Spastic Forms Of Cerebral Palsy Research Articles

ORTHOSIS MANAGEMENT OF CHILDREN WITH SPASTIC FORMS OF CEREBRAL PALSY: COMPARATIVE ANALYSIS OF THE INITIAL FILLING OF THE INDIVIDUAL REHABILITATION AND HABILITATION PROGRAM AND RECOMMENDATIONS OF THE MEDICAL AND TECHNICAL COMMISSION

Introduction. Cerebral palsy (CP) is one of the most common neurological causes of childhood disability. In patients with cerebral palsy, the underlying disease is often complicated by secondary orthopedic disorders, for the prevention of which orthopedic methods of treatment, including orthoses and other technical means of rehabilitation (TMR) are widely used. Funding for orthosis is carried out from the Federal budget on the basis of an individual program of rehabilitation and habilitation (IPRH) of a disabled child. IPRH, in turn, is filled in taking into account the appointments of the attending physician of the orthopedist. Purpose. To analyze the compliance of recommendations on orthosis, initially introduced in the IPRH, and clinical recommendations of the medical and technical commission (MTC) of the rehabilitation Center for disabled children with spastic forms of cerebral palsy. Materials and methods. Conducted a prospective analysis of IPRH and MTK findings was made in a group of 63 disabled children aged 2 to 17 years, formed by random sampling. All patients were divided into 5 groups depending on the level of motor activity in accordance with the classification of GMFCS. Results. There were statistically significant differences (p < 0.05) between the number of orthoses initially introduced into the IPRH and the recommended MTK with a fluctuation of the visibility index depending on the group (GMFCS) from 38.9% to 56.0%. Summary. All groups noted the need for orthopedic equipment recommended by the MTC and not included primarily in the IPRH, which suggests the need for a multidisciplinary approach to the selection of TMR, including orthoses for children with spastic forms of cerebral palsy. The level of motor activity is an important expert factor in the formation of IPRH recommendations: with a decrease in the level of motor activity, the number and range of orthoses required for the patient increases. The maximum number of orthoses is recommended for additional introduction in IPRH, noted in patients in groups 3 and 5 of GMFCS.

Diffusiontensor MRI tractography in patients with children’s cerebral palsy: assessment of structural lesions of conduction tracts

Introduction. The application of diffusion-tensor (DT)-MRI tractography in patients with children S cerebral palsy (CP) allows to establish pathophysiological mechanisms of the development of motor and sensory impairments, to perform a clinical and neuroimaging comparison, as well as to determine correlations between lesions of the conduction tracts and neurological deficits. Aim. For the determination of changes in fractional anisotropy (FA) and mean diffusivity coefficient (MDC), obtained with DT-MRI in the corticospinal and sensory tracts, structures of the corpus callosum in spastic forms of CP. Materials and methods. There were examined 105 children with spastic forms of CP (spastic tetraparesis - 47, spastic diplegia - 38, hemiparetic form - 20) and 50 children without neurological deficit, at the age of 2-18 years. In all CP patients the severity of motor deficit was evaluated according to Gross Motor Function Classification System (GMFCS). DT-MRI was performed in all cases with the use of devices of General Electric (US), under magnetic field strength of 1.5T and 3T, with the calculation of the FA and the MDC in areas of interest - cerebral peduncles the brain stem, the posterior limb of the internal capsule, the genu and splenium of the corpus callosum, posterior thalamic radiation, postcentral gyrus, the thalamus. Results. There was established the distribution of children according to the GMFCS scale: I - 14 (13,4%), II - 19 (18,1%), III - 20 (19%), IV- 10 (9,5%), V- 42 (40%) cases. The severity of motor impairment on the GMFCS scale closely correlated with the values of FA and ADC in cerebral peduncles, posterior limb of the internal capsule, posterior thalamic radiance, genu of the corpus callosum. Conclusion. DT-MRI enables to assess adequately the changes in the white matter of the brain, structural andfunctional state of the motor and sensory conduction tracts, gives a possibility to predict the development of a child with CP.

Effect of push-up exercises on hand grip strength in diplegic children.

Background: Diplegia is a spastic form of cerebral palsy with lower limbs more affected than upper limbs. The hand is effector organ of upper extremity for support, manipulation and prehension. Purpose: The purpose of this study is to determinethe effect of push-up exercises on hand grip strength in spastic diplegic cerebral palsied children. Subjects and methods: Sixty spastic diplegic children with age ranged from 4 to 7 years from both sexes participated in this study. They were chosen from physical therapy department, Mubarak Central Hospital, Giza Governorate, Egypt. Subjects were divided randomly into three groups A, B and C, of equal number [twenty patients each]. Each patient was evaluated pre and post-treatment individually by using Peabody Developmental Motor Scale (PDMS-2) to determine standard scores of grasping subtest and age equivalent for fine motor activities and Baseline pneumatic squeeze handheld dynamometer to detect maximum hand grip strength. Control group (A) received traditional physiotherapy program for spastic diplegia and the two study groups (B and C) received the same traditional physiotherapy program in addition to push-up exercises on stable surface for group B in form of wide base push-up exercises, while group C in form of narrow base push-up exercises. The treatment protocol was conducted for three successive months and six times per week. Results: The results of this study revealed significant improvement in hand grip strength, standard scores of grasping and age equivalent in the three groups equally. Conclusion: Conventional physiotherapy program is effective as push-up exercises in improving hand function in spastic diplegic children. Push-up exercises only do not add benefits on hand grip strength.

Impact of the Professor Kozyavkin Method on Gross Motor Functions in Children with Cerebral Palsy

Background and Aim: Changes of gross motor function during the course of intensive neurophysiological rehabilitation by the Professor Kozyavkin Method were studied in 61 patients with spastic forms of Cerebral Palsy at the age of 2 to 15 years. Material and Methods: All patients were examined before and at the end of a two-week course of treatment, using the Gross Motor Function Measurement GMFM-66 Item Sets test to calculate of scores of motor development. Results: Statistical analysis indicated a significant increase in the level of motor development of children after treatment from 45.1 to 47.6 (p> 0.01). The most significant progress was noted in patients at level II of Gross Motor Function Classification System. The score of motor development has increased from 66.2 to 69.6 with a difference of 3.42 points (p <0.01). Conclusions: The results suggest the effectiveness of the Professor Kozyavkin Method for the improvement of gross motor functions in patients with cerebral palsy. It is necessary to continue this study and conduct blinded randomized clinical trial according to the requirements of evidence based medicine.

Impact of abobotulinumtoxinA injections on the need for orthopedic operations in children with spastic forms of cerebral palsy

Impact of abobotulinumtoxinA injections on the need for orthopedic operations in children with spastic forms of cerebral palsy

Caused by Kozyavkin© method changes in hand function parameters in children with spastic form of cerebral palsy and their EEGs, HRVs and GDVs accompaniments

Caused by Kozyavkin© method changes in hand function parameters in children with spastic form of cerebral palsy and their EEGs, HRVs and GDVs accompaniments

EFFECTIVENESS OF THE COMBINED USE OF ROBOTIC KINESIOTHERAPY AND BOTULINUM THERAPY IN THE COMPLEX REHABILITATION OF CHILDREN WITH CEREBRAL PALSY

Objective: The objective of this study is to evaluate the effectiveness of combined use of robotic kinesiotherapy and botulinum therapy in the complex rehabilitation of children with spastic diplegia.Methods: In the research, 162 children were participated in the age from 4 to 6 years with spastic diplegia. The main group was carried out using robotic kinesiotherapy with the help of the Lokomat complex and intramuscular injection of botulinum toxin type A (BtA), as a part of complex rehabilitation. Children from the control group received rehabilitative treatment with traditional methods.Results: During the comparative study of groups, higher results were obtained in the main group, where average according to Gross Motor Function Measure 88 increased from 69.99 to 76.41 with a difference of 6.42 points (p=0.0001). In the control group, this indicator increased from 67.01 to 69.41 with a difference of 2.4 points. In the main group, a moderate coupling was noticed between overall motor activity improvement and muscle tone improvement (rs=0.411, p=0.001). Herewith, the correlation was pronounced more with children of the III level in Gross Motor Function Classification System (rs=0.483, p=0.002) in comparison with the II development level (rs=0.304, p=0.042).Conclusion: Research results indicated that the children with spastic diplegia have significant improvement in motor characteristics when the combined applying of robotic walking and botulinum therapy compared with conventional therapy. In our opinion, the data obtained allow to recommend this method as one of the perspective methods of rehabilitation treatment for children with spastic forms of cerebral palsy.

Low-dose botulinum toxin for the treatment of spastic children with cerebral palsy

The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BoNT-A) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. The aim was to analyze the efficacy and safety of a lower dose of BoNT-A injections into lower limb in children with CP. We analyzed retrospectively BoNT-A injections for 63 children (25 girls and 38 boys) with spastic CP. Children received 1-7 repeated injections and adapted physiotherapy. Children were classified according to the GMFCS. Treatment results were evaluated with the modified Ashworth scale. Side effects, total dose and dose per body weight were analyzed. Multilevel BoNT-A injections were indicated for 30 patients with spastic forms of CP, and in most of cases, the total dosage was 103.1 ± 20.8 U Allergan for Botox ® and 473 ± 105.9 U Speywood for Dysport ® . Doses for each muscle in U/kg were 1.5 ± 0.5 U Allergan for Botox ® and 3 ± 0.7 U Speywood for Dysport ® . The total doses of BoNT-A and the intervals between the repeated injections were stable for each patient. Side effects reported, out of which 10, were generalized and/or focal distant. Average Modified Ashworth scale decreased 1 point in each session. These effects were retained at 3.5 ± 1.3 months. The lower dose ranges suggested for CP are effective and safe for the reduction of spasticity in lower extremities in one treatment session.

Development of contractures in spastic forms of cerebral palsy: Pathogenesis and prevention

The origin of contractures in spastic forms of cerebral palsy (CP) is unclear. Tomorrow the early appearance and persistence of spasticity are not qualified as the main reason of growths disturbances, musculo-skeletal system deformations and secondary orthopedic complications. The latest investigations have shown prominent changes in the spastic muscles on the different structural levels and stages of muscle development. This study describes the histological, morphological, and biomechanical changes in the spastic muscles that play a pathophysiological role in the formation of CP contractions. The authors discuss the changes in the muscle fiber size, differentiation and elastic properties, degrees of the lengthening resistance in the bundles of muscle fibers, extracellular matrix proliferation, structural and mechanical changes, disturbances in gene expression and regulation in the tendons and muscle tissue, changes in the length and number of sarcomers, as well as the length and cross-section of the whole muscle.
 Therefore, the movement limitations and contractions in CP do not depend on one universal mechanism. It is a combination of different structural changes in the muscles and the failure of the central movement and postural control.

The efficacy of cellex combined with sanatorium-based rehabilitation scheme in patients with cerebral palsy

To study the efficacy of the drug cellex combined with sanatorium treatment in the rehabilitation of patients with cerebral palsy. The study included 59 patients, mean age 17.06±0.7 years, with spastic form of cerebral palsy who were administered a course of sanatorium-spa treatment in a specialized spa-resort. All patients underwent complex clinical and neurological examinations and electroencephalography. The main group (n=23) received cellex (a course of 10 injections) in addition to traditional treatment. The efficacy of treatment assessed by the level of hand functioning and cognitive abilities was higher in the main group compared to the patients of control and comparison groups. Besides, the higher academic performance and positive dynamics of EEG (higher alpha rhythm amplitudes and decreased activity of pathological rhythms) were observed.

Персонифицированный подход к лечению опорно-двигательных нарушений нижних конечностей при спастических формах детского церебрального паралича

Персонифицированный подход к лечению опорно-двигательных нарушений нижних конечностей при спастических формах детского церебрального паралича

Risk factors and prediction of spastic forms of cerebral palsy

The results are presented the observation of clinico-anamnestic information of 250 families: 210 families (main gr.) having children with spastic forms of cerebral palsy (CР) and 40 families (control gr.) with neurologically healthy children. The groups were compared with each other for the family, mother's obstetric history and (pre-, post-, natal) showings. The results obtained make it possible to interpret data on risk factors that affect the embryogenesis, central nervous system (CNS) of suckling.

ORGANIZATION OF TREATMENT OF CHILDREN WITH SPASTIC FORMS OF CEREBRAL PALSY BY BOTULINUM TOXIN TYPE A IN KRASNODAR REGION

This article presents the organizacion of treatment for children with cerebral palsy with the botulinum toxin type A in large children’s therapeutic and prophylactic institutions in Krasnodar region. Such organization allows to cover the treatment of about 20 % of children with spastic forms of cerebral palsy, to ensure the purity of performance technique and to provide adequate rehabilitation.

SPASTIC FORM OF CEREBRAL PALSY, EPILEPSY WITH BENIGN EPILEPTIFORM DISCHARGE OF CHILDHOOD ON ELECTROENCEPHALOGRAM, AND IATROGENIC STEVENS–JOHNSON SYNDROME (CASE DESCRIPTION)

The article describes the phenomenon of dual pathology – a combination of structural changes in the brain and benign epileptiform discharge of childhood on electroencephalogram. The uniqueness lies in the observation that the child, since birth suffering from spastic form of cerebral palsy and severe epilepsy, demonstrated the development of Stevens–Johnson syndrome due to intolerance of one of the antiepileptic drugs. Therapeutic approaches to overcome a whole range of violations are discussed in the article.

Correction of movement stereotype in patients with spastic forms of cerebral palsy

In this article, the author proposed a rehabilitation program, which includes the impact on the body of patients with cerebral palsy throughout the bio muscle kinematic chain, taking into account the construction of the spiral body muscles during rehabilitation procedures.

Aromaphytobalneotherapy in Treatment and Prophylaxis of Frequent Respiratory Infections in Children with Chronic and Disabling Diseases

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Multilevel Botulinum Toxin A (Abobotulinum Toxin A) Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

Background : The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections. Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP. Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities. Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others. Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.

The effect of seizures on functional status of people with spastic forms of cerebral palsy

SummaryBackground.Cerebral palsy (CP) is the most common childhood motor impairment. Epilepsy affects approximately one third of patients with CP. It is characterized by earlier disclosure, it is more severe and shows greater resistance than that of the general epilepsy treatment, associated with necessity for polytherapy. Its presence can result in gradual loss of function, loss of posture in non-ambulant individuals with severe disabilities and cognitive impairment risk, behavioural disorders and reducing probability of walking.Aim.The aim of the study was to evaluate the functioning of people with CP with and without epilepsy.Material and Methods.The study included 210 patients with a diagnosis of CP, aged 0–18 years. The study was conducted among the patients using the physiotherapy services in centres in southern Poland. The study used the Paediatric Evaluation of Disability Inventory (PEDI) and the classification systems: GMFCS, MACS, and CFCS.Results.There were significant differences with regards to social functioning (53.7/67.4; W = 179, p = 0.006) and support in the social functioning (65.4/89.9; W = 185.5, p = 0.007) in patients with diplegia. However, mobility (19.55/29.00; W = 392, p = 0.018) and the social functioning (36.95/44.1; W = 418.5, p = 0.042) were lower in epileptic patients with tetraplegia. In patients with hemiplegia, there were no significant differences, although each domain with epilepsy subgroup had a lower rating than the subgroup without epilepsy.Conclusion.The presence of epilepsy is associated with lower levels of social function in patients with cerebral palsy; particularly, with regard to mobility and selfservice.Assessment of epilepsy impact on the level of social functioning of people with CP (diplegia, tetraplegia, hemi-plegia) is difficult because ambiguous relationship with mental retardation. The assessment should be undertaken separately for each group of spastic CP.

Drooling in Patients with Cerebral Palsy: The Effectiveness of Botulinum Toxin A Treatment

Background . Drooling (sialorrhea) is a complex medical and social problem of patients with cerebral palsy (CP). During the last decade many methods for drooling correction in CP are under active development. Aim : to evaluate the effectiveness and safety of the first and repeated injections of botulinum toxin A (BTA) for correcting drooling in children with CP. Methods. 13 children (2 years — 14 years 7 months) with spastic forms of CP and drooling resistant to non-drug treatment. Drooling was evaluated with the Drooling Impact Scale — DIS before, 1, 3 and 6 months after the BTA injections. Parotid and submandibular salivary glands were injected under ultrasound control with Dysport — 1 group (5 children) or Botox — 2 group (8 children). The total dose of Dysport for the all glands was 120–320 U (3,8–14,5 U/kg), Botox — 30–100 U (2,5–4,5 U/kg). The median of the basic DIS index was 77 (64–90) points in the first group and 58 (53–66) points in the second group. Results. One month after the BTA injections the DIS index decreased by 20 and more points in 6 (42,2%) patients, by 10–19 points in 7 (53,8%) children. There were no persistent side effects and no difference in the BTA effectiveness between the two groups. The mean decrease of DIS was 30% in both groups. 3 months after the injections 2 patients (15,4%) kept 20 points decrease of the DIS index, 6 patients (46,2%) demonstrated 10 points decrease. 6 months after injections nearly all patients returned to the basic level of drooling. Repeated injections of the BTA demonstrated the same tendency and duration of the DIS changes. There was no significant correlation between the GMFCS level and the drooling intensity. Conclusion. BTA injections into salivary glands of children with CP was an effective and safe method of drooling correction with the maximum effect taking place 2–4 weeks after the injections and a stable effect — 3 months after the injections.

Фармакоэкономический анализ различных видов терапии спастических форм детского церебрального паралича

Фармакоэкономический анализ различных видов терапии спастических форм детского церебрального паралича