Background: gait disturbance is one of the most common consequences of hemiplegic cerebral palsy characterized by asymmetrical step length and reduced walking speed, robotic gait orthosis therapy is the most effective in gait training and enhance kinematic gait parameters. Purpose: to evaluate the effect of robotic gait orthosis on kinematic gait parameters in hemiplegic children. Patient and methods: 40 Cerebral palsy children with spastic hemiplegia ranged from 7 to 12 years old. They were selected from the outpatient clinic of Haven physical therapy center on 6th October city. They were allocated randomly in two groups (20 children each). Group I (control group): received a selected physical therapy program for 3 times weekly for 8 successive weeks. Group II (Study group): received the selected physical therapy program as the control group for 30 minutes in addition to Lokomat gait training for 30 minutes. This program was performed 3 times weekly for 8 successive weeks. Both 3-D kinematic gait analysis and robotic gait orthosis were carried out before and after intervention. Results: we found statistically significant increase in hip flexor (p=0.05) &hip extensor (p=0.018) & significant decreased in ankle at initial contact (p=0.001) &increase in single limb support (p=0.001) &decreased in cadence (p=0.020) and decreased in speed (p=0.020) at post treatment in study group compared to control group. Conclusion: Robotic gait orthosis is effective modalities in rehabilitation of children with hemiplegic cerebral palsied, combination between Lokomat and physical therapy program plays an important role in muscle strength and kinematic gait parameters thus improving patient gait pattern.

PurposeStudies showed that post-ischemic spastic hemiplegia can be linked to neuroinflammation mediated by microglial polarization. Microglial M1/M2 polarization is regulated by the PI3K/Akt pathway. We previously reported that acupuncture alleviated spasticity after permanent middle cerebral artery occlusion (p-MCAO). This study investigated whether its antispastic effects were associated with activation of the spinal PI3K/Akt pathway and promotion of microglial M2 polarization.Methodsp-MCAO was induced in Sprague-Dawley rats to establish a model of spastic hemiplegia. Yanglingquan (GB34) was needled using waggle needling, a motion‑style acupuncture technique. Its association with spasticity alleviation and motor recovery was evaluated by behavioral assessments, TTC staining, and the H-reflex test. Molecular analyses were performed to investigate the underlying mechanisms. Minocycline was used to examine the role of microglial polarization, while LY294002 and 740Y-P were used to determine whether the effects of acupuncture were mediated through the PI3K/Akt pathway.ResultsRats with p-MCAO-induced spastic hemiplegia exhibited neurological deficits, increased muscle tone, motor dysfunction, and spinal hyperexcitability, together with microglial M1 polarization, inflammatory responses, spinal excitatory/inhibitory imbalance, and suppressed PI3K/Akt activity. Acupuncture at GB34 alleviated spasticity and promoted motor recovery. It also activated the spinal PI3K/Akt pathway, promoted microglial M2 polarization, reduced IL-6 and TNF-α, and increased IL-10 and TGF-β. In addition, acupuncture attenuated spinal hyperexcitability, as indicated by improvement in the H-reflex, and restored spinal excitatory/inhibitory balance, as reflected by regulation of vGluT1/vGAT-associated synaptic markers and Glu/GABA levels. Minocycline produced partially similar improvements, whereas LY294002 partially blocked the effects of acupuncture and 740Y-P only partially mimicked them.ConclusionAcupuncture alleviates spastic hemiplegia by activating the PI3K/Akt pathway and promoting spinal microglial M2 polarization. These findings support its potential clinical application for post-stroke spasticity and identify the PI3K/Akt pathway as a potential therapeutic target.

Background:Hip displacement (HD), common in cerebral palsy (CP), is reportedly less prevalent for spastic hemiplegia. Patients with a Winter-Gage-Hicks (WGH) type IV gait pattern are believed at increased risk of HD, but true prevalence is unknown. This study aimed to analyze the rates of HD according to the sagittal plane-based WGH classification and identify associated risk factors.Methods:Patients with hemiplegic CP, ≥1 instrumented gait analysis (IGA), hip surveillance radiograph(s), and minimum 2-year follow-up were included. The primary outcome was presence of an “unsuccessful hip” defined as a migration percentage ≥30% and/or undergoing reconstructive osteotomies for HD. Secondary outcome variables included WGH type, previous surgery, sex, scoliosis, epilepsy, ventriculoperitoneal shunt, gastrostomy tube, and IGA-derived hip kinematics.Results:Included were 144 patients (39.6% female), classified as Gross Motor Function Classification System I (45.1%) or II (54.9%), mean follow-up 9.6 ± 4.6 years. Seventeen patients (11.8%) had an unsuccessful hip outcome (age 11.6 ± 3.6 years). Stratified by WGH type, unsuccessful hip outcome rates were I: 9.5% (2/21), II: 9.4% (6/64), III: 6.7% (2/30), and IV: 24.1% (7/29); age at onset was not different between WGH types (p = 0.8). Multivariate analysis identified hip internal rotation (odds ratio [OR]: 4.7, confidence interval [CI]: 1.2-18.1, p = 0.02) and hip adduction (OR: 5.2, CI: 1.2-22.1, p = 0.02) as significant independent risk factors.Conclusion:The rates of HD in spastic hemiplegia were higher than expected for all WGH types, particularly IV. A high index of suspicion and regular hip surveillance radiographs is required for patients with hip internal rotation and adduction, starting during preadolescence.Level of Evidence:III-Retrospective cohort observational study. See Instructions for Authors for a complete description of levels of evidence.

Background: Children with cerebral palsy (CP) often present with substantial motor impairments that affect both gait and postural control. A comprehensive multidimensional assessment of abnormal gait patterns is essential to establish a theoretical foundation for individualized rehabilitation strategies. Methods: Fifteen children with spastic hemiplegia (SH), 13 children with spastic diplegia (SD), and 30 typically developing (TD) children participated in an 8-minute upright walking task. Temporal gait parameters and kinematic angle parameters were recorded. Gait symmetry was quantified using the phase symmetry index (ID ps ), F-step size symmetry index (ID sp ), and asymmetry index (ASI). Gait variability was evaluated through sample entropy (SampEn), gait variability index (GVI), and gait deviation index (GDI). In addition, continuous relative phase (CRP) analysis was used to quantify the inter-joint coordination of ankle-knee, ankle-hip, and knee-hip joint pairs. Statistical analysis was performed using 1-way analysis of variance (ANOVA). Results: The TD group demonstrated significantly superior gait symmetry compared with both the SD and SH groups. The bilateral GDI index in TD group was significantly greater than that in SD and SH groups. Significant differences in SampEn for temporal parameters and kinematic angle were primarily observed between TD group and SD group. Except the SampEn for the left foot roll angle and ankle joint, all other statistically significant SampEn for metrics showed higher values in the children with cerebral palsy (CP) than in TD group; the mean absolute relative phase (MARP) value of the left ankle-knee joint pair in SD group showed a significant decrease during the initial swing phase (ISw). Conclusions: The results indicated that children with CP exhibited more complex temporal structures and kinematic variations in gait cycle. The foot-ankle showed a more rigid gait pattern, with discrepancies in ankle-knee coordination, suggesting the critical role of the foot-ankle in walking. These findings can assist clinicians in assessing children’s motor control capabilities and compensatory strategies, providing quantitative evidence for establishing individualized training objectives.

Peripheral nerve surgery is a potential treatment for chronic spastic hemiplegia, but the role of contralateral C7 nerve transfer combined with human acellular nerve allograft remains to be explored. This study aimed to investigate the functional outcomes of contralateral C7 nerve transfer combined with human acellular nerve allograft for spastic upper limb paralysis. From January 2020 to December 2023, 53 patients with unilateral spastic upper limb paralysis completed a 12-month follow-up. 17 patients underwent contralateral C7 nerve transfer combined with human acellular nerve allografts, while 36 received rehabilitation alone. The primary outcome was the change in the Fugl-Meyer Assessment. Safety outcomes included adverse events and changes in muscle strength and motor-sensory function assessment of the arm and hand on the side of the donor C7 nerve. The overall Fugl-Meyer Assessment increased by 15.88 ± 3.54 in the surgery group and 2.36 ± 2.34 in the rehabilitation group (difference, 13.52, P < 0.001). Spasticity improvements were observed on the Modified Ashworth Scale for various muscle groups (P < 0.001). Adverse events related to the donor nerve included mild numbness in the radial three digits, slightly weakened triceps brachii strength, and tolerable peripheral neuropathic pain. No other adverse event relative to the bilateral brachial nerve occurred except for the C7 nerve section, and all events resolved within 3months for all patients. Our study suggests that the combination of the contralateral C7 nerve transfer and the human acellular nerve allograft may be a viable treatment option for individuals experiencing long-term spastic upper limb impairment following chronic cerebral hemisphere injury. This clinical study was registered with the Chinese Clinical Trial Registry, and the registration number is ChiCTR2500099694.

Exploring the clinical efficacy of scraping therapy with Astragalus membranaceus (AMS, Huang Qi) ointment combined with tuina (Chinese Therapeutic Massage) in patients with upper limb spastic hemiplegia after hemorrhagic stroke. This retrospective analysis examined clinical data of 106 patients with upper limb spastic hemiplegia after hemorrhagic stroke who received treatment at Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2023 to June 2025. According to different treatment methods, patients were divided into a tuina group (n = 53, tuina massage treatment) and a scraping + tuina group (n = 53, scraping therapy with AMS ointment combined with tuina). The modified Ashworth Spasm Assessment Scale (MAS) was used to evaluate the degree of spasticity in the affected limb. The Simplified Fugl Meyer Upper Limb Function Assessment Scale (FMA-UE) was used to assess the motor function of the affected limb and the Modified Barthel Index Assessment Scale (MBI) was used to evaluate Activities of Daily Living (ADL). After treatment, the improvement in the MAS score in the scraping + tuina group was better than that in the tuina group (P<0.05). The post-treatment FMA-UE score and MBI score of both groups of patients significantly improved and were markedly higher in the scraping + tuina group compared to the tuina group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Scraping therapy with AMS ointment combined with tuina massage treatment can effectively alleviate upper limb spasticity. The combined regimen is associated with improved motor function and ADL in patients with upper limb spastic hemiplegia after hemorrhagic stroke.

Post-stroke spastic hemiplegia (PSSH) frequently leads to severe motor dysfunction, with its primary pathology being spinal hyperexcitability arising from attenuated descending inhibition. We previously reported that acupuncture alleviated spastic hypertonia induced by middle cerebral artery occlusion (MCAO) via upregulating potassium-chloride cotransporter 2 (KCC2) expression. Cumulative evidence has indicated that N-methyl-D-aspartate receptor (NMDAR) can be a pivotal determinant of spinal excitability via modulating KCC2-mediated neuronal chloride homeostasis. The present study investigated whether acupuncture exerts its therapeutic effects through modulation of NMDAR-mediated activation of protein phosphatase 1 (PP1)/Calpain1-KCC2 pathway. Multiple functional assessments, in vivo electrophysiological test, 2,3,5-triphenyl tetrazolium chloride (TTC) staining, immunofluorescence, quantitative real-time PCR (RT-qPCR), and Western blot were used. In the male MCAO rat model, assessments using the neurological-function score, muscle-tone scale, and footprint analysis demonstrated that acupuncture significantly attenuated spasticity and improved motor performance. H-reflex recordings and immediate early gene c-Fos (c-Fos) immunofluorescence indicated that acupuncture reduced hyperexcitability in spinal ventral horn. These observed effects of acupuncture were associated with its downregulation of N-methyl-D-aspartate receptor 1 (NMDAR1) expression and restoration of both the expression and function of KCC2 in spinal cord. Pharmacological interventions using NMDAR agonist and antagonist demonstrated that acupuncture upregulated KCC2 by inhibiting NMDAR-mediated activation of PP1 and Calpain1. Acupuncture modulated the NMDAR-PP1/Calpain1-KCC2 pathway in the spinal cord to suppress neuronal hyperexcitability, thereby relieving spasticity and promoting motor function in rats with PSSH.

This study aims to evaluate the efficacy, safety, and predictors of contralateral C7 nerve transfer (CC7) for central upper limb spastic hemiplegia and develop a preoperative prediction model. A retrospective analysis included 58 stroke patients with spastic hemiplegia undergoing CC7 surgery. Composite efficacy endpoints assessed efficacy. Univariate and multivariate logistic regression identified predictive factors. A nomogram prediction model was built and validated using receiver operating characteristic curves, calibration curves, and decision curve analysis. CC7 significantly improved affected upper limb function. The Fugl-Meyer Assessment for upper extremity (FMA-UE) score increased from 25.9 ± 3.6 preoperatively to 37.6 ± 3.4 at final follow-up (P < .001). Based on composite endpoints, the overall efficacy rate was 60.3% (35/58). Analysis of 15 potential factors identified 2 significant independent predictors of efficacy: younger age (odds ratio = 0.86, 95% confidence interval [CI]: 0.77–0.96, P = .006) and higher baseline FMA-UE score (odds ratio = 1.45, 95% CI: 1.12–1.89, P = .005). A nomogram incorporating these factors demonstrated strong diagnostic performance (area under the curve = 0.898, 95% CI: 0.820–0.976, P < .05). Bootstrap validation (area under the curve = 0.884), calibration curves, and decision curve analysis confirmed the model’s robustness and clinical utility. CC7 showed good safety; postoperative adverse reactions (transient contralateral limb numbness/pain) were mild and resolved without long-term issues. CC7 is a safe and effective treatment for central hemiplegia, significantly improving upper limb function. The developed nomogram, using age and baseline FMA-UE score, provides an accurate tool for predicting CC7 efficacy and aiding patient selection.

Challenges in the rehabilitation of gait impairments among children with spastic hemiplegia (CSH) suggest significant difficulties in controlling lower limb intersegmental dynamics (ISD), which may be closely associated with underlying proprioceptive and neuromuscular impairments. To quantify the ISD imbalance of lower limb in CSH, we developed a novel protocol utilizing motion capture and kinetic analysis to assess multi-joint torque contributions during the gait cycle. In this prospective, hospital and school-based, case-control study, 21 typically developing children (age = 7.7 ± 1.2 years, 15 boys and 6 girls) and 21 children with spastic hemiplegia (age = 7.9 ± 1.7 years, 14 boys and 7 girls) were tested. The kinematic and kinetic data were collected synchronously and gait parameters were analyzed. The intersegmental dynamics analysis was conducted by a customized program based on ISD formulation. The knee flexion angles (p = 0.045) and ankle dorsiflexion angles (p<0.001) of CSH were significantly lower than TDC. The Co-direction Ratio (CDR) of external contact torque of CSH was significantly lower than TDC (p = 0.015) during the first double stance phase. During the single stance phase, the CDR of hip external contact torque (p = 0.042), knee muscle torque p = 0.014), knee interactive torque (p < 0.001) of CSH were significantly greater than TDC. The net impulse of knee external contact torque (p < 0.001) and knee muscle torque (p < 0.001) of CSH were significantly greater than TDC. The net impulse of ankle gravitational torque of CSH was significantly lower than TDC (p = 0.03) during the swing phase. A mismatch between muscle and passive torques may be associated with gait disturbance of CSH, characterized by a pathological shift in leading joint (hip to knee), inefficient passive torque utilization, and excessive yet ineffective muscle contractions. The findings suggest the potential relevance of rehabilitation strategies that focus on improving coordination during the stance phase and enhancing gravitational torque utilization during the swing phase.

The quest for effective treatments for cerebral palsy (CP) remains a significant challenge, crucial for improving outcomes in affected individuals. This study aimed to evaluate the therapeutic effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower limb function in children with hemiplegic cerebral palsy (HCP) through a controlled clinical trial. Forty children with HCP were randomly assigned to either a sham stimulation group or an rTMS treatment group, with 20 participants in each. The rTMS group received low-frequency rTMS in conjunction with conventional rehabilitation, while the sham group received sham stimulation paired with the same rehabilitation. Conventional rehabilitation included physical therapy, occupational therapy, orthopedic shoes, acupuncture, and other training modalities. Treatments were administered 5 days a week for 12 weeks. We assessed gross and fine motor skills, spasticity, and gait parameters before and after treatment using the modified Ashworth scale (MAS), dorsiflexion angle, gross motor function measure 88 (GMFM-88), Gesell developmental scale, and plantar pressure gait analysis. After 12 weeks, both groups exhibited improvements in MAS scores of the affected hamstring muscle, dorsiflexion angles, GMFM-88 D and E zone scores, Gesell developmental scale scores (gross motor), and gait parameters (P < .05). Notably, the rTMS group demonstrated significantly greater improvements (P < .05). Low-frequency rTMS combined with conventional rehabilitation therapy leads to better outcomes in gross and fine motor functions while reducing spasticity and improving gait parameters in children with HCP compared to sham stimulation.

Background. The hemiplegic form of cerebral palsy (CP) is the most prognostically promising in terms of the possibilities of correction and social adaptation of disabled children. However, the main limitation of successful rehabilitation is severe limb muscle spasticity, because so reducing muscle hypertonicity is a priority task in this disease. The aim. To evaluate the effectiveness of improved method for correcting of upper limb spasticity in children with the hemiplegic form of CP. Materials and methods. An open, non-randomized, prospective, comparative study was conducted involving two groups of patients with spastic hemiplegia with predominant damage to the upper limb, compared to the case-control type. The control group of children (n = 20) was treated using standard methods – drug therapy, exercise therapy, massage, physiotherapy; the main group (n = 20) was additionally prescribed exercises on the new medical simulator "Glove". The study participants in the groups were compared by gender, age and severity of motor impairment. The course in comprehensive rehabilitation lasted 10 days. The effectiveness of the improved method for correcting upper limb spasticity was assessed by studying the dynamics of motor function indices using scales for assessing muscle tone (modified Ashworth scale) and manual skills (Frenchai and ARAT tests, V.G. Bosykh and N.T. Pavlovskaya method). Results. The additional inclusion of training using the new medical simulator for correcting upper limb spasticity "Glove" in the rehabilitation program for children with hemiplegic CP allowed achieving a significantly better treatment result with a significant decrease in muscle tonus, an increase in the volume and accuracy of movements, including in the section of small differentiated acts, with the elimination of the phenomenon of the «learned non-use» phenomenon. Conclusions. The use of a new medical simulator in the complex therapy of children with spastic hemiplegia allows increasing its effectiveness relative to standard rehabilitation methods. However, the question of the long-term effect remains open and requires an assessment of longer-term use of the simulator in the interhospital period.

BACKGROUND Existing clinical tools do not comprehensively assess gait patterns in patients with multiple sclerosis (MS) across all planes or account for spatiotemporal and kinematic parameters. This study investigated the feasibility of the Wisconsin Gait Scale (WGS), originally designed to evaluate hemiparetic gait after stroke, in individuals with the spastic hemiplegic subtype of MS. MATERIAL AND METHODS The study included 30 patients with the spastic hemiplegic subtype of MS. The WGS-based assessment of participants' gait was performed twice, by 3 independent raters. The results of the 2 measurements reported by the 3 raters were compared to determine intra-rater and inter-rater reliability. The WGS scores were also compared with results of clinical tools: the 10-Meter Walk Test, the 2-Minute Walk Test, and the Timed Up and Go Test, to determine the concurrent criterion validity of the WGS. RESULTS A comparison of the scores assigned by the same rater during measurement 1 and measurement 2 showed excellent agreement in each case, with intraclass correlation coefficients (ICCs) equal to or higher than 0.991. Likewise, there was excellent agreement between the scores awarded by the 3 raters, both in measurement 1 and measurement 2, with ICCs of 0.988 and 0.978, respectively. The analyses showed very strong and significant correlations (P<0.001) between the mean scores in the WGS and all the clinical tests applied in this study to assess gait. CONCLUSIONS The findings show excellent intra-rater and inter-rater reliability and confirm the concurrent criterion validity of the WGS in patients with hemiplegic MS.

Abstract Introduction/Objective Oligodendrogliomas are diffuse gliomas characterized by IDH mutation and 1p/19q codeletion, representing approximately 1–1.5% of all primary brain tumors and typically associated with an indolent clinical course and favorable prognosis. Extraneural metastasis of oligodendroglioma is exceedingly rare. We report here a case of oligodendroglioma, IDH-mutant and 1p/19q codeleted that was metastatic to the liver. This case aims to highlight the potential for metastasis of oligodendroglioma to the liver, as well as to emphasize the importance of comprehensive molecular and histologic analysis in accurately diagnosing such metastases. Methods/Case Report A 63-year-old male with a history of recurrent anaplastic oligodendroglioma in the left cerebral hemisphere, previously treated with three surgical resections and radiation therapy, presented with progressive neurological deficits including right upper extremity spastic hemiplegia, worsening motor strength in the right arm, and receptive aphasia. MRI revealed disease progression, and the patient subsequently underwent a left craniotomy for tumor resection. Histopathologic analysis confirmed recurrent oligodendroglioma (CNS WHO grade 3), with an IDH1 R132H mutation and 1p/19q codeletion. Postoperatively, the patient developed acute diarrhea, and further imaging revealed new hepatic and bone lesions as well as prominent mesenteric lymphadenopathy. Biopsy of one of the new liver lesions revealed metastatic oligodendroglioma. Molecular testing of both the liver and brain lesions revealed an IDH1 p.R132H mutation, TERT promoter mutation (c.-124C&amp;gt;T), PIK3CA alteration (p.E110del), and 1p/19q codeletion. These molecular findings were consistent with metastatic oligodendroglioma, IDH-mutant, 1p/19q-codeleted. Results NA Conclusion Liver metastasis from oligodendroglioma is exceedingly rare, but with the increasing survival of patients due to improved therapeutic approaches, metastatic patterns are becoming more evident. This case highlights the importance of considering extraneural metastasis in patients with the diagnosis of oligodendroglioma. Surgical procedures that disrupt the blood-brain barrier, such as repeated craniotomies, may provide a pathway for metastasis via vascular or lymphatic routes.

Purpose:Objectives were to evaluate if gait was improved after multilevel surgery on the involved leg and simultaneously performed guided growth procedure on the uninvolved leg and whether simultaneously performed guided growth is efficient in limb length discrepancy management in hemiplegic children.Methods:Gait pattern of 78 hemiplegic children (mean age 10.4 years) was evaluated using instrumented gait analysis before surgery and at 2 years. This study involved children with type 2a (Rodda and Graham classification) – 12, type 3 – 20, type 4 – 23, type 4s (undergone triceps lengthening at early age) – 23.Results:The mean limb length discrepancy was 2.3 cm before surgery and 0.4 cm at final control. In all patients aged over 144 months, the residual length discrepancy was over 10 mm. The improvement in gait kinematics was observed on both the uninvolved and hemiplegic limbs. Finally, control on uninvolved leg kinematics presented values similar to reference values. On the involved leg, there were significant improvements in sagittal and transverse kinematics. Only patients of the 4s (patients undergone previous triceps lengthening surgery at an early age) group had no improvements in ankle flexion moment and power generation.Conclusion:Multilevel surgery including simultaneous guided growth ensures improvements on both the uninvolved and hemiplegic limb gait kinematics. We suggest guided growth surgery before the age of 12 years for more exact equalization. Isolated triceps performed at an early age represent negative conditions for plantar flexion strength development in long term.

Several surgical approaches for contralateral C7 (CC7) nerve root transfer (NRT) exist, but they come with challenges such as long nerve bridging distances, complex surgical anatomy, and prolonged recovery times. Our objective was to evaluate and compare the clinical efficacy and safety of the posterior single-incision CC7 (PSCC7) NRT approach (posterior group) with the traditional anterior CC7 (ACC7) NRT approach (anterior group) for treating post-stroke upper limb spastic hemiplegia (PULSH). In this retrospective study, we retrieved and compared clinical efficacy as well as safety of the posterior group with the traditional anterior group for treating PULSH between February 2024 and February 2025. Key outcome measures included operative time, intraoperative blood loss, postoperative complications, and functional recovery at 6-month follow-up. In all, 12 patients who underwent the posterior group and 30 patients (control group) who underwent the traditional anterior group were retrieved from the hospital records. The posterior group demonstrated significantly shorter operative times (3.2 ± 0.5 hours vs 4.5 ± 0.8 hours, P < .01) and less intraoperative blood loss (150 ± 4 0 mL vs 280 ± 70 mL, P < .01) compared to the anterior group. The posterior group achieved comparable or superior improvements in Modified Ashworth Scale scores (1.2 ± 0.3 vs 1.5 ± 0.4, P > .05) and Berg Balance Scale scores (42 ± 5 vs 39 ± 6, P > .05). The posterior group is a safe and effective treatment for PULSH. It offers the advantages of reduced surgical trauma and shorter operative time.

Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia. A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children's Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05. Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up. SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.

Impact of inter-limb anthropometric asymmetries on physical performance in international footballers with spastic hemiplegia

Objective To investigate the clinical efficacy of the transvertebral anterior approach to contralateral C7 nerve translocation for treating patients with upper limb spastic hemiparesis caused by central nerve injury. Methods Clinical data from 30 patients with central upper limb spastic hemiplegia were included in the study. All patients underwent rehabilitation exercises before surgery. As no significant improvement in motor function or muscle tone of the paralyzed upper limb was observed, contralateral C7 nerve translocation was performed. Changes in motor function of the paralyzed upper limb were assessed using the Fugl-Meyer Motor Function Assessment Scale (FMA) and Brunnstrom Staging Scale (BSS). Changes in muscle tone were evaluated using the Modified Ashworth Spasticity Rating Scale (MAS). Generalized estimating equation (GEE) analysis was performed using the preoperative FMA, BSS, and MAS scores as baseline values to assess improvements in motor function and muscle tone at 6 and 12 months postoperatively. Results Significant differences were observed in motor function (FMA score and BSS stage) and muscle tone (MAS score) of the paralyzed upper limb at 6 and 12 months post-surgery compared to baseline (p < 0.05) in 30 patients. Recovery of the paralyzed upper limb showed a time-dependent cumulative effect, with greater improvement observed at 12 months post-surgery than at 6 months. Recovery of limb function exhibited progressive improvement from the proximal to the distal end. Conclusion Contralateral C7 nerve translocation helps improve central upper limb spastic paralysis and reduce muscle spasticity, thereby enhancing upper limb motor function.

CC7 (contralateral cervical seventh nerve transfer) is an effective treatment for spastic hemiplegia caused by brain injury. After stroke, contralateral C7 nerve transfer facilitates the transmission of sensory information from the affected upper limb to the intact cerebral hemisphere. This process promotes cortical reorganization and ultimately enhances motor function recovery in the paralyzed limb. However, there is no effective method to accelerate motor function recovery and enhance sensory input following CC7 surgery. Electrical stimulation has been proposed as a valuable solution for nerve injuries, yet its effectiveness post-CC7 surgery remains unknown. In this study, we firstly investigated the potential of a wireless passive electrical (WPE) stimulation device invivo as a rehabilitation approach. Subsequently, using the sciatic nerve model, we implanted the WPE electrodes to perform electrical stimulation and then evaluated nerve regeneration and motor function recovery using immunohistochemistry and behavioral analysis. Furthermore, we implanted the device in the transferred C7 nerve of CC7 mice and performed targeted electrical stimulation. We used immunofluorescence, electrophysiological, and behavioral assessments to explore the effects of repeated, targeted electrical stimulation on nerve regeneration, contralateral hemisphere remodeling, and motor function recovery in the paralyzed arm. The WPE stimulation protocol can effectively promote the regeneration of sensorimotor fibers after nerve repair. When applied to CC7 mice, it can accelerate the remodeling of the contralesional hemisphere by enhancing the ipsilateral sensory input and restore the impaired limb function. This stimulation modality can be considered a potential rehabilitation means to accelerate the efficacy of CC7 surgery.

Not required.