGIA: I. DESCRIPTIVE DATA, AND DEVELOPMENTAL AND BEHAVIOURAL PROFILES

Abstract Fifty-one children with congenital hemiplegia (6–16 years) were included in this study, 28 with right hemiplegia (14 male and 14 female) and 23 with left hemiplegia (15 male and 8 female) as well as a control group (15 male and 15 female) chosen to match the subjects on age at testing, full scale IQ and socioeconomic status. A neurological examination, parent questionnaires and an interview were used to assess neurological and socioeconomic status, development and current educational placement, behavioural profile and handedness of family members. Birth records and brain scans (CT) were examined. Strict inclusion criteria ensured the unilaterality of the lesion. There were more right than left hemiplegic children identified and relatively more males than females in the left hemiplegic group. The two hemiplegic groups were similar on all descriptive and developmental data. They differed significantly from the controls only in that the left hemiplegic group was more premature and smaller at birth; ...

Postural responses to unilateral arm perturbation in young, elderly, and hemiplegic subjects

Objective: To compare postural responses during standing associated with self-paced unilateral arm flexion exhibited by young and elderly healthy subjects and subjects with hemiplegia from stroke. Design and Setting: Descriptive cross-sectional study in a laboratory setting. Patients: Ten young, 10 elderly healthy subjects, and 12 volunteers with longstanding hemiparesis following stroke were tested. The hemiplegic group had good functional balance scores on the Berg Balance Scale (BBS). Main Outcome Measures: The peak arm acceleration, center of pressure (CP) excursion speed, and the electromyographic activity in the posterior leg muscles (bilateral hamstrings and triceps surae) were monitored during self-initiated rapid unilateral arm flexion and during quiet stance. Results: During unilateral arm flexion, the young group showed the highest arm accelerations and lowest CP excursion speeds. The variability of postural responses was largest in the elderly and hemiplegic groups with hemiplegic subjects showing the greatest CP excursion speeds for the lowest arm accelerations. The first burst of activity in ipsilateral hamstrings muscle was the same in all subjects. However, the hemiplegic group had less activation (latency and amplitude) of other posterior leg muscles. Conclusion: The elderly subjects had more variable responses to perturbation than the young subjects despite similar BBS scores. This may indicate that the BBS fails to detect differences in balance at the high end of the scale. Although the hemiplegic subjects demonstrated some anticipatory control of standing balance, they consistently performed poorer than elderly and young controls. The failure to coordinate postural leg muscle activity with focal movement may contribute to the instability of subjects with hemiplegia.

A longitudinal study of early intellectual development in hemiplegic children

Thirty-eight 3- to 5-year-old children with unilateral lesions sustained pre- or peri-natally were studied longitudinally over a 2-year period, and their IQ scores compared with those of 20 ‘medical’ controls. The failure to discover laterality effects following early unilateral injury supports the hypothesis of at least broad functional equipotentiality. There were few decrements in intellectual functioning provided the injury was not accompanied by seizures. The presence of seizures in contrast had a deleterious effect on both verbal and non-verbal aspects of cognitive functioning. While the IQs of the hemiplegic groups showed considerable stability over the 2-year span of the study, there was evidence that performance IQ, even in seizure-free patients, might be selectively impaired because of competition within the intact neural space for the sparing of verbal IQ. Copyright©1996 Elsevier Science Ltd.

A comparison of the range of walking speeds between normal and hemiplegic subjects

It is known that people who have suffered stroke walk slower than normal. However, their ability to deviate from a preferred speed of walking has not been reported. This study investigated the range of walking speeds of 20 hemiplegic subjects and compared the results with those of 20 normal age- and gender-matched controls. All subjects traversed a computerized grid walkway which measured selected temporal and spatial gait parameters. Subjects walked at five self-selected speeds: "normal"; "slower than normal"; "slowest"; "faster than normal"; and "fastest". Comparisons were made between velocity, range of velocity, stride time and stride length. The hemiplegic group walked significantly slower at all speeds, were less capable of adapting the speed of their gait, possessed a markedly reduced range of walking speed, and walked more cautiously than the controls. These deficiencies are likely to limit the stroke person's ability to respond to environmental demands.

Dichotic listening and focused attention in children with hemiplegic cerebral palsy.

Dichotic listening data are reported from children with left and right hemiplegia, compared with a normal, age-matched, control group. The dichotic listening test was performed under two different attentional instructions. The aim of the study was to investigate whether lateral injury to one hemisphere also affects the capacity to direct attention in a laterality task because of inattention. The dichotic task consisted of consonant-vowel syllables that were presented with two different instructions, to attend to the left- or right-ear stimulus. The results showed that the control children had a right-ear advantage during the forced-right attention instruction, and a small left-ear advantage during the forced-left instruction. The two hemiplegia groups, however, showed the same ear advantage irrespective of attentional instruction. The results are discussed in terms of hemi-inattention and hypoarousal of the lesioned hemisphere in children with hemiplegia.

GAIT ANALYSIS IN CHILDHOOD HEMIPLEGIA

We employed a new microcomputer based low cost method for the measurement of spatial/temporal parameters of gait in children and compared gait parameters of 50 hemiplegic children with 134 controls. This method provides an immediate profile of parameters of the gait cycle: step length, stride time, double support time, cadence, walking speed and maximum foot velocity during swing phase. The data were acquired using 2 test walks in order to gain 3 separate stride pairs for analysis. The subjects walked at a self-selected speed and were assessed using whatever orthotic assistance they normally used for the activities of daily living. In order to characterise and quantify deviations from normal controls we have used age and sex standardised scores for each gait parameter. Wilcoxon rank sum tests were used to compare measurements recorded in the hemiplegic group with control values.

Identification of Visual Scanning Deficits in Adults After Cerebrovascular Accident

Visual scanning deficits can result in the inefficient acquisition of information about one's environment. For adults who have had cerebrovascular accidents (CVAs), such deficits can interfere with the independent performance of many daily activities. The present study examined five tests designed to measure visual scanning deficits in post-CVA adults. Subjects with right and left hemisphere lesions were matched with control subjects by age and sex, and their performances on the tests were compared. The difference between the matched groups was statistically significant for all tests, with the hemiplegic subjects achieving lower scores than their normal counterparts. Deficits in visual scanning speed, identification of visual stimuli in the hemifield on the involved side, use of a systematic scanning pattern, and the ability to reproduce accurate visual designs were identified in the hemiplegic group. Statistically significant correlations were obtained on test-retest and interrater data, which indicates that the tests are reliable measures. The results of this study show that visual scanning deficits are present in post-CVA patients and can be measured with simple clinical evaluations. The presence of scanning deficits may significantly interfere with performance on tests measuring higher level visual-perceptual skills such as visual closure, figure-ground perception, and visual memory. An accurate assessment of visual-perceptual skills cannot be made without prior evaluation of such basic oculomotor functions as scanning. This approach is consistent with the developmental framework applied to most areas of treatment with brain-injured adults but is one that traditionally has not been applied in the evaluation of visual-perceptual skills.

GAIT CHANGES IN ADULT ONSET HEMIPLEGIA

Multiple parameters of gait were evaluated in 50 adult acquired hemiplegic patients and 30 control patients with no history of gait abnormality and no deviation from normal gait by observational analysis. Findings in the hemiplegic group include: 1) increase in the proportion of the gait cycle spent in stance and double-limb support phases in both the normal and affected limb; 2) consistent deviation from normal gait pattern by observation and objective pattern analysis; 3) abnormal phasic activity of specific muscles and muscle groups in the affected limb; and 4) a consistent electrogoniometric deviation from normal joint ankle progression in the affected hip, knee and ankle. These data lend credence to the hypothesis that gait deviation in adult acquired hemiplegia follows a consistent pattern varying with the severity of central nervous system involvement. These data also provide a baseline from which to measure therapeutic intervention in this complex patient population.

A study on laterality in the auditory reaction time of patients with cerebrovascular disorders

The auditory function of patients with hemispheric damage due to cerebrovascular accident was evaluated by measuring auditory reaction times.The tests were performed on simple reaction, discrimination reaction, binaural discrimination reaction, and tapping.The results of the tests were considered assuming that the tests are able to evaluate the processes of recognition, discrimination, binaural discrimination, and performance reaction to stimulated sounds.Results are. as follows; 1) Tapping time of younger snbjects was significantly faster than that of older onees. The trapping time of hemiplegic groups had no difference between right and left hands and it was the same as that of normal aged group.2) Although simple reaction time of normal group did not show prolonged time among different aged groups, discrimination time was prolonged.3) There was a significant laterality between tight and left ears in hoth simple and discrimina-tion reaction times of hemiplegic groups and the prolonged time was remarkable in affected side.4) Prolonged time of simple reaction of hemiplegic groups was recognized in the ears of both affected and sound sides, compared with that of normal aged group. Prolonged time of dis-crimination reaction was recognized only in the ear of affected side and almost the same reaction time in the car of sound side was recognized in the normal aged group.5) Binaural discrimination time of normal group was prolonged with the age increased. Right hemiplegic groups had almost the same reaction time as the normal group. On the other hand, left hemiplegic group had a remarkable prolonged time, 6) There was a tendency that hemiplegic groups had more errors in binaural discrimination reaction test when they heard the stimulation which should be selected to the ears of sound side.As indicated above, the auditory function of hemiplegic groups tend to listen to sounds dominantly with the ears of sound side and it is possible to infer lowering of hearing recognized in hemispheric damage by prolongation of reaction time, lateralitv, and errors of discrimination.

WISC-R and K-ABC Performances of Hemiplegic Children

Three groups of 12 right hemiplegic, 12 left hemiplegic, and 12 control children 6 to 12 years in age were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Kaufman Assessment Battery for Children (K-ABC), and the Finger Tapping Test (FTT). Children with left hemiplegia performed significantly below control children on both IQ measures. Children with right hemiplegia differed significantly from controls in Performance IQ test performance. Neither test completely reflected lateralized cognitive deficits in the hemiplegic children. Only the left hemiplegic group demonstrated a significant scale score difference with Simultaneous &lt; Sequential. The groups did not differ in the number of children with scale score differences &gt; 15. These findings suggest that congenital hemiplegia in children is not predictive of large intraindividual IQ scale differences, nor does it result in patterns of cognitive deficits found in adults with unilateral brain damage.

Right-Left Discrimination Skills of Hemiplegic Persons of Limited Intelligence

Past research has indicated a relationship between degree of unilateral usage of body parts and right-left discrimination skills. Further evidence for such an association was sought by comparing the scores of hemiplegic persons of limited intelligence on a test of rather advanced righ-left discrimination skills devised by the authors to those earned by a control group of non-hemiplegic persons matched on the variables of age, sex, race, and IQ. Mean scores of the hemiplegic group were significantly higher than those of the control group. Seventeen out of 21 hemiplegic persons scored higher than their matched controls. Results are discussed in terms of a possible causal relationship between perceived visual and kinesthetic differences between the right and left sides of one's own body and right-left discrimination in external space. Lesser degrees of inter-hemispheric communication among hemiplegic persons also are mentioned as a possible causal factor.

The hearing of cerebral apoplectic patients (author's transl)

The aim of this study is to report the results of hearing tests on the patients suffered from cerebral apoplexy. Audiological evaluations were performed on 90 patients. They were divided into two groups; hemiplegia group (72 cases) and aphasia with hemiplegia group (18 cases). The range of age was from twenties to fifties. Various kinds of audiometric tests including pure tone test, recruitment test, TTS test, speech test, filtered speech test, interrupted speech test, binaural summation test and directional hearing test were performed on all patients.The average pure tone loss for the speech frequency range was within 15 dB in a large majority of patients.The results were as follows;A) The recruitment phenomenon was recognized in 5 cases of hemiplegia hemiplegia group and TTS phenomenon was also recognized in only one case of hemiphegia group.It was considered that the phenomena might have no relation to cerebro-vascular accident. B) Speech tests in both groups showed a high incidence of abnormality.C) The abnormal findings by the filtered speech test were presented in 68 cases (94%) of hemiplegia group and 15 cases (83%) of aphasia with hemiplegia.The abnormalities by the interrupted speech test were presented in 58 cases (89%) of hemi-plegia group and 15 cases (83%) of aphasia with hemiplegia group. Mere was no difference of incidence of abnormalities in both tests.D) The abnormal findings by the binaural summation test were less than 40% in both groups. E) The abnormalities by the directional hearing test were not remarkably found in both groups; 8 cases in hemiplegia group and 1 case in aphasia with hemiplegia group. This test was thought not valuable for the topographical diagnosis of the lesions of the cerebral auditory pathway.F) The low discrimination scores in the ear of hemiplegic side appeared in 65% of the hemiplegia group and 83% of the aphasia with hemiplegia group.Therefore the ear of the low discrimination scores and hemiplegic side better agreed in aphasia with hemiplegia group than in hemiplegia group.