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Patients with hereditary neuropathy with liability to pressurepalsy (HNPP) typically present with a mononeuropathy (particularly peroneal or ulnar palsy) or a brachial plexopathy. Careful electrodiagnostic testing has an important role in establishing the diagnosis of HNPP differentiating this condition from other inherited or acquired neuropathies as well as obviating the need for unnecessary surgeries. We present a case of a patient who presented with a painless brachial plexopathy who was found to have multiple sites of segmental demyelination on nerve conduction studies, consistent with HNPP. We review the clinical and electrodiagnostic features of HNPP including the key electrodiagnostic findings to screen for this disorder. PMID:21988036
We tested 20 CMT 1 patients characterized according to the criteria of the European CMT consortium by Southern hybridization of MspI restricted genomic DNA with probes pVAW409R1, pVAW412Hec and pEW401HE. In 11 of the 20 CMT 1 cases (55%), we observed a duplication in 17q11.2; one patient had a dinucleotide insertion in exon 6 of the PO-gene (5%). One HNPP case had a typical 17p11.2 deletion. Analysis of CA-repeats was performed with primers RM11GT and Mfd41; SSCP-analysis of the PO, PMP22 and Cx32-genes is in progress. FISH was carried out with probe pVAW409R1. 125 interphase nuclei were analyzed for each proband by counting the signals per nucleus. Normal cells show a characteristic distribution of signals: 1 signal in 5.9% of nuclei, 2 in 86.3% and 3 in 7.8%. A duplication is indicated by a shift to 3 signals in more than approximately 60% and 2 in less than 25% of the nuclei. In contrast, the 17p11.2 deletion of the HNPP patient shifts to 82.4% of nuclei with a single hybridization signal versus 14.4% with 2 signals. We detected one case with significantly abnormal distribution of interphase nuclei hybridization signals compared to cultures of normal cells and to those with 17p11.2 duplication or deletion: 3.2% nuclei revealed 1 signal, 48.0% two signals and 48.8% 3 signals, indicating a pathogenic but moderate dosis increase compared to the throughout duplicated cases. FISH with probe pVAW409R1 is a versatile tool to detect the HNPP deletion both in interphase nuclei and in metaphase chromosomes. In CMT 1 disease interphase nuclei are required for FISH analysis due to the small duplication of 1.5 Mbp. In contrast to Southern techniques, FISH is able to detect genetic mosaicism.
Bathke, K.; Liehr. T.; Ekici, A. [Institute for Human Genetics, Erlange (Germany)] [and others
Hereditary neuropathy with liability to pressurepalsy (HNPP) is characterized by recurrent focal neuropathies, which usually become symptomatic in the second or third decade of life. However, clinical phenotypic heterogeneity among patients with HNPP has recently been reported. Certain patients show polyneuropathy-type diffuse nerve injuries, whereas others remain asymptomatic at older ages. We present two cases of elderly-onset bilateral peroneal nerve palsies with diffuse muscle weakness in the lower limbs and glove-and-stocking type sensory disturbance. Both patients were diagnosed with HNPP by genetic analyses that detected deletions of chromosome 17p11.2 in peripheral myelin protein 22 genes. Their clinical courses suggested that the Japanese sitting style termed 'seiza', a way of sitting on the floor with the lower legs crossed under the thighs, was a precipitating factor for the bilateral peroneal nerve palsies. PMID:23185166
Hereditary neuropathy with liability to pressurepalsies (HNPP) is an uncommon diagnosis that should be considered in patients\\u000a with multiple compressive neuropathies. We present the case of a woman who presented with bilateral hand numbness and weakness.\\u000a Electrodiagnostic testing revealed bilateral carpal tunnel syndrome, bilateral ulnar neuropathy at the elbow, left peroneal\\u000a neuropathy at the fibular head, and a primarily
Marc J. Grossman; Joseph Feinberg; Edward F. DiCarlo; Sherri B. Birchansky; Scott W. Wolfe
Objective: To clarify age related changes in the clinicopathological features of hereditary neuropathy with liability to pressurepalsy (HNPP) in Japanese patients with deletion of 17p11.2, particularly concerning axonal abnormalities. Methods: Forty eight proband patients from 48 HNPP families were assessed as to clinical, electrophysiological, and histopathological features, including age associated changes beyond those in controls. Results: Motor conduction studies showed age associated deterioration of compound muscle action potentials in nerves vulnerable to repetitive compression (median, ulnar, and peroneal nerves), but not in others such as the tibial nerve. Sensory conduction studies revealed more profound reduction of action potentials than motor studies with little age related change. Large myelinated fibre loss was seen in the sural nerve irrespective of age at examination. Conclusions: Irreversible axonal damage may occur at entrapment sites in motor nerves in HNPP patients, progressing with aging. Sensory nerves may show more profound axonal abnormality, but without age association. The electrophysiological features of HNPP are presumed to be a mixture of abnormalities occurring from early in life and acquired features caused by repetitive insults at entrapment sites. Unlike Charcot-Marie-Tooth disease type 1A, age associated axonal damage may not occur unless the nerves are subjected to compression.
Koike, H; Hirayama, M; Yamamoto, M; Ito, H; Hattori, N; Umehara, F; Arimura, K; Ikeda, S; Ando, Y; Nakazato, M; Kaji, R; Hayasaka, K; Nakagawa, M; Sakoda, S; Matsumura, K; Onodera, O; Baba, M; Yasuda, H; Saito, T; Kira, J; Nakashima, K; Oka, N; Sobue, G
A 1.4-Mb tandem duplication, including the gene for peripheral myelin protein 22 (PMP22) in chromosome 17p11.2-12 is responsible for 70% of the cases of the demyelinating type 1 of Charcot-Marie-Tooth disease or hereditary motor and sensory neuropathy I (CMT1A\\/HMSN I). A reciprocal deletion of this CMT1A region causes the hereditary neuropathy with liability to pressurepalsies (HNPP). The CMT1A duplication
Christian T Thiel; Cornelia Kraus; Anita Rauch; Arif B Ekici; Bernd Rautenstrauss; André Reis
Hereditary neuropathy with liability to pressurepalsies (HNPP) is an autosomal dominant disorder characterized by recurrent mononeuropathies that was recently associated with a 1.5 Mb deletion in chromosome 17p11.2-p12. Duplication of the same region is known to be associated with Charcot-Marie-Tooth disease type 1A (CMT1A), a more severe peripheral neuropathy characterized by symmetrically slowed nerve conduction velocity. The CMT1A duplication
The HNPP (hereditary neuropathy with liability to pressurepalsies) deletion and CMT1A (Charcot-Marie-Tooth disease type 1A) duplication are the reciprocal products of homologous recombination events between misaligned flanking CMT1A-REP repeats on chromosome 17p11. 2-p12. A 1.7-kb hotspot for homologous recombination was previously identified wherein the relative risk of an exchange event is 50 times higher than in the surrounding 98.7% identical sequence shared by the CMT1A-REPs. To refine the region of exchange further, we designed a PCR strategy to amplify the recombinant CMT1A-REP from HNPP patients as well as the proximal and distal CMT1A-REPs from control individuals. By comparing the sequences across recombinant CMT1A-REPs to that of the proximal and distal CMT1A-REPs, the exchange was mapped to a 557-bp region within the previously identified 1.7-kb hotspot in 21 of 23 unrelated HNPP deletion patients. Two patients had recombined sequences suggesting an exchange event closer to the mariner-like element previously identified near the hotspot. Five individuals also had interspersed patches of proximal or distal repeat specific DNA sequence indicating potential gene conversion during the exchange of genetic material. Our studies provide a direct observation of human meiotic recombination products. These results are consistent with the hypothesis that minimum efficient processing segments, which have been characterized in Escherichia coli, yeast, and cultured mammalian cells, may be required for efficient homologous meiotic recombination in humans.
Reiter, L T; Hastings, P J; Nelis, E; De Jonghe, P; Van Broeckhoven, C; Lupski, J R
Hereditary neuropathy with liability to pressurepalsies (HNPP) is an autosomal dominant disorder most commonly caused by a 1.5-Mb deletion in chromosome 17p11.2 which contains the peripheral myelin protein-22 (PMP22) gene. Mutations resulting in functional loss of one PMP22 gene copy are less frequent. We present a 51-year-old patient with a l.5-Mb deletion in chromosome 17p11.2 who exhibited signs of peripheral as well as central nervous system lesions. He gave a history of recurrent episodes of limb numbness and weakness with spontaneous but incomplete recovery since age 20. His father and two brothers had similar symptoms. Neurological examination revealed signs of multiple mononeuropathy associated with frontal lobe, corticospinal tract and cerebellar dysfunction, as well as signs of initial cognitive impairment. Electrophysiological investigations showed a demyelinating peripheral nerve disease with multiple conduction blocks and conduction disturbances in both optic nerves. Magnetic resonance imaging of the brain revealed multiple subcortical and periventricular foci of myelin lesions. The association of central and peripheral nervous system lesions in this patient indicates a possible role of PMP22 not only in peripheral but also in central nervous system myelin structure. PMID:11784354
Duplication and deletion of the 1.4-Mb region in 17p12 that is delimited by two 24-kb low copy number repeats (CMT1A–REPs) represent frequent genomic rearrangements resulting in two common inherited peripheral neuropathies, Charcot-Marie-Tooth disease type 1A (CMT1A) and hereditary neuropathy with liability to pressurepalsy (HNPP). CMT1A and HNPP exemplify a paradigm for genomic disorders wherein unique genome architectural features result in susceptibility to DNA rearrangements that cause disease. A gene within the 1.4-Mb region, PMP22, is responsible for these disorders through a gene-dosage effect in the heterozygous duplication or deletion. However, the genomic structure of the 1.4-Mb region, including other genes contained within the rearranged genomic segment, remains essentially uncharacterized. To delineate genomic structural features, investigate higher-order genomic architecture, and identify genes in this region, we constructed PAC and BAC contigs and determined the complete nucleotide sequence. This CMT1A/HNPP genomic segment contains 1,421,129 bp of DNA. A low copy number repeat (LCR) was identified, with one copy inside and two copies outside of the 1.4-Mb region. Comparison between physical and genetic maps revealed a striking difference in recombination rates between the sexes with a lower recombination frequency in males (0.67 cM/Mb) versus females (5.5 cM/Mb). Hypothetically, this low recombination frequency in males may enable a chromosomal misalignment at proximal and distal CMT1A–REPs and promote unequal crossing over, which occurs 10 times more frequently in male meiosis. In addition to three previously described genes, five new genes (TEKT3, HS3ST3B1, NPD008/CGI-148, CDRT1, and CDRT15) and 13 predicted genes were identified. Most of these predicted genes are expressed only in embryonic stages. Analyses of the genomic region adjacent to proximal CMT1A–REP indicated an evolutionary mechanism for the formation of proximal CMT1A–REP and the creation of novel genes by DNA rearrangement during primate speciation.
Inoue, Ken; Dewar, Ken; Katsanis, Nicholas; Reiter, Lawrence T.; Lander, Eric S.; Devon, Keri L.; Wyman, Dudley W.; Lupski, James R.; Birren, Bruce
NINDS Cerebral Palsy Information Page Condensed from Cerebral Palsy: Hope Through Research Table of Contents (click to jump to sections) ... Trials Organizations Additional resources from MedlinePlus What is Cerebral Palsy? The term cerebral palsy refers to any one ...
... Palsy? Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to one of ... nerves. It is the most common cause of facial paralysis. Generally, Bell's palsy affects only one of the ...
Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...
Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, ... and thinking. There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.
Our experience with 32 infants seen with Erb's palsy, of whom 11 were followed as long as 18 years, suggests two management axioms. First, it is probably harmful to the infant to use airplane splints. Seocnd, passive stretching of the tight scapulohumeral adductors and passive normal range of motion exercises to shoulder and elbow will usually give a successful outcome in this obstetrical complication. Finally, even though the shoulder muscles regain their strenght, the "Erb engram" may remain as a mark of Erb's palsy. PMID:849132
... can't move, so half of the person's face might look stiff or droopy. The paralysis does not last forever, but someone who has it will have trouble moving one side of his or her face. Bell's palsy can develop over a matter of ...
Bell's palsy is the most common cause of facial paralysis. It usually affects just one side of the face. Symptoms appear suddenly and are at their worst about 48 hours after they start. They can range from mild to severe and ... eyelid or corner of mouth Drooling Dry ...
Cerebral palsy (CP) is a group of disorders of movement and posture resulting from non-progressive disturbances of the fetal\\u000a or neonatal brain. More than 80% of cases of CP in term infants originate in the prenatal period; in premature infants, both\\u000a prenatal or postnatal causes contribute. The most prevalent pathological lesion seen in CP is periventricular white matter\\u000a injury (PWMI)
\\u000a Cerebral palsy is a disorder\\/symptom which can result from several underlying causes. Conditions from which cerebral palsy\\u000a may occur can arise before birth, at birth, or after birth. The usual classification of cerebral palsy is based on symptoms\\/location\\u000a of cerebral damage. Cerebral palsy affects muscle coordination and bodily movement. Cerebral palsy can be mild and hardly\\u000a recognizable or so severe
Facial palsy can be defined as a decrease in function of the facial nerve, the primary motor nerve of the facial muscles. When the facial palsy is peripheral, it affects both the superior and inferior areas of the face as opposed to central palsies, which affect only the inferior portion. The main cause of peripheral facial palsies is Bell's palsy, which remains a diagnosis of exclusion. The prognosis is good in most cases. In cases with significant cosmetic sequelae, a variety of surgical procedures are available (such as hypoglossal-facial anastomosis, temporalis myoplasty and Tenzel external canthopexy) to rehabilitate facial aesthetics and function. PMID:23627995
Pons, Y; Ukkola-Pons, E; Ballivet de Régloix, S; Champagne, C; Raynal, M; Lepage, P; Kossowski, M
Background: Current methods to determine gene dos- age are time-consuming and labor-intensive. We de- scribe a new and rapid method to assess gene copy number for identification of DNA duplications or dele- tions occurring in Charcot-Marie-Tooth disease type 1A (CMT1A) and hereditary neuropathy with liability to pressurepalsies (HNPP), respectively. Methods: We studied 16 patients with HNPP, 4 with CMT1A,
Clara Ruiz-Ponte; Lourdes Loidi; Ana Vega; Angel Carracedo; Francisco Barros
The presentation of cerebral palsy can be global mental and physical dysfunction or isolated disturbances in gait, cogni- tion, growth, or sensation. It is the most common childhood physical disability and affects 2 to 2.5 children per 1,000 born in the United States. The differential diagnosis of cerebral palsy includes metabolic and genetic disorders. The goals of treatment are to
Described by Schaltenbrand (1940), spontaneous intracranial hypotension is an unusual syndrome, sometimes revealed by an abducens nerve palsy motivating the patient to consult emergency ophthalmology services. The Authors report the case of a 50-Year-old Turkish woman who presented with diplopia due to a left abducens nerve palsy. These symptoms were associated with headache and nausea. Brain magnetic resonance imaging demonstrated diffuse pachymeningeal enhancement with gadolinium. A lumbar puncture showed low spinal fluid pressure (6 cm H2O), leading to the diagnosis of palsy by spontaneous intracranial hypotension. First, a classic treatment was prescribed with no result: increased water intake, corticoid therapy, and rest. Then a blood patch consisting of an injection of autologous blood by lumbar puncture between the third and fourth lumbar vertebrae to plug the spontaneous leak of spinal fluid, with success. A review of the literature provides information on the physiopathological mechanism, the clinical and imaging symptoms, and the treatment. PMID:15173648
Guigon, B; Tailla, H; de la Marnière, E; Macarez, R; Bazin, S; Madzou, M
... The most common cause is damage to the brain stem, often by a stroke. Often, the palsy is ... severe as that caused by damage to the brain stem, and symptoms often lessen with time. Vertical gaze ...
... has progressive supranuclear palsy is through a brain autopsy. This is important since other diseases can sometimes ... Clinic. Try Mayo Clinic Health Letter FREE! Improve heart health in just 10 minutes a day Heartburn, ...
... is. He or she still wants a high quality of life and parents of kids with cerebral palsy want ... FoodCORE Got Mice? Know Hepatitis B Secondhand Smoke TB & Corrections Data ... Stages & Populations Travelers' Health Workplace Safety & Health Features ...
Several neurological complications have been described after influenza vaccination. Oculomotor palsy has not been yet related with influenza vaccine. We report a 79-year-old man who developed an acute transient right oculomotor palsy two days after a routine influenza vaccination, for which no other cause was identified. There was no evidence of diabetes, glucose intolerance, high blood pressure, hipercholesterolemia, smoking, obesity, systemic vasculitis, or other risk factor for ischemic neuropathy. The cerebrospinal fluid was normal as well as the MRI and MRA scans. The differential diagnosis and the possible relationship between the vaccine and the oculomotor palsy are discussed. PMID:22389831
de Almeida, Diogo Fraxino; Teodoro, Adilson Teixeira; Radaeli, Rafael de Figueiredo
A form of peroneal palsy may be caused by crossing the legs. Two physical factors—pressure and tension — are the basic causes, although other factors may be contributory. Direct pressure is applied by the bones of the two legs, compressing the peroneal nerve between them at its superficial part near the head and neck of the fibula. The palsy may be overlooked as an integral part of a widespread disorder so that careful evaluation and observation of the patient's habits are required. Detection becomes especially difficult when the palsy is bilateral, for then the lesion by virtue of its symmetry blends more readily with associated polyneuritis. A case of recurrent peroneal palsy due to crossing the legs in a prolonged postoperative convalescence is reported in detail.
McNevin NH, Coraci L, Schafer J. Gait in adolescent cerebral palsy: the effect of partial unweighting. Arch Phys Med Rehabil 2000;81:525-8. Objective: To determine the efficacy of partial unweighting in improving gait in a patient with cerebral palsy. Patient: One medically stable 17-year-old female, classified as having spasticity. Methods and Materials: Heart rate, blood pressure, and perceived exertion were recorded
... L. Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2004; :CD001869. Holland NJ, ... palsy. BMJ 2004; 329:553. Ruckenstein MJ. Evaluating facial paralysis. Expensive diagnostic tests are often unnecessary. Postgrad Med ...
AIM: To compare the birthweight specific prevalence of cerebral palsy in singleton and multiple births. METHODS: Registered births of babies with cerebral palsy born to mothers resident in the counties of Merseyside and Cheshire during the period 1982 to 1989 were ascertained. RESULTS: The crude prevalence of cerebral palsy was 2.3 per 1000 infant survivors in singletons, 12.6 in twins,
Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although most babies recover spontaneously in the first 3 months of life, a small number remains with poor recovery which requires surgical brachial plexus exploration. Surgical indications depend on the type of lesion (producing total or partial palsy) and particularly the nonrecovery of biceps function by the age of 3 months. In a global palsy, microsurgery will be mandatory and the strategy for restoration will focus first on hand reinnervation and secondarily on providing elbow flexion and shoulder stability. Further procedures may be necessary during growth in order to avoid fixed contractured deformities or to give or increase strength of important muscle functions like elbow flexion or wrist extension. The author reviews the history of obstetrical brachial plexus injury, epidemiology, and the specifics of descriptive and functional anatomy in babies and children. Clinical manifestations at birth are directly correlated with the anatomical lesion. Finally, operative procedures are considered, including strategies of reconstruction with nerve grafting in infants and secondary surgery to increase functional capacity at later ages. However, normal function is usually not recovered, particularly in total brachial plexus palsy. PMID:23622302
Progressive supranuclear palsy (PSP) or Steele-Richardson-Olszewski syndrome is a neurodegenerative disease of middle and late age. It is under-diagnosed not only by general physicians but also by neurologists. The cause of PSP is not known. Exposure to toxins and viruses has been proposed in the aetiology of PSP without any concrete evidence. The features of PSP resemble those of Parkinson's disease and the two diseases are often confused. Corticobasal degeneration and multisystem atrophy are other differential diagnoses. Despite certain common features with Parkinson's disease, corticobasal degeneration, and mutisystem atrophy, there are important differences that help to differentiate it from these disorders.???Keywords: progressive supranuclear palsy; Steele-Richardson-Olszewski syndrome
The bone mineral density of the lumbar spine was assessed in nine non-ambulant children with cerebral palsy combined with measurements of serum 25-hydroxyvitamin D, parathyroid hormone, and urinary calcium excretion. Three children with recurrent fractures received treatment with bisphosphonates for periods ranging from 12-18 months. All the children demonstrated a severe reduction in bone mineral density even when allowance was
Progressive supranuclear palsy (PSP), or Steele-Richardson-Olszewski syndrome, is a rare, progressive neurodegenerative condition with cognitive and motor involvement. Diagnosis can be challenging as some people do not display the classic symptoms of the condition and there are no specific investigations to confirm diagnosis. Timely discussions and access to symptom management and palliative care services need to be provided from diagnosis throughout the disease trajectory to ensure holistic care of people with PSP. PMID:23965099
Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy. PMID:16391455
The objectives of this study were to quantitatively determine the effects of subtalar arthrodesis on the planovalgus foot using three-dimensional (3-D) gait analysis and plantar pressure measurements. Twelve children and adolescents with planovalgus foot deformity secondary to spastic cerebral palsy participated in this outcome study. The pediatric population were evaluated preoperatively and following subtalar fusion. Seventeen feet were operated for
Ziad O. Abu-Faraj; Gerald F. Harris; Peter A. Smith
Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured
|Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who…
Progressive supranuclear palsy (PSP) is a progressive neurodegenerative disorder, characterized by motor symptoms, postural instability, personality changes, and cognitive impairment. There is no effective treatment for this disorder. Reduced neurotransmission of GABA in the striatum and globus pallidus may contribute to the symptoms of motor and cognitive symptoms seen in PSP. Zolpidem is a GABA agonist of the benzodiazepine subreceptor BZ1. Here a nondiabetic, normotensive case of PSP is (Progressive Supranuclear Palsy) described, which showed improvement in swallowing, speech, and gaze paresis after zolpidem therapy and possible mechanism of actions are discussed. However, more trials are needed with large number of patients to confirm the effectiveness of zolpidem in progressive supranuclear palsy.
Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy\\u000a and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy.\\u000a Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support\\u000a the use and effectiveness
Objective. To estimate the contribution of body transverse rotation using weighted differential center of pressure signals during quiet standing in healthy children and in children with cerebral palsy.Design. Body sway was indirectly measured through center of pressure data, which was calculated using dual force platforms.Background. Assessment of postural control synergies using center of pressure data provides a unique method for
Mohammed Ferdjallah; Gerald F. Harris; Peter Smith; Jacqueline J. Wertsch
Facial palsy is a rare neurological complication of chickenpox. A 5-year-old girl exhibited a right facial palsy followed\\u000a by the appearance of the characteristic chicken pox exanthem. Subsequently she suffered a left facial palsy. In this patient\\u000a both pathophysiological mechanisms responsible and their relation to the phase of infection are illustrated.\\u000a \\u000a \\u000a Conclusion Facial palsy as a complication of chickenpox can
M. van der Flier; C. van Koppenhagen; F. J. M. Disch; H. W. Mauser; J. H. G. M. Bistervels; J. A. A. M. van Diemen-Steenvoorde
Epilepsy occurs in 15-60% of children with cerebral palsy; however, its clinical course is not well defined. This retrospective study reviewed the prevalence, nature, and prognosis of epilepsy in cerebral palsy. Thirty-two of 85 children with cerebral palsy seen in the Neurodevelopmental Clinic in Tuen Mun Hospital between 1990 and 1995 had epilepsy. A control group of 59 epileptic children
Background: Dyskinetic cerebral palsy results from extrapyramidal damage, often with high handicap in movement and hard to treat. In this article, we discuss the classification of epidemiology and etiology, neuroimaging findings, treatment and prognosis of dyskinetic cerebral palsy in children. Data sources: The literature about dyskinetic cerebral palsy was reviewed. Results: Dyskinesia accounts for approximately 20 percent in all types
Based on 6 years of work with cerebral palsied children, the thesis considers types and causes of cerebral palsy, the life pattern of the child with cerebral palsy from early years to adolescence, and the effect of the handicapped child on his parents and family. Literature on behavior disorders is reviewed, and kinds of behavior problems are…
The author presents the analysis of 29 cases of facial palsy collected in Shaba, Zaire (former Katanga, Belgian Congo) between 1984-1988 in the region called Copperbelt. Because to date there has been no work done on these problems in this part of Africa, it would be interesting to present a short report. Patients with facial palsy came to the ENT Department mostly for other reasons, and very late. Only 5 patients came before 3 mos after the onset. The different etiologies were as follows: 2--post traumatic, 7--otogenic, 9--tumors, 4--iatrogenic, 6--Bells palsy, 1--other. The assessment, comparison and the treatment of such cases in an underdeveloped country is very difficult or almost impossible. The small number of cases is insufficient for any conclusions, but the author tried to get some data, which would be a starting point in the future researches. PMID:8255587
Progressive supranuclear palsy (PSP) is a progressive neurodegenerative disorder, characterized by motor symptoms, postural instability, personality changes, and cognitive impairment. There is no effective treatment for this disorder. Reduced neurotransmission of GABA in the striatum and globus pallidus may contribute to the symptoms of motor and cognitive symptoms seen in PSP. Zolpidem is a GABA agonist of the benzodiazepine subreceptor BZ1. Here a nondiabetic, normotensive case of PSP is (Progressive Supranuclear Palsy) described, which showed improvement in swallowing, speech, and gaze paresis after zolpidem therapy and possible mechanism of actions are discussed. However, more trials are needed with large number of patients to confirm the effectiveness of zolpidem in progressive supranuclear palsy. PMID:23762677
Cerebral palsy (CP), the most common major disabling motor disorder of childhood, is frequently thought of as a condition that affects only children. Deaths in children with CP, never common, have in recent years become very rare, unless the child is very severely and multiply disabled. Thus, virtually all children assigned the diagnosis of CP will survive into adulthood. Attention to the adult with CP has been sparse, and the evolution of the motor disorder as the individual moves through adolescence, young adulthood, middle age, and old age is not well understood. Nor do we know what happens to other functional domains, such as communication and eating behavior, in adults with CP. Although the brain injury that initially causes CP by definition does not progressively worsen through the lifetime, the effects of CP manifest differently throughout the lifespan. The aging process must inevitably interact with the motor disorder, but we lack systematic, large-scale follow-up studies of children with CP into adulthood and through adulthood with thorough assessments performed over time. In this paper we summarize what is known of the epidemiology of CP throughout the lifespan, beginning with mortality and life expectancy, then survey what is known of functioning, ability, and quality of life of adults with CP. We conclude by describing a framework for future research on CP and aging that is built around the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) and suggest specific tools and approaches for conducting that research in a sound manner. PMID:19740206
Haak, Peterson; Lenski, Madeleine; Hidecker, Mary Jo Cooley; Li, Min; Paneth, Nigel
Peripheral facial weakness is a facial nerve damage that results in muscle weakness on one side of the face. It may be idiopathic (Bell's palsy) or may have a detectable cause. Almost 80% of peripheral facial weakness cases are primary and the rest of them are secondary. The most frequent causes of secondary peripheral facial weakness are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immune disorders, drugs, degenerative diseases of the central nervous system, etc. The diagnosis relies upon the presence of typical signs and symptoms, blood chemistry tests, cerebrospinal fluid investigations, nerve conduction studies and neuroimaging methods (cerebral MRI, x-ray of the skull and mastoid). Treatment of secondary peripheral facial weakness is based on therapy for the underlying disorder, unlike the treatment of Bell's palsy that is controversial due to the lack of large, randomized, controlled, prospective studies. There are some indications that steroids or antiviral agents are beneficial but there are also studies that show no beneficial effect. Additional treatments include eye protection, physiotherapy, acupuncture, botulinum toxin, or surgery. Bell's palsy has a benign prognosis with complete recovery in about 80% of patients, 15% experience some mode of permanent nerve damage and severe consequences remain in 5% of patients. PMID:24053080
We report here clinical, electrophysiological, and molecular findings in a family affected with two inherited genetic diseases: limb girdle muscular dystrophy type 1B (LGMD1B) and hereditary neuropathy with liability to pressurepalsies (HNPP). Members of the family carry a novel missense mutation in the LMNA gene and a nonsense mutation in the PMP22 gene. Interestingly, the double LMNA\\/PMP22 mutations carriers
Elena Pegoraro; Bruno F. Gavassini; Sara Benedetti; Immacolata Menditto; Gabriella Zara; Roberta Padoan; Maria Luisa Mostacciuolo; Maurizio Ferrari; Corrado Angelini
Genetic disease mechanisms in the demyelinating peripheral neuropathies Charcot-Marie-Tooth disease type 1A (CMTA) and hereditary neuropathy with liability to pressurepalsies (HNPP) as well as transgenic animals with altered PMP22 gene dosage revealed that alterations in PMP22 gene expression have profound effects on the development and maintenance of peripheral nerves. Consequently, the regulation of PMP22 is a crucial aspect in
Marcel Maier; François Castagner; Philipp Berger; Ueli Suter
Preeclampsia can cause myriad organ dysfunction, including cranial nerve palsies that pose diagnostic and management dilemmas. We present an unusual case of third nerve palsy, (presenting as diplopia, ptosis) with hypertension, hyperreflexia, proteinuria, easy bruising in a parturient at 34 + 6/52 weeks of twins gestation. She was treated as for severe preeclampsia and HELLP syndrome; intravenous magnesium sulphate and labetalol commenced and emergent cesarean delivery performed under general anesthesia due to concerns of low platelets and for airway protection should her glascow coma scale (GCS) deteriorate. Postoperatively, stroke, aneurysm and intra-cerebral causes of third nerve palsy were excluded, with subsequent recovery of symptoms upon blood pressure normalization. The eye signs are postulated to be due to two preeclamptic mechanisms involving disordered cerebral autoregulation: (1) hyperperfusion and breakdown of the blood-brain barrier that occurs with rising hypertension, causing fluid/blood product extravasation into brain parenchyma, or (2) focal reactive vasoconstriction and local hypoperfusion, contributed to by endothelial dysfunction. PMID:23478950
THIS MANUAL, WRITTEN BY A PSYCHOLOGIST, PROVIDES BASIC INFORMATION ABOUT THE NATURE OF CEREBRAL PALSY AND DISCUSSES FEELINGS AND REACTIONS OF PARENTS OF CEREBRAL PALSIED CHILDREN. INFORMATION ABOUT THE BRAIN AND BRAIN DAMAGE IN RELATION TO MOTOR AND EMOTIONAL FUNCTION, PERCEPTION AND INTELLIGENCE IS PRESENTED. PART TWO GIVES INSIGHT INTO PROBLEMS…
|This paper explains the use of a unique experimental therapy for students with a type of cerebral palsy specifically called Botox. Botulinum Toxin Type A has been tried on a sizable number of students with cerebral palsy in clinical settings to reduce spastic and dystonic movements. By injecting Botox into overly tight heel cords, a normal or…
After an initial patient with cerebral palsy had an apparent dramatic reduction in spasticity when placed on modafinil, a pilot study was undertaken in 10 pediatric patients to confirm or refute the benefit of modafinil in cerebral palsy. Nine of 10 patients completed the 1-month treatment period. The study patients were treated with 50 or 100 mg of modafinil once
A 64-year-old patient experienced palsy of the right spinal accessory nerve after rhytidectomy. She was evaluated 6 months after surgery for unexplained shoulder pain and weakness since the procedure. Electrophysiological testing showed bilateral spinal nerve palsy without abnormalities in the other shoulder nerves. The electrophysiological findings supported entrapment as the mechanism, rather than nerve section or pure axonal disease due to
During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI
Frank Thömke; Eckart Lensch; Kurt Ringel; Hanns Christian Hopf
|The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts…
Palisano, Robert J.; Shimmell, Lorie J.; Stewart, Debra; Lawless, John J.; Rosenbaum, Peter L.; Russell, Dianne J.
|Twenty-one papers on caring for children with cerebral palsy are organized into four sections, including: (1) cerebral palsy and the interdisciplinary team approach; (2) management of impairments related to cerebral palsy; (3) preventing disability by optimizing function of the child with cerebral palsy; and (4) preventing handicap by creating…
|THIS INTRODUCTORY TEXT ON CEREBRAL PALSY IS DIVIDED INTO TWO SECTIONS. THE FIRST SECTION OF THE BOOK CONTAINS INFORMATION ABOUT UNDERSTANDING THE MEANING OF CEREBRAL PALSY, PROGRAMS FOR THOSE WITH CEREBRAL PALSY, THE NEUROLOGICAL BASES, ETIOLOGY, AND DIAGNOSIS, AND THE CLASSIFICATION OF CEREBRAL PALSY. PROBLEMS OFTEN ASSOCIATED WITH CEREBRAL…
Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress. PMID:23560016
Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress.
: In a 48-year-old otherwise healthy man, a bilateral common peroneal palsy was diagnosed clinically and neurophysiologically. He reported on strength training with weights in both arms, lifting the weights and his upper body from a deep squatting position with broadly positioned legs akimbo in a hitherto unusual intensity. Regarding the pathophysiological mechanisms, 2 options are considered: first, stretching of the nerve at the fascia of the peroneal longus muscle and along the fibula neck, and second, compression of the nerve during squatting with weights loaded and with strongly activated anterior tibial and peroneal muscles. PMID:23615488
This article reviews the historical background, classification, and etiology of cerebral palsy (CP), the most common motor disability of childhood. The various methods employed to measure the prevalence of CP in the population are examined. Causes of CP are numerous, and the etiology multi-factorial. Risk factors are categorized by the timing of their proposed occurrence: prenatal, perinatal, and postnatal. The leading prenatal and perinatal risk factors for CP are birth weight and gestational age. Other risk factors include neonatal encephalopathy, multiple pregnancy, infection and inflammation, and a variety of genetic factors. PMID:19643346
Pakula, Amy Thornhill; Van Naarden Braun, Kim; Yeargin-Allsopp, Marshalyn
Rehabilitation is a major goal for children with cerebral palsy, although the potential to enhance cardio-respiratory fitness in such individuals remains unclear. This study thus compared current cardio-respiratory status between children with cerebral palsy and able-bodied children, and examined the ability to enhance the cardio-respiratory fitness of children with cerebral palsy by cycle ergometer training. 10 children with cerebral palsy (Gross Motor Function Classification System levels I and II) participated in thrice-weekly 30 min cycle ergometer training sessions for 8 weeks (mean age: 14.2±1.9 yrs). 10 additional subjects with cerebral palsy (mean age: 14.2±1.8 yrs) and 10 able-bodied subjects (mean age: 14.1±2.1 yrs) served as controls, undertaking no training. All subjects undertook a progressive cycle ergometer test of cardio-respiratory fitness at the beginning and end of the 8-week period. Cardio-respiratory parameters [oxygen intake V?O2), ventilation V ? E) and heart rate (HR)] during testing were measured by Cosmed K4 b gas analyzer. The children with cerebral palsy who engaged in aerobic training improved their peak oxygen consumption, heart rate and ventilation significantly (p<0.05) and they also showed a non-significant trend to increased peak power output. In conclusion, children with cerebral palsy can benefit significantly from cardio-respiratory training, and such training should be included in rehabilitation programs. PMID:23184482
Introduction This article summarizes our experience with cerebral palsy. The primary and secondary deformities that occur with cerebral\\u000a palsy are described, followed by a brief overview of the nature and role of gait analysis in the treatment of gait problems\\u000a in cerebral palsy. The concept of lever-arm dysfunction is introduced.\\u000a \\u000a \\u000a \\u000a Discussion Our current treatment program is then presented and subsequently illustrated by
Although Sir Charles Bell was the first to provide the anatomic basis for the condition that bears his name, in recent years researchers have shown that other European physicians provided earlier clinical descriptions of peripheral cranial nerve 7 palsy. In this article, we describe the history of facial distortion by Greek, Roman, and Persian physicians, culminating in Razi's detailed description in al-Hawi. Razi distinguished facial muscle spasm from paralysis, distinguished central from peripheral lesions, gave the earliest description of loss of forehead wrinkling, and gave the earliest known description of bilateral facial palsy. In doing so, he accurately described the clinical hallmarks of a condition that we recognize as Bell palsy.
Sajadi, Mohamad-Reza M.; Tabatabaie, Seyed Mahmoud
In regard to efforts to rehabilitate the adult cerebral palsied for optimal individual living or vocational placement, the concensus of opinion is that an adequate vocational appraisal must be flexible to meet the needs of the individual. Rehabilitation p...
Introduction The indications for surgical repair of congenital brachial plexus palsy are controversial. Our objective was to determine the results of early brachial plexus surgery following obstetric-induced brachial plexus palsy.Methods We performed a retrospective analysis of the outcome of 58 cases of brachial plexus surgery. The indication for operation consisted of the presence of less than antigravity strength in the biceps, triceps,
Donncha F. O’Brien; T. S. Park; Michael J. Noetzel; Trisha Weatherly
Facial baroparesis is facial nerve palsy secondary to barotrauma. This phenomenon is frequently seen in divers, but is under-reported there and has rarely been described in aviators or passengers aboard commercial aircraft. We describe a 24-yr-old healthy aviator who experienced an episode of facial nerve palsy during ascent while traveling as a passenger aboard a commercial flight. The probable pathogenesis of this phenomenon in this case is described. PMID:15619863
A register of children with cerebral palsy born in the period 1966-77 to mothers resident in the Mersey region was compiled from several different data sources. There were 685 cases, with a male:female ratio of 1.4:1. The birth prevalence of cerebral palsy ranged from 1.18 to 1.97 per 1000 live births each year, with a mean of 1.51 per 1000
Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell's palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell's palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell's palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell's palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae. PMID:18368417
Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell’s palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell’s palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell’s palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell’s palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell’s palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae.
Mrs PS, 78 years of age, presented with acute left-sided otalgia, ear swelling and subsequent unilateral facial paralysis (Figure 1). She denied any otorrhoea or hearing loss. Past medical history relevant to the presenting complaint included: * Bell palsy diagnosed 20 years ago with no residual effect * biopsy confirmed benign parotid lump (diagnosed 3 years previously). Histopathology revealed a pleomorphic adenoma. Mrs PS declined surgical intervention at the time * chicken pox as a child * normal fasting blood glucose 1 month previously and no known immune compromise. Examination revealed yellow crusts and small vesicles on the external acoustic meatus (Figure 2). A 10 mm well defined firm and nontender nodule was palpable at the ramus of the mandible. PMID:21597548
In 16 patients with cerebral palsy 23 painful fragmentations at the lower pole of the patella were observed and surgically removed. In all cases pain was relieved immediately. Patellar fragmentations usually appeared in children between 12 and 16 years, in males twice as often in females. Patella alta was seen in all cases. All patients were walkers, however, 4 with hand supports only. In 14 of the 16 children there was knee flexion deformity during gait of 20-60 degrees. The cause of fragmentation is regarded to be overload of the quadriceps muscle in a juvenile bone condition, and is related to the "jumper's knee" due to fatigue. In 9 of the 16 patients an achilles tendon lengthening had been performed several years before, without overcorrection. All patients were of reasonable intelligence. PMID:2140647
Cerebral palsy (CP) is a disorder of motor and posture impairment resulting from brain injury prior to completion of cerebral development. It affects 2 to 3 per 1000 individuals. CP is also associated with sensory, behavioral, cognitive, and emotional sequelae. Few systematic studies of psychiatric comorbidities in children and adolescents with CP have been conducted, as the main focus of concern has been on the physical disabilities. This has diverted attention from treatable psychiatric syndromes. Proper psychiatric evaluation of children with CP is an important task, as appropriate interventions can help them reach their full potential and enhance the quality of their lives and those of their families. We report the case of an individual with CP with behavioral and emotional symptoms to illustrate the diagnostic complexity involved. The case highlights the importance of engaging in a comprehensive diagnostic psychiatric evaluation process to assess and suggest treatment options for accompanying comorbid psychiatric conditions. PMID:20425296
Foster, Taliba; Rai, Aanmol I K; Weller, Ronald A; Dixon, Thomas A; Weller, Elizabeth B
This study explored how children with cerebral palsy describe competent performance in everyday activities and sought to better understand the processes by which the children developed competence. Five children with cerebral palsy aged six to 17 years participated in a three-step procedure that included two observations, one semi-structured interview with narrative elaboration, and one cognitive interview. Three factors influenced the
The diagnosis of unilateral trochlear nerve palsy is based on acute onset vertical deviation which increases in contralateral side gaze, down gaze and ipsilateral head-tilt together with excyclodeviation which also increases in both down gaze and ipsilateral head-tilt. Both vertical deviation and excyclodeviation decrease in contralateral head-tilt. To detect excyclotropia one must ask the patient whether there is a tilted double image in down gaze. Bilateral trochlear nerve palsy causes a change of vertical deviation between right and left gaze and between head-tilt to the right and to the left shoulder. In severely asymmetric bilateral palsy, this change of vertical deviation may be absent. Bilateral symmetric trochlear nerve palsy regularly causes only slight vertical deviation in side gaze and slight head-tilt phenomenon. Major symptoms of symmetric palsy are significant excyclodeviation increasing in down gaze and V-incomitance. Objective assessment of vertical and eventually horizontal deviation is performed by the alternate prism and cover test. Cyclodeviation can be measured by Maddox rods. Differentiated assessment of subjectively localised horizontal, vertical and cyclotorsional deviations in definite gaze directions is preferably being performed at the Harms tangent scale. Treatment of trochlear nerve palsy is nearly exclusively surgical. Prisms are rarely helpful due to incomitance of vertical deviation and since they are not suitable to correct for cyclodeviation. Surgery should be scheduled not earlier than 12 months after onset of the palsy. The preferred surgical strategies include weakening procedures on the inferior oblique, tucking or advancement of the superior oblique tendon, combination of both and, if fitting with the motility pattern rarely as a primary procedure, but usually as a possible second procedure contralateral inferior rectus recession. Surgery will not alter the neurogenic palsy but it modulates the squint angle pattern resulting from the movements of both eyes. Normal binocular vision in all directions of gaze for slight palsy and in large part of the daily used gaze area for severe palsy can be achieved by one or sometimes two operations. PMID:19830636
... Shed New Light on Cerebral Palsy, Early Infant Death Birth defects, poor fetal growth appear to be ... that contribute to cerebral palsy and early infant death. The U.S. and Australian researchers compared the medical ...
This lab is not inquiry-based because the teacher must explain how to calculate pressure before doing the activity, but the lab gives students a great concept of what PSI means. They usually have no idea if 10 PSI is a lot or a little. They also don't und
Cerebral palsy is the most prevalent cause of persisting motor function impairment with a frequency of about 1/500 births. In developed countries, the prevalence rose after introduction of neonatal intensive care, but in the past decade, this trend has reversed. A recent international workshop defined cerebral palsy as "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain." In a majority of cases, the predominant motor abnormality is spasticity; other forms of cerebral palsy include dyskinetic (dystonia or choreo-athetosis) and ataxic cerebral palsy. In preterm infants, about one-half of the cases have neuroimaging abnormalities, such as echolucency in the periventricular white matter or ventricular enlargement on cranial ultrasound. Among children born at or near term, about two-thirds have neuroimaging abnormalities, including focal infarction, brain malformations, and periventricular leukomalacia. In addition to the motor impairment, individuals with cerebral palsy may have sensory impairments, cognitive impairment, and epilepsy. Ambulation status, intelligence quotient, quality of speech, and hand function together are predictive of employment status. Mortality risk increases incrementally with increasing number of impairments, including intellectual, limb function, hearing, and vision. The care of individuals with cerebral palsy should include the provision of a primary care medical home for care coordination and support; diagnostic evaluations to identify brain abnormalities, severity of neurologic and functional abnormalities, and associated impairments; management of spasticity; and care for associated problems such as nutritional deficiencies, pain, dental care, bowel and bladder continence, and orthopedic complications. Current strategies to decrease the risk of cerebral palsy include interventions to prolong pregnancy (eg, 17alpha-progesterone), limiting the number of multiple gestations related to assisted reproductive technology, antenatal steroids for mothers expected to deliver prematurely, caffeine for extremely low birth weight neonates, and induced hypothermia for a subgroup of neonates diagnosed with hypoxic-ischemic encephalopathy. PMID:18981805
The purpose of the study was to identify predictive risk factors for epilepsy among children with cerebral palsy. We conducted a retrospective study of the clinical characteristics of children with cerebral palsy and epilepsy in comparison to those of children with cerebral palsy without epilepsy. The examined parameters included: the prevalence and the age of onset of the seizures, the
A study was conducted between November 2006 and October 2009 to determine the factors predicting the presence and prognosis of epilepsy in patients with cerebral palsy. We enrolled 2 groups of patients: 42 with cerebral palsy in group 1 and 56 patients with cerebral palsy and epilepsy in group 2. The subjects in group 2 were considered to have good
Gulen Gul Mert; Faruk Incecik; Sakir Altunbasak; Ozlem Herguner; Mustafa Kurthan Mert; Nurcihan Kiris; Ilker Unal
Children with neurodevelopmental disabilities, such as cerebral palsy, are considered to be a population at risk for the occurrence of sleep problems. Moreover, recent studies on children with cerebral palsy seem to indicate that this population is at higher risk for sleep disorders. The importance of the recognition and treatment of sleep problems in children with cerebral palsy cannot be
Elisabeth Simard-Tremblay; Evelyn Constantin; Reut Gruber; Robert T. Brouillette; Michael Shevell
|Four visual imagery tasks were presented to three groups of adolescents with or without spastic diplegic cerebral palsy. The first group was composed of six adolescents with cerebral palsy who had associated visual-perceptual deficits (CP-PD), the second group was composed of five adolescents with cerebral palsy and no associated…
A review of the selective posterior rhizotomy procedure for reduction of spasticity in cerebral palsy is presented. The history of the procedure, selection of patients, operative technique, and results are described. The neurophysiologic basis for spasticity is considered, as well as the role of spasticity in the complex motor disorder of cerebral palsy. Cerebral palsy is a multifaceted disorder of
Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.1 Osteoporosis remains a major health problem worldwide, costing an estimated $13.8 billion in health care each year in the United States. Despite advances in treating osteoporosis in the elderly, no cure exists. Osteoporosis has its roots in childhood. Accrual of bone mass occurs throughout childhood and early adulthood, and peak bone mass is a key determinant of the lifetime risk of osteoporosis. Because the foundation for skeletal health is established so early in life, osteoporosis prevention begins by optimizing gains in bone mineral throughout childhood and adolescence.2,3 Osteoporosis evaluation and prevention is relevant to children with cerebral palsy (CP). CP is the most prevalent childhood condition associated with osteoporosis. Bone density is significantly decreased, and children with CP often sustain painful fractures with minimal trauma that impair their function and quality of life. Preventing or improving osteoporosis and maximizing bone accrual during critical stages of growth will minimize the future lifelong risks of fractures in children with CP. This article addresses the anatomy and structure of bone and bone metabolism, the clinical assessment of bone mass, the causes of osteoporosis and its evaluation and treatment in children with CP.
Objective: To observe and evaluate a method that is effective and practical for treatment of cerebral palsied (CP) children in China. Method: The patient's age and disease type and individual specific conditions were considered in choosing therapy methods accordingly: Chinese herbs, acupuncture, auricular seed pressure, point finger pressing, massage, orthopedic hand manipulation, physiotherapy, occupational therapy, language therapy, etc. Meanwhile we
Exploration of the history, terminology, and classification of cerebral palsy reveals it as a complex entity. Criteria exist that may make early diagnosis and appropriate intervention possible. Dealing with patients who have cerebral palsy requires recognition of the associated problems and deficits. Comprehensive management usually requires a multidisciplinary setting, which is used to outline the contributions of many therapeutic modalities--developmental pediatrics, occupational and physical therapy, hearing and speech, psychology, social services, special education, ophthalamology, neurology, orthopedics and neurosurgery. The poor prognosis for full function within the community is recognized, as are areas of research that require investigation. PMID:779449
Vining, E P; Accardo, P J; Rubenstein, J E; Farrell, S E; Roizen, N J
The stability of the diagnosis of cerebral palsy from 2 to 5 years of age was examined in 83 children of birthweight under 1000 gm, and 112 of birthweight 1000 to 1500 gm. In 20 2-year-old children with cerebral palsy, the diagnosis persisted in 11 (55%, 95% confidence intervals 35.1 to 76.9%); 2 of 175 children (1.1%) free of cerebral palsy at 2 years of age subsequently developed the condition. Severe or moderate cerebral palsy at 2 years persisted in all eight children (100%). In 9 of 12 children in whom cerebral palsy at 2 years had disappeared by 5 years, minor neurologic abnormalities and left-hand preference occurred frequently but mean psychologic tests scores were similar to children always free of cerebral palsy. In this cohort, cerebral palsy at 2 years was not a static condition, but overestimated later prevalence. PMID:2331281
Ford, G W; Kitchen, W H; Doyle, L W; Rickards, A L; Kelly, E
Following recent advances in the analysis of centre-of-pressure (COP) recordings, we examined the structure of COP trajectories\\u000a in ten children (nine in the analyses) with cerebral palsy (CP) and nine typically developing (TD) children while standing\\u000a quietly with eyes open (EO) and eyes closed (EC) and with concurrent visual COP feedback (FB). In particular, we quantified\\u000a COP trajectories in terms
Stella F. Donker; Annick Ledebt; Melvyn Roerdink; Geert J. P. Savelsbergh; Peter J. Beek
\\u000a Cranial nerve III, IV, and VI palsies in cancer patients can be caused by primary cranial nerve neoplasms, direct extension\\u000a from brain, brain stem and skull base tumors, direct extension or perineural spread from head and neck tumors, metastases\\u000a from tumors at distant sites, leptomeningeal disease, and other conditions, including raised intracranial pressure, radiation\\u000a effect, infection, paraneoplastic syndromes, and certain
Behavioral problems are common in children with cerebral palsy; however, little is known about the persistence of these difficulties during adolescence. This study aimed to describe the nature and frequency of behavioral difficulties in adolescents with cerebral palsy and to explore associated factors. Parents of the participants completed the Strengths and Difficulties Questionnaire. Participants' motor and cognitive abilities, functional status, as well as parental stress were evaluated. Overall, the study enrolled 160 adolescents with cerebral palsy (65 girls, mean age 15.4 ± 2.17 years). Behavioral difficulties were present in 36.9% of the adolescents, with peer problems the most frequently reported (61.9%). Prosocial behaviors were associated with better function (r = 0.24-0.65) whereas hyperactive symptoms were associated with greater limitations (r = -0.19 to -0.55). Weak associations were found between parental stress and externalized problems (r = 0.22-0.24). Behavioral difficulties remained frequent in adolescents with cerebral palsy, particularly in those with greater functional limitations. PMID:23076425
Lightning is a significant cause of mortality in Zimbabwe. The same study showed that 21 per cent of fatal lightning strikes occurred with victims inside a hut. We report a case who survived a severe lightning strike with unusual features of a temporary bulbar palsy. PMID:2124515
|The optimal practice of medicine includes integrating individual clinical expertise with the best available clinical evidence from systematic research. This article reviews nine treatment modalities used for children who have cerebral palsy (CP), including hyperbaric oxygen, the Adeli Suit, patterning, electrical stimulation, conductive…
Cerebral palsy is a pathological state characterized primarily with the damage to the motoric functioning which can be accompanied by the other disorders such as: problems with sight and hearing, intellectual deficit, emotional problems, conduct disorders, speech disorders, epileptic seizures etc. Martin Bax defines this entity as a disorder of movements and postural balance due to defect or damage of the young brain (Gavrankapetanovi? I. at all., 2001). Study of the influence of prenatal ethiological factors on learning difficulties of children and adolescents with cerebral palsy in Canton Sarajevo is cohort, epidemiologicaly based and retrospectively prospective. In this study a Structural interview for the parents of children and adolescents with cerebral palsy was used. Sample was consisted of 80 respondents, children and adolescents with cerebral palsy of Canton Sarajevo, age from 6 up to 20 years, mean age was 13.94 years, 47 male 858.75%) and 33 (41.25%) female. In the group of respondents with illnesses during pregnancy 16 (53.3%) have epilepsy, and 14 (46.7%) does not. In the group withaut illnesses during pregnancy 17 (34%) have epilepsy, and 33 (66%) does not. Risk ration is 1.59 which means that these respondents whose mothers had illnesses during pregnancy have 1.6 times larger probability of developing epilepsy. PMID:15997681
School children severely afflicted with cerebral palsy, but unselected in regard to their visual status. have been studied. Of 120 children examined only 24 (20%) had normal eyes or ocular adnexae. Squint was found in 52.5% of the children and significant refractive errors in 50%. There was also a high incidence of strabismic and anisometropic amblyopia (15%) and visual field
The purpose of this report is to review the surgical treatment of the upper extremity involved with cerebral palsy over a 25-year period and present our results with regard to changes in upper limb function. Surgical results were assessed by comparison of preoperative and postoperative levels of upper extremity functional use using a previously described 9-level scale. The effect of
The clinical features and management of 27 children with cerebral palsy referred with symptoms of lower urinary tract dysfunction were reviewed. The mean age at referral was 9.9 years. Daytime urinary incontinence was the commonest presenting symptom. Videourodynamic studies were abnormal in 23 patients (85%). Only two children had evidence of upper renal tract damage. Treatment was determined by urodynamic
The ultimate goal for management of patients with cerebral palsy is to help them grow up to become as independent as possible, learn to make their own choices in life, and pursue their own dreams. Optimal mobility is crucial to achieving independence and is also necessary for better health and quality of life in these patients. This article discusses the
|Children with unilateral Cerebral Palsy (CP) have several gait impairments, amongst which impaired gait stability may be one. We tested whether a newly developed stability measure (the foot placement estimator, FPE) which does not require long data series, can be used to asses gait stability in typically developing (TD) children as well as…
Bruijn, Sjoerd M.; Millard, Matthew; van Gestel, Leen; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat
Our purpose was to investigate brain atrophy and signal intensity changes on MRI in patients with progressive supranuclear palsy (PSP) and to correlate them with pathological features. We reviewed MRI and brain specimens of six patients with PSP, nine with Parkinson's disease (PD) and six with striatonigral degeneration (SND). Sagittal T1-weighted images showed that four patients with PSP had obvious
|Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the children's…
Pfeifer, Luzia Iara; Pacciulio, Amanda Mota; dos Santos, Camila Abrao; dos Santos, Jair Licio; Stagnitti, Karen Ellen
A register of infants with cerebral palsy born to mothers resident in the Mersey region from 1967-84 has been maintained using various sources of information. A total of 1056 patients are registered of whom 331 (31%) have hemiplegia or mixed hemiplegia, 236 (22%) have diplegias or mixed diplegia, and 369 (35%) have quadriplegia or mixed quadriplegia. The remainder have dyskinetic
Cerebral palsy is the most common chronic disability of childhood today. The concept of management rather than cure forms the basis of intervention. Therapy programs should be integrated with summer camps, home activities, and school, enabling the child and the family to live as close to normal as possible. Successful rehabilitation should prevent additional problems, minimize disability, and create a happy child. PMID:18929061
|In a previous study a group of children with cerebral palsy (CP) were found to have considerable difficulties with narratives, performing several standard deviations below the criteria for the Information score of the Bus Story Test (BST). To examine in depth the performance of children with CP and a control group with typically developing (TD)…
Charcot-Marie-Tooth type 1A disease (CMT1A) and hereditary neuropathy with liability to pressurepalsies (HNPP) are common inherited disorders of the peripheral nervous system associated with duplication and deletion, respectively, of the 17p11.2 segment including the gene of peripheral myelin protein 22. We studied 48 subjects belonging to 29 families with clinical and electrophysiological signs of definite CMT1, 20 patients with suspected CMT phenotype, and 17 patients and healthy members of their families with HNPP. Blood sampling and DNA isolation, PCR, restriction analysis, southern blotting were performed using standard procedures. Of 48 patients with diagnosis of definite CMT1 in 25 (52%) we found a 1.5 Mb tandem duplication in chromosome 17p11.2. These duplications were not found in any of 20 sporadic cases with the clinical phenotype of CMT but without reliable electrophysiological data. Only 13 (44.8%) of 29 unrelated CMT1 patients from the first group had 17p11.2 duplications. Three of 4 sporadic cases (75%) with definite CMT1 had 17p11.2 duplications. Of 17 patients from 6 families with HNPP deletion of 17p11.2 segment was found in 15 (88.2%), as well as in 5 (83.3%) of six unrelated cases. Detection of CMT1A/HNPP recombination hotspot is a simple and reliable DNA diagnostic method, which is useful only for the patients with clinically already verified CMT1, and HNPP for further genetic counselling of patients and members of their families. PMID:12154515
This paper describes a one-month-old girl presenting with respiratory and growth failure due to diaphragmatic paralysis associated with left brachial plexus palsy after forceps delivery. Despite continuous positive pressure ventilation and nasogastric feeding, the situation did not improve and a laparoscopic diaphragmatic plication had to be performed. When dealing with a child born with brachial plexus palsy, one must think of this possible association and if necessary proceed to the complementary radiological examinations. The treatment must avoid complications like feeding difficulties and failure to thrive, respiratory infections or atelectasis. It includes intensive support and a good evaluation of the prognosis of the lesion to decide the best moment for a surgical therapy. PMID:22970808
Isolated third cranial nerve palsy is usually due to vascular causes like posterior communicating artery aneurysm and it is rare in neurocysticercosis. Third cranial nerve palsy in neurocysticercosis is usually caused by supratentorial or sub-arachnoid lesions with accompanying hydrocephalus or meningitis. We report a patient who presented with isolated third cranial nerve palsy without any other brainstem signs caused by neurocysticercosis involving the midbrain. PMID:19340520
The recurrence of cerebral palsy in the same family is uncommon. We, however, report on two families with two or more affected siblings. In both families, numerous potential risk factors were identified including environmental, obstetric, and possible maternal effects. We hypothesize that multiple risk factors may lead to the increased risk of recurrence of cerebral palsy in families. Intrinsic and maternal risk factors should be investigated in all cases of cerebral palsy to properly counsel families on the risk of recurrence. Recent studies of genetic polymorphisms associated with cerebral palsy are considered with reference to our observations in these two families.
Richer, Lawrence P.; Dower, Nancy A.; Leonard, Norma; Chan, Alicia K. J.; Robertson, Charlene M. T.
We report an unusual case of hydrocephalus in which unilateral oculomotor nerve paralysis was the predominant sign. Misinterpretation of such an atypical clinical sign may lead to inappropriate therapy. We outline the role of intracranial pressure monitoring as an adjunctive diagnostic tool and we suggest a presumptive mechanism to explain the correlation between enlarged ventricles and 3(rd) nerve dysfunction. A 16-year-old boy presented with a complete left oculomotor nerve palsy associated with imaging findings of dilated ventricles and Dandy-Walker variant cystic malformation. Monitoring of intracranial pressure through a ventricular catheter was undertaken. In the first phase (no cerebrospinal fluid drainage [CSF] drainage) mean intracranial pressure (ICP) values were >0 mmHg. A second phase (with progressively longer CSF draining) further defined the diagnosis. A ventriculo-peritoneal shunt was then placed and the nerve function returned to normal within few days. Third cranial nerve dysfunction as a predominant sign of hydrocephalus is very rare and may raise doubts as to the real significance of the imaging findings of enlarged ventricles. In this ground, ICP monitoring is a safe and helpful diagnostic tool that can afford a more accurate evaluation and proper treatment. The supposed mechanism of 3(rd) nerve dysfunction was bending/stretching of the nerve. PMID:19546847
Cultrera, F; D'Andrea, M; Battaglia, R; Chieregato, A
Cerebral palsy (CP) is a description of a spectrum of central nervous system (CNS) impairments that affect mobility, communication, intellectual ability, and neurobehavior as a result of developmental brain dysfunction. CP is the most common contributor to motor disability in children with prevalence of about 2-3/1000 live births globally. Presently, no curative therapies or successful methods of prevention on a population level are available for children with one of the cerebral palsy syndromes. Despite these challenges, orthopedic, rehabilitation, neuropharmacological, and other management interventions can help maintain mobility, prevent deformity, and promote quality of life for children with CP. Typically, the diagnosis of CP is based on clinical observations and parent concerns regarding delays in attaining motor milestones (e.g., rolling, sitting, crawling, walking), not on laboratory testing or neuroimaging. However, since 2004 the American Academy of Neurology (AAN) has recommended that neuroimaging of the CNS be part of diagnostic process for cerebral palsy. Although the guideline was initially met with controversy and criticism, neuroimaging has allowed a broader appreciation of timing of lesions, extent of white matter involvement, and the complexity of the motor spectrum of disability. In this article we shall describe the major types of neuroimaging techniques and review their roles in identification and evaluation of children with one of the cerebral palsy syndromes. The authors will focus on the emerging knowledge of how brain structure can inform us about children's functioning, especially among children with prematurity, recognizing that we are only beginning to understand brain plasticity and developmental resiliency. PMID:19752850
Cerebral palsy is the most common developmental disorder causing a physical disability arising from an injury to the central\\u000a nervous system. The majority of pediatric neurologists remain minimally involved in the rehabilitation of these children.\\u000a Recent advances in basic and clinical neuroscience give hope that effective rehabilitation strategies, based on motor learning\\u000a science, can be developed for these children. The
Marjorie A. Garvey; Margot L. Giannetti; Katharine E. Alter; Peter S. Lum
Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.
Summary: This study was designed to assess the impact of gait analysis on the treatment of patients with cerebral palsy. One hundred two ambulant patients with cerebral palsy were assessed clinically and with gait analysis. Separate treatment proposals for each patient were recorded after clinical exami- nation and after gait analysis. The results of the two methods of assessment were
Robert E. Cook; Ingo Schneider; M. Elizabeth Hazlewood; Susan J. Hillman; James E. Robb
Cerebral palsy is one of the most common causes of chronic childhood disability. Rehabilitation planning and management is\\u000a needed for optimal outcome. The concept of sexuality counseling for persons with cerebral palsy has been proposed for a long\\u000a time but not well known.
Abuse and mistreatment of women with disabilities is a complex problem that affects their health and well-being. Previous studies have focused on heterogeneous groups of women with disabilities, with only small numbers of women with cerebral palsy included, but different disabilities may play specific roles in relation to abuse. Exploring mistreatment of women with cerebral palsy is important in determining
A retrospective review was undertaken at Texas Tech University Health Sciences Center regarding the use of modafinil for the treatment of spasticity associated with cerebral palsy. Neurology clinic records were reviewed from January 1, 2000, until October 1, 2001. Thirty pediatric patients with cerebral palsy were identified who were treated empirically with modafinil during this time period. Twenty-three (76%) patients
Daniel L. Hurst; Walter A. Lajara-Nanson; Pradeep Dinakar; Randolph B. Schiffer
Cervical myelopathy complicating athetoid cerebral palsy has not been adequately highlighted in the literature. We report two cases of patients with athetoid cerebral palsy and long histories of involuntary movements who developed cervical myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result
Bilateral facial nerve palsy is a rare but recognised manifestation of HIV seroconversion illness. The pathophysiology of this clinical presentation is thought to be associated with the immune response of the dissemination of virus throughout the body. We describe a case of bilateral facial nerve palsy, subsequently diagnosed with HIV. Related medical literature is also reviewed. The case highlights the
This report is the result of the joint efforts of an ad hoc workgroup on cerebral palsy and aging and the National Invitation Colloquium on Aging and Cerebral Palsy held in Alexandria, Virginia in April 1993. The ad hoc workgroup was chartered and support...
The survival of children in the South East Thames region, born between 1970 and 1979 and diagnosed as having some form of cerebral palsy was investigated. Of the 732 children studied, 651 (90%) are still alive, and hence cerebral palsy must be regarded as a condition with which people live rather than a condition of which they die. Survival varies
|The aim of this exploratory study was to investigate the quality of arithmetic education for children with cerebral palsy. The use of individual educational plans, amount of arithmetic instruction time, arithmetic instructional grouping, and type of arithmetic teaching method were explored in three groups: children with cerebral palsy (CP) in…
Jenks, Kathleen M.; de Moor, Jan; van Lieshout, Ernest C. D. M.; Withagen, Floortje
Two patients had isolated unilateral cranial nerve palsies due to spontaneous internal carotid artery (ICA) dissection without ischaemic cerebral involvement. One had acute glossopharyngeal and vagal, the other isolated hypoglossal nerve palsy. Reviewing all reported cases of angiographically confirmed ICA dissection in the literature, 36 additional cases with unequivocal ipsilateral cranial nerve palsies were analysed. While an isolated palsy of the IXth and Xth has not been reported previously, palsies of the XIIth nerve or the IXth to XIIth nerves were most frequently found. In these patients, lower cranial nerve palsies are probably the result of compression by an enlarging ICA due to mural haematoma. Symptoms and signs indicative of carotid dissection were concurrently present only in some reported cases. This raises the question of unrecognised carotid dissection as a cause of isolated cranial nerve palsies. When the dissection occurs in the subadventitial layer without relevant narrowing of the arterial lumen and when an aneurysm is thrombosed, angiography does not reliably yield the diagnosis. Therefore, carotid dissection might have been underestimated as a cause of isolated lower cranial nerve palsies before the advent of MRI. MRI demonstrates directly the extension of the wall haematoma in the axial and longitudinal planes. Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Images
Cerebral Palsy is mean damage to the brain, causing non-progressive brain injury, such as hemiplegia, limbs palsy, epilepsy, involuntary movements, poor coordination. This paper proposes a movement evaluation and classification system, in view Cerebral Palsy children hand movement smoothness evaluation. In addition, the application of the movement classification system in the diagnosis of children with cerebral palsy is also discussed.
Peripheral facial palsy is a clinical entity, which may be presented as the first symptom of multiple sclerosis (MS). Although MS is mostly a multifocal chronic inflammation of the central nervous system, peripheral nervous system can also be involved. Isolated cranial nerve palsies are rare and occur in 1.6% of MS patients. In this report, a case is presented of a 35-year-old woman who developed isolated seventh nerve palsy that was misdiagnosed as Bell's palsy. Despite recurrent peripheral facial palsy, positive cerebrospinal fluid finding and magnetic resonance imaging, the diagnosis of MS could only be confirmed when the patient developed other neurologic symptoms and when the criteria for dissemination in space were satisfied. In clinical presentation, the patient had only cranial nerve involvement, with complete recovery. PMID:22384779
Cranial nerve palsy in internal carotid artery (ICA) dissection occurs in 3--12% of all patients, but in 3% of these a syndrome of hemicranias and ipsilateral cranial nerve palsy is the sole manifestation of ICA dissection, and in 0.5% of cases there is only cranial nerve palsy without headache. We present two cases of lower cranial nerve palsy. The first patient, a 49-year-old woman, developed left eleventh and twelfth cranial nerve palsies and ipsilateral neck pain. The angio-RM showed an ICA dissection with stenosis of 50%, beginning about 2 cm before the carotid channel. The patient was treated with oral anticoagulant therapy and gradually improved, until complete clinical recovery. The second patient, a 38-year-old woman, presented right hemiparesis and neck pain. The left ICA dissection, beginning 2 cm distal to the bulb, was shown by ultrasound scanning of the carotid and confirmed by MR angiogram and angiography with lumen stenosis of 90%. Following hospitalisation, 20 days from the onset of symptoms, paresis of the left trapezius and sternocleidomastoideus muscles became evident. The patient was treated with oral anticoagulant therapy and only a slight right arm paresis was present at 10 months follow-up. Cranial nerve palsy is not rare in ICA dissection, and the lower cranial nerve palsies in various combinations constitute the main syndrome, but in most cases these are present with the motor or sensory deficit due to cerebral ischemia, along with headache or Horner's syndrome. In the diagnosis of the first case, there was further difficulty because the cranial nerve palsy was isolated without hemiparesis, and the second case presented a rare association of hemiparesis and palsy of the eleventh cranial nerve alone. Compression or stretching of the nerve by the expanded artery may explain the palsies, but an alternative cause is also possible, namely the interruption of the nutrient vessels supplying the nerve, which in our patients is more likely. PMID:11239957
Purpose Two modalities of epidural analgesia in children with two types of cerebral palsy (CP) were compared for differences in the\\u000a incidence of common complications (inadequate analgesia, hypopnea, hypoxaemia, sedation, vomiting, pruritus, urinary retention,\\u000a and seizures).\\u000a \\u000a \\u000a \\u000a Methods Demographic, procedural and postoperative complication data were collected on children with CP receiving epidural analgesia.\\u000a Information was recorded contemporaneously with the child’s care by one
An institutionalized adult cerebral palsy (CP) population was studied to evaluate the orthopaedic, functional, and cardiopulmonary status of 14 residents with untreated scoliosis greater than 45 degrees as compared with 42 residents with mild or no curves. Both groups were comparable in age, sex distribution, percentage of quadriplegics, and extent of mental retardation. Patients in the scoliosis group had more orthopaedic deformities involving the pelvis and hips and needed modified wheelchairs more often than did those without curves. There were no differences in incidence of decubiti, highest functional level achieved, functional loss, oxygen saturation, or pulse. PMID:1572997
Progressive supranuclear palsy (PSP) was originally described in 1964. Although some contended it was merely a variant of Parkinson's disease, a specific electron microscopic finding of straight, rather than twisted, filaments in the neurofibrillary tangles established PSP as a distinct entity. The almost pathognomonic early clinical finding of paralysis of downward gaze is due to lesions involving the lateral portions of the rostral interstitial nucleus of the medial longitudinal fasciculus. Recent neurochemical studies have identified both a decrease in central dopamine and acetylcholine. The etiology of PSP is unknown, and the therapy is generally ineffective.
Isolated abducens nerve palsies associated with the rupture of intracranial aneurysms have rarely been reported. We report two cases of isolated bilateral abducens nerve palsies occurring after subarachnoid hemorrhage due to the rupture of an intracranial aneurysm. Case 1: A 49-year-old woman had bilateral abducens nerve palsies following subarachnoid hemorrhage due to the rupture of the left vertebral artery-posterior inferior cerebellar artery aneurysm. Case 2: A 55-year-old man had bilateral abducens nerve palsies following subarachnoid hemorrhage due to dissecting aneurysm of the right vertebral artery. Case 1 and 2 were treated with surgical clipping of the aneurysm and internal occlusion of the parent artery. In both cases, bilateral abducens nerve palsies achieved almost full recovery several months after treatment. It is speculated that the main causes of palsies are compression and stretching of the bilateral abducens nerves by a thick clot in the prepontine cistern. Although most of the abducens palsies may be reversible and have good prognosis, it is important that they are kept in mind as isolated symptoms of subarachnoid hemorrhage. PMID:22824578
Cerebral palsy (CP) is a catastrophic acquired disease, occurring during development of the fetal or infant brain. It mainly affects the motor control centres of the developing brain, but can also affect cognitive functions, and is usually accompanied by a cohort of symptoms including lack of communication, epilepsy, and alterations in behavior. Most children with cerebral palsy exhibit a short stature, progressively declining from birth to puberty. We tested here whether this lack of normal growth might be due to an impaired or deficient growth hormone (GH) secretion. Our study sample comprised 46 CP children, of which 28 were male and 18 were female, aged between 3 and 11 years. Data obtained show that 70% of these children lack normal GH secretion. We conclude that GH replacement therapy should be implemented early for CP children, not only to allow them to achieve a normal height, but also because of the known neurotrophic effects of the hormone, perhaps allowing for the correction of some of the common disabilities experienced by CP children.
Devesa, Jesus; Casteleiro, Nerea; Rodicio, Cristina; Lopez, Natalia; Reimunde, Pedro
To evaluate facial nerve function, the visual assessment method proposed by the Japan Society of Facial Research is used frequently. It is of great value clinically, but the method has several weak points concerning objective and quantitative assessment. This study uses moire topography to solve these problems. mA moire camera, FM3013, of the lattice irradiation type was used for measurement of the face. Five moire photographs were taken: at rest, wrinkling the forehead, closing the eyes lightly, blowing out the cheeks and grinning. The degree of facial palsy was determined by the Asymmetry Index (AI) as a measure of the degree of facial deviation. Total AI was expressed as the average AI based on calculations of the measurement in 5 photos. Severe paralysis is represented by an AI of more than 20%. Partial paralysis has a range of 20-8%. Nearly normal is judged to be less than 8%. Ten normal individuals are measured as control and show an AI of 3% or less. Moire topography is useful in assessing the recovery process because it has the benefit of making the site and grade of palsy easily achieved by the AI and the deviation in its patterns. The authors propose that the moire method is better for an objective and quantitative evaluation than the society's method.
Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services. PMID:10414775
We present a patient with a Rathke's cleft cyst who presented with rapidly progressive bilateral 6th nerve palsy. A 20-year-old woman with a history of cleft palate, hypertension, and hydronephrotic kidneys presented with a one month history of headache, associated with dizziness and diplopia on horizontal gaze. Examination was significant for profound bilateral 6th nerve palsies. Magnetic resonance imaging showed a hypodense mass that filled the sella and compressed the right cavernous sinus without contacting the optic chiasm. Pituitary function was normal. An endoscopic, transnasal transsphenoidal resection of the lesion was performed; microscopic examination revealed a Rathke's cleft cyst. Surgical excision resulted in near complete resolution of the bilateral 6th nerve palsy. Rathke's cleft cysts are an unusual cause of bilateral sixth nerve palsy and represent a potential cause of cranial neuropathy. PMID:19621262
Grover, Vinni; Hamrahian, Amir H; Prayson, Richard A; Weil, Robert J
The regional plan of the North Central Texas Council of Governments for the developmental disabilities of epilepsy, cerebral palsy, and mental retardation is presented. It is pointed out that the three developmental disabilities share many common needs wh...
A 32-year-old man had an unusual gunshot wound to the leg, causing a peroneal nerve palsy. Sonography provided useful complementary findings to the electrodiagnostic localization of the injury. PMID:9038435
A 79-year old man noticed paresthesia in all 4 limbs, quadriplegia and dysarthria, and then developed respiratory arrest requiring mechanical ventilation. After level of consciousness was improved, vertical gaze palsy, left hemifacial palsy (central type) and quadriplegia were noted. Brain magnetic resonance imaging (MRI) on day 9 revealed bilateral upper medial medullary infarction. In general, the vertical gaze center is thought to be present in the midbrain, including the rostral interstitial nucleus of the medial longitudinal fasciculus, posterior commissure and interstitial nucleus of Cajal. Few reports have described vertical gaze palsy due to medullary lesions. The upper medial medullary lesions, particularly the paramedian tract in the medulla, may have been responsible for vertical gaze palsy in this patient. PMID:16541794
A 58-year-old man with progressive supranuclear palsy (PSP) developed two episodes of respiratory failure associated with laryngeal spasm. It was revealed he had adductor laryngeal breathing dystonia, a relatively unrecognized complication of PSP. PMID:16597502
Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in\\u000a children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children,\\u000a spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus,\\u000a treatment to reduce spasticity
BERGER, W. Characteristics of locomotor control in children with cerebral palsy. NEUROSCI BIOBEHAV REV 22(4) 579–582, 1998.—The typical features of electromyographical (EMG) recordings from children with cerebral palsy (CP) consist of a coactivation of antagonistic leg muscles during the stance phase, a low and tonic activation of extensor EMG, and enhanced stretch reflex excitability with short latency. This characteristic reflex
The aim of this study was to quantitatively assess the stability and harmony of gait in children with cerebral palsy. Seventeen children with spastic hemiplegia due to cerebral palsy (5.0 [plus or minus] 2.3 years old) who were able to walk autonomously and seventeen age-matched children with typical development (5.7 [plus or minus] 2.5 years old,…
|The aim of this study was to quantitatively assess the stability and harmony of gait in children with cerebral palsy. Seventeen children with spastic hemiplegia due to cerebral palsy (5.0 [plus or minus] 2.3 years old) who were able to walk autonomously and seventeen age-matched children with typical development (5.7 [plus or minus] 2.5 years…
Objective: To investigate the characteristics of psychosexual functioning in adults with cerebral palsy, as compared with able-bodied control subjects, matched by gender and marital status, and to identify the factors affecting psychosexual functioning.Design: Interview and survey using the Derogatis Sexual Functioning Inventory (DSFI).Setting: Inpatient and outpatient units in a rehabilitation hospital and welfare facilities.Subjects: Sixty-two adults with cerebral palsy and
Sung-Rae Cho; Eun Sook Park; Chang Il Park; Sang-il Na
This study examined whether motor-related participation could be assessed by global positioning systems in individuals with cerebral palsy. Global positioning systems monitoring devices were given to 2 adolescent girls (14-year-old with diplegic cerebral palsy and her 15-year-old healthy sister). Outcome measures were traveling distances, time spent outdoors, and Children's Assessment of Participation and Enjoyment questionnaires. Global positioning systems documented that the girl with cerebral palsy did not visit nearby friends, spent less time outdoors and traveled shorter distances than her sister (P = .02). Participation questionnaire corroborated that the girl with cerebral palsy performed most activities at home alone. Lower outdoor activity of the girl with cerebral palsy measured by a global positioning system was 29% to 53% of that of her sibling similar to participation questionnaires (44%). Global positioning devices objectively documented low outdoor activity in an adolescent with cerebral palsy compared to her sibling reflecting participation reported by validated questionnaires. Global positioning systems can potentially quantify certain aspects of participation. PMID:23456536
Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant. PMID:23326715
A complex study of 55 patients with children cerebral palsy who complained on visual and eye movement disturbances in the age from 4 to 10 years has been carried out. Main factors in the anamnesis that have negative effect on the organism formation in antenatal and perinatal periods have been analyzed. Most of children had ophthalmologic symptoms (visual acuity decrease, disturbance of pupillary reaction to convergence, disturbance of refraction, refraction strabismus, horizontal nystagmus, restriction of the field of vision, ophtalmoparesis), movement and coordination disorders, mental and speech disorders. Plausibly, the combination of different aversive factors in the antenatal, intranatal and neonatal periods led to the brain lesion, including structures of movement and visual analyzers and their links to other analyzers, that determined the clinical picture of disease. PMID:21512495
Sal'kov, V N; Levchenkova, V D; Lobanova, L V; Grishina, T G; She?nkman, O G
The case notes of 2453 consecutive patients admitted for thyroid surgery and with successful preoperative laryngoscopy were examined retrospectively. Of the 2408 patients who had not had previous operations on the gland, 2321 proved to have benign pathology. A total of 29 patients had a preoperative vocal cord palsy of which 22 were associated with benign disease. Return of cord movement after surgery occurred in 89% of the patients with a benign goitre. We advocate routine preoperative laryngoscopy to detect vocal cord paresis. Such a finding with a goitre does not necessarily indicate malignancy. The recurrent laryngeal nerve should therefore be identified at surgery and preserved to allow for recovery of vocal cord movement.
Rowe-Jones, J. M.; Rosswick, R. P.; Leighton, S. E.
A 20-year-old woman presented with common cold symptoms was found to have a left-sided facial droop. On examination, peripheral facial nerve palsy was confirmed. Subsequent testing showed nephrotic range proteinuria and positive serologies including antinuclear antibody and anti-smith antibody. Kidney biopsy showed stage III lupus nephritis. Treatment with pulse steroids along with mycophenolate mofetil for her lupus nephritis resulted in concomitant improvement of her facial palsy. PMID:23978499
Background The aim of this study was to find an objective graduation of pes equinus in infantile cerebral palsy, especially with regard to functional aspects, to allow a differentiated choice of the therapeutic options. Very often raises the question of whether a surgical lengthening of the Achilles tendon may let expect a functional improvement. Methods For this documentation 17 patients with pes equinus and a diagnosis of spastic cerebral palsy, primarily of the lower limbs, and hemiplegia were examined first clinically and then by a procedure for calculating the functional kinetic parameters from an in-shoe plantar pressure distribution measurement (novel pedar-X system), which is used in many orthopedic practices and clinics as a standard measuring device. Using additional video motion analysis, the flexion in the ankle joint and the ankle joint torque were determined. From this the physical performance of the spastically shortened calf muscle was calculated. The course of the curves of torque and joint performance allows a functional classification of the pes equinus. Results Approximately three quarters of all pes equinus demonstrated functional activity of the most part of the normal push-off propulsion power. Even the rigid pes equinus was capable of performing push-off propulsion work, provided it converted energy that was absorbed during the heel-strike phase and released it again during the push-off phase. This suggests that the function of paretic ankle joint is better than its kinematics of motion. Conclusions A heel strike with a pes equinus triggers via stretching stimuli in the muscle-ligament structure reflex motor functions, thereby causing the typical spastic gait pattern. This remarkable gait pattern is often evaluated as dysfunctional and as absolutely requiring correction. However, an aspect possibly neglected in this instance is the fact that this gait pattern may be efficient for the patient and may in fact be a suitable means allowing for economic locomotion despite the cerebral control deficits. Keywords Pes equinus; Cerebral palsy; Pedography; Ankle joint performance
Idiopathic facial nerve palsy, also known as Bell palsy is rare in the neonatal age group. Other more common causes such as birth trauma; infections, especially otitis media; and congenital malformations need to be excluded. We present here a 4-week-old neonate with Bell palsy who responded rapidly to oral corticosteroids. Such an early presentation of idiopathic facial nerve palsy and use of corticosteroids in neonates is scarcely reported in the literature. PMID:22592004
Saini, Arushi; Singhi, Pratibha; Sodhi, K S; Gupta, Ajit
Background There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids\\u000a can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy\\u000a in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages\\u000a of this
OBJECTIVES--To examine the rate of cerebral palsy in twins and triplets in births from 1980 to 1989 in Western Australia and to identify factors associated with increase in risk. DESIGN--Pluralities for all births in Western Australia were identified through the standardised midwives' notification system, and cases of cerebral palsy were identified from the Western Australian cerebral palsy register. MAIN OUTCOME
BACKGROUND: There is a controversy regarding the existence of a socio-economic gradient for cerebral palsy. Perinatal emergencies and preterm birth increase the risk for the offspring to develop cerebral palsy. The aim of this study was to investigate the association of socio-economic indicators with cerebral palsy (CP) and the role of perinatal health as mediator of this association. METHODS: Register
Objective: To determine if habitual physical activity could be increased in people with cerebral palsy.Data sources: We searched electronic databases until February 2010 using key words related to concepts of cerebral palsy and physical activity. This search was supplemented with citation tracking.Methods: Studies had to include participants with cerebral palsy who have habitual physical activity measured over at least one
The topics of neonatal encephalopathy and cerebral palsy, as well as hypoxic–ischemic encephalopathy, are of paramount importance to anyone who ventures to deliver infants. Criteria sufficient to define an acute intrapartum hypoxic event as sufficient to cause cerebral palsy have been advanced previously by both The American College of Obstetricians and Gynecologists (ACOG) and the International Cerebral Palsy Task Force.
Cerebral palsy is a disorder of movement and posture caused by a non-progressive lesion to the brain. The incidence of cerebral palsy is over 2 per 1000 live births in Europe. Management of cerebral palsy is primarily supportive – none of the current treatments offered attempt to correct the primary problem of a brain lesion.Neurological problems may be treated by
Objective: My purpose was to explore the criteria of The American College of Obstetricians and Gynecologists (Technical Bulletin No. 163) for perinatal asphyxia to be linked to subsequent cerebral palsy.Study design: Analysis of four cases of intrapartum fetal insults with subsequent cerebral palsy and a literature review are presented.Results: All of the four cerebral palsy cases had sufficient intrapartum causes
Several studies have examined bone mineral density (BMD) and related factors in children with cerebral palsy, but there are no such studies of adults with cerebral palsy. We evaluated BMD in 123 institutionalized adults (51 men aged 21–41 years and 72 premenopausal women aged 24–46 years) with cerebral palsy, and examined the associations of BMD with mobility level, use of
|This fact sheet on cerebral palsy is written in both English and Spanish. First, it provides a definition of cerebral palsy and considers various causes (e.g., an insufficient amount of oxygen reaching the fetal or newborn brain). The fact sheet then offers incidence figures and explains characteristics of the three main types of cerebral palsy:…
National Information Center for Children and Youth with Disabilities, Washington, DC.
Although approximately 30% of facial nerve schwannoma cases present with no facial palsy, a large facial nerve schwannoma extending to the middle and posterior cranial fossa quite rarely presents without facial palsy. The authors encountered two patients with large facial nerve schwannoma who presented with only hearing impairment and no facial palsy. The first patient was a 64-year-old woman who
In a controlled trial of the effects of intramuscular corticotrophin and oral prednisolone in the treatment of acute Bell's palsy 186 successive patients with idiopathic facial palsy were grouped for age and duration of palsy. They were then allocated at random to either corticotrophin or prednisolone therapy in pairs. The results were:(1) 94 received corticotrophin and 32 developed some degree
Bell's Palsy is the sudden onset of unilateral temporary paralysis of facial muscles resulting from seventh cranial nerve dysfunction. Presented here is a two-year old female patient with right peripheral facial palsy following hepatitis B vaccination. Readers’ attention is drawn to an uncommon cause of Bell's Palsy, as a rare complication of hepatitis B vaccination.
Background: Peripheral nerve palsies of the upper extremities presenting at birth can be distressing for families and care providers. It is therefore important to be able to identify patients whose diagnosis is compatible with full recovery so that their families can be reassured. Methods: We conducted a retrospective review of all infants presenting with weakness of the upper extremity to our clinic between July 1995 and September 2009. We also conducted a review of the current literature. Results: During the study period, 953 infants presented to our clinic. Of these patients, 25 were identified as having isolated radial nerve palsy (i.e., a radial nerve palsy in isolation with good shoulder function and intact flexion of the elbow). Seventeen infants (68.0%) had a subcutaneous nodule representing fat necrosis in the inferior posterolateral portion of the affected arm. Full recovery occurred in all patients within a range of one week to six months, and 72.0% of the patients (18/25) had fully recovered by the time they were two months old. Interpretation: Although the outcome of obstetrical brachial plexus palsy is highly variable, isolated radial nerve palsy in the newborn carries a uniformly favourable prognosis.
Alsubhi, Fatema S.; Althunyan, Abdullah M.; Curtis, Christine G.; Clarke, Howard M.
Bell's palsy is defined as a peripheral facial nerve palsy, idiophatic, and sudden onset and is considered the most common cause of this pathology. It is caused by damage to cranial nerves VII, resulting in complete or partial paralysis of the facial mimic. May be associated with taste disturbances, salivation, tearing and hyperacusis. It is diagnosed after ruling out all possible etiologies, because its cause is not fully understood.Some researches shows that herpes virus may cause this type of palsy due to reactivation of the virus or by imunnomediated post-viral nerve demielinization. Physical therapy, corticosteroids and antiviral therapy have become the most widely accepted treatments for Bell's palsy. Therapy with low-level laser (LLLT) may induce the metabolism of injured nerve tissue for the production of proteins associated with its growth and to improve nerve regeneration. The success of the treatment of Bell's palsy by using laser phototherapy isolated or in association with other therapeutic approach has been reported on the literature. In most cases, the recovery occurs without uneventfully (complications), the acute illness is not associated with serious disorders. We will present a clinical approach for treating this condition.
Children with unilateral Cerebral Palsy (CP) have several gait impairments, amongst which impaired gait stability may be one. We tested whether a newly developed stability measure (the foot placement estimator, FPE) which does not require long data series, can be used to asses gait stability in typically developing (TD) children as well as children with CP. In doing so, we tested the FPE's sensitivity to the assumptions needed to calculate this measure, as well as the ability of the FPE to detect differences in stability between children with CP and TD children, and differences in walking speed. Participants were asked to walk at two different speeds, while gait kinematics were recorded. From these data, the FPE, as well as the error that violations of assumptions of the FPE could have caused were calculated. The results showed that children with CP walked with marked instabilities in anterior-posterior and mediolateral directions. Furthermore, errors caused by violations of assumptions in calculation of FPE were only small (? 1.5 cm), while effects of walking speed (? 20 cm per m/s increase in walking speed) and group (? 5 cm) were much larger. These results suggest that the FPE may be used to quantify gait stability in TD children and children with CP. PMID:23500163
Bruijn, Sjoerd M; Millard, Matthew; van Gestel, Leen; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat
BACKGROUND: Progressive supranuclear palsy (PSP) is an akinetic-rigid syndrome of unknown aetiology which usually presents with a combination of unsteadiness, bradykinesia, and disordered eye movement. Speech often becomes dysarthric but language disorders are not well recognised. METHODS: Three patients with PSP (pathologically confirmed in two) are reported in which the presenting symptoms were those of difficulty with language output. RESULTS: Neuropsychological testing showed considerable impairment on a range of single word tasks which require active initiation and search strategies (letter and category fluency, sentence completion), and on tests of narrative language production. By contrast, naming from pictures and from verbal descriptions, and word and sentence comprehension were largely intact. The degree of semantic memory impairment was also slight. CONCLUSIONS: Relatively selective involvement of cognitive processes critical for planning and initiating language output may occur in some patients with PSP. This presentation resembles the phenomenon of "verbal adynamia" or "dynamic aphasia" seen in patients with frontal lobe damage. Although definite cortical changes were present at postmortem examination, it is likely that the neuropsychological deficits reflect functional frontal deafferentation secondary to interruption of frontostriatal feedback loops.
Legionnaires' disease is primarily a pneumonic process caused by Legionella pneumophilia, a gram-negative aerobic bacillus but also has multiple system involvement. The most common manifestation is encephalopathy suggesting a generalized brain dysfunction but focal neurological manifestations have been reported. We report a patient with Legionella pneumonia associated with cerebellar dysfunction and unilateral facial nerve weakness. 51-year-old previously healthy male presented with shortness of breath, cough, slurred speech, and unsteadiness on feet associated with malaise, fevers and myalgias. Patient's family reported facial asymmetry for 2 days. Patient had no significant medical history and was not on any medication. He denied smoking, alcohol or illicit drug use. Chest X-ray showed bilateral lower lobe infiltrates. Urinary antigen assay for Legionella pneumophilia serogroup 1 was positive. Patient was started on intravenous moxifloxacin. On day 5 the patient was discharged home and continued oral moxifloxacin for two weeks. After the two weeks, his respiratory symptoms, gait ataxia and dysarthria resolved. We report the first case of Legionnaires' disease with cerebellar dysfunction and seventh nerve palsy. Legionnaires' disease should be considered in patients with any neurological symptoms in the setting of pneumonia. Failure to recognize and treat the infection may lead to poor outcomes.
Olecranon fracture is not an uncommon fracture in clinical practice. Simple olecranon fracture usually heals quite well without any types of iatrogenic complications. Despite close proximity of the fracture to the nerve, median nerve palsy after operative treatment of olecranon fracture is a rare complication. To the authors' knowledge, this complication has not been previously reported in the Thai or English literature. The authors present a patient who had median nerve palsy after tension-band wiring for olecranon fixation. Intraoperative finding revealed that the median nerve was injured by the tip of K-wire. While this complication is uncommon on a per-person basis, it may results in serious complication, such as nerve palsy or limb ischemia. Orthopedic surgeons must remain vigilant with regard to any type of internal fixation in the upper extremity because the risk of neurovascular injury is high. PMID:16519392
Two infants with acute unilateral facial palsy were examined serially as to the electrically and mechanically elicited blink reflex, photo-evoked eyelid microvibration and auditory brainstem response (ABR). The results indicated that in hemifacial palsy beside the affection of the facial nerve also central pathways in the brainstem were involved in the pathogenetic processes. In particular, a neurapraxic change of the facial nerve itself in one case played an important role in pathogenesis, while a wide spread involvement was observed in another case. The clinical recovery of a patient with a wide spread involvement was more prolonged. We suggest that serial determinations of blink reflexes and ABR are helpful in clarifying the underlying pathogenetic processes concerning the brainstem affection during facial nerve palsy. PMID:1555530
Hatanaka, T; Takedatsu, M; Yasuhara, A; Kobayashi, Y
We report a case of multiple myeloma that presented as a fluctuating sixth cranial nerve palsy in the absence of widespread signs of systemic disease. A 63-year-old woman presented with horizontal diplopia of two weeks duration that subjectively changed over time. Ocular examination showed a fluctuating sixth nerve palsy. A computed tomography (CT) scan of the brain showed multiple, enhancing, soft tissue, mass-like lesions involving the left cavernous sinus and the apex of both petrous bones. Based on bone marrow biopsy and hematologic findings, she was diagnosed with multiple myeloma. Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs.
Patient: Female, 47 Final Diagnosis: Traumatic bilateral abducens • unilateral hypoglossal nerve palsy Symptoms: Diplopia Medication: — Clinical Procedure: — Specialty: Neurology Objective: Rare disease Background: Incidence of unilateral abducens palsy from head trauma has been reported to be as high as 1% to 2.7%, but bilateral abducens nerve palsy is extremely rare. Case Report: We present a case in which bilateral abducens nerve and unilateral hypoglossal nerve palsy developed with a high Glasgow Coma Score (GCS) 3 hours after head trauma due to a motor vehicle crash. Conclusions: This case highlights the occurrence and management of posttraumatic bilateral sixth nerve palsy.
We performed a cross-sectional study of 160 adult patients with severe cerebral palsy to study the relationship between radiographic hip disorders (migration and deformity of the femoral head), on the one hand, and complications such as handling problems, seating problems, decubitus ulcers, fractures and contractures, on the other hand. Both migration and deformity were positively related to the need for a special seat in the wheelchair and adduction contractures of the hip. We conclude that migration and deformity of the femoral head, if possible, should be prevented in patients with severe cerebral palsy. PMID:17159530
Boldingh, Eric J K; Jacobs-van der Bruggen, Monique A M; Bos, Cees F A; Lankhorst, Gustaaf J; Bouter, Lex M
Purpose Children with cerebral palsy may have low bone density stemming from various etiologies and are, thereby, at risk for fractures.\\u000a The treatment of femur fractures in children with cerebral palsy may need to be tailored to address the management of spastic\\u000a muscle tone and multiple medical co-morbidities.\\u000a \\u000a \\u000a \\u000a Methods Our study is a retrospective review that evaluates the treatment of 47 femur
Arabella I. Leet; Eric D. Shirley; Chris Barker; Franck Launay; Paul D. Sponseller
OBJECTIVE: Asians have a reduced risk for cerebral palsy (CP) compared with whites. We examined whether individual Asian subgroups have a reduced risk of CP and whether differences in sociodemographic factors explain disparities in CP prevalence. METHODS: In a retrospective cohort of 629?542 Asian and 2?109?550 white births in California from 1991 to 2001, we identified all children who qualified for services from the California Department of Health Services on the basis of CP. Asians were categorized as East Asian (Chinese, Japanese, Koreans), Filipino, Indian, Pacific Islander (Guamanians, Hawaiians, and Pacific Islanders), Samoan, or Southeast Asian (Cambodian, Laotian, Thai, Vietnamese). RESULTS: Overall, CP prevalence was lower in Asians than whites (1.09 vs 1.36 per 1000; relative risk = 0.80, 95% confidence interval [CI] = 0.74–0.87) and ranged from 0.61/1000 in Thai children to 2.08/1000 in Samoan children. Several Asian subgroups had low risk profiles with respect to maternal age, educational attainment, and birth weight. However, after we adjusted for maternal age and education, infant gender, and birth weight, the adjusted risk of CP remained lower in East Asians (odds ratio [OR] = 0.75, 95% CI = 0.65–0.87), Filipinos (OR = 0.87, 95% CI = 0.75–0.99), Indians (OR = 0.59, 95% CI = 0.44–0.80), Pacific Islanders (OR = 0.62, 95% CI = 0.40–0.97), and Southeast Asians (OR = 0.68, 95% CI = 0.57–0.82) compared with whites. CONCLUSIONS: Most Asian national origin subgroups have a lower rate of CP than whites, and this disparity is unexplained. Additional studies that focus on the cause of ethnic disparities in CP may provide new insights into pathogenesis and prevention.
Lang, Tess C.; Fuentes-Afflick, Elena; Gilbert, William M.; Newman, Thomas B.; Xing, Guibo
To significantly increase the delivery of oxygen delivery to the tissues requires the use of hyperbaric conditions, that is, pressures greater than normal sea level atmospheric pressure. When tissue is damaged, the blood supply within the tissue is also damaged and too little oxygen may be available for recovery to take place. Hyperbaric medicine is not taught in most medical
|Aim: Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function. Method: We examined attention and executive function with standardized neuropsychological measures in a group of children with…
Bottcher, Louise; Flachs, Esben Meulengracht; Uldall, Peter
Erb’s palsy is initially frightening. The infant’s arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia. However, Erb’s palsy may occur following cesarian section. The experience of the delivering physician may not influence the risk of Erb’s palsy (0.9 to 2.6 per 1000 live births). Differential diagnosis includes clavicular fracture, osteomyelitis and septic arthritis. Fortunately, the rate of complete recovery is 80% to 96%, especially if improvement begins in the first two weeks. Recommended treatment includes early immobilization followed by passive and active range of motion exercises (although there is no proof that any intervention is effective). For the few infants with no recovery by three to five months, surgical exploration of the brachial plexus may improve the outcome. Three infants with Erb’s palsy who illustrate variations in the evolution of this disorder are presented.
|Helpful techniques are offered for making bathtime easier, safer, and more fun for children who have cerebral palsy. Safety in the bathtub is stressed, both for the child who needs protection from slippery surfaces and extreme water temperature, and for the caregiver who must lift and carry the child without causing injury to the lower back.…
A model swimming program for cerebral palsied children based on the underlying principles of the neurodevelopmental treatment approach is presented following a review of the current literature pertaining to swimming programs for the physically handicapped and a discussion of the values of hydrotherapy. PMID:674385
Background For most parents, the birth of their child is a unique and touching moment. However, in some families a child is born with a physical disability. Among the large variety of childhood developmental disabilities, cerebral palsy (CP) is considered to be the major physical disability affecting the functional development of children. CP describes a group of disorders of the
|Growth and nutrition disorders are common secondary health conditions in children with cerebral palsy (CP). Poor growth and malnutrition in CP merit study because of their impact on health, including psychological and physiological function, healthcare utilization, societal participation, motor function, and survival. Understanding the etiology…
|Our goal was to examine the feasibility of applying therapeutic robotics to children and adults with severe to moderate impairment due to cerebral palsy (CP). Pilot results demonstrated significant gains for both groups. These results suggest that robot-mediated therapy may be an effective tool to ameliorate the debilitating effects of CP and…
We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an
INTRODUCTION: Isolated spinal accessory nerve dysfunction has a major detrimental impact on the functional performance of the shoulder girdle, and is a well-documented complication of surgical procedures in the posterior triangle of the neck. To the best of our knowledge, the natural course and the most effective way of handling spontaneous spinal accessory nerve palsy has been described in only
Ioannis N Charopoulos; Nikolas Hadjinicolaou; Ioannis Aktselis; George P Lyritis; Nikolaos Papaioannou; Constantinos Kokoroghiannis
The popliteal angle is a widely used clinical measure for hamstring contracture in cerebral palsy (CP) patients and in healthy individuals. The reliability of popliteal angle measurement is being questioned. The aim of this study is to determine the reliability of popliteal angle measurement by means of visual and goniometric assessment. Methods: Three different observers measured the popliteal angle in
Þ Jan; P. K. Halbertsma; Patrick G. M. Maathuis; Nienke P. Verheij; Þ Pieter; U. Dijkstra; Karel G. B. Maathuis
The aim of the study was to investigate associations between the severity of motor limitations, cognitive difficulties, language and motor speech problems in children with cerebral palsy. Also, the predictive power of neonatal cranial ultrasound findings on later outcome was investigated. For this purpose, 36 children (age range 1 year 10 months…
Pirila, Silja; van der Meere, Jaap; Pentikainen, Taina; Ruusu-Niemi, Pirjo; Korpela, Raija; Kilpinen, Jenni; Nieminen, Pirkko
OBJECTIVES.In conducting reviews on the effectiveness of physiotherapy interven- tions on children with cerebral palsy, the assessment of trials can be hampered by problems in reporting. Therefore, we set out to evaluate trial reporting by using the Consolidated Standards of Reporting Trials (CONSORT) statement recommenda- tions. METHODS.Randomized, controlled trials published in 1990 or later were identified in literature searches for
Prevalence of cerebral palsy (CP) has been found to rise in the last 40 years with its management becoming an issue of considerable socio-economic concern worldwide. Further, there is mounting evidence regarding the association of CP with a high incidence of cognitive impairment, and a causal–effect relationship between interictal epileptiform discharges (IEDs) and cognitive impairment is being established through recent
Children with cerebral palsy (CP) expend up to three times the energy required for ambulation as compared to typically developed children of the same age. Measuring the metabolic energy required to execute a task is an intuitively appealing way to quantify task efficiency. Task energy demand is often quantified through pulmonary tests that measure oxygen consumption. Although providing an accepted
In this paper we present a study of 6 cases, running through three generations of a Dutch family, with alternating Bell’s palsy in an autosomal dominant mode of inheritance. The study included medical history data, neurological examination, blood glucose tests, electromyography, orbicularis oculi reflexes and radiological investigation. In 3 cases a bilateral hypoplasia or scanty cellularization of the mastoid bone
G. Hageman; P. F. Ippel; E. N. H. Jansen; A. R. Rozeboom
The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107 children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and
|Studies of the degree of involvement (DOI) and its relationship to therapeutic intervention effectiveness and related services for young children with cerebral palsy were reviewed. Three dimensions of DOI: (1) brain damage and mental retardation, (2) functional motor ability, and (3) emotional disturbance and behavior problems were reviewed. The…
As one component of the upper motor neuron syndrome, spasticity can have a significant functional impact on the child with cerebral palsy. Treatment planning requires the determination that excess tone interferes with some aspect of function, comfort, or care, and takes into consideration carefully devised goals that meet the needs of the patient and the caregiver. Treatment options include physical
|The aim of this study was to compare the effect of the delivery of the same amount of intermittent versus continuous physiotherapy given to children with cerebral palsy (CP). This was organized either in an intermittent regime four times a week for 4 weeks alternating with a 6-week treatment pause, or a continuous once or twice a week regime,…
Despite advances in obstetric and neonatal care, the overall prevalence of cerebral palsy has remained stable, supporting the belief that pathogenesis is primarily due to prenatal brain dysgenesis and injury. Neuroimaging studies have consistently shown abnormalities in 70% to 90% of affected children, facilitating clinical classification into groups with early brain malformations, white-matter injury, neonatal encephalopathies, and a heterogeneous group
In this article, the author talks about functional electrical stimulation in children and adolescents with cerebral palsy. Functional electrical stimulation (FES) is defined as the electrical stimulation of muscles that have impaired motor control, in order to produce a contraction to obtain functionally useful movement. It was first proposed in…
Childhood Cerebral Palsy - the group of diseases concerned with motor disorders as the result of brain damage or dysfunction of certain brain centers - is usually acquired during the first years of life, at the time when the system of primary movement patterns is developing. Primary movements are genetically programmed for protection and survival, and also for the development
A large percentage of cases of Bell's palsy may be caused by herpes-simplex virus (H.S.V.). It is suggested that H.S.V. takes up residence within the peripheral-nerve-cell axon, where it is protected from neutralizing antibody and sensitised mononuclear i...
BACKGROUND: Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme. METHODS: In a
Gunnar Hägglund; Henrik Lauge-Pedersen; Philippe Wagner
|This official training manual of the United States Cerebral Palsy Athletic Association includes the latest coaching and training techniques specific to all sports in the national program. The book features guidelines for coaching over a dozen sports, including soccer, swimming, cycling, and track and field. It contains everything coaches,…
An unusual combination of downgaze palsy and bilateral ptosis occurred in a patient with central nervous system lymphoma involving bilateral thalamus and midbrain tegmentum. Following treatment with corticosteroids, the transition from total paralysis of downgaze to the supranuclear form was noted, along with alleviation of ptosis, followed by complete resolution of both. The results of serial magnetic resonance images were
Ken Johkura; Atsushi Komiyama; Osamu Hasegawa; Yoshiyuki Kuroiwa
|The goal of the present study was to examine the precursors of verbal working memory in 52 children with cerebral palsy with varying degrees of speech impairments in the first grade of special education. Following Baddeley's model of working memory, children's verbal working memory was measured by means of a forced-recognition task. As precursors…
|In this article, the author talks about functional electrical stimulation in children and adolescents with cerebral palsy. Functional electrical stimulation (FES) is defined as the electrical stimulation of muscles that have impaired motor control, in order to produce a contraction to obtain functionally useful movement. It was first proposed in…
|This review evaluates the clinimetric properties of tactile assessments for children with cerebral palsy. Assessment of registration was reported using Semmes Weinstein Monofilaments (SWMs) or exteroception. Assessment of two-point discrimination was reported using the Disk-Criminator[R] or paperclip methods; Single point localization and double…
Auld, Megan Louise; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie
|The aim of the study was to investigate associations between the severity of motor limitations, cognitive difficulties, language and motor speech problems in children with cerebral palsy. Also, the predictive power of neonatal cranial ultrasound findings on later outcome was investigated. For this purpose, 36 children (age range 1 year 10 months…
Pirila, Silja; van der Meere, Jaap; Pentikainen, Taina; Ruusu-Niemi, Pirjo; Korpela, Raija; Kilpinen, Jenni; Nieminen, Pirkko
|Background: Various aspects of the home literacy environment are considered to stimulate the emergent literacy development in children without disabilities. It is important to gain insight into the home literacy environment of children with cerebral palsy given that they have been shown to have difficulty acquiring literacy skills. Aims: The aims…
Peeters, Marieke; Verhoeven, Ludo; van Balkom, Hans; de Moor, Jan
|The aim of this study was to identify determinants of daily function in a population-based sample of children with cerebral palsy (CP). The study took into consideration factors from the entire scope of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, the determinants of daily function were examined from…
In an effort to obtain data on services delivered by one clinical center (Downey, California) to nonspeaking cerebral palsied persons, demographic and clinical characteristics were obtained on 66 such patients during the assessment, management, and follow-up phases of a service delivery program. (Author/DB)
Bell's palsy is caused by a nuclear and/or infranuclear lesion of the facial nerve, producing an ipsilateral deficit of the facial muscles. The etiology is unknown. Bell's palsy has a frequency of 20:100000 individuals/year, a familiarity of 1-2% of cases, and a recurrence rate of 9% of cases. We studied 33 children (mean age 9.1 years) admitted to our Division during the period 1991-1994 because of Bell's palsy. We propose our personal diagnostic and therapeutical trial: in every patient a full neurological and otoscopic examination, and an audioimpedenzometric test. Treatment is then commenced with prednisone (1 mg/kg/day p.o. for 5-10 days and gradual reduction in 5 days), vitamins B1, B6 and B12 p.o. for 30 days, and local treatment with artificial tears, and occlusive bandage at nighttime until the lagophthalmus is resolved. Electromyography-electroneurography, and brain CT-scan are carried out after 15 days and 21 days respectively of treatment, if neurological deficit is unchanged. 80 to 90% of patients are reported to recover spontaneously from Bell's palsy. With our approach we achieved a 100% recovery rate within an average of 3 weeks (range: 1 week to 5 months). PMID:8926963
Micheli, R; Telesca, C; Gitti, F; Giordano, L; Perini, A
|Participation in home, school, and community activities is a primary outcome of early intervention services for children with disabilities and their families. The objectives of this study were to (a) describe participation of preschool-age children with cerebral palsy (CP); (b) determine effects of sex, age, and gross motor function on intensity…
Chiarello, Lisa Ann; Palisano, Robert J.; Orlin, Margo N.; Chang, Hui-Ju; Begnoche, Denise; An, Mihee
|This study described the aerobic capacity [VO[subscript 2peak] (ml/kg/min)] in contemporary children and adolescents with cerebral palsy (CP) using a maximal exercise test protocol. Twenty-four children and adolescents with CP classified at Gross Motor Functional Classification Scale (GMFCS) level I or level II and 336 typically developing…
Background and Purpose. Adults with a diagnosis of cerebral palsy (CP) are living longer lives similar to the general population. Consequently, there is an emerging need for knowledge pertaining to the effectiveness of medical care for adults with CP. The purpose of this study was to gain insight from adults with CP regarding the priority components of well-being that contribute
|The purpose of this study was to examine the childhood experiences of women with cerebral palsy (CP), from the perspectives of these women. Using the feminist biographical method, eight women with CP participated in two in-depth interviews. Participants ranged in age from 22 to 55 years and had moderate to severe athetoid or spastic CP. Four…
|Classification of the quality and topographical pattern of motor impairment is used to describe cerebral palsy (CP). As an adjunct to a study characterizing the quality of life and participation of school-age children with CP, initial and follow-up classification of CP were compared. A cohort of 93 children (58 males, 35 females) were initially…
Shevell, Michael I.; Majnemer, Annette; Poulin, Chantal; Law, Mary
|A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were…
Auld, Megan Louise; Ware, Robert S.; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie
|The aim of our study was to identify feeding and gastrointestinal system (GIS) problems in children with cerebral palsy (CP), and to evaluate the relationship between these problems and the severity of CP. A total of 120 children with CP were enrolled consecutively into the study (67 males, 53 females; mean age: 6.0[plus or minus]2.4 years;…
|In this study bimanual grip-force coordination was quantified using a novel "Gripper" system that records grip forces produced while holding a lower and upper unit, in combination with the lift force necessary to separate these units. Children with unilateral cerebral palsy (CP) (aged 5-14 years, n = 12) were compared to age matched typically…
|Children with cerebral palsy (CP) often have problems with arithmetic, but the development of numerical abilities in these children has received only minor attention. In comparison, detailed accounts have been written on the arithmetic abilities of typically developing children, but a theoretical framework is still lacking. A promising…
van Rooijen, Maaike; Verhoeven, Ludo; Steenbergen, Bert
|The aim of this study was to investigate the participation of children with cerebral palsy (CP) in activities outside school and to compare their participation with a large representative sample of children. A population-based survey was conducted of children with CP born in Victoria, Australia in 1994 and 1995. Of 219 living children identified,…
Progressive supranuclear palsy is a neurodegenerative disease with progressive brain atrophy over time. It is unknown which specific brain regions decline over time, whether regional volume loss occurs in a linear fashion, and whether regional atrophy correlates with clinical decline over time in progressive supranuclear palsy. Twenty-eight subjects meeting probable progressive supranuclear palsy criteria were prospectively recruited and completed 96 MRI scans over 2 years. Mixed-effect models were utilized to determine which regions had significant atrophy over time and whether decline was linear or nonlinear. We assessed 13 regions across the brain, as well as whole-brain and ventricular volume. Regional trajectories were also correlated with change in clinical measures of executive function and gait and ocular motor impairment. A linear decline was observed in all frontal and temporal regions, the superior parietal lobe, the thalamus, the caudate nuclei, and the midbrain, as well as in the whole brain. Ventricular expansion was also linear. Nonlinear decline was observed for the caudal middle frontal lobe and globus pallidus. Rates of change in the superior frontal lobe, thalamus, and midbrain were beyond those expected in normal aging. Decline in frontal lobe volume and the midbrain area correlated best to decline in clinical measures. In progressive supranuclear palsy, atrophy is occurring in multiple brain regions, particularly in those that have previously been implicated in the disease. Decline is mainly linear but can be nonlinear for some regions. The frontal lobe and midbrain seem to be playing the most significant roles in the progressive worsening of clinical signs in progressive supranuclear palsy. PMID:23568852
Josephs, Keith A; Xia, Rong; Mandrekar, Jay; Gunter, Jeffrey L; Senjem, Matthew L; Jack, Clifford R; Whitwell, Jennifer L
|Presents the use of six sensorimotor functions (SMF) as a screening test for cerebral palsy in neonates. Functions include sitting in air, self-pulling to sit, self-propelling Katona slide crawl, assisted crawling, and elementary walking. Nine case examples are provided in an appendix. (Author/CR)|
Cerebral palsy is the most common neurodevelopmental motor disability in children. The condition requires medical, educational, social, and rehabilitative resources throughout the life span. Several countries have developed population-based registries that serve the purpose of prospective longitudinal collection of etiologic, demographic, and functional severity. The United States has not created a comprehensive program to develop such a registry. Barriers have been large population size, poor interinstitution collaboration, and decentralized medical and social systems. The Cerebral Palsy Research Registry was created to fill the gap between population and clinical-based cerebral palsy registries and promote research in the field. This is accomplished by connecting persons with cerebral palsy, as well as their families, to a network of regional researchers. This article describes the development of an expandable cerebral palsy research registry, its current status, and the potential it has to affect families and persons with cerebral palsy in the United States and abroad.
Hurley, Donna S.; Sukal-Moulton, Theresa; Msall, Michael E.; Gaebler-Spira, Deborah; Krosschell, Kristin J.; Dewald, Julius P.
Cerebral palsy has been associated with a number of candidate genes. To date, no systematic review has been conducted to synthesise\\u000a genetic polymorphism associations with cerebral palsy. We apply the HuGE NET guidelines to search PubMed and EMBASE databases\\u000a for publications investigating single nucleotide polymorphisms (SNPs) and cerebral palsy outcome. 22 papers were identified\\u000a and are discussed in this review.
M. E. O’Callaghan; A. H. MacLennan; E. A. Haan; G. Dekker
Blankenship LD, Basford JR, Strommen JA, Andersen RJ. Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports. Arch Phys Med Rehabil 2002;83:269-72. Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII)
Lisa D. Blankenship; Jeffrey R. Basford; Jeffrey A. Strommen; Renee J. Andersen
Postoperative C5 palsy is a common complication after cervical spine decompression surgery. However, the incidence, prognosis,\\u000a and etiology of C5 palsy after anterior decompression with spinal fusion (ASF) have not yet been fully established. In the\\u000a present study, we analyzed the clinical and radiological characteristics of patients who developed C5 palsy after ASF for\\u000a cervical degenerative diseases. The cases of
Summary Background The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy. Methods 111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised
Jean-Paul Collet; Michel Vanasse; Pierre Marois; Maxime Amar; Joanne Goldberg; Jean Lambert; Maryse Lassonde; Paule Hardy; Josée Fortin; Stéphane D Tremblay; David Montgomery; Jacques Lacroix; Ann Robinson; Annette Majnemer
Cerebral palsy is the most common disabling condition in childhood, involving a diverse group of movement and posture disorders\\u000a of varying etiologies. Yet, much is unknown about how cerebral palsy affects individual joints because currently applied techniques\\u000a cannot quantify the three-dimensional kinematic parameters at the joint level. We quantified the effects of cerebral palsy\\u000a at the knee using fast phase
Frances T. Sheehan; Andrea R. Seisler; Katharine E. Alter
Osteoarthritis (OA) secondary to dislocation and dysplasia is a common problem in patients with cerebral palsy. The purpose\\u000a of this study was to evaluate the results of total hip replacement (THR) in ambulatory patients with cerebral palsy. Eighteen\\u000a total hip arthroplasties were performed in 16 ambulatory patients with cerebral palsy. The patient's mean age at surgery was\\u000a 42?±?8 years (range 32–58
Kerstin Schroeder; Christian Hauck; Bernd Wiedenhöfer; Frank Braatz; Peter R. Aldinger
OBJECTIVE: Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups. METHODS: In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants. RESULTS: Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19–1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged <18 years) had increased risk of having a child with cerebral palsy. CONCLUSIONS: The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies.
Xing, Guibo; Fuentes-Afflick, Elena; Danielson, Beate; Smith, Lloyd H.; Gilbert, William M.
As primary health care clinicians, chiropractors are increasingly providing the initial assessment of many diverse musculoskeletal conditions. As a consequence, occasionally chiropractors are consulted to assess rare neuromusculoskeletal disorders. A 12-year-old girl was brought in by her mother for a second opinion on the present status of her daughter’s Erb-Duchenne palsy (Erb’s palsy), a diagnosis given at birth. Erb’s palsy
Diaphragmatic palsy after acute stroke is a novel clinical entity and may result in a high incidence of respiratory dysfunction\\u000a and pneumonia, which especially cause greater morbidity and mortality. Generally, internal capsule and complete middle cerebral\\u000a artery (MCA) infarctions are major risk-factors for developing diaphragmatic palsy. Herein, we present a case with contralateral\\u000a diaphragmatic palsy after a subcortical MCA infarction
Cerebral palsy is the most common disabling condition in childhood, involving a diverse group of movement and posture disorders of varying etiologies. Yet, much is unknown about how cerebral palsy affects individual joints because currently applied techniques cannot quantify the three-dimensional kinematic parameters at the joint level. We quantified the effects of cerebral palsy at the knee using fast phase contrast MRI, with the ultimate intent of improving the assessment of joint impairments associated with cerebral palsy, improving clinical outcomes, and reducing the impact of cerebral palsy on function. We addressed three questions: (1) Can patients with cerebral palsy perform the required repetitive extension task? (2) Which of the 12 degrees of freedom defining complete knee kinematics are abnormal in individual patients with cerebral palsy and is the patellar tendon moment arm abnormal in these patients? (3) Are the individual kinematic differences consistent with clinical observations? All patients were able to perform the required task. We found kinematic differences for each patient with cerebral palsy consistent with clinical findings, in comparison to an able-bodied population. Fast phase contrast MRI may allow differentiation of patellofemoral and tibiofemoral function in various functional subtypes of cerebral palsy, providing insights into its management.
Although vertical gaze palsy (VGP) is commonly associated with lesions of the rostral mesencephalon, there is some evidence that VGP may also be caused by a unilateral thalamic lesion. The case of a 68-year-old man with persistent upward gaze palsy after a unilateral thalamic infarction, demonstrated on computed tomography and magnetic resonance imaging scans, is presented. Subsequent high-resolution magnetic resonance scanning, however, showed involvement of the rostral mesencephalon as well. The authors suggest that in previous patients with VGP ascribed to a unilateral thalamic infarction, a coexisting mesencephalic involvement may have been missed because of inappropriate imaging techniques. Strong evidence of unilateral thalamic infarction as a cause of VGP is still lacking. PMID:10870929
We report on a 47-year-old-woman who developed sudden complete loss of vertical saccades, smooth pursuit, and vestibular eye movements bilaterally. MRI revealed a unilateral midbrain infarct involving the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the interstitial nucleus of Cajal (INC) and spared the posterior commissure (PC). The lesion is presumed to have interrupted the pathways involved in vertical gaze just before they decussate, inducing an anatomically unilateral but functionally bilateral lesion. Previous reports of bidirectional vertical gaze palsy have shown lesions involving the PC or both riMLFs. This case is the first to show that a unilateral lesion of the riMLF and the INC that spares the PC may cause complete bidirectional vertical gaze palsy. PMID:16966933
Cerebral palsy is a non-progressive disorder of the developing brain with different etiologies in the pre-, peri- or postnatal period. The most important of these diseases is cystic periventricular leukomalacia (PVL), followed by intra- and periventricular hemorrhage, hypoxic-ischemic encephalopathy, vascular disorders, infections or brain malformations. The underlying cause is always a damage of the first motor neuron. Prevalence of cerebral palsy in Europe is 2-3 per 1000 live births with a broad spectrum in different birth weight groups. Our own data concerning only pre-term infants in the NICU with birth weight below 1500 g (VLBW) are between 10%-20%. Established classical treatment methods include physiotherapy (Bobath, Vojta, Hippotherapy), methods of speech and occupational therapists (Castillo-Morales, Sensory Integration) and other therapeutical concepts (Petö, Affolter, Frostig). PMID:11862678
Introduction Due to the publicity about stem cell transplantation for the treatment of cerebral palsy, many families seek information on treatment, and many travel overseas for cell transplantation. Even so, there is little scientific confirmation of benefit, and therefore existing knowledge in the field must be summarized. Areas covered This paper addresses the clinical protocols examining the problem, types of stem cells available for transplant, experimental models used to test the benefit of the cells, possible mechanisms of action, potential complications of cell treatment, and what is needed in the field to help accelerate cell-based therapies. Expert Opinion While stem cells may be beneficial in acute injuries of the central nervous system, the biology of stem cells is not well enough understood in chronic injuries or disorders such as cerebral palsy. More work is required at the basic level of stem cell biology, in the development of animal models, and finally in well-conceived clinical trials.
Opinion statement Progressive supranuclear palsy (PSP) is an atypical parkinsonian disorder that, in spite of its growing recognition, is still\\u000a underdiagnosed. For management, prognosis, and research, an accurate and early diagnosis is essential. PSP is a relentlessly\\u000a progressive neurodegenerative disorder, clinically characterized by parkinsonism with prominent axial involvement and postural\\u000a instability, bulbar symptoms, supranuclear ophthalmoplegia, and executive dysfunction. Abnormal neuronal and
Choice of surgical option for lagophthalmos correction (use of encircling allotendinous string or fixation of medial aspect of the lower tarsal plate) in patients with chronic facial palsy is proved. This technique was reinforced with dissection of the tendon or superior tarsal muscle resection and lateral canthopexy. The advantages of surgical methods considering clinical aspects (in particular the degree of medial canthal tendon laxity) are shown. PMID:23120921
The School of Medicine at The University of Notre Dame Australia’s Sydney Campus has hosted the annual Cerebral Palsy (CP) Institute’s 3rd conference as part of a growing partnership between the two institutions.\\u000aThe conference was an opportunity for CP researchers from all over the world to disseminate their research findings and to form new collaborations. It also provided a
\\u000a The term cerebral palsy (CP) was originally coined more than a century ago and loosely translated as brain paralysis. A precise\\u000a definition has remained elusive because CP is not a single diagnosis but an umbrella term describing nonprogressive brain\\u000a lesions involving motor and postural abnormalities that are noted during early development . Recently, the executive committee\\u000a for the definition of
Objective: To determine preliminary associations between collected health status variables of women with cerebral palsy (CP) residing in the community.Design: Cross-sectional study using survey research.Participants: Sixty-three women residing in the community were administered the Telephone Questionnaire when contacted to arrange their visit to the study site located within the medical clinic of a local developmental services office. During the course
Margaret A. Turk; Cynthia A. Geremski; Paula F. Rosenbaum; Robert J. Weber
Object: The purpose of this article was to review the published outcomes after selective dorsal rhizotomy (SDR) for treatment of\\u000a spastic cerebral palsy. Methods: A literature search identified all articles related to outcomes after SDR. The outcomes were reviewed according to a paradigm\\u000a developed by the National Center for Medical Rehabilitation Research (NCMRR). The quality of the evidence for each
\\u000a Abstract\\u000a Ophthalmoplegic migraine (OM) is a rare form of primary headache. Because of its rarity, only a few cases, mostly symptomatic,\\u000a are reported. We analyse nine cases among 52 973 adults who suffer from headaches with an oculomotor palsy firstly considered\\u000a as OM. The study was retrospective and multicentric in a database set up in France. The aim of our
Pierric Giraud; Dominique Valade; Michel Lanteri-Minet; Anne Donnet; Gilles Geraud; Evelyne Guégan-Massardier
Developmental dysplasia of the hip (DDH) in cerebral palsy (CP) is very rare, and very little clinical data is available.\\u000a We have analysed the results of open reduction of the hip (Howorth), acetabuloplasty (Salter, Pemberton), pelvic osteotomy\\u000a (Chiari) and femoral osteotomy in the treatment of the DDH in CP patients. Radiographic assessment was based on the Severin\\u000a grading classification system
I. Gavrankapetanovic; G. Cobeljic; Z. Bajin; Z. Vukasinovic; F. Gavrankapetanovic
BROGREN, E., M. HADDERS-ALGRA, H. FORSSBERG. Postural control in sitting children with spastic diplegia. NEUROSCI BIOBEHAV REV 22(4) 591–596, 1998.—Children with cerebral palsy (CP) display postural problems, largely interfering with daily life activities. Clarification of neural mechanisms controlling posture in these children could serve as a base for more successful intervention.Studies on postural adjustments following horizontal forward and backward displacements
CRENNA, P. Spasticity and `spastic' gait in children with cerebral palsy. NEUROSCI BIOBEHAV REV 22(4) 571–578, 1998.—The current notion of spasticity as a velocity-dependent increase of muscle response to imposed stretch was mainly derived from studies performed under stationary experimental conditions. To address the issue of a spastic muscle behaviour under dynamic conditions, we conceived a novel approach, aimed at
Reaching to grasp an object of interest requires complex sensorimotor coordination involving eye, head, hand and trunk. While\\u000a numerous studies have demonstrated deficits in each of these systems individually, little is known about how children with\\u000a cerebral palsy (CP) coordinate multiple motor systems for functional tasks. Here we used kinematics, remote eye tracking and\\u000a a trunk support device to examine
Sandra Saavedra; Aditi Joshi; Marjorie Woollacott; Paul van Donkelaar
Six athetoid cerebral palsy patients participated in the following: speech and motor prebiofeedback training evaluation; frontal EMG biofeedback training, 6 wk; speech and motor postbiofeedback training evaluation, Frontal pretraining levels for the subjects averaged 28.9 µV p-p. Subjects' feedback consisted of an auditory signal(clicks) varying proportionately with frontal EMG activity. A visual meter display of the integrated EMG was also
William W. Finley; Carol Niman; Janet Standley; Patricia Ender
Background: Many studies have shown that certain cytokines in amniotic fluids are correlated to premature labor and neonatal brain insults. Aims: We investigated whether different fetal phagocyte and vascular mediators including IL-8, myeloperoxidase (MPO), PGE2 and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were correlated to prematurity and cerebral palsy (CP) of premature infants. Subjects: Umbilical cord blood samples from
Hsin-Chun Huang; Chih-Lu Wang; Li-Tung Huang; Hau Chuang; Chieh-An Liu; Te-Yao Hsu; Chia-Yo Ou; Kuender D. Yang
Objective Posture induced common peroneal nerve (CPN) palsy is usually produced during the prolonged squatting or habitual leg crossing while seated, especially in Asian culture and is manifested by the onset of foot drop. Because of its similarity to discogenic foot drop, patients may be diagnosed with a lumbar disc disorder, and in some patients, surgeons may perform unnecessary examinations and even spine surgery. The purpose of our study is to establish the clinical characteristics and diagnostic assessment of posture induced CPN palsy. Methods From June 2008 to June 2012, a retrospective study was performed on 26 patients diagnosed with peroneal nerve palsy in neurophysiologic study among patients experiencing foot drop after maintaining a certain posture for a long time. Results The inducing postures were squatting (14 patients), sitting cross-legged (6 patients), lying down (4 patients), walking and driving. The mean prolonged neural injury time was 124.2 minutes. The most common clinical presentation was foot drop and the most affected sensory area was dorsum of the foot with tingling sensation (14 patients), numbness (8 patients), and burning sensation (4 patients). The clinical improvement began after a mean 6 weeks, which is not related to neural injury times. Electrophysiology evaluation was performed after 2 weeks later and showed delayed CPN nerve conduction study (NCS) in 24 patients and deep peroneal nerve in 2 patients. Conclusion We suggest that an awareness of these clinical characteristics and diagnostic assessment methods may help clinicians make a diagnosis of posture induced CPN palsy and preclude unnecessary studies or inappropriate treatment in foot drop patients.
|Aim: The aim of the study was to investigate coordination of fingertip forces during an asymmetrical bimanual task in children with unilateral cerebral palsy (CP). Method: Twelve participants (six males, six females; mean age 14y 4mo, SD 3.3y; range 9-20y;) with unilateral CP (eight right-sided, four left-sided) and 15 age-matched typically…
Islam, Mominul; Gordon, Andrew M.; Skold, Annika; Forssberg, Hans; Eliasson, Ann-Christin
|We describe the cognitive profile in a complete national cohort of children with cerebral palsy (CP). One hundred and twenty-seven Icelandic children (67 females, 60 males) with CP, born between 1985 and 2000 and assessed between the ages of 4 and 6 years 6 months (mean age 5y 5mo, SD 6mo), were included in the study. IQ was measured using the…
The incidence of dysphonia in healthy elderly people is high. In individuals with iatrogenic vocal-fold paresis following thyroid surgery, serious aggravation of vocal skills contributes to impaired quality of life and requires proper management. Electroglottography is a common method for providing noninvasive measurements of glottal activity, yielding reliable indicators of glottal closing instants. The purpose of the study was to determine how electroglottography measures change with voice recovery in elderly speakers with vocal-fold palsy, compared with healthy elderly individuals, and which coefficient best represents dysphonia. An electroglottograph with Speech Studio 1.04 software was used to record and analyze the data. Electroglottography data were collected from 12 patients aged 65-78 years (mean=71.3, S.D.=3.8, median=71) and 10 healthy speakers aged 65-77 years (mean=70.9, S.D.=3.9, median=72). The findings show that the distribution of values of % irregularity differs between the groups of patients and controls. % Irregularity and closing quotient significantly correlate with the perceptual degree of dysphonia. Electroglottography can objectify dysphonia in elderly patients with vocal-fold palsy and is a suitable noninvasive tool for tracking the elderly patients' long-term progress. % Irregularity best represents the vocal-fold dysfunction in elderly patients with a vocal-fold palsy. PMID:18504110
OBJECTIVES—To investigate the effects of injection of botulinum toxin type A (BTX A) into the orbicularis oculi muscle and lacrimal gland in patients with aberrant regeneration after facial palsy (facial synkinesias and hyperlacrimation).?METHODS—The effect of the toxin injection (on average 75 mouse units of BTX A) into the orbicularis oculi muscle on facial synkinesias was assessed on a five point (0 to 4) scale in 10 patients with aberrant regeneration of facial nerve fibres after a peripheral facial nerve palsy. Six patients underwent a videographic control, which was assessed by a blinded independent investigator. In two patients with hyperlacrimation an extra dose of botulinum toxin (on average 20 mouse units BTX A) was injected into the lacrimal gland and the effect was assessed using the Schirmer test and on a three point scale.?RESULTS—Botulinum toxin type A had a good to excellent (grades 3 and 4) effect over an average of six months after 91% of injections. In 9% the injections had a moderate (grade 2) effect. Patients with hyperlacrimation showed a nearly complete recovery. There were no systemic side effects but focal side effects due to a temporary weakness of the orbicularis oculi muscle were not uncommon.?CONCLUSIONS—Botulinum toxin type A is the treatment of choice in motor and autonomic effects of aberrant regeneration of facial nerve after a peripheral palsy. The required dose is similar to or slightly lower than the dose usually recommended for hemifacial spasm. ??
Boroojerdi, B; Ferbert, A; Schwarz, M; Herath, H; Noth, J
OBJECTIVES To assess the food intake pattern and the nutritional status of children with cerebral palsy. METHODS Cross-sectional study with 90 children from two to 12.8 years with cerebral palsy in the following forms: hemiplegia, diplegia, and tetraplegia. Nutritional status was assessed by weight, height, and age data. Food intake was verified by the 24-hour recall and food frequency questionnaire. The ability to chew and/or swallowing, intestinal habits, and physical activity were also evaluated. RESULTS For 2-3 year-old age group, the mean energy intake followed the recommended range; in 4-6 year-old age group with hemiplegia and tetraplegia, energy intake was below the recommended limits. All children presented low intake of carbohydrates, adequate intake of proteins and high intake of lipids. The tetraplegia group had a higher prevalence of chewing (41%) and swallowing (12.8%) difficulties compared to 14.5 and 6.6% of children with hemiplegia, respectively. Most children of all groups had a daily intestinal habit. All children presented mild physical activity, while moderate activity was not practiced by any child of the tetraplegia group, which had a significantly lower height/age Z score than those with hemiplegia (-2.14 versus -1.05; p=0.003). CONCLUSIONS The children with cerebral palsy presented inadequate dietary pattern and impaired nutritional status, with special compromise of height. Tetraplegia imposes difficulties regarding chewing/swallowing and moderate physical activity practice. PMID:24142317
Lopes, Patrícia Ayrosa C; Amancio, Olga Maria S; Araújo, Roberta Faria C; Vitalle, Maria Sylvia de S; Braga, Josefina Aparecida P
|Objectives: To describe psychological symptoms in 8-12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. Design: A cross-sectional multi-centre survey. Participants: Eight hundred and eighteen children with cerebral palsy, aged 8-12 years, identified from population-based…
The majority of children with cerebral palsy in developing countries have no access to trained therapists; for example, in Pakistan, there is less than one trained general physiotherapist per million population. In Pakistan, cerebral palsy handling skills were taught to a group of parents, teachers, and paraprofessionals in a series of practical…
|The main goal of the present study was to characterise the pragmatic abilities of French children with cerebral palsy through their understanding of irony and other people's mental states. We predicted that children with cerebral palsy would have difficulty understanding false-belief and ironic remarks, due to the executive dysfunction that…
BACKGROUND: Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may
Kristie L Bell; Roslyn N Boyd; Sean M Tweedy; Kelly A Weir; Richard D Stevenson; Peter SW Davies
OBJECTIVES: To examine the relation between cognitive dysfunction and pseudobulbar features in patients with amyotrophic lateral sclerosis (ALS). METHODS: The performance of two patient groups, ALS with pseudobulbar palsy (n = 24) and ALS without pseudobulbar palsy (n = 28), was compared with 28 healthy age matched controls on an extensive neuropsychological battery. Tests used were the national adult reading
S Abrahams; L H Goldstein; A Al-Chalabi; A Pickering; R G Morris; R E Passingham; D J Brooks; P N Leigh
A systematic review of the literature on horseback riding therapy as an intervention for children with cerebral palsy (CP) was carried out. The terms horse, riding, hippotherapy, horseback riding therapy, equine movement therapy, and cerebral palsy were searched in electronic databases and hand searched. Retrieved articles were rated for methodological quality using PEDro scoring to assess the internal
Laurie Snider; Nicol Korner-Bitensky; Catherine Kammann; Sarah Warner; Maysoun Saleh
Summary We report the outcome of endovascular treatment in a series of patients presenting with posterior communicating artery aneurysm causing ocular motor nerve palsy. A retrospective study was made of ten patients who were treated by coil embolization of posterior communicating artery aneurysm caused by oculomotor nerve palsy. The assessed parameters were as follows: patient’s age, presence of subarachnoid hemorrhage, aneurysm size, preoperative severity of symptoms, and timing of treatment after onset of symptoms. Improvement of oculomotor nerve palsy after treatment was noted in eight patients (80.0%). Complete recovery was noted in seven patients (70.0%), partial recovery in one patient (10.0%), and no recovery in two patients (20%). Clinical presentations with early management (?2 days) were significant in influencing recovery. Complete recovery from ocular motor nerve palsy was significantly higher in patients with initial incomplete palsy compared with initial complete palsy patients (6/6 versus 1/4). Early treatment and initial partial palsy are relevant to improving prognoses. Endovascular treatment is favored method for treating oculomotor palsy.
Objective: To examine prevalence and localization of musculo-skeletal pain in adults with cerebral palsy com- pared with the general population and to investigate variables potentially associated with pain. Design: A postal survey. Subjects: Persons with cerebral palsy and no intellectual disabilities, 18 years or more, living in Norway. Methods: A multidimensional questionnaire, including items on musculo-skeletal pain, was sent to
Reidun Jahnsen; Lisbeth Villien; Geir Aamodt; Johan K Stanghelle; Inger Holm
Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle…
Maruishi M, Mano Y, Sasaki T, Shinmyo N, Sato H, Ogawa T. Cerebral palsy in adults: independent effects of muscle strength and muscle tone. Arch Phys Med Rehabil 2001;82:637-41. Objective: To investigate clinical characteristics and their contribution to activities of daily living (ADLs) in adults with cerebral palsy (CP). Design: Descriptions of the clinical features of medical disorders; survey. Setting:
In clinical medicine there may be times when clinical conditions manifest differently both when they present individually or concomitantly. Such scenarios warrant a broader differential diagnosis with thorough investigations. We present one such case of a patient of Bell's palsy with unexplained eye pain on the ipsilateral side. The patient had a chronic retinal detachment which became worse due to the concomitant Bell's palsy.
Loss and grief is a universal human experience, yet little is known about how older adults with a lifelong disability, such as cerebral palsy, and complex communication needs (CCN) experience loss and manage the grieving process. In-depth interviews were conducted with 20 Australian participants with cerebral palsy and CCN to determine the types…
OBJECTIVES/HYPOTHESIS: To study reports of abducens nerve palsy following dural puncture procedures and to discuss possible etiologic theories, treatment, and prognosis. STUDY DESIGN: Systematic review of peer-reviewed literature. METHODS: A systematic literature review was conducted (PubMed, 1950 to September 2011) for cases of sixth cranial nerve palsy following dural puncture procedures. RESULTS: We report a case of abducens nerve palsy following lumbar drain placement for endoscopic trans-sphenoidal pituitary macroadenoma resection. Sixth nerve palsy was noted immediately after surgery. Postoperative computed tomography and magnetic resonance imaging revealed no injury to the nerve or surrounding structures. A systematic literature review conducted for cases of abducens nerve palsy following dural puncture procedures found 22 studies (17 case reports and five case series). Twenty-eight patients with temporary or permanent abducens nerve palsy were reported. Procedures included diagnostic lumbar puncture, spinal anesthesia, intrathecal catheterization, and shunting. Traction and local ischemia due to intracranial hypotension at the petroclival junction were proposed as causes of palsy. CONCLUSIONS: Lumbar puncture procedures carry a rare risk of abducens nerve palsy from ischemic or traction injury. Routine use of lumbar drain during endoscopic skull base surgery is not without risk, and need for its placement should be carefully determined. Knowledge of such rare complications is helpful in risk-benefit analysis as endoscopic skull base techniques gain popularity. LEVEL OF EVIDENCE: 4. Laryngoscope, 2013. PMID:23670572
Cain, Rachel B; Patel, Naresh P; Hoxworth, Joseph M; Lal, Devyani
The use of neuromuscular electrical stimulation (NMES) is an emerging modality for the treatment of children with cerebral palsy. Early evidence has demonstrated improvements in strength, range of motion and motor control, with the use of NMES. Well designed prospective clinical trials will be needed to determine the role of NMES in the treatment of children with cerebral palsy
Objective: To assess the effect of intrathecal baclofen on spastic dysarthia in cerebral palsy.Design: Single case study.Methods: Functional outcome measures, including the Assessment of Intelligibility of Dysarthric Speech, were performed before and after a trial of intrathecal baclofen in an adult patient with spastic dysarthria due to cerebral palsy. The patient proceeded to intrathecal baclofen pump implantation and was reassessed
S M Leary; P Gilpin; L Lockley; L Rodriguez; L Jarrett; V L Stevenson
Many young children with cerebral palsy have motor impairments that affect their ability to sit and do activities unsupported. They often rely on special adaptive seating devices for postural control and stability. Healthcare practitioners generally accept that these products improve functioning in children with cerebral palsy. However, little empirical proof exists. The objective of this thesis is to propose a
BACKGROUND: The use of thickeners is a standard therapy for decreasing episodes of regurgitation or vomiting in infants. However, it remains to be investigated whether thickener is effective for vomiting and\\/or chronic respiratory symptoms in children with cerebral palsy. METHODS: We enrolled 18 neurologically impaired children caused by cerebral palsy, with gastroesophageal reflux disease. In the first part of this
The authors of this study used a phenomenological method to examine how the caregiving experiences of Taiwanese women who took care of a sibling with cerebral palsy influenced their life decisions. In-depth qualitative interviews were conducted with six adult women, each of whom self–identified as being the sister most involved in caring for a sibling with cerebral palsy. Themes emerging
We would like to thank Babara Godwin and Kay Xu for their help in translating this article. Cerebral palsy is one of the major conditions that cause severe disability in children and constitutes a relatively large percentage of disabled children. The definition of cerebral palsy is non-progressive brain damage that occurs for various reasons in the period from pregnancy through
Children with cerebral palsy who receive selective dorsal rhizotomy (SDR) for treatment of spasticity may show suprasegmental changes in upper limb function and control of speech musculature. Anecdotal reports suggest that suprasegmental effects may extend to cognitive functions such as attention and language. This study examined the performance of 16 children with spastic diplegic cerebral palsy on tests of visual
Suzanne Crafts; T. S. Park; Desiree A. White; Jeffrey Schatz; Michael Noetzel; Susan Arnold
Murphy NA, Nicole Irwin MC, Hoff C. Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil 2002;83:1721-5. Objectives: To describe the efficacy of intrathecal baclofen (ITB) therapy in the management of spasticity in young children with cerebral palsy (CP) and to identify risk factors for complications. Design: Consecutive case series of 25 implanted ITB
Nancy A. Murphy; Melanie C. Nicole Irwin; Charles Hoff
BACKGROUND.Spasticity is a prevalent disabling clinical symptom for children with cerebral palsy. Treatment of spasticity with botulinum toxin in children with cerebral palsy was first reported in 1993. Botulinum toxin provides a focal, controlled muscle weakness with reduction in spasticity. Interpretation of the literature is difficult because of the paucity of reliable measures of spasticity and challenges with measuring meaningful
Kristie Bjornson; Ross Hays; Cathy Graubert; Robert Price; Francine Won; John F. McLaughlin; Morty Cohen
Objective: To identify the stress experienced by mothers of young children with cerebral palsy in Bangla- desh and to determine predictive factors. Methods: We recruited 91 mothers of children with cerebral palsy ages 1.5 to 5 years as they sought ser- vices at an urban and a rural center for their children. Mothers were interviewed with the Self-Report Ques- tionnaire
Reaz Mobarak; Naila Z. Khan; Shirin Munir; Sultana S. Zaman; Helen McConachie
Cerebral palsy is a non-progressive neurological disorder caused by disturbances to the developing brain. Physical and occupational therapy, if started at a young age, can help minimizing complications such as joint contractures, and can improve limb range of motion and coordination. While current forms of therapy for children with cerebral palsy are effective in minimizing symptoms, many children find them
Alan Dunne; Son Do-Lenh; G. O. Laighin; Chia Shen; P. Bonato
Cerebral palsy (CP) has an incidence of approximately 1 in 750 births, although this varies between ethnic groups. Genetic forms of the disease account for about 2% of cases in most countries, but contribute a larger proportion in certain sub-types of the condition and in populations with a large proportion of consanguineous marriages. Ataxic cerebral palsy accounts for 5–10% of
DP McHale; AP Jackson; DA Campbell; MI Levene; P Corry; CG Woods; NJ Lench; RF Mueller; AF Markham
Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It…
|Some children with cerebral palsy have articulation disorders that are resistant to conventional speech therapy. The aim of this study was to investigate whether the visual feedback method of electropalatography (EPG) could be an effective tool for treating five children (mean age of 9.4 years) with dysarthria and cerebral palsy and to explore…
|Children with cerebral palsy often have speech, language and communication difficulties that affect their access to social and educational activities. Speech and language therapy to improve the intelligibility of the speech of children with cerebral palsy has long been advocated, but there is a dearth of research investigating therapy…
|Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle…
Surgical treatment of equines deformity in cerebral palsy can be carried out successfully by Achilles tendon lengthening and gastrocnemius aponeurosis lengthening. From 1993 to 1998, we performed 59 operations in 37 cerebral palsied patients with equinus deformity using Z-lengthening in 30 cases and a modified Baker’s procedure in 29 cases. The operations, associated with other hip and knee procedures in
The aim of this study was to explore the experiences of patients with cerebral palsy and complex communication needs (CCN) in hospital. Ten adults with cerebral palsy and CCN participated in semistructured interviews about their recent hospital experiences. Along with identifying barriers to successful communication, the participants suggested strategies to improve the hospital communication experience. The findings are discussed in
Susan Balandin; Bronwyn Hemsley; Jeff Sigafoos; Vanessa Green
|Loss and grief is a universal human experience, yet little is known about how older adults with a lifelong disability, such as cerebral palsy, and complex communication needs (CCN) experience loss and manage the grieving process. In-depth interviews were conducted with 20 Australian participants with cerebral palsy and CCN to determine the types…
Progressive supranuclear palsy (PSP) is a relatively common neurodegenerative tauopathy clinically characterized by parkinsonism, axial rigidity, and supranuclear gaze palsy. Pathologic findings of PSP are neuronal loss, gliosis, and neurofibrillary tangles in basal ganglia, diencephalon, and brainstem; there is increasing recognition of clinicopathologic variants of PSP.(1.) PMID:23635960
Fujioka, Shinsuke; Algom, Avi A; Murray, Melissa E; Strongosky, Audrey; Soto-Ortolaza, Alexandra I; Rademakers, Rosa; Ross, Owen A; Wszolek, Zbigniew K; Dickson, Dennis W
We experienced four cases of vertical gaze palsy induced by midbrain lesions. Lesions commonly covered the rostral midbrain, including the rostral interstitial nucleus, dorsomedial to the red nucleus. Two of the four cases resulted from vascular insult, in which a single, unpaired perforator is supposed to innervate the rostral midbrain and medial thalamus bilaterally. One case showed vertical gaze palsy
|Based on the concept of iconicity, the iconicity hypothesis was emphasized for decades. The aims of this study were to explore the effect of translucency on transparency and symbol learning for children with and without cerebral palsy. Twenty children with cerebral palsy and forty typical peers participated in the study. Ten symbols with high…
|This case report describes the use of treadmill training without body weight support to improve walking speed in a child with diplegic cerebral palsy. The child was a six-year-old girl with spastic diplegic cerebral palsy. She walked short distances independently using a posterior support walker but was unable to keep up with her peers walking…
|This study explored how children with cerebral palsy describe competent performance in everyday activities and sought to better understand the processes by which the children developed competence. Five children with cerebral palsy aged six to 17 years participated in a three-step procedure that included two observations, one semi-structured…
|The purpose of this study was to investigate the effect of frequency of knowledge of results (KR) on the learning of dart in individuals with cerebral palsy type I. Twenty-four individuals with cerebral palsy (CP) between the ages of 5 and 17 were chosen for this study. They were put into 3 homogenous groups according to their records after 20…
|Background: Changes in the swallowing capabilities of adults with cerebral palsy as they age may impact on their health, safety, and well-being. Method: Thirty-two adults with cerebral palsy aged between 30 and 69 years participated in in-depth interviews about their experiences of changes in their swallowing and related management of their…
Balandin, Susan; Hemsley, Bronwyn; Hanley, Leah; Sheppard, Justine Joan
|Background: Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. Methods: Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n = 41) and mainstream education (n = 16) and…
Jenks, Kathleen M.; de Moor, Jan; van Lieshout, Ernest C. D. M.
|Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It…
|The Cerebral Palsy Quality of Life for Children (CP QOL-Child) is the first health condition-specific questionnaire designed for measuring QOL in children with cerebral palsy (CP). However, its construct validity has not yet been confirmed by confirmatory factor analysis (CFA). Hence, this study assessed the construct validity of the caregiver…
Neuromuscular electrical stimulation (NMES) applied to the triceps surae muscle is claimed to be effective in improving gait in children with cerebral palsy. The main aim of this study was to determine the effect of NMES on the triceps surae muscle in improving the gait and function of children with cerebral palsy. Twelve children with spastic diplegia or hemiplegia were
In a controlled trial of the effects of intramuscular corticotrophin and oral prednisolone in the treatment of acute Bell's palsy 186 successive patients with idiopathic facial palsy were grouped for age and duration of palsy. They were then allocated at random to either corticotrophin or prednisolone therapy in pairs. The results were: (1) 94 received corticotrophin and 32 developed some degree of denervation and 92 received prednisolone and 13 developed some degree of denervation (P <0·005); (2) six of the corticotrophin group became severely denervated (less than 50% recovery) compared with none of the prednisolone group (P <0·02); (3) the best results were obtained in the younger patients (less than 45 years old) treated on the first or second day of palsy; and (4) side effects were minimal. It is concluded that oral prednisolone is the treatment of choice for idiopathic facial (Bell's) palsy.
A 6-year review of complications of mastoid surgery between June 1995 and June 2001 revealed five cases with serious iatrogenic complications from mastoid surgery, of which four were facial nerve palsy and two were labyrinthine fistula. One of these patients had concomitant facial nerve palsy and labyrinthine fistula. There were two cases of complete facial nerve palsy (House Brackmann grade VI) and two cases of incomplete palsy (House Brackmann grades IV and V). The second genu was the site of injury in three of the four cases. Of the four cases with facial nerve palsy, two patients had full recovery (House Brackmann grade I), one recovered only to House Brackmann grade III, and one was lost to follow-up. Both patients with labyrinthine fistula had postoperative vertigo and profound sensorineural hearing loss. The site of iatrogenic fenestration was the lateral semicircular canal in both cases. PMID:15564156
Background Evaluating the integrity of white matter tracts with diffusion tensor imaging may differentiate primary lateral sclerosis from progressive supranuclear palsy. Methods Thirty-three prospectively recruited subjects had standardized evaluations and diffusion tensor imaging: 3 with primary lateral sclerosis who presented with features suggestive of progressive supranuclear palsy, 10 with probable or definite progressive supranuclear palsy, and 20 matched controls. We compared fractional anisotropy of the corticospinal tract, superior cerebellar peduncle and body of the corpus callosum between groups. Results Both the primary lateral sclerosis and progressive supranuclear palsy subjects showed reduced fractional anisotropy in superior cerebellar peduncles and body of the corpus callosum compared to controls, but only primary lateral sclerosis subjects showed reductions in the corticospinal tracts. A ratio of corticospinal tract/superior cerebellar peduncle best distinguished the disorders (p<0.02). Conclusions The corticospinal tract/superior cerebellar peduncle ratio is a marker to differentiate primary lateral sclerosis from progressive supranuclear palsy.
Coon, Elizabeth A.; Whitwell, Jennifer L.; Jack, Clifford R.; Josephs, Keith A.
Postoperative C5 palsy is a common complication after cervical spine decompression surgery. However, the incidence, prognosis, and etiology of C5 palsy after anterior decompression with spinal fusion (ASF) have not yet been fully established. In the present study, we analyzed the clinical and radiological characteristics of patients who developed C5 palsy after ASF for cervical degenerative diseases. The cases of 199 consecutive patients who underwent ASF were analyzed to clarify the incidence of postoperative C5 palsy. We also evaluated the onset and prognosis of C5 palsy. The presence of high signal changes (HSCs) in the spinal cord was analyzed using T2-weighted magnetic resonance images. C5 palsy occurred in 17 patients (8.5%), and in 15 of them, the palsy developed after ASF of 3 or more levels. Among ten patients who had a manual muscle test (MMT) grade ?2 at the onset, five patients showed incomplete or no recovery. Sixteen of the 17 C5 palsy patients presented neck and shoulder pain prior to the onset of muscle weakness. In the ten patients with a MMT grade ?2 at the onset, nine patients showed HSCs at the C3–C4 and C4–C5 levels. The present findings demonstrate that, in most patients with severe C5 palsy after ASF, pre-existing asymptomatic damage of the anterior horn cells at C3–C4 and C4–C5 levels may participate in the development of motor weakness in combination with the nerve root lesions that occur subsequent to ASF. Thus, when patients with spinal cord lesions at C3–C4 and C4–C5 levels undergo multilevel ASF, we should be alert to the possible occurrence of postoperative C5 palsy.
Cerebral palsy (CP) affects 2/1 000 live-born children. There are several antenatal factors, including preterm delivery, low birth weight, infection/inflammation, multiple gestations, and other pregnancy complications, that have been associated with CP in both the preterm and term infant, with birth asphyxia playing a minor role. Due to the increasing survival of the very preterm and very low birth weight infant secondary to improvements in neonatal and obstetric care, the incidence of CP may be increasing. The topics of neonatal encephalopathy and CP, as well as hypoxic-ischemic encephalopathy, are of vital importance to anyone who ventures to deliver infants. Criteria sufficient to define an acute intrapartum hypoxic event as sufficient to cause CP have been advanced previously by both the American College of Obstetricians and Gynecologists and the International Cerebral Palsy Task Force. This review will cover the progression toward defining the pathogenesis and pathophysiology of cerebral palsy. Four essential criteria were advanced as prerequisites if one is to propose that an intrapartum hypoxic-ischemic insult has caused a moderate to severe neonatal encephalopathy that subsequently results in CP. Importantly, all four criteria must be met: 1) evidence of metabolic acidosis (pH <7.0 and base deficit of 12 mmol/L or more); 2) early onset of severe or moderate neonatal encephalopathy in infants born at 34 or more weeks' gestation; 3) CP of the spastic quadriplegic or dyskinetic type, and 4) exclusion of other identifiable etiologies, such as trauma, coagulation disorders, infectious conditions, or genetic disorders. Other criteria that together suggest intrapartum timing are also discussed. The focus of this paper is to explore antenatal antecedents as etiologies of CP and the impact of obstetric care on the prevention of CP. PMID:19749673
Purpose: To examine the employment status and determinants of employability for adults with cerebral palsy (CP) in Taiwan. Method: A cross-sectional survey was conducted. Participants were recruited from five main branches of the Cerebral Palsy Association. Two hundred and seventy-nine persons over the age of 18 (M = 26.4, SD = 7.7) with a diagnosis of cerebral palsy participated in the current study. Results: Sixty-four of the 279 participants were employed with an employment rate of 22.9%. Of the 64 employed individuals, 67% worked in an integrated setting, 14% in supported employment, and 19% in sheltered employment. Hierarchical logistic regression analyses indicated that having an older age (odds ratio [OR] = 1.05; 95% confidence intervals [CI]: 1.01-1.10), a diagnosis of ataxia (OR = 3.44; 95% CI: 1.29-9.13), a higher educational attainment (OR = 1.86; 95% CI: 1.09-3.18), a higher mobility function in the community (OR = 1.48; 95% CI: 1.04-2.10), and a higher level of independence in daily activities (OR = 1.60; 95% CI: 1.23-2.09) were associated with an increased odds for employment. Conclusions: The employment rate for adults with CP in Taiwan is low. Age, CP diagnosis, educational attainment, and functional performance are important determinants related to employment outcomes for this group. Further research to validate effective medical and vocational rehabilitation interventions to improve the employability of people with CP in Taiwan is warranted. [Box: see text]. PMID:22691128
Several visual assessment methods have been proposed for evaluating facial nerve function. They are of value clinically, but they have drawbacks when objective, quantitative, and reproducible assessment is required. To solve these problems, we used moire topography, which helps visualize information in three dimensions. We previously reported that one could evaluate the severity of facial palsy by observing characteristic patterns of the moire strips produced by facial movement. Accordingly, we developed a new form of the dynamic evaluation by recording the dynamic changes in moire strip patterns on the face on a videotape.
Unilateral and bilateral facial palsies are debilitating and depressing conditions for the patient. For the past 30 years attempts have been made to improve the reanimation of these patients. The ability to transfer axons over significant distances with nerve grafts and the transfer of muscle that can be revascularised by microvascular surgery greatly improves results of this surgery. The revascularisation of muscle has been the important step forward but the re-focusing of interest in this condition has brought about a number of peripheral advances.
Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis. PMID:20616921
Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis.
A 67-year-old patient, who had previously undergone Lucite ball plombage for pulmonary tuberculosis, presented with a hoarse voice, intermittent stridor and breathlessness. Direct laryngoscopy confirmed a left vocal fold palsy. A left supraclavicular mass became apparent and a computerized tomograph (CT) scan showed that a Lucite ball had migrated into her supraclavicular fossa. Subsequently she developed left arm pain and weakness. The balls were removed surgically, following which her arm symptoms improved but her voice remained unchanged. Migration of implanted material should be considered when new symptoms appear in patients who have undergone plombage treatment. PMID:15829068
Barnett, G C; Smith, I E; Wells, F C; Shneerson, J M
Objective The purpose of this report is to review the historical development, current operative techniques, selection criteria, outcomes,\\u000a and complications of selective dorsal rhizotomy (SDR) for treatment of spastic cerebral palsy (CP).\\u000a \\u000a \\u000a \\u000a Materials and methods This review is based on a review of literature and personal observations.\\u000a \\u000a \\u000a \\u000a Results SDR has evolved from the 1960s onwards into a standard neurosurgical procedure for spastic CP.
Background Children with cerebral palsy (CP) often walk with a slower speed and a higher energy cost. Their walking performance and choice\\u000a of mobility method may vary in different environments. Independent mobility is important for activity and participation.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We described walking performance at different distances and environments in relation to gross motor function, CP subtype,\\u000a and age.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods We performed
We performed a retrospective review of all hemiplegic and diplegic cerebral palsy (CP) patients who had tendo-Achillis lengthening by open Z-plasty between 1974 and 1985. Fifty-seven patients with 77 heelcord lengthening were followed approximately 10 years. Our postoperative regimen did not routinely include bracing and physiotherapy, but our recurrence rates of 18 and 41% for diplegic and hemiplegic patients, respectively, are comparable to those reported in the literature. Children aged > or = 6 years at initial operation did not have recurrence. Diplegic patients who were operated on before age 4 years or patients who had longitudinal incisions had statistically significantly higher recurrence rates. PMID:8459008
Rattey, T E; Leahey, L; Hyndman, J; Brown, D C; Gross, M
We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence.
Cranial palsies are a very rare feature of SLE. Similarly, peripheral sensory-motor axonal neuropathy is very uncommon in SLE. The combination of the two as the presenting symptoms of SLE is a diagnostic challenge particularly in an elderly male patient with a known diagnosis of sarcoidosis. This case serves to highlight the diagnostic considerations in such a patient. The lack of response to standard therapy and the presence of subtle clues like anemia, proteinuria, and mild serositis should prompt the physician to look for alternate diagnoses. The potential association of SLE and sarcoidosis is also discussed. SLE can be present in elderly male patients with cranial and peripheral neuropathy.
Aslam, Fawad; Bannout, Firas; Russell, Elizabeth B.
Lemierre syndrome is characterized by pharyngotonsillitis that is typically secondary to Fusobacterium necrophorum infection and causes adjacent septic thrombophlebitis and thrombosis with subsequent metastatic abscesses. A 3-year-old boy presented with fever, tonsillar enlargement, and bilateral otomastoiditis with purulent discharge. Physical examination revealed abducens nerve palsy on the left side, with a compensatory left head turn. Otomastoid discharge culture was positive for anaerobic F. necrophorum. Magnetic resonance venography of the head and neck revealed thromboses in left internal jugular vein, left cavernous sinus, left superior ophthalmic vein, and left sigmoid sinus. The patient was treated with anticoagulation and a 10-week course of intravenous antibiotics, including ceftriaxone and metronidazole. PMID:22153405
Bababeygy, Simon R; Almarzouki, Hashem; Buffenn, Angela N
The concentrations of somatostatin and choline acetyl transferase (CAT) were measured in nine brains from patients with progressive supranuclear palsy (PSP) and compared with those obtained from 19 matched control brains. In PSP, CAT activity was reduced in the caudate nucleus and limbic areas (amygdala, hippocampus and cingulate cortex) but was not different from controls in neocortical areas (frontal and temporal). Somatostatin concentrations were not different from controls in any region tested. In contrast to Alzheimer's disease and Parkinson's disease, intellectual deterioration in PSP is not associated with a deficit in neocortical somatostatin and CAT levels.
This cross-sectional study aimed at investigating the prevalence and the etiological factors of cerebral palsy (CP) and comparing them with normal population within the rural and urban areas of Duzce province. Of the 102 children with cerebral palsy, 98 were associated with antenatal and delivery risk factors. The mean crude prevalence of cerebral palsy was 1.1 per 1000 live births. The children with CP were compared with 530 control subjects. The mothers of the children with cerebral palsy were significantly younger than the mothers of children in control group, and they had less parity and abortion. Preeclampsia, premature rupture of membranes, home births, prolonged labor, and twin pregnancies were significantly more common in the mothers of children with cerebral palsy, where no significant differences were found between the groups in terms of breech delivery, rate of cesarean births, gestational diabetes, and hemorrhage in late pregnancy. Birth asphyxia, liqueur with meconium stained, prolonged jaundice and neonatal seizure were also significantly more common in the group with cerebral palsy. Of the children with cerebral palsy, 78% were born at term, 20% were born with gestational ages of 32-36 weeks, 2% were born with gestational ages of 30-31 weeks. Nine percent of those children had a birth weight of >or= 3000 g, 12.2% had a birth weight of 2500-2999 g, 33.7% had a birth weight of 1500-2499 g, and 5.1% had a birth weight of palsy were due to insufficient neonatal care, resulting in low survival in preterm and low birth weight children, and poor postnatal care of children with cerebral palsy. PMID:16824718
Oztürk, A; Demirci, F; Yavuz, T; Yildiz, S; De?irmenci, Y; Dö?o?lu, M; Av?ar, Y
Research on nutrition and cerebral palsy (CP) has been directed at newborns and young children, leaving practitioners with a limited understanding of the nutritional status of the adult population. The purpose of this study was to determine the anthropometric profile and nutrient intakes of 86 adults with cerebral palsy. When compared with growth standards for healthy individuals, the mean body fat percentages and body mass indexes of both men and women with CP were within the normal range. However, 40% of the sample had heights below the 5th percentile for their age and gender, indicating permanent growth stunting. In general, the diets of these individuals were similar to the typical American diet. Both men and women had low nutrient adequacy ratios (NARs) for calcium (0.86 and 0.76, respectively); the women also had low NARs for iron (0.69) and niacin (0.86). Although nutrients obtained from supplements were not included in the NAR score, 26% of the men and 50% of the women reported using nutritional supplements. Fifty-five percent of the sample reported feeding problems. Multivariate analysis illustrated that individuals who participated in regular exercise programs had significantly higher mean adequacy ratios and lower body fat percentages than those who did not exercise regularly. PMID:1512365
Incomplete recovery of peroneal palsy, after a sealbite during swimming has not been reported. A 58-year-old woman was bitten into the right knee by a seal during swimming, resulting in incomplete division of the right profound branch of the peroneal nerve and complete division of the superficial branch of the peroneal nerve. Initial drop-foot, absent foot eversion, and hypaesthesia of the lateral lower leg were followed by almost complete clinical recovery of motor functions within four month by spontaneous re-innervation from the proximal nerve stump, despite severely abnormal electrophysiological findings. Re-evaluation 6 years after the accident revealed only discrete weakness for foot and toe extension, slight distal hypaesthesia, but still increased distal latency, reduced compound muscle action potential, slowed nerve conduction velocity of the right peroneal nerve, and neurogenic electromyography of the right anterior tibial and long peroneal muscles. Nerve conduction studies were hampered by co-innervation of the extensor digitorum brevis muscles by the tibial nerves. This case shows that peroneal palsy from a sealbite may recover spontaneously almost completely, but may go along with residual, subclinical, electrophysiological abnormalities. The later may be enhanced by innervation variants. PMID:18446579
Facial nerve oedema and anatomical predisposition to compression within the fallopian tube seem to be the only generally accepted facts in the pathophysiology of Bell's palsy. Several infectious causes have been suggested as possible triggers of this oedema. Most of the suggested pathogens have been associated with facial nerve lesions during latent infections, reinfections or endogenous reactivations. The aim of this study was to investigate the seroprevalence of three such pathogens Toxoplasma gondii, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in a population of patients with facial nerve palsy. Fifty-six patients with Bell's palsy were included in the study. A group of 25 individuals with similar age and gender distribution was used as control. Seropositivity for T. gondii, EBV viral capsid antigen (VCA) and CMV-specific IgM and IgG antibodies was investigated 2-5 days after the onset of the palsy. Comparisons for both IgM and IgG antibodies against T. gondii attributed significantly higher seroprevalence in the patients' group than in the control group (p = 0.024 and 0.013, respectively). The respective examinations for EBV and CMV attributed no significant results. The roles of EBV and CMV in the pathogenesis of Bell's palsy were not confirmed by this study. However, a significantly higher seroprevalence of IgM- and IgG-specific T. gondii antibodies was detected in patients with Bell's palsy when compared to healthy controls. The possibility that facial nerve palsy might be a late complication of acquired toxoplasmosis may need to be addressed in further studies. PMID:21305313
Riga, Maria; Kefalidis, G; Chatzimoschou, A; Tripsianis, G; Kartali, S; Gouveris, H; Katotomichelakis, M; Danielides, V
Uni- or bilateral radial nerve palsy in newborn is a rare symptom. We report about a case of unusual bilateral radial nerve palsy in a term-born girl who recovered completely after 10 months and review the English-speaking literature about this condition. Review of the literature shows less than 60 reported cases of radial nerve palsy, most of them unilateral. Conclusion: Besides the clinical examination, in most cases, no further diagnostic investigation is necessary. An incomplete restitution is rare as recovery mostly occurs within 3-6 months. PMID:23686513
Physical inactivity in youth with cerebral palsy (CP) places them at increased risk of developing cardiovascular disease. The current study assessed indices of arterial health in adolescents with CP, classified as levels I-II of the Gross Motor Function Classification System (GMFCS) (n = 11, age 13.2 ± 2.1?yr), in comparison to age- and sex-matched controls (n = 11, age 12.4 ± 2.3?yr). Groups were similar in anthropometric measurements, resting blood pressures, and heart rates. There were no group differences in brachial flow-mediated dilation (11.1 ± 7.8 versus 6.1 ± 3.6), carotid intima-media thickness (0.42 ± 0.04 versus 0.41 ± 0.03?mm), and distensibility (0.008 ± 0.002 versus 0.008 ± 0.002?mmHg) or central (4.3 ± 0.6 versus 4.1 ± 0.9?m/s) and peripheral pulse wave velocity (7.1 ± 1.7 versus 7.6 ± 1.1?m/s); CP versus healthy controls, respectively. Vigorous intensity physical activity (PA) was lower in the CP group (CP: 38 ± 80?min versus controls: 196 ± 174?min); groups were similar in light and moderate intensity PA levels. Arterial health of ambulatory youth with CP is not different from a control group despite lower vigorous PA levels. Similar studies need to examine individuals with more pronounced mobility limitations (GMFCS level III–V).
Martin, Audra A.; Cotie, Lisa M.; Timmons, Brian W.; Gorter, Jan Willem; MacDonald, Maureen J.
Physical inactivity in youth with cerebral palsy (CP) places them at increased risk of developing cardiovascular disease. The current study assessed indices of arterial health in adolescents with CP, classified as levels I-II of the Gross Motor Function Classification System (GMFCS) (n = 11, age 13.2 ± 2.1?yr), in comparison to age- and sex-matched controls (n = 11, age 12.4 ± 2.3?yr). Groups were similar in anthropometric measurements, resting blood pressures, and heart rates. There were no group differences in brachial flow-mediated dilation (11.1 ± 7.8 versus 6.1 ± 3.6), carotid intima-media thickness (0.42 ± 0.04 versus 0.41 ± 0.03?mm), and distensibility (0.008 ± 0.002 versus 0.008 ± 0.002?mmHg) or central (4.3 ± 0.6 versus 4.1 ± 0.9?m/s) and peripheral pulse wave velocity (7.1 ± 1.7 versus 7.6 ± 1.1?m/s); CP versus healthy controls, respectively. Vigorous intensity physical activity (PA) was lower in the CP group (CP: 38 ± 80?min versus controls: 196 ± 174?min); groups were similar in light and moderate intensity PA levels. Arterial health of ambulatory youth with CP is not different from a control group despite lower vigorous PA levels. Similar studies need to examine individuals with more pronounced mobility limitations (GMFCS level III-V). PMID:22778755
Martin, Audra A; Cotie, Lisa M; Timmons, Brian W; Gorter, Jan Willem; Macdonald, Maureen J
We compared anteroposterior and mediolateral range of motion and velocity of the center of pressure (COP) on the horse's back between riders without disabilities and riders with cerebral palsy. An electronic pressure mat was used to track COP movements beneath the saddle in 4 riders without disabilities and 4 riders with cerebral palsy. Comparisons between rider groups were made using the Mann-Whitney test (p < .05). The two rider groups differed significantly in anteroposterior range of COP motion, mediolateral range of COP motion, and mediolateral COP velocity. Anteroposterior COP velocity did not differ between groups. The results suggest that measurements of COP range of motion and velocity are potentially useful for monitoring changes in balance as an indicator of core stability during equine-assisted activities. PMID:21476369
Clayton, Hilary M; Kaiser, Leeann J; de Pue, Bonnie; Kaiser, Lana
Hereditary neuropathy liability to pressurepalsies is characterized by recurring accesses of painless paralysis at the level of various nerves likely to be compressed. This affection remains underdiagnosed because of its usually benign course, sometimes without any symptom. The diagnosis is supported by clinical and electrophysiological data associated with, in the majority of patients, a deletion of one of the alleles coding for protein PMP 22 on the level of the locus 17p11.2. PMID:12481468
Tinant, F; Zeevaert, B; Benkirane, H; Laurent, L; Wang, F
ObjectivesTo prospectively study the efficacy and safety of intraparotid gland injection of Botulinum neurotoxin serotype A (Dysport®) for the treatment of sialorrhea (drooling) in children with cerebral palsy (CP).
Ali H. Alrefai; Samah K. Aburahma; Yousef S. Khader
Two workshops (1969) on bracings of children with (1) paraplegia from spina bifida and (2) cerebral palsy reflected the current state of treatment programs for these patients. As far as the spina bifida patient with paraplegia was concerned, the consensus...
In 41 patients with clinically determined Progressive Supranuclear Palsy, a model of degenerative subcortical dementia, alterations in regional brain energy metabolism with respect to control subjects have investigated using positron computed tomography a...
Twelve children with mild, moderate, or severe cerebral palsy were examined and videotaped before and after an intensive course of physical therapy in a neurodevelopmental treatment course. These tapes, demonstrating various predetermined movement patterns, were then randomized and viewed by six evaluators. None of the evaluators could tell the difference between before and after films. This demonstrated that significant changes were not seen in children with cerebral palsy after 6 weeks of therapy. PMID:3611334
Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil 2002;83:1157-64. Objective: To determine whether strength training is beneficial for people with cerebral palsy (CP). Data Sources: We used electronic databases to find trials conducted from 1966 though 2000; key words used in our search were
Karen J. Dodd; Nicholas F. Taylor; Diane L. Damiano
Currently there is no specific treatment for the brain insults leading to motor dysfunction in cerebral palsy. The available symptomatic therapeutic options place cerebral palsy among the costliest chronic childhood conditions. Therefore, it is necessary to make well-informed decisions in an effort to match cost-effectiveness with patient and family needs.This presentation aims to analyze the efficacy of rehabilitation therapy, orthoses,
Objective: To evaluate the effect of hippotherapy (physical therapy utilizing the movement of a horse) on muscle activity in children with spastic cerebral palsy. Design: Pretest\\/post-test control group. Setting\\/location: Therapeutic Riding of Tucson (TROT), Tucson, AZ. Subjects: Fifteen (15) children ranging from 4 to 12 years of age diagnosed with spastic cere- bral palsy. Interventions: Children meeting inclusion criteria were
William Benda; Nancy H. McGibbon; Kathryn L. Grant
An arachnoid cyst of the quadrigeminal plate in a 49-year-old female is reported. This is the seventh published case of a cyst of this kind in an adult. The presenting symptom was an isolated left fourth cranial nerve palsy. Up to now, no other case with isolated superior oblique muscle palsy has been described which was caused by an arachnoidal cyst of the quadrigeminal plate. PMID:2275426
The relative sparing of visual fixation in parallel with disruption of saccade function in progressive supranuclear palsy\\u000a (PSP) creates a unique human model for the study of gaze-shift strategies which are adopted when vertical gaze palsy impairs\\u000a primarily the eye-movement component of gaze control. It was hypothesized that people with PSP would rely on head pitch as\\u000a a primary component
Spontaneous intracranial hypotension is an uncommon cause of sudden and persistent headache: associated symptoms are common,\\u000a among which there are cranial nerve palsies, especially of the abducens nerve. We report a case of a 21-year-old man with\\u000a a transient and isolated third nerve palsy due to spontaneous intracranial hypotension. To our knowledge, there are only few\\u000a reports in the literature
Antonio Russo; Alessandro Tessitore; Mario Cirillo; Alfonso Giordano; Rosa De Micco; Gennaro Bussone; Gioacchino Tedeschi
Objective: The goal was to assess the effectiveness of an occupational therapy home program (OTHP), compared with no OTHP, with respect to function and parent satisfaction with child function, participation, goal attainment, and quality of upper limb skill in school-aged children with cerebral palsy.\\u000aMethods: Thirty-six children with cerebral palsy (mean age: 7.7 years; male: 69%; Gross Motor Function Classification
Objective: To evaluate effectiveness of motor learning coaching on retention and transfer of gross motor function in children with cerebral palsy.Design: Block randomized trial, matched for age and gross motor function.Setting: Coordinated, multinational study (Israel, Jordan and Palestinian Authority) in schools and rehabilitation centers.Subjects: 78 children with spastic cerebral palsy, gross motor functional levels II and III, aged 66 to
Simona Bar-Haim; Netta Harries; Ibtisam Nammourah; Saleh Oraibi; Waddah Malhees; Jack Loeppky; Neil J Perkins; Mark Belokopytov; Jacob Kaplanski; Eli Lahat
Objective: To investigate risk factors for cerebral palsy in relation to gestational age.Design: Three case-control studies within a geographically defined cohort.Setting: The former Oxfordshire Health Authority.Participants: A total of 235 singleton children with cerebral palsy not of postnatal origin, born between 1984 and 1993, identified from the Oxford Register of Early Childhood Impairment; 646 controls matched for gestation in three
C Greenwood; P Yudkin; S Sellers; L Impey; P Doyle
Objective: To study the effect of pedometer-based gait training on changing gait parameters in children with spastic hemiparetic cerebral palsy.Design: Two group randomized controlled trial with pre-treatment and posttreatment measures.Setting: Rehabilitation clinics.Subjects: Thirty spastic hemiparetic children with cerebral palsy of both sexes (13 females and 17 males) ranging in age from six to eight years old with mean age 7.05
ObjectivesTo estimate the effect of cranial osteopathy on the general health and wellbeing, including physical functioning, of children with cerebral palsy.DesignPragmatic randomised controlled trial.Participants142 children from Greater London and the South West of England, aged 5–12 years with cerebral palsy.InterventionParticipants were randomised to six sessions of cranial osteopathy with a registered osteopath or a waiting list with partial attention control
Katrina Wyatt; Vanessa Edwards; Linda Franck; Nicky Britten; Siobhan Creanor; Andrew Maddick; Stuart Logan
Purpose: To investigate therapeutic methods and results of comprehensive convalescent method of acupoint-pressing, Tuina,\\u000a acupoint-injection and exercise in the treatment of childhood cerebral palsy. Methods: Six hundreds and forty children under\\u000a 7 years old with cerebral palsy were divided randomly into treatment and control groups, and they were both given routine\\u000a acupoint-injection and functional exercise, children in treatment groups were
BACKGROUNDDespite the plenitude of reports concerning partial or complete third nerve palsies, especially as presenting symptoms with posterior communicating artery (PCoA) aneurysms, we present a patient with an unusual variation.CASE DESCRIPTIONA 66-year-old woman presented with progressive right-sided headaches and diplopia and was found to have a partial, pupil-sparing third nerve palsy. A small right-sided PCoA aneurysm, nearly indistinguishable from an
Jeffrey E Arle; John M Abrahams; Eric L Zager; Carolyn Taylor; Steven L Galetta
Our objective was to study the short-term efficacy and safety of methylphenidate in patients with the dual diagnosis of cerebral palsy and attention-deficit hyperactivity disorder (ADHD). Twenty-nine patients (8.0 ± 4.0 years old) with cerebral palsy and ADHD completed the study. In a prospective, crossover, double-blind paradigm, patients were treated with methylphenidate or placebo, each for 4 weeks. Parents and
Varda Gross-Tsur; Ruth S. Shalev; Navah Badihi; Orly Manor
|The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period.…
Isolated spinal accessory nerve (SAN) palsy is a well-recognized complication of surgical prodecures in the posterior triangle\\u000a of the neck. Various rare etiological factors were also described. Whatever the etiology, the typical clinical features of\\u000a SAN palsy can be listed as atrophy\\/weakness of the trapezius muscle and moderate winging of the scapula. It is imperative\\u000a to promptly diagnose this condition
The use of central venous catheters as access for hemodialysis has become common in children with end-stage renal disease.\\u000a Phrenic nerve palsy is an unusual complication of this procedure. We report a case of delayed right diaphragmatic palsy due\\u000a to phrenic nerve damage resulting from an indwelling right subclavian catheter in a 3-year-old child.
Sandeep Aggarwal; Pankaj Hari; Arvind Bagga; S. N. Mehta
Lebiedowska MK, Gaebler-Spira D, Burns RS, Fisk JR. Biomechanic characteristics of patients with spastic and dystonic hypertonia in cerebral palsy. Arch Phys Med Rehabil 2004;85:875-80. Objective: To determine what biomechanic characteristics of knee joint motion and walking show potential to quantita- tively differentiate spasticity and dystonia in cerebral palsy (CP). Design: Descriptive measurement study. Setting: University hospital. Participants: Seventeen pediatric
Maria K. Lebiedowska; Deborah Gaebler-Spira; Richard S. Burns; John R. Fisk
About 23 percent of the sixty-eight children with cerebral palsy, studied at the Werner-Otto-Institute's Pediatric Rehabilitation Center, suffered from a spastic tetraparesis. About 19 percent suffered from an athetosis; about 20 percent from a hypotonia, including three with cerebellar ataxia. The remainder of the group had minimal sequelae of cerebral palsy; mental problems were predominant. Their orofacial dysfunctions were treated according to the therapeutic concepts of Castillo-Morales. PMID:2147927
Studies with typically developing children have supported the efficacy of parents’ direct efforts to facilitate social development.\\u000a In this study, it was hypothesized that use of direct parenting methods would be associated with aspects of social functioning\\u000a of children with cerebral palsy. Study participants were 60 children with cerebral palsy, ages 5–12 (M?=?8.75; SD?=?1.82), 62.3% male and their parents or
The authors compared the outcomes of 17 children aged 7 to 15 years with DYT1 dystonia or cerebral palsy following deep brain stimulation. While patients with cerebral palsy presented with significantly greater motor disability than the DYT1 cohort at baseline, both groups demonstrated improvement at 1 year (cerebral palsy = 24%; DYT1 = 6%). The group as a whole demonstrated significant improvement on the Barry-Albright Dystonia Scale across time. Gains in motor function were apparent in both axial and appendicular distributions involving both upper and lower extremities. Gains achieved by 6 months were sustained in the cerebral palsy group, whereas the DYT1 group demonstrated continued improvement with ongoing pallidal stimulation beyond 18 months. Young patients with dystonia due to cerebral palsy responded comparably to patients with DYT1 dystonia. The severity of motor impairment in patients with cerebral palsy at baseline and follow-up raises the issue of even earlier intervention with neuromodulation in this population to limit long-term motor impairments due to dystonia. PMID:23666041
Fractures of the upper cervical spine rarely occur but carry a high rate of mortality and neurological disabilities in children. Although odontoid fractures are commonly caused by high-impact injuries, cerebral palsy children with cervical instability have a risk of developing spinal fractures even from mild trauma. We herein present the first case of an odontoid fracture in a 4-year-old boy with cerebral palsy. He exhibited prominent cervical instability due to hypotonic cerebral palsy from infancy. He suddenly developed acute respiratory failure, which subsequently required mechanical ventilation. Neuroimaging clearly revealed a type-III odontoid fracture accompanied by anterior displacement with compression of the cervical spinal cord. Bone mineral density was prominently decreased probably due to his long-term bedridden status and poor nutritional condition. We subsequently performed posterior internal fixation surgically using an onlay bone graft, resulting in a dramatic improvement in his respiratory failure. To our knowledge, this is the first report of an odontoid fracture caused by cervical instability in hypotonic cerebral palsy. Since cervical instability and decreased bone mineral density are frequently associated with cerebral palsy, odontoid fractures should be cautiously examined in cases of sudden onset respiratory failure and aggravated weakness, especially in hypotonic cerebral palsy patients. PMID:23270699
The topics of neonatal encephalopathy and cerebral palsy, as well as hypoxic-ischemic encephalopathy, are of paramount importance to anyone who ventures to deliver infants. Criteria sufficient to define an acute intrapartum hypoxic event as sufficient to cause cerebral palsy have been advanced previously by both The American College of Obstetricians and Gynecologists (ACOG) and the International Cerebral Palsy Task Force. ACOG convened a task force that over the past 3 years reviewed these criteria based upon advances in scientific knowledge. In this review, we cover the slow but steady progression toward defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Four essential criteria are also advanced as prerequisites if one is to propose that an intrapartum hypoxic-ischemic insult has caused a moderate to severe neonatal encephalopathy that subsequently results in cerebral palsy. Importantly, all four criteria must be met: 1) evidence of metabolic acidosis in fetal umbilical cord arterial blood obtained at delivery (pH less than 7 and base deficit of 12 mmol/L or more), 2) early onset of severe or moderate neonatal encephalopathy in infants born at 34 or more weeks' gestation, 3) cerebral palsy of the spastic quadriplegic or dyskinetic type, and 4) exclusion of other identifiable etiologies, such as trauma, coagulation disorders, infectious conditions, or genetic disorders. Other criteria that together suggest intrapartum timing are also discussed. PMID:12962954
Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1years) and had higher BMI (34.5kg/m(2)) than those who did not have nerve palsy (67.5years and 31.8kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03). PMID:23562462
Park, Jai Hyung; Restrepo, Camilo; Norton, Robert; Mandel, Steven; Sharkey, Peter F; Parvizi, Javad
A unilateral facial palsy can be considered established and therefore unlikely to recover, if a year has passed since the injury which initiated it. Fascial slings and muscle transfers have still a place in maintaining static position and preventing the mouth swinging to the animated side on smiling. They do not, however, produce a smile responsive to emotion. Crossed facial nerve grafting is rather unreliable and rarely produces a symmetrical smile. Since the mid 1970s vascularised muscle grafts have been employed to compensate for the degeneration of the paralysed facial musculature. The pectoralis minor is a particularly suitable muscle for transplantation to the face because of size and shape. Experience with these techniques and the results of the first 30 cases using this muscle are presented. Images Figure 3 Figure 4 p98-a
The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and coping strategies. Dissatisfaction with how the diagnosis had been disclosed was greater where children had been premature and/or low birth weight, where they developed more severe degrees of physical disability, and where the diagnosis had been made later. Dissatisfaction was related to greater degrees of later self reported depression. The guidelines take account of the findings, in particular the need for early close liaison between neonatology and community paediatric services. Suggestions are made for how to ensure implementation and monitoring of good practice.??
The purpose of this study was to examine the childhood experiences of women with cerebral palsy (CP), from the perspectives of these women. Using the feminist biographical method, eight women with CP participated in two in-depth interviews. Participants ranged in age from 22 to 55 years and had moderate to severe athetoid or spastic CP. Four themes emerged: (a) academic experiences, (b) experiences with teachers, (c) experiences with peers, and (d) coping methods, with both positive and negative subthemes for each theme. Participants with positive academic experiences and positive interactions with teachers and peers were able to develop better ways of dealing with the negative experiences they encountered in education and attained higher levels of education. Participants who primarily had poorer educational experiences developed negative coping mechanisms that continued to affect their lives. Findings support ways in which school nurses can support the educational experiences of students with CP. PMID:20404356
Children with disabilities that limit mobility are at increased risk for osteoporosis. In the United States, 10 million people have osteoporosis and 34 million people are estimated to be at risk of acquiring this condition. Typically, bone fragility and osteoporosis have been associated with older adults; however, these problems can also affect children. The childhood and adolescent years are critically important in producing healthy bone mass. Yet cerebral palsy and epilepsy, which are both chronic disorders that frequently coexist, are predictors of muscular and skeletal compromise. Nurse practitioners should be aware of recommendations for promoting and achieving optimal bone health in children with these disabilities and screening patients who are at risk of sustaining fractures. PMID:22525999
The stages of development of infant cerebral palsy (ICP) in 300 patients during the childdhood period, beginning from the neonate period, are presented in this article. Clinico-morphological analysis has been realized in 35 cases with the mortal outcome. It has been established, that combination of the following signs is the morphological basis of ICP: dysontogenetic development of the separate structures of the brain, cerebrovascular disturbances, dystrophic changes of the structural elements of the brain and in number of cases--of the focal inflammation of the brain matter, predominantly in the region of walls of the lateral ventricle of the brain. In parallel with the destructive changes in the brain the compensatory restorative processses have been also observed. PMID:23330184
The paper is devoted to the problem of early diagnosis and correction of development of children with perinatal lesion of the nervous system. Early rehabilitation treatment in children cerebral palsy (CCP) is necessary due to the plasticity of the child's brain and its universal ability to compensate for disturbed functions as well as due to the fact that the first two years of life are optimal for maturation of the speech functional system. Evidence for the differentiation of early, chronic and residual studies of CCP is presented. The authors emphasize the role of the pathology of the functional antigravitation system in the formation of motor-reflex disorders. Possibilities of pathogenetic treatment in each stage of disease are considered. PMID:23330185
Patients affected by VI cranial nerve palsy were required to orient their attention in monocular vision and to detect a stimulus appearing either in attended or in unattended locations. Results showed that while during non-paretic eye vision stimulus detection in the attended location was faster than that in the unattended one, during paretic eye vision no difference in detection speed was present. However, in this latter condition, detection speed in both attended and un attended locations were as fast as that measured during non-paretic eye vision in attended location. Demonstration that peripheral oculomotor impairment influences monocular covert orienting of visuospatial attention strongly support the idea that visuospatial attention and oculomotor mechanisms share similar cortical networks. PMID:11711871
Trigemino-cervical reflexes (TCRs) are multisynaptic neck muscle withdrawal responses that are clearly identifiable in humans. Mediated by neural circuits at brainstem level, these reflex responses have been found to be significantly impaired in patients with Parkinson's disease (PD), and it has been hypothesized that a degeneration of brainstem neural structures could play a role in these abnormalities. Because extensive neuronal degeneration at brainstem level has been demonstrated in progressive supranuclear palsy (PSP), in this pilot study we evaluated the TCR responses in 12 subjects with PSP, and in 16 healthy controls. The TCRs were absent in 11 out of the 12 PSP patients while clear responses were evoked in all the healthy subjects. These findings indicate that PSP patients are unable to react to the painful stimuli to the face, suggesting a generalized impairment of the brainstem circuits mediating TCRs. PMID:18561341
Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.
Background There are a variety of treatment options for Bell's palsy. Evidence from randomized controlled trials indicates corticosteroids can be used as a proven therapy for Bell's palsy. Acupuncture is one of the most commonly used methods to treat Bell's palsy in China. Recent studies suggest that staging treatment is more suitable for Bell's palsy, according to different path-stages of this disease. The aim of this study is to compare the effects of prednisolone and staging acupuncture in the recovery of the affected facial nerve, and to verify whether prednisolone in combination with staging acupuncture is more effective than prednisolone alone for Bell's palsy in a large number of patients. Methods/Design In this article, we report the design and protocol of a large sample multi-center randomized controlled trial to treat Bell's palsy with prednisolone and/or acupuncture. In total, 1200 patients aged 18 to 75 years within 72 h of onset of acute, unilateral, peripheral facial palsy will be assessed. There are six treatment groups, with four treated according to different path-stages and two not. These patients are randomly assigned to be in one of the following six treatment groups, i.e. 1) placebo prednisolone group, 2) prednisolone group, 3) placebo prednisolone plus acute stage acupuncture group, 4) prednisolone plus acute stage acupuncture group, 5) placebo prednisolone plus resting stage acupuncture group, 6) prednisolone plus resting stage acupuncture group. The primary outcome is the time to complete recovery of facial function, assessed by Sunnybrook system and House-Brackmann scale. The secondary outcomes include the incidence of ipsilateral pain in the early stage of palsy (and the duration of this pain), the proportion of patients with severe pain, the occurrence of synkinesis, facial spasm or contracture, and the severity of residual facial symptoms during the study period. Discussion The result of this trial will assess the efficacy of using prednisolone and staging acupuncture to treat Bell's palsy, and to determine a best combination therapy with prednisolone and acupuncture for treating Bell's palsy. Trial Registration ClinicalTrials.gov: NCT01201642
Aim To determine the age of development of bladder and bowel control and the frequency of enuresis, encopresis, and urinary infections in children with cerebral palsy. Methods The study included 45 children with cerebral palsy who regularly attended a rehabilitation center in Isparta, Turkey, and two groups of age- and sex-matched children, 37 siblings of the children with cerebral palsy and 37 healthy children. Demographic data and information on the age of development of total bladder and bowel control and presence of possible urinary symptoms in children were collected from their caregivers by use of a questionnaire. Frequency of enuresis and encopresis was estimated among the children aged ?5 years. A mid-way urinary sample was obtained from 40, 22, and 21 children in the cerebral palsy, siblings, and healthy children, respectively. Results The mean age of nighttime bladder and bowel control development was 47 months (95% confidence interval [CI], 35-58) and 45 (36-55) months, respectively, for the children with cerebral palsy, 35 months (95% CI, 24-46) and 26 months (95% CI, 24-28), respectively, for their siblings, and 27 months (95% CI, 22-33) and 25 months (95% CI, 23-27) months, respectively, for the healthy children. Among the children aged ?5 years, enuresis was present in 11 of 34 children with cerebral palsy, 7 of 30 siblings, and 4 of 30 healthy children (P?=?0.200), whereas encopresis was present in 5 children with cerebral palsy, one sibling, and one healthy child. Constipation was significantly more present in chidlren with cerebral palsy than in other two groups (P<0.001). Urine culture was positive in 13 children with cerebral palsy, 1 sibling, and 2 healthy chidlren (P?=?0.024). There were no significant differences in other urinary symptoms and laboratory findings among the three groups. Conclusion The children with cerebral palsy gained bladder and bowel control at older age in comparison with their siblings and healthy children. They also had more frequent enuresis and urinary infections.
OBJECTIVES—To assess muscarinic acetylcholine receptors (mAChRs) in the brains of patients with progressive supranuclear palsy and Parkinson's disease, and to correlate the cholinergic system with cognitive function in progressive supranuclear palsy and Parkinson's disease.?METHODS— Positron emission tomography (PET) and [11C]N-methyl-4-piperidyl benzilate ([11C]NMPB) was used to measure mAChRs in the brain of seven patients with progressive supranuclear palsy, 12 patients with Parkinson's disease, and eight healthy controls. All of the patients with progressive supranuclear palsy were demented. The Parkinson's disease group consisted of 11 non-demented patients and one demented patient. The mini mental state examination (MMSE) was used to assess the severity of cognitive dysfunction in all of the subjects. The modified Wisconsin card sorting test (WCST) was used to evaluate frontal cognitive function in the non-demented patients with Parkinson's disease and controls.?RESULTS—The mean K3 value, an index of mAChR binding, was significantly higher for the frontal cortex in the patients with Parkinson's disease than in the controls (p<0.01). By contrast, the patients with progressive supranuclear palsy had no significant changes in the K3 values of any cerebral cortical regions. The mean score of the MMSE in the progressive supranuclear palsy group was significantly lower than that in the control group. Although there was no difference between the Parkinson's disease and control groups in the MMSE, the non-demented patients with Parkinson's disease showed significant frontal lobe dysfunction in the WCST.?CONCLUSIONS—The increased mAChR binding in the frontal cortex of the patients with Parkinson's disease may reflect denervation hypersensitivity caused by loss of the ascending cholinergic input to that region from the basal forebrain and may be related to frontal lobe dysfunction in Parkinson's disease. The cerebral cortical cholinergic system may not have a major role in cognitive dysfunction in progressive supranuclear palsy.??
Asahina, M.; Suhara, T.; Shinotoh, H.; Inoue, O.; Suzuki, K.; Hattori, T.
|The paper addresses issues involved in the management of and curriculum for children with sensory impairments combined with cerebral palsy. The first part details typical deformities and their causes in children with cerebral palsy, and describes (with illustrations) techniques for therapeutic handling and positioning in daily living tasks at…
Background and Objectives: Central muscle relaxants are a clinical option in patients with spastic palsy. Eperisone is a cen- tral muscle relaxant used in several conditions, but its therapeutic potential in spastic palsy needs to be verified. This dose-ranging trial compares two doses of eperisone in patients with spastic palsy associated to cerebral or spinal diseases. Patients and Methods: In
N. BRESOLIN; C. ZUCCA; A. PECORI; Maggiore Policlinico; E. Medea
BACKGROUND:: Cervical laminectomy and fusion (CLF) is a treatment option for multilevel cervical spondylotic myelopathy. Postoperative C5 nerve palsy is a possible complication of CLF. It has been suggested that C5 nerve palsy may be due to posterior drift of the spinal cord related to a wide laminectomy trough. PURPOSE:: To test the hypothesis that excessive spinal cord drift into a wide laminectomy trough is associated with C5 palsy. STUDY DESIGN:: Retrospective case-control study. PATIENT SAMPLE:: Seventeen patients with C5 palsy, 8 patients as control group. OUTCOME MEASURES:: Spinal cord positional measurements on magnetic resonance imaging (MRI). METHODS:: All patients who underwent elective CLF for cervical spondylotic myelopathy or ossified posterior longitudinal ligament using posterior instrumentation between 2004 and 2008 were included. Patients who underwent CLF for trauma, infection, or tumors were excluded. Clinical and radiographic outcomes were assessed by chart review (minimum of 1 y follow-up). Patients who developed a new postoperative C5 nerve palsy underwent repeat MRI. The control group also underwent CLF, did not develop a neurological deficit, and received a postoperative MRI for evaluation of possible infection. MRI measurements included the width of the laminectomy trough, the distance from the posterior vertebral body or disk to the anterior spinal cord, the width of the spinal cord herniated into the laminectomy defect, and C2-7 sagittal alignment. Preoperative radiographic measurements included preoperative vertebral body diameter, spinal canal diameter, and sagittal vertical offset. RESULTS:: There were seventeen patients with C5 nerve root palsy and 8 patients without C5 nerve root palsy. There were no baseline differences in fusion levels, instrumentation used, patient age, or sex. MRI measurements revealed an increase in mean postoperative cord drift in patients with C5 palsy at C3 (4.2 vs. 2.2 mm, P=0.002), C4 (4.6 vs. 2.8 mm, P=0.056), C5 (5.1 vs. 2.4 mm, P=0.011), and C6 (5.2 vs. 2.4 mm, P=0.003). There was a significant increase in C5 laminectomy trough width among patients with postoperative C5 palsy (17.9 vs. 15.2 mm, P=0.032), but there was no difference in sagittal alignment. CONCLUSIONS:: A wider laminectomy at C5 was associated with an increased risk of postoperative C5 palsy. Increased preoperative spinal canal diameter is also associated with increased risk of C5 palsy. In addition, patients who experienced C5 nerve palsy had a significantly greater posterior spinal cord drift. Strategies to reduce postoperative laminectomy trough width and spinal cord drift may reduce the risk of postoperative C5 palsy. PMID:22425890
Radcliff, Kris E; Limthongkul, Worawat; Kepler, Chris K; Sidhu, Gursukhman D S; Anderson, D Greg; Rihn, Jeffrey A; Hilibrand, Alan S; Vaccaro, Alexander R; Albert, Todd J
Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k>.58 for all comparisons). Test-retest reliability was substantial to almost perfect for all groups (k>.68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review. PMID:23891732
Pennington, Lindsay; Virella, Daniel; Mjøen, Tone; da Graça Andrada, Maria; Murray, Janice; Colver, Allan; Himmelmann, Kate; Rackauskaite, Gija; Greitane, Andra; Prasauskiene, Audrone; Andersen, Guro; de la Cruz, Javier
Objective Incomplete recovery from facial palsy has a long-term impact on the quality of life, and medical options for the sequelae of Bell's palsy are limited. Invasive treatments and physiotherapy have been employed to relieve symptoms, but there is limited clinical evidence for their effectiveness. Acupuncture is widely used on Bell's palsy patients in East Asia, but there is insufficient evidence for its effectiveness on Bell's palsy sequelae. The objective is to evaluate the efficacy and safety of acupuncture in patients with sequelae of Bell's palsy. Method/Design This study consists of a randomized controlled trial with two parallel arms: an acupuncture group and a waitlist group. The acupuncture group will receive acupuncture treatment three times per week for a total of 24 sessions over 8 weeks. Participants in the waitlist group will not receive any acupuncture treatments during this 8 week period, but they will participate in the evaluations of symptoms at the start of the study, at 5 weeks and at 8 weeks after randomization, at which point the same treatment as the acupuncture group will be provided. The primary outcome will be analyzed by the change in the Facial Disability Index (FDI) from baseline to week eight. The secondary outcome measures will include FDI from baseline to week five, House-Brackmann Grade, lip mobility, and stiffness scales. Trial registration Current Controlled-Trials ISRCTN43104115; registration date: 06 July 2010; the date of the first patient's randomization: 04 August 2010
Aims: To derive a reliable estimate of the frequency of pupillary involvement and to study the patterns and course of anisocoria in conjunction with ophthalmoplegia in diabetes-associated oculomotor nerve palsy. Materials and Methods: In this prospective analytical study, standardized enrolment criteria were employed to identify 35 consecutive patients with diabetes-associated oculomotor nerve palsy who were subjected to a comprehensive ocular examination. Standardized methods were used to evaluate pupil size, shape, and reflexes. The degree of anisocoria, if present and the degree of ophthalmoplegia was recorded at each visit. Results: Pupillary involvement was found to be present in 25.7% of the total number of subjects with diabetic oculomotor nerve palsy. The measure of anisocoria was < 2 mm, and pupil was variably reactive at least to some extent in all cases with pupillary involvement. Majority of patients in both the pupil-involved and pupil-spared group showed a regressive pattern of ophthalmoplegia. Ophthalmoplegia reversed much earlier and more significantly when compared to anisocoria. Conclusions: Pupillary involvement in diabetes-associated oculomotor nerve palsy occurs in about 1/4th of all cases. Certain characteristics of the pupil help us to differentiate an ischemic insult from an aneurysmal injury to the 3rd nerve. Ophthalmoplegia resolves much earlier than anisocoria in diabetic oculomotor nerve palsies.
Background: Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure. Case Description: A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face. Conclusions: Partial hypoglossal–facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique.
The purpose of this study was to describe the quality of life and anticipatory grieving among Jordanian parents living with a child with cerebral palsy. A cross-sectional, descriptive, correlational design was used with 204 Jordanian parents. Both mothers and fathers were recruited from health-care centres that provided comprehensive care for children with cerebral palsy in Jordan and from schools for special education. Structured interviews were conducted using the Marwit and Meuser Caregiver Grief Inventory Cerebral Palsy and Quality of Life Index. The majority of the parents reported that providing care for a child with cerebral palsy is requiring more emotional energy and determination than ever expected. There was a significant negative correlation between total anticipatory grief score and total quality of life score and all subscales. This indicates that parents with high level of intensity of anticipatory grief had lower quality of life. No statistically significant differences were found in anticipatory grief and quality of life responses between mothers and fathers. The outcomes of this study have important implications for encouraging family-centred care and inform policy to improve the lives of children with cerebral palsy and their parents. PMID:23730861
|The purpose of the study was to determine the use of computers and assistive devices amongst children with cerebral palsy (CP) and establish the satisfaction level of both users and educational staff. The study was carried out with 30 children with cerebral palsy. A questionnaire was designed to characterize the use of new technologies and…
Garcia, Thais Pousada; Loureiro, Javier Pereira; Gonzalez, Betania Groba; Riveiro, Laura Nieto; Sierra, Alejandro Pazos
Background: The direct quantitative correlation between thickness of the corpus callosum and volume of cerebral white matter in children with cerebral palsy and developmental delay has not been demonstrated. Objective: This study was conducted to quantitatively correlate the thickness of the corpus callosum with the volume of cerebral white matter in children with cerebral palsy and developmental delay. Material and
Ashok Panigrahy; Patrick D. Barnes; Robert L. Robertson; Lynn A. Sleeper; James W. Sayre
The present paper aims to analyze trends over time in prevalence of cerebral palsy of post-neonatal origin, to investigate whether changes are similar according to severity and to describe the disability profile by etiology. Post-neonatal cases, birth years 1976 to 1998, were identified from the Surveillance of Cerebral Palsy in Europe…
|The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT…
|Although physical activity can have substantial mental and physical health benefits, people with cerebral palsy usually lead sedentary lives. To understand, at an individual level, this inactivity, we interviewed a 29-year-old minimally active woman with cerebral palsy (Alana) about the meanings and experiences of physical activity throughout her…
Gaskin, Cadeyrn J.; Andersen, Mark B.; Morris, Tony
BACKGROUND: Although hippotherapy treatment has been demonstrated to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is
Pablo Herrero; Ángel Asensio; Elena García; Álvaro Marco; Barbara Oliván; Alejandro Ibarz; Eva M Gómez-Trullén; Roberto Casas
Although trihexyphenidyl is used clinically to treat both primary and secondary dystonia in children, limited evidence exists to support its effectiveness, particularly in dystonia secondary to disorders such as cerebral palsy. A prospective, open-label, multicenter pilot trial of high-dose trihexyphenidyl was conducted in 23 children aged 4 to 15 years with cerebral palsy judged to have secondary dystonia impairing function
Terence D. Sanger; Amy Bastian; Jan Brunstrom; Diane Damiano; Mauricio Delgado; Leon Dure; Deborah Gaebler-Spira; Alec Hoon; Jonathan W. Mink; Sara Sherman-Levine; Leah J. Welty
OBJECTIVE: Because recent epidemiologic data suggest an association between maternal magnesium sulfate use and a decreased risk of cerebral palsy in infants who survive preterm birth, we investigated the feasibility of a randomized trial of intrapartum maternally administered magnesium sulfate to prevent cerebral palsy in children who were born before term. STUDY DESIGN: On the basis of a literature review,
The authors examined the relation between intrapartum magnesium sulfate exposure and risk of cerebral palsy in a case-control study of low birth weight children designed to control for confounding by the clinical indications for magnesium in pregnancy. Case children (n = 97) included all singleton children with cerebral palsy who were born in 1985-1989 in Atlanta, Georgia with a birth
C. A. Boyle; M. Yeargin-Allsopp; D. E. Schendel; P. Holmgreen; G. P. Oakley
Objectives To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia.Design Population based cohort study.Setting The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data
Objective: Our aim was to examine magnesium sulfate tocolysis and cerebral palsy in infants born prematurely to women without preeclampsia. Study Design: We conducted a retrospective case-control study of infants with birth weights 3 hours after admission, and had survived to age 2 years. Results: Among 170 children with cerebral palsy and 288 control subjects, similar proportions of case mothers
Judith K. Grether; Jenny Hoogstrate; Eileen Walsh-Greene; Karin B. Nelson
The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT…
Progressive supranuclear palsy (PSP) is typically manifested by vertical supranuclear gaze palsy, frequent falls early in the disease course, axial rigidity and poor response to levodopa. Prominent anterograde memory dysfunction with subsequent impairment in other cognitive domains is characteristic of Alzheimer’s disease (AD). No clear clinical syndrome has been identified in argyrophilic grain disease (AGD). Frontotemporal dementia (FTD) is characterized
G. A. Rippon; B. F. Boeve; J. E. Parisi; D. W. Dickson; R. I. Ivnik; C. R. Jack; M. Hutton; M. Baker; K. A. Josephs; D. S. Knopman; R. C. Petersen
The Cerebral Palsy Treatment Center in Houston, Texas, located outside of the Comprehensive Social Service Program area in relatively new facilities built for its use. It is equipped to provide almost total services to the cerebral palsy victims up to age...
|Purpose: In this study, the authors proposed and tested a preliminary speech and language classification system for children with cerebral palsy. Method: Speech and language assessment data were collected in a laboratory setting from 34 children with cerebral palsy (CP; 18 male, 16 female) with a mean age of 54 months (SD = 1.8). Measures of…
|The question under consideration was does cardiorespiratory training improve aerobic fitness in children with cerebral palsy and is there any carryover into activity? The study design consisted of a systematic review of randomized trials using the Cochrane Collaboration guidelines. Participants were children of school age with cerebral palsy.…
|The present paper aims to analyze trends over time in prevalence of cerebral palsy of post-neonatal origin, to investigate whether changes are similar according to severity and to describe the disability profile by etiology. Post-neonatal cases, birth years 1976 to 1998, were identified from the Surveillance of Cerebral Palsy in Europe…
This study uses the bioelectrical impedance method to assess the body composition, basal metabolic rate, and some other physical properties of children with cerebral palsy. In this study, 41 children with spastic cerebral palsy were assessed, and 56 normally developed children were included as control. Parameters such as body compositions, basal metabolic rate, body resistance, liquid compartment, and capacitance of
|To assess the measurement properties of a new QOL instrument, the Cerebral Palsy Quality of Life Questionnaire-Teen (CP QOL-Teen), in adolescents with cerebral palsy (CP) aged 13-18 years, examining domain structure, reliability, validity and adolescent-caregiver concordance. Based on age, 695 eligible families were invited to participate by…
Lower limb muscles of children with cerebral palsy undergo progressive pathological changes. Type-I fiber abundance and Type-II fiber deficiency are found to be common in these muscles. Both fiber types also suffer from atrophy. This paper investigates the effects of simulated physiological changes that occur in muscles of subjects with cerebral palsy using computer generated muscle action potentials (CGAPs). The
The authors describe a 12-year-old boy with dyskinetic (athetoid-dystonic subtype) cerebral palsy and os odontoideum. Dystonic and choreoathetotic components in cerebral palsy are movement disorders that are difficult to treat and cause major disability. Dystonic posturing causes excessive flexion, extension, and rotation of the neck. Repetitive abnormal movements in patients with this type of cerebral palsy give rise to a higher incidence of pathologic conditions affecting the craniovertebral junction. Os odontoideum is one of these pathologies, and it represents a rare anomaly of the odontoid process. There are only a few reports describing os odontoideum in children with dyskinetic cerebral palsy. This clinical and neuroradiologic study focuses on the problem of atlantoaxial instability and os odontoideum in these forms of cerebral palsy, which is too often underestimated. PMID:21616925
Trabacca, Antonio; Dicuonzo, Franca; Gennaro, Leonarda; Palma, Michele; Cacudi, Marilena; Losito, Luciana; De Rinaldis, Marta
Radiologic measures of migration percentage (MP) and acetabular index (AI) taken from plain radiographs of the pelvis are the most commonly used tools for determining hip displacement and management options in children with cerebral palsy and spastic hip disease. This study determined interrater and intrarater reliability of MP and AI on pelvic radiographs chosen to represent a wide range of age (11 months to 8 years 5 months), MP (0%-56%), and AI (9 degrees -33 degrees ). The study demonstrated that an experienced rater would be expected to measure MP on a single radiograph to within +/-5.8% of the true value and a change in MP between two radiographs taken at different times to within +/-8.3% of the true value. Similarly for AI, the measurement error for a typical rater would be within +/-2.6 degrees on a single reading and +/-3.7 degrees if recording change between two occasions. The authors believe that the results indicating true change are acceptable in clinical practice, provided treatment decisions are based on a series of radiographs taken at 6-month intervals, methods and training are standardized, and consistent raters are used. PMID:12198471
In this study bimanual grip-force coordination was quantified using a novel "Gripper" system that records grip forces produced while holding a lower and upper unit, in combination with the lift force necessary to separate these units. Children with unilateral cerebral palsy (CP) (aged 5-14 years, n=12) were compared to age matched typically developing (TD) children (n=23). Compared to TD, the CP-group is much slower and takes 50% more time to generate grip and lift forces with more fixating force before lifting the upper unit. In addition the coordination between forces in both hands is reduced. The CP-group increases the lift force in the upper hand 2.5 times more than the holding force when pulling the two units apart, while this is only 1.5 times in TD. Moreover, the correlation between forces generated in both hands in the CP-group is lower. The lack of fine tuning of the forces, measured by the linearity error is increased, especially when the magnet load keeping the unit together is low. The results indicate an impaired pull-hold synergy between upper and lower hand and the lift force. Bimanual tasks evaluating bimanual grip and lift forces in children with CP and can give us new insights in the underlying force control mechanisms of the spastic hand. PMID:21592724
An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org. PMID:21335676
Morris, Christopher; Bowers, Roy; Ross, Karyn; Stevens, Phil; Phillips, David
This study quantified perception and reorientation ability after passive horizontal rotations in thirteen children with cerebral palsy (CP). They stood barefoot on a platform in front of a fixed reference point (static posture task, SPT) and were then blindfolded and passively rotated with six velocity profiles (maximum angular velocity: 57°/s; rotation amplitudes: ±90°, ±180° and ±360°). After the perturbation, the blindfolded children were asked to point to the fixed reference point with their preferred hand (pointing task, PT) and to step back to the initial position on the stationary platform (reorientation task, RT). In order to gain further insight into rotational attitude, the results were comparatively examined with body segment rotations determined using standardized gait analysis (gait task, GT). The kinematic evaluations were conducted using an optoelectronic system: for SPT, PT and RT we confined the analysis, in the horizontal plane, to the head and upper pointing arm of the subject and to the platform; for GT a full body analysis was performed. When CP children were passively rotated towards their more affected side, they overestimated the imposed angle in PT but under-reproduced it in RT. A higher variability emerged in left-hemiplegic children, confirming that the spatial disorganization is predominantly related to right brain lesion. Patients tended to rotate in GT towards the more affected side while in RT they showed an opposite trend. PMID:23040836
Rostral midbrain atrophy in progressive supranuclear palsy (PSP) is detected by mid-sagittal plain magnetic resonance imaging (MRI). The shape of the atrophy looks like the bill of a hummingbird (hummingbird sign). We studied this sign to elucidate the nature of midbrain atrophy in PSP. Eight patients with PSP, 12 with Parkinson's disease (PD), and 10 normal controls were studied. Using mid-sagittal plain MRI, we measured the rostral and caudal midbrain tegmentum (MT), superior and inferior colliculus, pontine base, and tegmentum. We compared the length of the interpeduncular fossa, which is posterior to the mammillary body, to the diameter of the midbrain tegmentum. The multiple comparison method was used for the statistical analysis. The hummingbird sign was demonstrated in all of the PSP patients studied, and it was not observed in PD patients nor in normal controls. The hummingbird sign in the PSP patients was due to the atrophy of the midbrain tegmentum (rostral and caudal) and to a relative increase in the length of the interpeduncular fossa over that of the anteroposterior diameter of the midbrain tegmentum. The hummingbird sign, which represents the atrophy of the rostral midbrain tegmentum, strongly suggests the involvement of the rostral interstitial nucleus of the medial longitudinal fasciculus in patients with PSP. Demonstration of a hummingbird sign on MRI is thought to be useful for a diagnosis of PSP. PMID:12736089
Purpose To analyse the consequences of using different radiographic measurements and different threshold values for hip screening in children with cerebral palsy (CP). Methods In a total sample of children with CP a standardised radiological follow-up of the hips was carried out as a part of a hip prevention programme. Acetabular index (AI) and migration percentage (MP) were measured on all radiographs. In this study, 1,067 radiographs of 272 children born 1992–1998 were analysed. Results Lateral displacement of the femoral head was common without acetabular dysplasia, and acetabular dysplasia occurred at a later stage than femoral head lateralisation. Hip dysplasia without lateral displacement of the femoral head was rare. In 16 of the 56 hips (29%) with AI ? 27° and in 23 of the 71 (32%) hips with MP ? 33% the values decreased below the threshold value without operative treatment. In hips with AI ? 30° only 2 of 31 hips (6%) and in hips with MP ? 40% only 5 of 44 hips (11%) decreased below the threshold values without operative treatment. Conclusions Radiographic follow-up with only measurement of the MP seems sufficient in screening for dislocation in children with CP. MP ? 33% is recommended as threshold for reaction or intensified observation. In children with MP ? 40%, the lateral displacement increased over time in most hips, thus indicating the need for operative intervention. In children with MP 33–40%, treatment should be based on other clinical signs and the progression of MP over time.
Symptomatic treatment of cerebral palsy (CP) is difficult, with variable beneficial effect. The choice of therapy is guided by the main clinical features (spasticity, dystonia/choreoathetosis), by the experience of experts, and by the results of open-label trials and a few controlled studies. Treatments of spasticity are not discussed in depth here. From open-label trials and a few controlled studies in dystonia/choreoathetosis CP, it appears that treatment should be started at a low dose and increased slowly, and that more beneficial effects are obtained on upper extremity function, face and jaw dystonia and drooling, and in children. L-Baclofen or antiepileptic drugs are rarely effective and poorly tolerated whereas benzodiazepines may be moderately helpful. Local injections of botulinum toxin help to reduce pain and limit the amplitude of some movements (violent neck movements with high risk of symptomatic radiculomyelopathy). In a rare subtype of dystonia-choreathetosis CP with little spasticity and MRI lesions, bilateral pallidal stimulation (GPi) has shown mild to moderate improvement of dystonia (in open-label small series and in one controlled study) with no cognitive or mood adverse effects. Optimal placement of the leads was a major (but not exclusive) factor for good outcome but results cannot be predicted on an individual basis and larger studies are needed. PMID:23622164
Objectives To identify the types and frequencies of pain treatments used by individuals with cerebral palsy (CP); examine the perceived effectiveness of these treatments; and identify the types of healthcare providers that were accessed for pain-related services. Design A cross-sectional survey design was employed. 83 adults (mean age=40.3 years, SD=13.6) with CP indicated their pain location and intensity during the past 3 months. Next, they indicated their use of 24 different pain treatments and the effectiveness of each. Finally, participants indicated the frequency of pain-related healthcare visits to specific providers over the past 6 months. Results 63% of participants reported experiencing chronic pain and rated their pain intensity over the past week as 5.1/10, on average. The most common pain locations were the lower back, hips, and legs. Physical interventions (e.g., physical therapy, strengthening) were the most common pain treatments reportedly used, and were rated as moderately effective. Many other treatments were also used, and participants sought pain-related care from a variety of providers. Conclusions Although participants reportedly accessed pain care from a variety of providers, and perceived that several types of treatments were effective, many of the treatments rated as effective were rarely used or provided. Future research using clinical trial methods would further elucidate the specific pain treatments that are most beneficial for adults with CP.
Hirsh, Adam T.; Kratz, Anna L.; Engel, Joyce M.; Jensen, Mark P.
Using Wechsler Intelligence Tests, we compared the intellectual status of children with cerebral palsy (CP) immediately before and 2 years after entering school. Verbal and performance IQs could be assessed for 23 children with spastic diplegia but only verbal IQs in six children with spastic quadriplegia. Performance IQs were much lower than verbal IQs in both the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and the Wechsler Intelligence Scale for Children-Revised (WISC-R) in children with spastic diplegia. After schooling, verbal IQ was significantly increased but there was no change in performance IQ, thus, the difference between these IQs became more pronounced. When comparing the school class types, the verbal IQs of children studying in ordinary classes became statistically higher than those of children in special classes. In contrast, since the increases in mean performance IQs were greater in children in special classes, the differences between these IQs became more pronounced in children studying in ordinary classes. We also found that although verbal IQs were lower for quadriplegic children than for diplegic children at preschool age, there was no difference after 2 years of schooling. These results underline the importance and benefits of appropriate education for children with CP. PMID:9689256
This exploratory study investigated meaning in life (MiL) in patients with progressive supranuclear palsy (PSP). In the "Schedule for Meaning in Life Evaluation" (SMiLE), respondents list individual MiL areas before rating their current satisfaction and importance with them (index of weighting [IoW], index of satisfaction [IoS], and index of weighted satisfaction [IoWS], range 0-100). A total of 38 patients with PSP completed the SMiLE (IoS: 68.6 ± 25.6, IoW: 79.6 ± 12.6, and IoWS: 69.2 ± 26.1). A representative sample of healthy participants (n = 977) scored significantly higher in the IoS (82.8 ± 14.7, P < .001), the IoW (85.6 ± 12.3, P = .006), and the IoWS (83.3 ± 14.8, P < .001). Compared to healthy individuals, patients with PSP were less likely to list health (P = .001) and more likely to list partner (P = .04), leisure (P = .01), home/garden (P = .01), and pleasure (P = .02). Patients with PSP seem to focus on supportive relationships and leisure, while the decreasing health status is becoming less important to them. PMID:23785042
Fegg, Martin Johannes; Kögler, Monika; Abright, Carina; Hensler, Mira; Lorenzl, Stefan
Corticobasal syndrome (CBS) and progressive supranuclear palsy syndrome (PSPS) are two of the atypical Parkinsonism syndromes, in that patients exhibit rigidity, occasional tremor and postural instability, but do not symptomatically respond to dopamine replacement. CBS and PSPS can often present with complex cognitive difficulties and neuropsychiatric disturbances. Symptoms of depression, apathy, or agitation can be subtle and are often overlooked as reactions to learning a new diagnosis of Parkinsonism. These symptoms may be the earliest presenting evidence of CBS or PSPS, and these syndromes can be misdiagnosed with a primary psychiatric disorder rather than a neurodegenerative condition. Patients may be inappropriately treated with antipsychotic medications that exacerbate the extra-pyramidal motor features of the syndromes. When symptoms are considered to comprise a neurodegenerative syndrome, it may be an inaccurate diagnosis as many features of CBS and PSPS not only overlap with each other, but also with other dementia syndromes. This review discusses similarities and differences between the syndromes of CBS and PSPS in terms of neuropsychiatric features. Improved characterization of the clinical syndromes is necessary to better predict underlying pathology. Improved education about these diseases would help patients, caregivers and clinicians to anticipate symptom progression and avoid premature nursing home placement. PMID:23611349
AIM To examine the relation of axial and appendicular bone properties in ambulatory children with cerebral palsy (CP) to functional (Gross Motor Function Classification System [GMFCS]) level. METHOD Quantitative computed tomography measurements were compared among 37 children with CP (12 children in GMFCS level I, five in level II, 18 in level III, two in level IV; five with hemiplegia, 23 with diplegia, two with triplegia, seven with quadriplegia; mean age 9y 4mo, SD 1y 6mo; 18 males, 19 females) and 37 children in a comparison group (same age and sex distributions). Linear regression was used to evaluate differences in volumetric cancellous bone density (vBMD) and geometric properties of the L3 vertebra and tibia, adjusting for height, weight, and sex as covariates. RESULTS The comparison group had larger vertebrae than the children with CP (p=0.02) owing to smaller vertebral size in GMFCS levels III and IV, but there was no difference in vertebral vBMD (p=0.49). In the tibia, bone volumetric density (p=0.09) and size (p=0.02) decreased with increasing GMFCS level. GMFCS level had a greater effect on bone size in females than in males (p<0.07). INTERPRETATION Children with CP of all levels may have less bone in their tibias, whereas spine deficits differentially affect more involved children. Because even small bone deficits may manifest as osteoporosis later in life, it is important to study bone acquisition in all children with CP.
WREN, TISHYA A L; LEE, DAVID C; KAY, ROBERT M; DOREY, FREDERICK J; GILSANZ, VICENTE
Background Cerebral palsy (CP) is a major cause of childhood disability. There are various maternal and neonatal predictors associated with the development of CP, and they are variable across different populations. This case–control study was designed to investigate maternal and neonatal predictors of CP at Khartoum pediatric neurology clinics. Data (maternal sociodemographic characteristics and neonatal expected predictors) were collected from mothers of children with CP and healthy controls using questionnaires. Results One hundred and eleven cases of CP and 222 controls were included. Spastic CP was the most common type (69.4%). In logistic regression, maternal age, parity, birth weight, and sex were not associated with CP. However, maternal fever (OR = 8.4, CI = 2.3–30.5; P = 0.001), previous neonatal death (OR = 5.4, CI = 1.8–16.2; P = 0.003), and poor sucking (OR = 30.5, CI = 10.0–93.1; P < 0.001) were predictors of CP. Conclusions Fever during labor is a significant risk factor for developing CP in children. Further efforts are required for labor management to prevent CP in this setting.
Isolated third cranial nerve palsies may be caused by compressive intracranial aneurysms located at the junction of the internal carotid and posterior communicating arteries or, less commonly, at the apex of the basilar artery or its junction with the superior cerebellar or posterior cerebral arteries. Such aneurysms typically measure at least 4 mm in diameter. Technical improvements in noninvasive techniques, including CT and MRA, have yielded a detection rate of such aneurysms that approaches that of catheter cerebral angiography (CCA), which itself carries a small but serious risk. Multidetector technology, which allows a rapid scan time, has promoted CT to the first choice for investigating aneurysms in this setting except when dye or radiation exposure is unacceptable, as with pregnant women, children, and those with renal or severe cardiac disease. Major impediments to accurate detection are a lack of availability of trained technicians, who must perform manipulation of the raw imaging data ("post-processing"), and a paucity of certified neuroradiologists with the time, skill, and experience to devote to interpreting difficult cases. To avoid diagnostic mishaps, noninvasive studies should be reviewed by at least one neuroradiologist before aneurysm is rejected as the cause or before the patient undergoes CCA. PMID:19726948
Starting from the case of a 12-year-old boy with dyskinetic (athetoid-dystonic subtype) cerebral palsy, the authors apply the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) of the World Health Organization (WHO) as a comprehensive documentation tool to guide the pathway of care and illustrate a multidisciplinary and interdisciplinary neurorehabilitation team approach. The ICF-CY provides a common and universal language for describing and measuring health and disability in the first 2 decades of life. Despite the fact that this is a single case design, the authors consider it useful for the identification of an ICF-CY core set for the description of children with cerebral palsy. The results of this single case study are preliminary and need to be tested in a large trial of children with cerebral palsy. PMID:21911416
The smile of the famed portrait 'The Mona Lisa' has perplexed both art historians and researchers for the past 500 years. There has been a multitude of theories expounded to explain the nature of the model's enigmatic smile. The origin of the model's wry smile can be demonstrated through a careful analysis of both documented facts concerning the portrait--some gathered only recently through the use of modern technology--and a knowledge of the clinical presentation of Bell's palsy. Bell's palsy is more prevalent in women who are either pregnant or who have recently given birth. This paper postulates that the smile of the portrait's model was due to Leonardo da Vinci's anatomically precise representation of a new mother affected by Bell's palsy subsequent to her recent pregnancy. PMID:20929717
Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.
The authors report the unique occurrence of an isolated post-ictal contralateral oculomotor nerve (OCN) palsy following excision of a medial frontal oligoastrocytoma. A 45-year-old male presented with a history of generalized tonic clonic seizures (GTCS) for 8 years. His neurological examination was unremarkable. Magnetic resonance imaging (MRI) of the brain revealed a left frontopolar low grade glioma. Nine hours after an uneventful near total microsurgical excision, the patient had a GTCS, following which he was noted to have an isolated right-sided OCN palsy. The immediate post-ictal computed tomographic scan and magnetic resonance images acquired 2 weeks after surgery failed to reveal any abnormality. The palsy had recovered completely by the 9-month follow-up. PMID:19448971
Though some anecdotal evidence supports the efficacy of orofacial myofunctional therapy in cerebral palsy and other disorders, controlled studies are very scant. This study was undertaken to examine the efficacy of orofacial myofunctional therapy in sixteen children diagnosed with spastic cerebral palsy. Following baseline measures, all children participated in a four-month therapy program, consisting of training the tongue, lips, and jaw muscles for adequate posturing and functioning. Post-therapy measures indicated significant improvement in functioning of lips, tongue, and jaw. Speech intelligibility of words also improved significantly as measured by two judges using a five-point rating scale. A significant correlation was found between tongue functioning and improvement in speech intelligibility; however no significant correlation was obtained between functioning of lips/jaw and speech intelligibility. Clinical implications regarding use of orofacial myofunctional therapy with cerebral palsied children are discussed. PMID:11892371
Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle weakness in children. Because facial palsy and muscle weakness may be an indicator of a serious or life threatening condition, the school nurse plays a critical role in early recognition and referral. The Gordon Facial Muscle Weakness Assessment Form is presented as a tool designed to assist school nurses in recognizing children with facial muscle weakness and in determining whether a primary health care provider referral should be considered immediate or urgent. PMID:19114470
Paralysis of diaphragm on one or, exceptionally, both sides is a common cause of delayed recovery and excessive morbidity following pediatric cardiac surgery. The consequences of this complication after all forms of congenital heart surgery in newborns and young infants can be potentially serious. The impact of diaphragmatic palsy on the physiology after single ventricle palliations is particularly significant. It is necessary for all professionals taking care of children with heart disease to be familiar with the etiology, diagnosis, and management of this condition. Early recognition and prompt management of diaphragmatic palsy can potentially reduce the duration of mechanical ventilation and intensive care in those who develop this complication. This review summarizes the anatomy of the phrenic nerves, reasons behind the occurrence of diaphragmatic palsy, and suggests practical guidelines for management.
Some children with cerebral palsy have articulation disorders that are resistant to conventional speech therapy. The aim of this study was to investigate whether the visual feedback method of electropalatography (EPG) could be an effective tool for treating five children (mean age of 9.4 years) with dysarthria and cerebral palsy and to explore whether training improved the posteriorly placed articulation of the Swedish dental/alveolar target consonants /t/, /d/, /n/ and /s/ produced in different positions. An EPG analysis was conducted and some of the data were combined with a perceptual analysis. A more anterior placement was seen after treatment for the target sounds. Features of diagnostic importance revealed were unusual tongue-palate contacts, such as double articulation and abnormally retracted articulation. A possible change in stop closure duration was indicated. The results suggest that EPG could be of potential benefit for diagnosing, treating and describing articulation errors associated with cerebral palsy. PMID:21591933
Delayed facial palsy after acoustic neuroma resection may occur in up to 15% of cases. Prognosis is generally good if the palsy does not progress to total paralysis. However, a delayed palsy with subsequent total paralysis has a more variable final outcome, which ranges from normal function to permanent total paralysis. This delayed paralysis has been attributed to edema from surgical manipulation of the facial nerve. Steroids and intraoperative decompression of the meatal foramen have been used with some success, but some cases remain refractory to these measures. Herpes simplex virus and varicella-zoster virus are ubiquitous in the population and remain in a latent state in neural ganglia. These viruses are reactivated during times of stress. Trigeminal nerve surgery (partial sensory rhizotomy and microvascular decompression) stimulates reactivation of herpes simplex with manifestations in the sensory distribution of the trigeminal nerve in 38-94% of procedures. Prevention of this reactivation has been demonstrated in placebo-controlled trials by using prophylactic acyclovir. We present a patient who underwent translabyrinthine resection of an intracanalicular acoustic neuroma and in whom developed otalgia, vesicles on the ear canal and the ipsilateral buccal mucosa, and progressive facial palsy the week after surgery. Serologic evaluation confirmed the diagnosis of herpes zoster oticus. Reactivation of latent virus apparently occurred as a result of surgical manipulation of the facial nerve. This parallels viral reactivation seen in trigeminal nerve surgery. We propose a new theory for an additional cause of delayed facial palsy after acoustic neuroma resection-reactivation of latent herpesvirus resulting from surgical trauma. Acyclovir should be evaluated in clinical trials for a prophylactic role in patients undergoing acoustic neuroma resection or a therapeutic role in patients in whom a delayed postoperative facial palsy develops. PMID:8841711
Objective We studied the annual change in measures of motor, oculomotor and cognitive function in progressive supranuclear palsy. This had twin objectives, to assess the potential for clinical parameters to monitor disease progression in clinical trials and to illuminate the progression of pathophysiology. Methods Twenty three patients with progressive supranuclear palsy (Richardson’s syndrome) were compared to 22 matched controls at baseline and 16 of these patients compared at baseline and one year using: the progressive supranuclear palsy rating scale; the unified Parkinson’s disease rating scale; the revised Addenbrooke’s cognitive examination; the frontal assessment battery; the cubes section of the visual object and space perception battery; the Hayling and Brixton executive tests; and saccadic latencies. Results Patients were significantly impaired in all domains at baseline. However, cognitive performance was maintained over a year on the majority of tests. The unified Parkinson’s disease rating scale, saccadic latency and progressive supranuclear palsy rating scale deteriorated over a year, with the latter showing the largest change. Power estimates indicate that using the progressive supranuclear palsy rating scale as an outcome measure in a clinical trial would require 45 patients per arm, to identify a 50% reduction in rate of decline with 80% power. Conclusions Motor, oculomotor and cognitive domains deteriorate at different rates in progressive supranuclear palsy. This may be due to differential degeneration of their respective cortical-subcortical circuits, and has major implications for the selection of outcome measures in clinical trials due to wide variation in sensitivity to annual rates of decline.
Ghosh, Boyd C. P.; Carpenter, Roger H. S.; Rowe, James B.
Children with cerebral palsy are at greater risk of a whole range of oral conditions than their peers. These include bruxism (tooth grinding), oral skill dysfunction, gross malocclusion due to effects of the abnormal orofacial muscle tone on tooth eruption, drooling of saliva, and poor oral hygiene.1 A challenging case of a painful buccal lesion in a 2 year old girl with cerebral palsy (CP) that did not respond to antifungal, antiviral or antibiotic treatment is presented as a factitious lesion. The recognition and significance of self?injurious behaviour and factitious lesions in children are discussed.
Haemodynamics of 58 Pediatric patients with cerebral palsy was studied during combined anaesthesia based on sevoflurane and peripheral nerve block. Sevoflurane and peripheral nerve block with infusion support 14-15 ml/kg/ hr provide stable cardiac output during orthopedic surgeries in Pediatric patients with cerebral palsy. Excessive arterial hypotension and total peripheral vascular resistance decrease were registered in older patients as results of more pronounced vascular effect of anaesthetics in patients with decreased adaptive-compensatory possibilities and insufficient infusion support. The proposed anaesthesia method provides adequate intraoperative analgesia, fast recovery and comfortable postoperative period. PMID:23808254
Ophthalmoplegia due to 3rd nerve palsy is a common occurrence, and is usually a sign of diabetes mellitus or a serious intracranial disease. We report a rare case of pupil sparing 3rd nerve palsy caused by mucocele of the sphenoid sinus. The patient regained 3rd nerve functions after successful decompression of the mucocele. Early and correct diagnosis of this relatively benign condition is important to prevent permanent neurological deficits, including visual loss by optic nerve atrophy. Etiology, clinical manifestations and treatment of the sphenoid mucoceles is discussed and available literature is reviewed.
Kataria, Rashim; Gupta, Swati; Chopra, Sanjeev; Bagaria, H.; Sinha, V. D.
Ophthalmoplegia due to 3(rd) nerve palsy is a common occurrence, and is usually a sign of diabetes mellitus or a serious intracranial disease. We report a rare case of pupil sparing 3(rd) nerve palsy caused by mucocele of the sphenoid sinus. The patient regained 3(rd) nerve functions after successful decompression of the mucocele. Early and correct diagnosis of this relatively benign condition is important to prevent permanent neurological deficits, including visual loss by optic nerve atrophy. Etiology, clinical manifestations and treatment of the sphenoid mucoceles is discussed and available literature is reviewed. PMID:22566736
Kataria, Rashim; Gupta, Swati; Chopra, Sanjeev; Bagaria, H; Sinha, V D
The case of a child injured by a knitting needle penetrating transorbitally and intracranially, resulting in carotid cavernous fistula and pontine injury, is reported. After receiving medical and endovascular treatment, the only remaining abnormal neurological manifestation was right peripheral facial nerve palsy. The clinical sequences of events and the demonstration of a pontine lesion leading to peripheral facial palsy are presented. Facial nuclear injury with a penetrating trauma is an extremely rare condition. It is important to identify the anatomical regions injured in penetrating traumas. The lesions must be identified by computerized tomography, magnetic resonance imaging, clinical and laboratory investigation. PMID:16283198
Cosan, T Erhan; Adapinar, Baki; Cakli, Hamdi; Gurbuz, M Kezban
A five year old female had an isolated abducens nerve palsy following closed head injury. There was no associated skull fracture, haematoma, or other cranial nerve injury. The significance, frequency, and differential diagnosis of traumatic sixth cranial nerve injury is discussed, particularly in paediatric patients. Management is symptomatic; occlusion with an eye pad may be used if diplopia is significant. In young children alternate day occlusion of each eye will help prevent amblyopia. Most cases improve within three months and many resolve by six months. Residual palsy at six months is likely to be permanent and surgical treatment may be needed.
AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury. METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation. RESULTS: Among 87 patients, 9 (10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion < -12°, whereas only 1 patient (1.1%) with finger movement had a PHHA > 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0° ± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1), when compared to those patients, who had primary surgeries (nerve and muscle surgeries), and lacked finger movement at birth (group 2), (PHHA 10.7% ± 15.8%; Version -8.0° ± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group. CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.
Background: Psychological stress associated with cerebral palsy (CP) is known to be one of the most depressing conditions of families. In the traditional African society, some peculiar factors may contribute to the stress. Aims: The aims of this study were to identify and describe, from the African perspective, the psychological impact of CP on families and determine the strategies adopted by families in coping with it. Settings and Design: The study was a cross-sectional descriptive survey conducted in the Physiotherapy Department of a tertiary hospital. Materials and Methods: Participants were 52 parents of children with CP. They completed a questionnaire designed to determine the degree of psychological stress on the families and strategies adopted to cope with the stress. Statistical Analysis: Descriptive statistics were used to show responses in graphical formats. Results: Respondents agreed that having adequate knowledge of CP would help them cope well with the demands of taking care of children with CP. 38.5% of respondents said that people in the society accused them of some wrongdoing that has made their children to have CP. Personal problems experienced include loss of job, lack of concentration at work, loss of family joy, and derangement of financial affairs of the family. 26 (50%) of them resort to religious/spiritual intervention as an alternative or complementary mode of treatment for their children while 28% resort to dependence on the extended family system for support. Conclusion: Families caring for children with CP generally have a positive attitude towards their children. However, there is need to educate the public on the causes of CP and treatment options available to families.
Olawale, Olajide A; Deih, Abraham N; Yaadar, Raphael KK
Background It has been hypothesised that cerebral palsy (CP) and other congenital anomalies are attributable to feto–fetal transfusion problems in a monochorionic multiple gestation. Thus more than one organ could be compromised leading to the coexistence of two or more anomalies in a fetus. Such anomalies in a singleton birth may be attributable to early demise of the co?conceptus as a vanishing twin. Aim To determine whether the coexistence of congenital anomalies and CP is greater than a chance finding by comparing the prevalence of congenital anomalies in children with CP with that in the general population of children. Methods A population?based register of children with CP born in 1966–1991 in the counties of Merseyside and Cheshire, UK, comprised the index population. Coexisting congenital anomalies were recorded. For comparison the population prevalence of congenital anomalies was obtained from eight congenital malformation registers in the UK. Results Children with CP were found to have highly significant increases in risk for microcephaly, isolated hydrocephaly, congenital anomalies of the eye, congenital cardiac anomalies, cleft lip and/or palate and congenital dislocation of the hips and talipes (p<0.001) and atresias of the oesophagus (p<0.001) and intestines (p<0.01). The relative risks ranged from 3.1 (95% CI 1.9 to 4.8; p<0.001) for congenital malformations of the cardiac septa to 116.09 (95% CI 84.0 to 162.3; p<0.001) for microcephaly. Conclusions Congenital anomalies in children with CP are found much more frequently than expected by chance. A common pathogenic mechanism may account for the coexistence of disparate congenital anomalies. A hypothesis is proposed for such a common pathogenic mechanism.
Aim: Oral motor dysfunction is a common issue in children with cerebral palsy (CP). Drooling, difficulties with sucking, swallowing, and chewing are some of the problems often seen. In this study, we aimed to research the effect of oral motor therapy on pediatric CP patients with feeding problems. Materials and Methods: Included in this single centered, randomized, prospective study were 81 children aged 12-42 months who had been diagnosed with CP, had oral motor dysfunction and were observed at the Pediatric Neurology outpatient clinic of the Children's Health and Diseases Department, Istanbul Medical Faculty, Istanbul University. Patients were randomized into two groups: The training group and the control group. One patient from the training group dropped out of the study because of not participating regularly. Following initial evaluation of all patients by a blinded physiotherapist and pedagogue, patients in the training group participated in 1 h oral motor training sessions with a different physiotherapist once a week for 6 months. All patients kept on routine physiotherapy by their own physiotherapists. Oral motor assessment form, functional feeding assessment (FFA) subscale of the multidisciplinary feeding profile (MFP) and the Bayley scales of infant development (BSID-II) were used to evaluate oral motor function, swallowing, chewing, the gag reflex, the asymmetrical tonic neck reflex, tongue, jaw, and mouth function, severity of drooling, aspiration, choking, independent feeding and tolerated food texture during the initial examination and 6 months later. Results: When the initial and post-therapy FFA and BSID-II scores received by patients in the training and the study group were compared, the training group showed a statistically significant improvement (P < 0.05). Conclusion: Oral motor therapy has a beneficial effect on feeding problems in children with CP.
Objective Currently [F-18]FDDNP is the only PET imaging probe with the ability to visualize hyperphosphorylated tau fibrillar aggregates in living subjects. In this work, we evaluate in vivo [F-18]FDDNP labeling of brain neuropathology, primarily tau fibrillar aggregates, in patients with progressive supranuclear palsy (PSP), a human tauopathy usually lacking ?-amyloid deposits. Methods Fifteen patients with PSP received [F-18]FDDNP PET scanning. [F-18]FDDNP distribution volume ratios (DVR), in reference to cerebellar gray matter, were determined for cortical and subcortical areas and compared with those of patients with Parkinson’s disease (PD) with short disease duration, and age-matched control subjects without neurodegenerative disorders. Results [F-18]FDDNP binding was present in subcortical areas (e.g., striatum, thalamus, subthalamic region, midbrain and cerebellar white matter) regardless of disease severity, with progressive subcortical and cortical involvement as disease severity increased. Brain patterns of [F-18]FDDNP binding were entirely consistent with the known pathology distribution for PSP. High midbrain and subthalamic region [F-18]FDDNP binding was distinctive for PSP subjects and separated them from controls and patients with PD. Conclusions These results provide evidence that [F-18]FDDNP is a sensitive in vivo PET imaging probe to map and quantify the dynamic regional localization of tau fibrillar aggregates in PSP. Furthermore, [F-18]FDDNP PET may provide a tool to detect changes in tau pathology distribution either associated with disease progression or as a treatment biomarker for future tau-specific therapies. Patterns of [F-18]FDDNP binding may also be useful in diagnosis early in disease presentation when clinical distinction among neurodegenerative disorders is often difficult.
Kepe, Vladimir; Bordelon, Yvette; Boxer, Adam; Huang, Sung-Cheng; Liu, Jie; Thiede, Frederick C.; Mazziotta, John C.; Mendez, Mario F.; Donoghue, Natacha; Small, Gary W.; Barrio, Jorge R.
Normal blood pressure is important for proper blood flow to the body’s organs and tissues. The force of the blood on the walls of the arteries is called blood pressure. Blood pressure is measured both as the heart ...
... may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers. Symptoms What are the symptoms ... put in a vein) or orally (by mouth). Prevention How can pressure sores be prevented? The most important step to ...
This paper discusses a sciatic nerve palsy developed after a right total hip revision with a Burch-Schneider metal cage. A sciatalgic nerve pain appeared after surgery, while the palsy developed in about fifteen days. An electromyography showed the delay of the nerve impulse gluteal level. During the surgical exploration of the hip, a compression of the nerve on the metal cage was observed. The nerve was isolated, released from the fibrotic tissue and from the impingement, and was protected with a muscular flap. The recover from the pain was immediate, while the palsy recovered one month later.
Purpose To assess the outcome of children with cerebral palsy following reposition of the distal rectus femoris tendon for treatment\\u000a of stiff knee gait.\\u000a \\u000a \\u000a \\u000a Methods Children with cerebral palsy with stiff knee gait who underwent rectus femoris transfer were studied retrospectively. Inclusion\\u000a criteria were cerebral palsy of diplegic or quadriplegic type, preoperative and 1 year postoperative three-dimensional motion\\u000a analysis, and no other surgery
Yoram Hemo; Michael D. Aiona; Rosemary A. Pierce; Robin Dorociak; Michael D. Sussman
|Compared with motor impairment in children with hemiplegic cerebral palsy (CP), less attention has been paid to sensory feedback processing deficits. This includes, especially, proprioceptive information regarding arm position. This study examined the ability of children with hemiplegic CP to use proprioceptive feedback during a goal-directed…
Goble, Daniel J.; Hurvitz, Edward A.; Brown, Susan H.
|This study examined inter-rater reliability of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP) and the presence of rater bias. A consecutive sample of 118 children with CP, 2-18 years old (mean 10.3 years, SD 3.6), was recruited from a hospital setting. Children were classified using the gross motor function…
Harvey, Adrienne R.; Morris, Meg E.; Graham, H. Kerr; Wolfe, Rory; Baker, Richard
|The study examined the effects of mirror feedback information on neuromuscular activation during bimanual coordination in eight children with spastic hemiparetic cerebral palsy (SHCP) and a matched control group. The "mirror box" creates a visual illusion, which gives rise to a visual perception of a zero lag, symmetric movement between the two…
Feltham, Max G.; Ledebt, Annick; Deconinck, Frederik J. A.; Savelsbergh, Geert J. P.
|This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after…
Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma or cardiac surgery. We describe two new patients with phrenic nerve palsy associated with birth trauma. Both patients exhibited profound dyspnea and general hypotonia immediately after birth. A chest roentgenogram and fluoroscopy revealed elevation of the diaphragm, leading to a diagnosis of phrenic nerve palsy associated with birth trauma. Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively. Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once. However, this recovery was transient and subsequently led to an increased ventilation volume demand, finally resulting in surgical treatment at 15 months. Histological examination of the diaphragm at this time showed grouped muscle atrophy caused by phrenic nerve degeneration. To our knowledge, this is the first pathologically proven report of grouped muscle atrophy of the diaphragm due to phrenic nerve degeneration, suggesting that partial impairment of phrenic nerves resulted in respiratory dysfunction with incomplete recovery. We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period. PMID:22742777
In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we conducted a cost-effectiveness analysis alongside our prospective national study. We compared the costs and health effects of CITB
M. A. Hoving; S M A A Evers; A J H A Ament; E P M van Raak; J. S. H. Vles; J. G. Becher; R. Vermeulen; O. F. Brouwer; C. G. Maathuis; C. E. Catsman-Berrevoets; J. Gerritsen; M. J. Geerts; P. H. Jongerius; O. F. Nieuwenhuizen; J. J. Rotteveel; L. A. Speth; H. Stroink; E. G. van der Ziel
The aims of this study are to compare quantitatively the gait strategy of the right and left hemiplegic children with Cerebral Palsy (CP) using gait analysis. The gait strategy of 28 right hemiparetic CP (RHG) and 23 left hemiparetic CP (LHG) was compared using gait analysis (spatio-temporal and kinematic parameters) and considering the hemiplegic…
Galli, Manuela; Cimolin, Veronica; Rigoldi, Chiara; Tenore, Nunzio; Albertini, Giorgio
|Aim: The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants. Method: As part of EPIPAGE, a population-based prospective cohort study, perinatal data…
A rare case of acute posterior interosseous nerve palsy caused by septic elbow arthritis is reported. The nerve was compressed beneath the arcade of Frohse by hypertrophied synovium and joint fluid at the anterior aspect of the radial neck. Decompression of the nerve, synovectomy, and irrigation of the elbow joint were done. effective. Six months after the surgery the nerve
A relationship is considered between abnormal postural reflex activity and its effect on vocal processes in infants and very young children having cerebral palsy. Neurodevelopmental treatment concepts are interpreted as they may apply to evaluation and intiial management of hypertonic children who exhibit voice usage deviations. Interdisciplinary team function in the areas of physical therapy, occupational therapy, and speech pathology is suggested. PMID:996091
Constructing and maintaining a supportable daily routine is an important task for families with young children, particularly when the child has a disability. In this study, we examined relationships between children's developmental needs, disability diagnosis, and families' resources and accommodations. Participants included families with infants or toddlers receiving early intervention services because of Down syndrome, cerebral palsy, or developmental delay.
ABSTRACT. Objective. Most children enjoy healthy childhoods with little need for specialized health care services. However, some children experience difficulties in early childhood and require access to and utilization of considerable health care resources over time. Although impaired motor function is the hallmark of the cerebral palsy (CP) syndromes, many children with this develop- ment disorder also experience sensory, communicative,
Dianne Russell; Marilyn Swinton; Ellen Wood Parminder Raina; Maureen O'Donnell; Peter Rosenbaum; Jamie Brehaut
Some people with cerebral palsy have motor and associated impairments that may hinder verbal and gestural expression to various extents. This study explores whether the ability to produce verbal or gestural expressions may be related to the comprehension of verbal communications and gestures. The influence of severity of motor impairment, general cognitive performance, and age on comprehension ability was also explored. Forty people with cerebral palsy were assigned to different groups according to their verbal and gestural expression abilities. A neuropsychological assessment of comprehension abilities and general cognitive performance was carried out. Multiple linear regression analysis was applied to identify the possible influence of expression abilities on comprehension abilities and also to detect the possible contribution of severity of motor impairment, general cognitive performance, and age. Results indicate that verbal and gestural comprehension was mainly predicted by general cognitive performance. Severity of motor impairment and age did not contribute to predicting comprehension abilities. Only verbal grammar comprehension was significantly predicted by verbal expression ability. Verbal expression ability may be an important marker for cerebral palsy therapies. In non-ambulant patients with bilateral cerebral palsy, impaired gestural expression should not be taken as an indicator of impaired gestural comprehension. PMID:24032327
Aim: To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics. Method: Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated.…
van Wely, Leontien; Becher, Jules G.; Balemans, Astrid C. J.; Dallmeijer, Annet J.
|Background: Cognitive dysfunction is frequent in Cerebral Palsy (CP). CP motor impairment and associated speech deficits often hinder cognitive assessment, with the result being that not all CP studies consider cognitive dysfunction. Raven's Coloured Progressive Matrices is a simple, rapid test which can be used in persons with severe motor…
Pueyo, R.; Junque, C.; Vendrell, P.; Narberhaus, A.; Segarra, D.
|Aim: Cerebral visual impairment (CVI) is a disorder caused by damage to the retrogeniculate visual pathways. Cerebral palsy (CP) and CVI share a common origin: 60 to 70% of children with CP also have CVI. We set out to describe visual dysfunction in children with CP. A further aim was to establish whether different types of CP are associated with…
Fazzi, Elisa; Signorini, Sabrina G.; La Piana, Roberta; Bertone, Chiara; Misefari, Walter; Galli, Jessica; Balottin, Umberto; Bianchi, Paolo Emilio
|Aim: To evaluate spasticity under controlled velocities and torques in children with cerebral palsy (CP) using a manual spasticity evaluator. Method: The study involved 10 children with spastic CP (six males, four females; mean age 10y 1mo, SD 2y 9mo, range 7-16y; one with quadriplegia, six with right hemiplegia, three with left hemiplegia; Gross…
In care and research, there is increasing interest in the daily lives of children with cerebral palsy (CP). So far, we know that CP can have a limiting impact on daily activities such as locomotion and self-care. What we, however, don’t know is how children with CP develop over time in terms of their daily activities. Is there progress, stagnation,
|Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…
Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.
|Aim: To examine the stability of caregiver-reported classifications of function of children with cerebral palsy (CP) measured 12 months apart. Method: Participants were 86 children (50 males, 36 females) with CP of all motor types and severities who were recruited into a population-based longitudinal study. Children were aged 11 years 8 months…
|The primary objective of the study was to determine whether there was any difference, with respect to depression, between mothers of children with cerebral palsy (CP) and mothers of healthy children. The secondary objective was to evaluate whether some additional factors had an impact on the depression of the mothers. The study included 49…
Riding therapy (hippotherapy) is a novel progressive and original method for treating infantile cerebral palsy (ICP) and can be applied early in life. We examined 100 ICP patients aged from 3 to 14 years, who were divided into two equal groups, one assigned to riding therapy and the other (control) to therapeutic exercises by the Bobath method. It was shown
N. I. Ionatamishvili; D. M. Tsverava; M. Sh. Loriya; E. G. Sheshaberidze; M. M. Rukhadze
Aim: Cerebral visual impairment (CVI) is a disorder caused by damage to the retrogeniculate visual pathways. Cerebral palsy (CP) and CVI share a common origin: 60 to 70% of children with CP also have CVI. We set out to describe visual dysfunction in children with CP. A further aim was to establish whether different types of CP are associated with…
Fazzi, Elisa; Signorini, Sabrina G.; La Piana, Roberta; Bertone, Chiara; Misefari, Walter; Galli, Jessica; Balottin, Umberto; Bianchi, Paolo Emilio
Conductive education (CE) is an educational approach for children with cerebral palsy. This paper describes the history of conductive education, and the characteristics of current programs that exist in many countries. The underlying principles and the unique techniques used in CE programs are described. These include the role of the conductor or…
Aim: Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP. Method: Five hundred…
Orlin, Margo N.; Palisano, Robert J.; Chiarello, Lisa A.; Kang, Lin-Ju; Polansky, Marcia; Almasri, Nihad; Maggs, Jill
|A common problem in children with hemiplegic cerebral palsy (CP) is the asymmetrical development of arm and hand capacity caused by the lack of use of the affected upper limb, or developmental disregard. In this paper, we provide a neuropsychological model that relates developmental disregard to attentional processes and motor learning. From this…
Houwink, Annemieke; Aarts, Pauline B. M.; Geurts, Alexander C. H.; Steenbergen, Bert
Aim: The purpose of this study was to determine if our previously developed muscle model could be used to predict forces of the quadriceps femoris and triceps surae muscles of children with spastic diplegic cerebral palsy (CP). Method: Twenty-two children with CP (12 males, 10 females; mean age 10y, SD 2y, range 7-13y; Gross Motor Function…
Lee, Samuel C. K.; Ding, Jun; Prosser, Laura A.; Wexler, Anthony S.; Binder-Macleod, Stuart A.
The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of…
van Munster, Judith C.; Maathuis, Karel G. B.; Haga, Nienke; Verheij, Nienke P.; Nicolai, Jean-Philippe A.; Hadders-Algra, Mijna
Aim: The aim of this study was to assess the independent role of cerebral lesions on ultrasound scan, and several other neonatal and obstetric factors, as potential predictors of cerebral palsy (CP) in a large population-based cohort of very preterm infants. Method: As part of EPIPAGE, a population-based prospective cohort study, perinatal data…
OKAim: The aim of this systematic review was to examine the literature on the effects of partial body-weight support treadmill training (PBWSTT) in children with cerebral palsy (CP) on functional outcomes and attainment of ambulation. Method: We searched the relevant literature from 1950 to July 2007. We found eight studies on the use of PWSBTT on…
Antiphospholipid antibody syndrome (APS) is now recognized as an important risk factor for young stroke. Recurrent stroke seems to be common in patients with APS and a first stroke, recurrent stroke and vascular dementia are feared consequences of APS. We are reporting a case of primary APS with recurrent stroke presenting as pseudobulbar palsy in an young man. PMID:11848316
Aleem, M A; Govindaraj, K; Senthil, V J; Kanagaraj, V; Jayapal, V
The purposes of the study were to examine the effect of task constraint on the reaching performance in children with spastic cerebral palsy (CP) and to examine the correlations between the reaching performance and postural control. Eight children with CP and 16 typically developing (TD) children participated in the study. They performed a…
This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after…
|Children with multiple handicaps, including cerebral palsy (CP), often lose or regress in their functional ability through adolescence and young adulthood. The purpose of this study was to examine functional and psychosocial changes in children, adolescents, and young adults with CP. A retrospective chart review and a prospective telephone…
Krakovsky, Gina; Huth, Myra Martz; Lin, Li; Levin, Ron S.
|Reports were elicited from 56 Bengali parents of children (ages 1-18) with cerebral palsy on activities they engaged in with their child and on the toys the child possessed. The majority reported spending time playing with their child and all respondents named at least two toys belonging to their child. (Contains references.) (Author/CR)|
This paper describes a video game for the rehabilitation of the pronation and supination movements of children with cerebral palsy. It is used as an interface for a robot that is currently under development. The game was programmed in LabVIEW and MATLAB is used for analyzing the results. It simulates a formula one racecar on a racetrack. Its objective is
J. E. Cifuentes-Zapien; J. A. Valdez-Aguilar; F. J. Rojas-Correa; J. E. Chong-Quero; A. Pineda-Olivares
Increased knee flexion during stance is a common gait deviation in the child with cerebral palsy (CP), with distal hamstring lengthening surgeries being an accepted course of treatment. Post-operatively, improvements in gait kinematics have been reported, however little change is noted in the patterns of muscle activity as portrayed by onset and offset timing in the surface electromyographic (sEMG) signals.
Richard T. Lauer; Brian T. Smith; Patricia A. Shewokis; James J. McCarthy; Carole A. Tucker
Sit-to-stand (STS) movement is widely performed in daily life and an important pre requisite for acquisition of functional abilities. However, STS is a biomechanical demanding task which requires high levels of neuromuscular coordination, muscle strength and postural control. As children with cerebral palsy (CP) exhibit a series of impairments in…
In clinical settings, the spastic catch is judged subjectively. This study assessed the psychometric properties of objective parameters that define and quantify the severity of the spastic catch in children with cerebral palsy (CP). A convenience sample of children with spastic CP (N = 46; age range: 4-16 years) underwent objective spasticity…
We investigated whether motor planning problems in people with Hemiparetic Cerebral Palsy (HCP) are paralleled by impaired ability to use Motor Imagery (MI). While some studies have shown that individuals with HCP can solve a mental rotation task, it was not clear if they used MI or Visual Imagery (VI). In the present study, motor planning and MI…
Craje, Celine; van Elk, Michiel; Beeren, Manuela; van Schie, Hein T.; Bekkering, Harold; Steenbergen, Bert
OBJECTIVE: To determine the relationship between resting energy expenditure and body cell mass in a group of children with spastic quadriplegic cerebral palsy (SQCP) in comparison with a group of healthy volunteers. SUBJECTS AND METHODS: Children with SQCP (n = 13) and healthy control subjects (n = 21) participated in the study. Resting energy expenditure (REE) by indirect calorimetry, as
Maria P. Azcue; Gordon A. Zello; Lance D. Levy; Paul B. Pencharz
Pragmatically related abilities were studied in three clinical groups of children from 5 to 11 years of age; children with cerebral palsy (CP; n=10), children with spina bifida and hydrocephalus (SBH; n=10) and children with pragmatic language impairment (PLI; n=10), in order to explore pragmatic abilities within each group. A range of pragmatic, linguistic and cognitive assessments were performed, and
The aim of the study was to investigate and compare the ability to make inferences in three groups of children ranging from 5;2 to 10;9 years: 10 children with cerebral palsy (CP), 10 children with spina bifida and hydrocephalus (SBH) and 10 children with pragmatic language impairment (PLI). The relationship between inferential and literal comprehension was investigated by analysing atypical
|The aim of the study was to investigate and compare the ability to make inferences in three groups of children ranging from 5;2 to 10;9 years: 10 children with cerebral palsy (CP), 10 children with spina bifida and hydrocephalus (SBH) and 10 children with pragmatic language impairment (PLI). The relationship between inferential and literal…
|Aim: Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP. Method: Five hundred…
Orlin, Margo N.; Palisano, Robert J.; Chiarello, Lisa A.; Kang, Lin-Ju; Polansky, Marcia; Almasri, Nihad; Maggs, Jill
|We investigated whether motor planning problems in people with Hemiparetic Cerebral Palsy (HCP) are paralleled by impaired ability to use Motor Imagery (MI). While some studies have shown that individuals with HCP can solve a mental rotation task, it was not clear if they used MI or Visual Imagery (VI). In the present study, motor planning and MI…
Craje, Celine; van Elk, Michiel; Beeren, Manuela; van Schie, Hein T.; Bekkering, Harold; Steenbergen, Bert
|Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I…
|Aim: To test a model of child, family, and service determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy (CP). Method: Participants were 288 children with CP, age range 6 to 12 years (mean 9y 8mo, SD 2y), and their parents from seven children's hospitals. The sample comprised 166 (57.6%)…
Palisano, Robert J.; Chiarello, Lisa A.; Orlin, Margo; Oeffinger, Donna; Polansky, Marcy; Maggs, Jill; Bagley, Anita; Gorton, George
|Aim: The aim of this study was to examine the relationship between gross motor capacity and daily-life mobility in children with cerebral palsy (CP) and to explore the moderation of this relationship by the severity of CP. Method: Cross-sectional analysis in a cohort study with a clinic-based sample of children with CP (n=116; 76 males, 40…
Smits, Dirk-Wouter; Gorter, Jan Willem; Ketelaar, Marjolijn; van Schie, Petra Em; Dallmeijer, Annet J.; Lindeman, Eline; Jongmans, Marian J.
|Aim: Conventional constraint-based therapies are intensive and demanding to implement, particularly for children. Modified forms of constraint-based therapies that are family-centred may be more acceptable and feasible for families of children with cerebral palsy (CP)-but require rigorous evaluation using randomized trials. The aim of this study…
Wallen, Margaret; Ziviani, Jenny; Naylor, Olivia; Evans, Ruth; Novak, Iona; Herbert, Robert D.
|This systematic review critically appraises the literature on the psychometric properties and clinical utility of evaluative activity limitation outcome measures used for children with cerebral palsy (CP). The search strategy yielded 29 articles for eight outcome measures that met the inclusion criteria for the review. The Gross Motor Function…
Harvey, Adrienne; Robin, Jonathan; Morris, Meg E.; Graham, H. Kerr; Baker, Richard
BackgroundCerebral palsy (CP) is the most common cause of motor disability in children and an important public health issue in the United States. The Autism and Developmental Disabilities Monitoring (ADDM) Network is a multisite program funded by the Centers for Disease Control and Prevention to determine trends in the prevalence of children with developmental disabilities, including CP, in the United
Carrie L. Arneson; Maureen S. Durkin; Ruth E. Benedict; Russell S. Kirby; Marshalyn Yeargin-Allsopp; Kim Van Naarden Braun; Nancy S. Doernberg
OBJECTIVE--To analyse the trends in stillbirths, neonatal deaths, and cerebral palsy in all infants born in Western Australia from 1967 to 1985. To relate these trends to changes in perinatal care, particularly in relation to avoidance of intrapartum asphyxia in term infants and the increased survival of low birthweight infants. DESIGN--Descriptive epidemiological study calculating population rates for perinatal deaths and
Aim: This paper is a systematic review of physical activity measurement instruments for field-based studies involving children with cerebral palsy (CP). Method: Database searches using PubMed Central, MEDLINE, CINAHL Plus, PsycINFO, EMBASE, Cochrane Library, and PEDro located 12 research papers, identifying seven instruments that met the inclusion…
Capio, Catherine M.; Sit, Cindy H. P.; Abernethy, Bruce; Rotor, Esmerita R.
|Data about communication breakdown were gathered through interviews of care providers and mailed surveys of special education teachers and speech and language pathologists of 17 children with cerebral palsy and significant language delay. Most care providers indicated that children used personalized communication systems and that these frequently…
Snell, Martha E.; Chen, Lih-Yuan; Allaire, Janet H.; Park, Eunhye
The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP, aimed at ankle strengthening and improved control for children with cerebral palsy (CP). The system was an upgrade in hardware (new foot attachment, new robot controller) and software (new games and programming language) of the earlier Rutgers Ankle in order to permit training
Daniel Cioi; Angad Kale; Grigore Burdea; Jack Engsberg; William Janes; Sandy Ross
|Aim: Ankle-foot orthoses are the standard of care for foot drop in cerebral palsy (CP), but may overly constrain ankle movement and limit function in those with mild CP. Functional electrical stimulation (FES) may be a less restrictive and more effective alternative, but has rarely been used in CP. The primary objective of this study was to…
Prosser, Laura A.; Curatalo, Lindsey A.; Alter, Katharine E.; Damiano, Diane L.
Objectives: To identify evidence evaluating the effectiveness of physiotherapy in adolescents (>16 years of age) and adults with cerebral palsy.Data sources: Systematic literature search from the earliest available time until March 2009. Additional studies were identified through reference and citation tracking.Review methods: Two reviewers independently agreed on eligibility, methodological quality and quality of evidence assessment. Standard methods were used for
I. Jeglinsky; J. Surakka; E. Brogren Carlberg; I. Autti-Rämö
We performed this study to compare the correlation of bispectral index (BIS) values with different sevoflurane concentrations between normal children and those with quadriplegic cerebral palsy with mental retarda- tion (CPMR). Twenty children with CPMR (Group I) and 21 normal children (Group II) between 2 and 14 yr of age were studied. Anesthesia was induced and main- tained with sevoflurane
Objective. Constraint-Induced Move- ment (CI) therapy has been found to be a promising treatment for substantially increasing the use of extrem- ities affected by such neurologic injuries as stroke and traumatic brain injury in adults. The purpose of this study was to determine the applicability of this interven- tion to young children with cerebral palsy. Methods. A randomized, controlled clinical
Edward Taub; Sharon Landesman Ramey; Stephanie DeLuca; Karen Echols
|These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the…
Siebert, Kara L.; DeMuth, Sharon K.; Knutson, Loretta M.; Fowler, Eileen G.
Assessed pain, anxiety, physical functioning, and cooperativeness in 32 children with spastic cerebral palsy. This is the first study to assess children throughout rehabilitation following selective posterior rhizotomy. Results of the Observa- tional Scale of Behavioral Distress and observer Liken ratings confirmed the hypothesis that children's pain and anxiety decrease over time. Children's physi- cal functioning and cooperativeness improve over
A. Cate Miller; Marjoire Johann-Murphy; Ineke M. Pit-ten Cate
Parental participation in intervention programs for children with physical disabilities has become an important issue in recent years, often emphasized by both professionals and parents. In this article, recent studies examining parental involvement in intervention programs for children with cerebral palsy are reviewed. Only a few studies were found that were explicitly designed to study the effects of parental involvement.
M. Ketelaar; A. Vermeer; P. J. M. Helders; H.'t Hart
|A literature review of seven articles published from 1980 to 1996 on the effects of parental participation in the intervention program for children with cerebral palsy found that most of the studies reported positive results, especially for child-related outcomes. Effects on parents were related to parental involvement in goal setting.…
Ketelaar, Marjolijn; Vermeer, Adri; Helders, Paul J. M.; Hart, Harm't