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Hereditary neuropathy with liability to pressurepalsy (HNPP) is an autosomal dominant disorder characterized by recurrent mono-neuropathies secondary to minor trauma or compression. Whilst typical episodes of palsy generally become apparent during the second and the third decades, HNPP is rarely diagnosed in the first decade. We present the case of a 6-year-old patient to draw attention to the possibility
Hereditary neuropathy with liability to pressurepalsies (HNPP) is an autosomal dominantly inherited disorder that affects peripheral nerves by repeated focal pressure. HNPP can be diagnosed by clinical findings, electrodiagnostic studies, histopathological features, and genetic analysis. Ultrasonography is increasingly used for the diagnosis of neuromuscular diseases; however, sonographic features of HNPP have not been clearly defined. We report the sonographic findings and comparative electrodiagnostic data in a 73-year-old woman with HNPP, confirmed by genetic analysis. The cross-sectional areas of peripheral nerves were enlarged at typical nerve entrapment sites, but enlargement at non-entrapment sites was uncommon. These sonographic features may be helpful for diagnosis of HNPP when electrodiagnostic studies are suspicious of HNPP and/or gene study is not compatible.
Hereditary neuropathy with liability to pressurepalsies (HNPP) is an uncommon diagnosis that should be considered in patients with multiple compressive neuropathies. We present the case of a woman who presented with bilateral hand numbness and weakness. Electrodiagnostic testing revealed bilateral carpal tunnel syndrome, bilateral ulnar neuropathy at the elbow, left peroneal neuropathy at the fibular head, and a primarily demyelinating generalized sensorimotor neuropathy. Subsequent genetic testing identified a deletion at chromosome 17p11.2 to confirm the diagnosis of HNPP. Treatment of this largely self-limiting disease is controversial, and this patient suffered minimal disability with treatment including splinting and surgical releases.
Feinberg, Joseph; DiCarlo, Edward F.; Birchansky, Sherri B.; Wolfe, Scott W.
Charcot-Marie-Tooth disease (CMT) and hereditary neuropathy with liability to pressurepalsies (HNPP) are two inherited peripheral neuropathies. The most prevalent mutations are a reciprocal 1.5-Mb duplication and 1.5-Mb deletion, respectively, at the CMT1A/HNPP locus on chromosome 17p11.2. Point mutations in the coding region of the myelin genes, peripheral myelin protein 22 (PMP22), myelin protein zero (MPZ) or connexin 32 (Cx32) have been reported in CMT patients, including CMT type 1 (CMT1), CMT type 2 (CMT2) and Déjérine-Sottas neuropathy (DS) patients, and only in the coding region of PMP22 in HNPP families lacking a deletion. We have investigated point and small mutations in the MPZ, PMP22 and Cx32 genes in a series of patients of Spanish ancestry: 47 CMT patients without duplications, and 5 HNPP patients without deletions. We found 15 different mutations in 16 CMT patients (34%). Nine different mutations in ten patients were detected in the Cx32 gene, this being the most frequently involved gene in this series, whereas five mutations involved the MPZ gene and only one the PMP22 gene. Six out of nine nucleotide substitutions in the Cx32 gene involved two codons encoding arginine at positions 164 and 183, suggesting that these two codons may constitute two Cx32 regions prone to mutate in the Spanish population. Analysis of HNPP patients revealed a 5' splicing mutation in intron 1 of the PMP22 gene in a family with autosomal dominance, which confirms allelic heterogeneity in HNPP. Ectopic mRNA analysis on leukocytes suggests that this mutation might behave as a null allele. PMID:9187667
Bort, S; Nelis, E; Timmerman, V; Sevilla, T; Cruz-Martínez, A; Martínez, F; Millán, J M; Arpa, J; Vílchez, J J; Prieto, F; Van Broeckhoven, C; Palau, F
The majority of cases of Charcot-Marie-Tooth type 1A (CMT1A) and of hereditary neuropathy with a liability to pressurepalsies (HNPP) are the result of heterozygosity for the duplication or deletion of peripheral myelin protein 22 gene (PMP22) on 17p11.2. Southern blots, pulsed-field gel electrophoresis (PFGE), fluorescence in situ hybridization (FISH) and polymorphic marker analysis are currently used diagnostic methods. But they are time-consuming, labor-intensive and have some significant limitations. We describe a rapid realtime quantitative PCR method for determining gene copy number for the identification of DNA duplication or deletion occurring in CMT1A or HNPP and compare the results obtained with REP-PCR. Six patients with CMT1A and 14 patients with HNPP [confirmed by Repeat (REP)-PCR], and 16 patients with suspicious CMT1A and 13 patients with suspicious HNPP [negative REP-PCR], and 15 normal controls were studied. We performed REP-PCR, which amplified a 3.6 Kb region (including a 1.7 Kb recombination hotspot), using specific CMT1A-REP and real-time quantitative PCR on the LightCycler system. Using a comparative threshold cycle (Ct) method and ?-globin as a reference gene, the gene copy number of the PMP22 gene was quantified. The PMP22 duplication ratio ranged from 1.35 to 1.74, and the PMP22 deletion ratio from 0.41 to 0.53. The PMP22 ratio in normal controls ranged from 0.81 to 1.12. All 6 patients with CMT1A and 14 patients with HNPP confirmed by REP-PCR were positive by real-time quantitative PCR. Among the 16 suspicious CMT1A and 13 suspicious HNPP with negative REP-PCR, 2 and 4 samples, respectively, were positive by real-time quantitative PCR. Real-time quantitative PCR is a more sensitive and more accurate method than REP-PCR for the detection of PMP22 duplications or deletions, and it is also faster and easier than currently available methods. Therefore, we believe that the real-time quantitative method is useful for diagnosing CMT1A and HNPP.
Choi, Jong Rak; Lee, Woon Hyoung; Sunwoo, Il Nam; Lee, Eun Kyung; Lee, Chang Hoon
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
OBJECTIVE--To investigate the feasibility of negative extrathoracic pressure ventilation as a respiratory support following phrenic nerve palsy after cardiac surgery. DESIGN--An uncontrolled pilot study. PATIENTS--14 patients aged one week to 30 months (median 5.3 months) with phrenic nerve palsy diagnosed by phrenic nerve conduction tests and diaphragmatic electromyograms. Four had bilateral and 10 unilateral palsy. Before treatment all required oxygen
J Raine; M P Samuels; Q Mok; E A Shinebourne; D P Southall
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
Blood pressure and heart rate variability were analyzed in eight patients with progressive supranuclear palsy in comparison with two control groups (10 healthy patients and 10 patients with multiple system atrophy). Blood pressure and heart rate were recorded using digital photoplethysmography with the patient in supine position and during a head-up-tilt test (70° for 10 minutes). Spectral analysis was performed
Christine Brefel-Courbon; Claire Thalamas; Oliver Rascol; Jean-Louis Montastruc; Jean-Michel Senard
The purpose of this study was to investigate the effectiveness of Johnstone pressure splints (JPSs) on spasticity and cutaneous sensory inputs in children with spastic cerebral palsy (CP). Thirty-four children with spastic diplegic CP participated in this study. Children whose motor development levels were similar were divided into a treatment and a control group. Each group consisted of 17 participants (six females and 11 males). Mean age of the treatment group was 48.82 months (SEM 4.42), and the control group, 47.52 months (SEM 5.27). The treatment group underwent Bobath's neurodevelopmental therapy (NDT) combined with JPSs. The control group underwent NDT alone five days a week for three months. Before and after treatments, lower-extremity passive range of motion (ROM) by goniometric measurements, spasticity by Modified Ashworth Scale (MAS), and somatosensory evoked potentials (SEPs) were measured. Passive ROM showed significant improvements in both groups (p<0.01). In the treatment group, all MAS scores increased. In the control group, the difference was significant except for values of internal rotator muscles. Improvements in passive ROM in the treatment group were significantly higher than the control group except in hip abduction and external rotation (p<0.05). MAS scores of the treatment group were significantly higher than the control group (p<0.05). SEP values increased in both groups but values of the treatment group were significantly higher than the control group (p<0.05). PMID:11368483
Resources - cerebral palsy ... The following organizations are good resources for information on cerebral palsy : National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy. ...
... also associated with the infectious agent that causes Lyme disease . Of course, this doesn't mean that everyone who has a viral infection or Lyme disease will develop Bell's palsy — most people don't. ...
... same age a pediatric physiatrist , who helps treat children with disabilities of many kinds There is no special test to figure out if a kid has cerebral palsy. Doctors may order X-rays and blood tests ...
... ear. That muscle is responsible for muffling the sounds we hear. The facial nerve also controls salivation, ... Along with paralysis, Bell’s palsy patients may experience sounds being louder than usual and some pain in ...
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 ...
Dementia-nuchal dystonia; Richardson-Steele-Olszewski syndrome; Palsy - progressive supranuclear ... Progressive supranuclear palsy is a condition that causes symptoms similar to those of Parkinson's disease . It involves ...
... the report and see where your state ranks! World CP Day Shortlisted Ideas Announced! United Cerebral Palsy ( ... three shortlisted ideas for the 2014 “Change My World in 1 Minute” contest for World Cerebral Palsy ...
... NIH Patient Recruitment for Progressive Supranuclear Palsy Clinical Trials At NIH Clinical Center Throughout the U.S. and Worldwide NINDS Clinical Trials Organizations Column1 Column2 CUREPSP (Foundation for PSP|CBD ...
... 888) 232-6348 Contact CDC-INFO Cerebral Palsy Homepage Facts Treatment Services (IDEA) Causes Screening & Diagnosis Data & Statistics Tracking & Research Articles & Key Findings My Story Links to Other Websites About Us Information ...
Progressive supranuclear palsy (PSP) is a rare brain disease. It affects brain cells that control the movement of your eyes. This leads to ... speech, vision and swallowing problems. Doctors sometimes confuse PSP with Parkinson's disease or Alzheimer's disease. PSP has ...
The life expectancy of people who have perinatally acquired cerebral palsy can be similar to that of the general population, or it can be reduced substantially. The most important factors that are associated with reduced survival are disabilities of motor, cognitive, or visual functions. Prematurity and low birth weight are associated with lower rates of disability, and better survival. A 2-year-old who has severe cerebral palsy has about a 40% chance of living to age 20, in contrast to a child who has mild cerebral palsy, for whom the chance is 99%. Cerebral palsy, respiratory diseases, epilepsy, and congenital malformation are the most commonly recorded causes of early death. PMID:16765736
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
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.
de Almeida, Diogo Fraxino; Teodoro, Adilson Teixeira; Radaeli, Rafael de Figueiredo
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,
Cerebral palsy has a complex and multifactorial etiology. Approximately 5%-10% of cases can be ascribed to perinatal hypoxia, but the vast majority of cases are caused by the interplay of several risk factors and antenatal, perinatal, and neonatal events. The strongest risk factors include prematurity and low birth weight. The prevalence of cerebral palsy has remained constant despite improvements in obstetric and neonatal care. For a long time, the only causal factors explored to account for risk for cerebral palsy were complications of labor and delivery. As other periods have been investigated, new associations have come to light. The current understanding of contributors to the risk for cerebral palsy is still incomplete. Multiple causes may interact by way of excitotoxic, oxidative, or other converging pathophysiologic pathways. A single factor, unless present to an overwhelming degree, often may be insufficient to produce cerebral damage, whereas two or three interacting pathogenic assaults may overwhelm natural defenses and produce irreversible brain injury. The low prevalence of cerebral palsy makes the formal testing of preventative strategies difficult. There is a need for such strategies to be carefully assessed in well designed, multicenter, randomized, controlled trials before becoming part of clinical practice, however, so that the balance between harm and benefit is known in advance. PMID:14596546
Upper limbs palsy as a result of affliction of plexus brachialis nervous bunch is disorder, whose frequency moves among 0.42-5.1 / 1000 liveborn children. Delivery mechanism itself certain weighty, no however only cause rising paralysis. Some way paralysis rise already intrauterinne, some way then at surgical childbirth per sectionem caeseream. Brachial plexus palsy isn't benign disorder. If isn't this disorder in time diagnosed and accordingly treated, child threatens late aftermath, especially significant limitation of limbs movement with functional consequencies. PMID:20925223
Progressive supranuclear palsy (PSP) is the second-most-common parkinsonian neurodegenerative disorder following Parkinson's disease. Although PSP was first identified clinically more than 40 years ago, it remains poorly recognized and underdiagnosed. Using an individual example, this article describes the epidemiology, neuropathology, clinical course, supportive management strategies, and resources for patients with PSP and their families. PMID:22329395
Cerebral palsy (CP) can cause disturbances in sensory and cognitive development as well as motor disorders. Problems in these areas of functioning can affect children’s speech, language and communication development. The intelligibility of children’s speech, gesture and the communication signals expressed by body movement may be reduced, and children’s expression and understanding of language can be delayed. This review describes
Neurocysticercosis (NCC) is the most common helminthic infestation of the central nervous system (CNS) and a leading cause of acquired epilepsy worldwide. The common manifestations of NCC are seizures and headache. The NCC as a cause of pseudobulbar palsy is very unusual and not reported yet in the literature. A pseudobulbar palsy can occur in any disorder that causes bilateral corticobulbar disease. The common etiologies of pseudobulbar palsy are vascular, demyelinative, or motor neuron disease. We report a 38-year-old female patient who presented with partial seizures and pseudobulbar palsy. The MRI brain showed multiple small cysts with scolex in both the cerebral hemispheres and a giant intraparenchymal cyst. Our patient responded well to standard treatment of neurocysticercosis and antiepileptics.
Kumar, Arinaganahalli Subbanna Praveen; Subrahmanyam, Dharanitragada Krishna Suri
... Prognosis and treatment in adults Clinical manifestations of Lyme disease in adults Patient information: Bell's palsy (The Basics) Patient information: Lyme disease (The Basics) Patient information: Myasthenia gravis (The Basics) ...
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 study the clinical profile and outcome of surgery for injection nerve palsies. Materials and Methods: This is a retrospective study of patients with INP who were treated at our institute during May 2000 to May 2009. Clinical, electroneuromyography (ENMG), and operative findings were noted. Intraoperative nerve action potential monitoring was not used in any case. Outcome of patients who were followed was reviewed. Results: INP comprised 92 (11%) of 837 nerve injury patients. Seventy one patients were children less than 16 years. The nerves involved were sciatic in 80 patients, radial in 8, and others in four. Fifty seven patients had power, grade 0/5. ENMG studies revealed absent compound muscle action potential in 64 and absent sensory nerve action potential in 67 patients. Thirty nine (42.3%) of 92 patients underwent surgery. The mean duration since injury in these patients was 5.2 months (3 months to 11 months). All underwent neurolysis. Only 18 patients who underwent surgery had a follow up of more than 3 months. Ten (55.5%) patients had good or fair outcome after surgery. Except for grade of motor deficit prior to surgery, none of the variables were found to significantly affect the outcome. Conclusion: The outcome of INP is generally good and many patients recover spontaneously. The outcome of surgery is dependent on preoperative motor power.
Six children had recurrent sixth nerve palsy the average duration of which was six weeks. One youngster, after several episodes of sixth nerve palsy, had residual esotropia and underwent strabismus surgery. The average interval between recurrences was 1.3 years. Ipsilateral recurrences were a prominent feature. Thus far the recurrences of palsy in this group of patients has not been associated with any identifiable intracranial process. Multiple recurrences in the absence of any recognizable febrile illness clearly suggests that not all "benign" sixth nerve palsies in children are due to postinfectious processes. The etiology of isolated benign sixth nerve palsy remains uncertain. Benign sixth nerve palsy with recurrence may account for a larger percentage of truly "isolated" palsies in otherwise healthy youngsters than has been generally appreciated since several widely quoted papers on this subject have included individuals with multiple neurologic deficits at the time of initial presentation. This report of recurrent palsies for which etiologies were not established should not diminish the concern that there might be an identifiable, serious, cause for sudden onset of sixth nerve palsy in a youngster. The diagnosis of "benign" sixth nerve palsy is one of exclusion that is made retrospectively and only after an adequate period of close observation. PMID:6712067
Boger, W P; Puliafito, C A; Magoon, E H; Sydnor, C F; Knupp, J A; Buckley, E G
BACKGROUND Perinatal brachial plexus palsy (PBPP) is a flaccid paralysis of the arm at birth that affects different nerves of the brachial plexus supplied by C5 to T1 in 0.42 to 5.1 infants per 1000 live births. OBJECTIVES To identify antenatal factors associated with PBPP and possible preventive measures, and to review the natural history as compared with the outcome after primary or secondary surgical interventions. METHODS A literature search on randomized controlled trials, systematic reviews and meta-analyses on the prevention and treatment of PBPP was performed. EMBASE, Medline, CINAHL and the Cochrane Library were searched until June 2005. Key words for searches included ‘brachial plexus’, ‘brachial plexus neuropathy’, ‘brachial plexus injury’, ‘birth injury’ and ‘paralysis, obstetric’. RESULTS There were no prospective studies on the cause or prevention of PBPP. Whereas birth trauma is said to be the most common cause, there is some evidence that PBPP may occur before delivery. Shoulder dystocia and PBPP are largely unpredictable, although associations of PBPP with shoulder dystocia, infants who are large for gestational age, maternal diabetes and instrumental delivery have been reported. The various forms of PBPP, clinical findings and diagnostic measures are described. Recent evidence suggests that the natural history of PBPP is not all favourable, and residual deficits are estimated at 20% to 30%, in contrast with the previous optimistic view of full recovery in greater than 90% of affected children. There were no randomized controlled trials on nonoperative management. There was no conclusive evidence that primary surgical exploration of the brachial plexus supercedes conservative management for improved outcome. However, results from nonrandomized studies indicated that children with severe injuries do better with surgical repair. Secondary surgical reconstructions were inferior to primary intervention, but could still improve arm function in children with serious impairments. CONCLUSIONS It is not possible to predict which infants are at risk for PBPP, and therefore amenable to preventive measures. Twenty-five per cent of affected infants will experience permanent impairment and injury. If recovery is incomplete by the end of the first month, referral to a multidisciplinary team is necessary. Further research into prediction, prevention and best mode of treatment needs to be done.
Andersen, John; Watt, Joe; Olson, Jaret; Van Aerde, John
Fifty-four patients with oculomotor nerve palsy who presented over a 21-year period at our institution were reviewed retrospectively. There were 38 isolated third nerve lesions, and 16 with additional cranial nerve involvement. Eleven cases were congenital in origin, and 43 were acquired. Of the acquired group, 31 were traumatic, 7 infection-related, 3 attributed to migraine or other vascular causes, and 2 neoplastic. Average follow up was 36 months. The congenital lesions were predominantly right-sided; amblyopia, although common, responded well to treatment. Trauma and bacterial meningitis accounted for more cases of isolated oculomotor nerve palsy than seen in the previous literature. In distinct contrast to the adult population, no cases of diabetes, posterior communicating artery aneurysms, metastatic tumors, or pituitary lesions were found. PMID:1287170
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
In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly impressive and emphasizes the medical, social and economic importance of this problem. The term cerebral palsy is restricted to non-progressive disorders of motor function, already observed at an early age and due to cerebral lesions. These motor disorders can be of paretic, dystonic and dyskinetic nature. Their epidemiology, classification, etiology, pathology, early diagnosis and evolution are extensively reviewed by Th. Deonna. The difficulty in evaluation of treatment is the absence of a generally accepted rating scale. G. Broggi has proposed one on the basis of a large experience which could serve in the future for more objective evaluation. This monograph is devoted to the functional neurosurgical treatment of cerebral palsy. Physiotherapy and rehabilitation are part of the basic treatment of cerebral palsy, and must be continued after any neurosurgical treatment. Various conservative methods of treatment and their neurophysiological rationale are mentioned by P. Claverie. Some technical devices which improve the neurological deficits and facilitate rehabilitation are presented. Radiculotomies and neurotomies are probably the oldest neurosurgical operations for the treatment of spasticity. The neurophysiological and neuroanatomical basis of this therapeutic approach are treated in the review of the material from the neurosurgical department of Montpellier. Sixty cases were collected and the results analysed according to the type of operation (posterior radiculotomy, anterior radiculotomy, mixed) performed. Stereotactic thalamotomies and subthalamotomies are believed to be the best neurosurgical method to treat the tremor and improve other dyskinesias and hyperkinesias. The technique and a personal review of 49 cases of cerebral palsy are presented. The long-term follow-up in this study demonstrates that this type of operation markedly improves the functional disability of patients with moderate hyperkinesias, moderately improves patients severely affected, but also demonstrates that possible side effects cannot be ignored. Review of the literature indicates the difficulty in interpretation of results due to a lack of objective evaluation. Nevertheless, stereotactic thalamotomy can still be recommended when tremor and rigidity are the most prominent symptoms. Stereotactic dentatotomies in the treatment of spasticity were very popular 20 years ago, but have been largely forgotten for nearly a decade.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3908955
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
As a companion research subsequent to analyzing displacement of center of mass (COM) and center of pressure (COP) in Part I, the purposes of this study were to quantify dynamic stability using magnitudes and patterns of instantaneous velocity and acceleration of COM and COP of the children with cerebral palsy (CP) during walking, and compare the data with those of
This study presents initial results from a bi-planar model used to investigate the neurological factors affecting balance deficits in children with diplegic cerebral palsy (CP). The model uses an inverted pendulum to describe sway in both the anteroposterior (AP) and mediolateral (ML) planes. The study presents Center of Pressure (COP) data from 17 children diagnosed with spastic diplegic CP using
K. D. Bustamante Valles; J. T. Long; S. A. Riedel; A. Graf; J. Krzak; S. Hassani; P. A. Smith; G. F. Harris
Although Bell's palsy is the most common acute facial paralysis, the cause of it is still unknown. This made the treatment for it remain very limited. Many methods are simply symptomatic treatment. Up to now we have known that Bell's palsy is related to viral infection and the pathomechanism of Bell's palsy involves inflammatory oedema and entrapment neuropathy in the narrow bony facial canal. So treatment plans for Bell's palsy mainly focus on antiviral therapy, relieving inflammatory oedema and accelerating facial nerve recovery. Sodium beta-aescin is derived from horse chestnut and its major constituent is aescigenin which has been approved by China national drug standard. The pharmacologic action of sodium beta-aescin is to relieve tissue oedema, recover vasopermeability and eliminate pressure caused by oedema. Nowadays sodium beta-aescin has been widely used clinically for encephaledema or tumefaction caused by trauma or operation. It also can be used for treating disease of digestive system and increasing intravenous tension and improving microcirculation. Although many papers had been published on the anti-edema effects of sodium beta-aescin, little was known about the effects in treating oedema complicated by Bell's palsy. PMID:18762387
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
We describe a patient who presented with an acute paresis of her distal right hand suggesting a peripheral median nerve lesion. However, on clinical examination a peripheral origin could not be verified, prompting further investigation. Diffusion-weighted magnetic resonance imaging revealed an acute ischaemic lesion in the hand knob area of the motor cortex. Isolated hand palsy in association with cerebral infarction has been reported occasionally. However, previously reported cases presented predominantly as ulnar or radial palsy. In this case report, we present a rather rare finding of an acute cerebral infarction mimicking median never palsy.
Manjaly, Zina-Mary; Luft, Andreas R.; Sarikaya, Hakan
The incidence of long thoracic nerve palsy after radical mastectomy has been documented to be approximately 10%. No cases have been reported after the more recent treatment for breast cancer, lumpectomy with axillary dissection. This more recent surgical procedure is customarily followed by aggressive radiation therapy to the remaining breast tissue. This is the first case report of a patient with radiation-induced long thoracic nerve palsy. The patient was a young woman who underwent left breast quadrantectomy and axillary dissection for breast cancer. After radiation therapy, she had isolated left long thoracic nerve palsy. The diagnosis was confirmed by electrodiagnostic studies. Almost full recovery occurred after 5 months.
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
... 888) 232-6348 Contact CDC-INFO Cerebral Palsy Homepage Facts Treatment Services (IDEA) Causes Screening & Diagnosis Data & Statistics Tracking & Research Articles & Key Findings My Story Links to Other Websites About Us Information ...
... 888) 232-6348 Contact CDC-INFO Cerebral Palsy Homepage Facts Treatment Services (IDEA) Causes Screening & Diagnosis Data & Statistics Tracking & Research Articles & Key Findings My Story Links to Other Websites About Us Information ...
... assembles into abnormal clumps within neurons and other brain cells, although it is unclear what effect these clumps ... palsy is characterized by the gradual death of brain cells, particularly in structures deep within the brain that ...
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...
Hypoglossal nerve palsy following intubation is a rare complication that can be reversible depending on the extent of nerve damage. A 63-year-old male with a sigma carcinoma was repeatedly intubated orotracheally due to postoperative complications. After the fourth intubation, bilateral, complete hypoglossal nerve palsy with severe dysarthria and swallowing disability was observed. A percutaneous endoscopic gastrostomy tube was inserted for nutrition and to prevent aspiration. Cerebral MRI showed no pathological findings, particularly in the brainstem. Electromyographic studies revealed pathological spontaneous activity of both glossal muscles without any motor unit potential consistent with an axonal lesion of both hypoglossal nerves. Nevertheless, complete clinical and electromyographical recovery occurred within 7 months. The bilateral hypoglossal nerve palsy in our patient was probably due to mechanical alteration during intubation, leading to axonotmesis. Hypoglossal nerve palsy following intubation might have a favourable prognosis as long as continuity of the nerve sheath is maintained. PMID:16133427
Recombination between repeated sequences at various loci of the human genome are known to give rise to DNA rearrangements associated with many genetic disorders. Perhaps the most extensively characterized genomic region prone to rearrangement is 17p12, which is associated with the peripheral neuropathies, hereditary neuropathy with liability to pressurepalsies (HNPP) and Charcot-Marie-Tooth disease type 1A (CMT1A;ref. 2). Homologous recombination
Lorraine Potocki; Ken-Shiung Chen; Sung-Sup Park; Doreen E. Osterholm; Marjorie A. Withers; Virginia Kimonis; Anne M. Summers; Wendy S. Meschino; Kwame Anyane-Yeboa; Catherine D. Kashork; Lisa G. Shaffer; James R. Lupski
Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell’s palsy). Three quarters\\u000a of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections,\\u000a trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the\\u000a presence of typical symptoms
Joubert syndrome (JS) is a rare autosomal recessive disorder with cerebellar vermis hypoplasia and complex brainstem malformation. The diagnosis of cases can be difficult as the presentation can be similar to cases of cerebral palsy. We present a case of JS in an 18-month-old girl who presented to pediatric rehabilitation with a diagnosis of hypotonic cerebral palsy and abnormal eye movements. The brain MRI confirmed the typical brain malformations. PMID:24983287
Dekair, Lubna H; Kamel, Hussein; El-Bashir, Haitham O
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
Risk factors for mortality of young children with cerebral palsy were studied using a sample of 12,709 children aged 0.5–3.5 years with cerebral palsy who had received services from the State of California between 1980 and 1995. The most powerful prognostic factors for survival were simple functional items: mobility and feeding skills. Once these were known, factors such as severity
David J. Strauss; Robert M. Shavelle; Terence W. Anderson
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.
ABSTRACT Cerebral palsy refers to a lesion on an immature brain, that determines permanent neurological disorders. Knowing the exact cause of the disease does not alter the treatment management. The etiology is 2-2.5/1000 births and the rate is constant in the last 40-50 years because advances in medical technologies have permitted the survival of smaller and premature new born children. Gait analysis has four directions: kinematics (represents body movements analysis without calculating the forces), kinetics (represents body moments and forces), energy consumption (measured by oximetry), and neuromuscular activity (measured by EMG). Gait analysis can observe specific deviations in a patient, allowing us to be more accurate in motor diagnoses and treatment solutions: surgery intervention, botulinum toxin injection, use of orthosis, physical kinetic therapy, oral medications, baclofen pump.
... disorder catalog Conditions > Horizontal gaze palsy with progressive scoliosis (often shortened to HGPPS ) On this page: Description ... What is HGPPS? Horizontal gaze palsy with progressive scoliosis (HGPPS) is a disorder that affects vision and ...
OBJECTIVE—To elucidate the character and distribution of the abnormal muscle tonus in the body axis in progressive supranuclear palsy. Although neck hypertonus has been well described in progressive supranuclear palsy, little is known about the involvement of the truncal muscles.?METHODS—Muscle tonus of the neck and trunk was separately investigated in 13 patients with progressive supranuclear palsy by clinical examination and surface EMG during passive rotation. Muscle hypertonus was graded according to a four point scale, and subjected to statistical analysis. The results were compared with those from 13 age matched patients with Parkinson's disease and six healthy volunteers.?RESULTS—In all but one patient with progressive supranuclear palsy, there was a distinct difference in muscle tonus between the neck and trunk. A tonic shortening reaction characteristic of dystonia and an increased tonic stretch reflex (rigidity) were present in the neck muscles of patients with progressive supranuclear palsy, whereas only normal to moderately increased tonus was noted in the truncal muscles (neck v trunk, shortening reaction p=0.0001; stretch reflex p=0.0241). Follow up studies disclosed an increase in axial muscle tonus with predilection for the neck in three of four patients. In the 13 patients with Parkinson's disease, however, no significant difference was found in muscle rigidity between the neck and trunk.?CONCLUSION—Mild changes in truncal muscle tonus with prominent neck dystonia and rigidity are characteristic of progressive supranuclear palsy. It is suggested that separate clinical evaluation of muscle tonus in the neck and trunk may be helpful for distinguishing progressive supranuclear palsy from Parkinson's disease.??
Three cases of progressive supranuclear palsy are reported in which In111-DTPA cisternography showed slow diffusion, ventricular reflux and failure of isotope clearance. The clinical diagnosis of progressive supranuclear palsy was confirmed histologically in two of these patients. The possible causes of the cisternographic changes and their relationship to the changes of CSF dynamics in progressive supranuclear palsy are discussed. Images
Brusa, A; Claudiani, F; Meneghini, S; Mombelloni, P; Piccardo, A
Haemorrhage in pituitary adenoma is an unusual cause of recurrent oculomotor palsy. Three episodes of right oculomotor palsy are reported from a patient having haemorrhage in pituitary adenoma. Early operation and decompression of haemorrhagic pituitary adenoma should be performed so that vision may be preserved and recovery of oculomotor palsy be assured. Images Fig. 1 Fig. 2 Fig. 3
... Duchenne and Dejerine-Klumpke Palsies Information Page Synonym(s): Brachial Plexus Birth Injuries, Dejerine-Klumpke Palsy Table of Contents ( ... are Erb-Duchenne and Dejerine-Klumpke Palsies? The brachial plexus is a network of nerves that conducts signals ...
C erebral palsy is a nonprogressive disorder of the devel- oping brain principally affecting the motor system. Cerebral palsy affects 2 to 3 per 1000 newborns, with a conservative estimate of its impact on society being $5 billion per year. Cerebral palsy can be associated with epilepsy and abnormalities of speech, vision, and intellect. The impact of diseases affecting the
Matthew Derrick; Alexander Drobyshevsky; Xinhai Ji; Sidhartha Tan
Introduction Spontaneous radial palsy is a not rare finding in hand clinics. The anatomy of the radial nerve renders it prone to pressure paralysis as often called “Saturday night palsy”. This problem is a transient nerve lesion and an acute one but the case presented here is very unusual in that it seems this entity can also occur as an acute on chronic situation with neuroma formation. Case Presentation A 61 year-old man presented with the chief complaint of inability to extend the wrist and the fingers of the left hand which began suddenly the night before admission, following a three-week history of pain, numbness and tingling sensation of the affected extremity. He had no history of trauma to the extremity. Electromyography revealed a severe conductive defect of the left radial nerve with significant axonal loss at the upper arm. Surgical exploration identified a neuroma of the radial nerve measuring 1.5 cm in length as the cause of the paralysis. The neuroma was removed and an end-to-end nerve coaption was performed. Conclusions Complete recovery of the hand and finger extension was achieved in nine months.
Electromyograms were recorded with hooked-wire electrodes from sixteen lip, tongue and jaw muscles in six normal and seven cerebral palsied adult subjects during a variety of speech and non-speech tasks. The recorded patterns of muscle activity fail to support a number of theories concerning the pathophysiology of dysarthria in cerebral palsy. There was no indication of weakness in individual articulator muscles. There was no evidence of uncontrolled sustained background activity or of abnormal tonic stretch reflex responses in lip or tongue muscles. Primitive or pathological reflexes could not be elicited by orofacial stimulation. No imbalance between positive and negative oral responses was observed. The view that random involuntary movement disrupts essentially normal voluntary control in athetosis was not supported. Each cerebral palsied subject displayed an idiosyncratic pattern of abnormal muscle activity which was reproduced across repetitions of the same phrase, indicating a consistent defect in motor programming.
The extraocular muscle palsies associated with herpes zoster ophthalmicus (HZO) are transient, self-limiting conditions, usually seen in elderly patients. There are different treatment recommendations for paralytic complications, but prognosis has generally reported to be favorable. A 75-year-old male patient presented with diplopia. Clinical history revealed left facial vesicular eruptions and pain treated by oral aciclovir 1 week following symptom onset. On examination, we observed cicatricial lesions with crusts involving left hemiface, a limitation in abduction of the left eye, and a superficial punctuate keratitis (SPK) with decreased visual acuity (4/10). Examination of the right eye was unremarkable. Hess screen test confirmed left six nerve palsy.
Kawasaki Disease (KD) is a vasculitic disease and can affect any organ system in the body. The development of coronary artery aneurysms is the most common and life threatening complication of KD and makes this disease the leading cause of acquired heart disease in children in the developed world. Facial nerve palsy has been reported as a possible marker of more severe disease and increased risk of coronary artery involvement in KD. Herein, the authors report an 8-mo-old infant who had left sided facial nerve palsy and multiple coronary aneurysms associated with KD. PMID:23423832
Kocaba?, Abdullah; Kardelen, F?rat; Aldemir-Kocaba?, Bilge; Akçurin, Gayaz; Ertu?, Halil
Two of every 1000 live-born children develop cerebral palsy (CP). The aetiology of CP is often unclear and because CP is a symptom complex rather than a disease, clinically defined at 4–5 years of age, it is not surprising that there are considerable problems associated with epidemiological studies of its aetiology. The only reason for the CP concept is that
Progressive supranuclear palsy (Steele et al.) has a characteristic pattern of dementia: (1) forgetfulness, (2) slowing of thought processes, (3) emotional or personality changes (apathy or depression with occasional outbursts of irritability), and (4) impaired ability to manipulate acquired knowledge. In many neurological disease states associated with subcortical pathology a similar pattern of dementia exists. The neurobehavioural changes of progressive
Martin L. Albert; Robert G. Feldman; Anne L. Willis
This article describes the balanced combination of medical history, detailed physical examination, functional assessment, imaging, observational gait analysis, computerized gait analysis, and assessment of patient and family goals that are necessary to prepare treatment plans and accurately assess outcomes of treatment of children with cerebral palsy. PMID:20868879
A 12-month-old boy with progressive cranial nerve palsies followed by ventilatory failure demanding artificial ventilation, generalized muscle weakness, and rapid progression to death at the age of 21 months is described. The patient had normal early development and also apparently normal hearing at presentation of illness but, after 6 months of the onset of the disease, hearing loss was documented
Konstantinos A Voudris; Angeliki Skardoutsou; Eleni A Vagiakou
Cerebral palsy (CP) is a common problem, occurring in about 2 to 2.5 per 1000 live births. The diagnosis of CP is based upon a history of abnormal motor development that is not progressive coupled with an examination (e.g. hypertonicity, increased reflexes, clonus) “placing” the lesion in the brain. In order to establish that a brain abnormality exists in children
We have performed selective posterior rhizotomies on 60 children with cerebral palsy. The procedure involves lumbar laminectomy with stimulation of the rootlets (fascicles) of the second lumbar to the first sacral posterior roots bilaterally; those rootlets associated with an abnormal motor response, as evidenced by sustained or diffused muscular contraction, are divided leaving intact rootlets associated with a brief localized
Warwick J. Peacock; Leila J. Arens; Barbara Berman
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
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 education,…
This page contains three Physlets that are able to share data using a connection made by a common superclass, SApplet. The ensemble walls keep track of the change in momentum, i.e., the pressure, during each time step, dt, and provides this data to the DataGraph Physlet and the DataTable Physlet.
The pathogenesis and clinical course of hip dysplasia in cerebral palsy and Down syndrome is different than idiopathic developmental dysplasia of the hip. Unlike idiopathic developmental hip dysplasia, hip development in cerebral palsy and Down syndrome is typically normal in utero and instability develops after birth secondary to musculoskeletal disorders associated with the disease condition. For this reason, treatment protocols in Down syndrome and cerebral palsy hip dysplasia differ greatly from protocols designed to treat idiopathic hip dysplasia. The purpose of this review is to describe the pathologic hip morphology that results from cerebral palsy and Down syndrome. PMID:23764790
The extraocular muscle palsies associated with herpes zoster ophthalmicus (HZO) are transient, self-limiting conditions, usually seen in elderly patients. There are different treatment recommendations for paralytic complications, but prognosis has generally reported to be favorable. A 75-year-old male patient presented with diplopia. Clinical history revealed left facial vesicular eruptions and pain treated by oral aciclovir 1 week following symptom onset. On examination, we observed cicatricial lesions with crusts involving left hemiface, a limitation in abduction of the left eye, and a superficial punctuate keratitis (SPK) with decreased visual acuity (4/10). Examination of the right eye was unremarkable. Hess screen test confirmed left six nerve palsy. PMID:24966563
A 52-year-old Caucasian man presented with sudden onset of difficulty in moving his tongue to the left with preceding left-sided headache with no neck pain. Earlier, he had self-limiting chest infection without rashes or tonsillar enlargement. His medical and surgical history was unremarkable with no recent trauma. Oral examination revealed difficulty in protruding his tongue to the left with muscle bulk loss and fasciculation on the same side, suggesting left hypoglossal nerve palsy. Examination of the rest of the cranial nerves and nervous system was normal. The patient's oropharyngeal and laryngeal examination was unremarkable with no cervical lymphadenopathy. He had normal laboratory investigations and cerebrospinal fluid examination. Extensive imaging of the head, neck and chest failed to reveal any pathology. Further review by an otorhinologist and rheumatologist ruled out any other underlying pathology. He made a good recovery without treatment. English literature search revealed very few cases of idiopathic, transient, unilateral hypoglossal nerve palsy. PMID:24969070
A 36-year-old woman was admitted to our hospital for further examination of an acute febrile illness with liver dysfunction. A peripheral blood smear displayed atypical lymphocytes. Cytomegalovirus (CMV) mononucleosis was diagnosed based on the detection of CMV-specific IgM and conventional CMV pp65 antigen. The physical examination on admission revealed signs of lower motor neuron right facial palsy. There were no significant cerebrospinal fluid findings, nor were there other neurological abnormalities. After receiving a short-course of oral corticosteroids, the patient gradually recovered from the facial paralysis. A one-month follow-up examination indicated that she had fully recovered neurologically, showing disappearance of CMV-DNA and a significant increase in the anti-CMV IgG titer. To our knowledge, there has been only one previous report describing CMV as the cause of an isolated facial palsy combined with CMV mononucleosis. PMID:24681941
Brachial plexus compressive neuropathy following the use of axillary crutches (crutch palsy) is a rare but well-recognized entity. Most reported cases involve the posterior cord of the brachial plexus in children and have resolved spontaneously within 8-12 weeks. We recently treated a 36-year-old man who was using axillary crutches for mobilization after a supracondylar femoral fracture. Bilateral posterior cord (predominantly radial nerve) compressive neuropathy subsequently developed, with lesser involvement of the ulnar and median nerves. The patient had little to no improvement clinically 8 weeks after the estimated onset of the palsy, and an electromyogram at that time confirmed the presence of a severe axonotmesis lesion of the radial, median, and ulnar nerves bilaterally. The patient was treated with static cock-up wrist splinting and discontinuation of the axillary crutches. Return of sensory and motor function was delayed but occurred within 9 months. PMID:9057152
Objectives After reading this article (part II of II), the participant should be able to: 1. Describe the anatomy and function of the median and ulnar nerves in the forearm and hand. 2. Describe the clinical deficits associated with injury to each nerve. 3. Describe the indications, benefits, and drawbacks for various tendon transfer procedures used to treat median and ulnar nerve palsy.4. Describe the treatment of combined nerve injuries. 5. Describe postoperative care and possible complications associated with these tendon transfer procedures. Summary This article discusses the use of tendon transfer procedures for treatment of median and ulnar nerve palsy as well as combined nerve palsies. Postoperative management and potential complications are also discussed.
Skeletal structures act as lever arms during walking. Muscle activity and the ground reaction against gravity exert forces on the skeleton, which generate torque (moments) around joints. These lead to the sequence of movements which form normal human gait. Skeletal deformities in cerebral palsy (CP) affect the function of bones as lever arms and compromise gait. Lever arm dysfunction should be carefully considered when contemplating treatment to improve gait in children with CP. PMID:24432098
Since 1971, we have surgically treated spasticity in 109 cases of cerebral palsy with posterior rhizotomy. The best results have been obtained with functional posterior rhizotomy, an original modification of Foerster’s technique, in which the selection of the roots\\/rootlets to be sectioned is based on functional exploration of the spinal circuits involved in the maintenance of spasticity, using intra-operative electrostimulation
V. A. Fasano; G. Broggi; G. Barolat-Romana; A. Sguazzi
Left spinal accessory nerve palsy occurred in a young man when he quickly turned his head to the right while his shoulders were pulled down by heavy hand-held objects. Electrophysiologic studies demonstrated partial axonotmesis of the spinal accessory nerve branches innervating the sternocleidomastoid and upper and middle trapezius and complete axonotmesis of spinal accessory branches to the lower trapezius. There was a separate, although functionally minor, cervical plexus innervation of the lower trapezius. PMID:3343990
Logigian, E L; McInnes, J M; Berger, A R; Busis, N A; Lehrich, J R; Shahani, B T
We report a case of severe hypothyroidism with nongoitrous, autoimmune thyroiditis and pituitary hyperplasia in a 13-year-old boy, who presented with sudden palsy on the left side of his face. Prednisolone and antiviral medication was administered. However, the facial palsy did not improve completely. The medications were replaced with thyroxine, and the facial palsy recovered. Endocrinological testing showed severe hypothyroidism as follows: thyroid stimulating hormone (TSH) level >100 µIU/mL, T4 of 1.04 µg/dL, T3 of 0.31 ng/mL, and free T4 of 0.07 ng/dL. Level of serum antithyroid peroxidase antibodies was 1,933.39 IU/mL, and that of antithyroglobulin antibodies was 848.16 IU/mL. Level of TSH receptor antibodies was >40 IU/L. Bioassay result for TSH receptor stimulating antibodies was negative. Thyroid sonography revealed no increase in the size or vascularity of the bilateral gland. Thyroid scintigraphy with 99mTc showed decreased uptake, and magnetic resonance imaging demonstrated an enlarged pituitary gland. PMID:24904880
Introduction Progressive supranuclear palsy is a relentlessly progressive neurodegenerative disorder and is clinically characterized by parkinsonism. Adipose tissue-derived mesenchymal stem cells have recently demonstrated the possibility of treating neurological disorders. Therefore, autologous adipose tissue-derived mesenchymal stem cells transplantation can be an alternative method for treating progressive supranuclear palsy. Case presentation This study was approved by the Korea Food and Drug Administration through the Emergency Use Investigational New Drug Application. A 71-year-old Asian man from South Korea with progressive supranuclear palsy was treated with five intravenous infusions (each time 2×108 cells) and four intrathecal infusions (each time 5×107 cells) with autologous adipose tissue-derived mesenchymal stem cells expanded under good manufacturing practice conditions. Clinical examinations were performed immediately before treatment and throughout the six months of follow-up. The tests included: 1) Progressive Supranuclear Palsy Rating Scale; 2) Berg Balance Scale; 3) Korean Mini Mental State Examination; 4) Modified Barthel Index; 5) grip strength; 6) Box and Block Test; and 7) Nine-Hole Peg Test. The Progressive Supranuclear Palsy Rating Scale results gradually decreased, and the clinical rating scale scores of the Berg Balance Scale, Korean Mini Mental State Examination, and Modified Barthel Index gradually increased. Grip strength was maintained. Performance in the Box and Block Test and Nine-Hole Peg Test improved after adipose tissue-derived mesenchymal stem cells treatment compared to baseline throughout the six months of follow-up. Except for the intermittent mild fever and transient elevated blood pressure, the treatment of our patient with progressive supranuclear palsy with autologous adipose tissue-derived mesenchymal stem cells showed no significant adverse events, and delayed the progression of neurological deficits by achieving functional improvement in the follow-up period. Conclusions These results are encouraging and hopeful for further studies in patients with progressive supranuclear palsy using autologous adipose tissue-derived mesenchymal stem cells as a safe and effective therapy. This case report is the first known study of adipose tissue-derived mesenchymal stem cells safely delaying the progression of progressive supranuclear palsy with functional improvement during the follow-up period.
We report a rare complication following insertion of an uncemented hip prosthesis that resulted in posterior perforation of\\u000a the femoral stem and a sciatic nerve palsy. To our knowledge, sciatic nerve palsy due to the femoral stem perforating the\\u000a cortex has not been previously described.
Amyloidosis affecting peripheral nerves causing isolated nerve palsies is uncommon. Localised amyloidosis occurs less frequently than the reactive or immune related systemic forms, and mediastinal localisation is virtually unknown. We present a case of recurrent laryngeal nerve palsy associated with mediastinal AL amyloidosis in a middle aged man.??
Objective: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living. The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP).Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs
Esther M. J. Steultjens; Joost Dekker; Lex M. Bouter; Brigitte L. M. Lambregts; Cornelia H. M. Van Den Ende
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
Over the past decade, selective posterior rhizotomy has been used successfully to reduce spasticity in patients with cerebral palsy. Although clinical evaluation of these patients revealed functional improvement following surgery, more objective analysis of the outcome of this surgery was sought. Kinematic gait analysis of 14 patients with spastic cerebral palsy was performed before and after selective posterior rhizotomy. Measurements
Christopher L. Vaughan; Barbara Berman; Loretta A. Staudt; Warwick J. Peacock
With advances in the neuro-imaging modalities, diverse manifestations of the cerebral venous sinus thrombosis (CVT) are being recognized. There are very few reports of isolated cranial nerve palsies in CVT. In this case report, we describe a patient of lower motor neuron facial palsy with CVT who was successfully treated with anticoagulation, highlighting the atypical manifestation of the disease. PMID:23914113
The cause of Bell’s palsy (BP) remains unknown despite various hints to an infectious etiology. Mycoplasma pneumoniae is a common pathogen of the respiratory tract causing pharyngitis, tracheobronchitis or pneumonia. Neurological complications are the most frequent extrapulmonary manifestation. So far, only a few case reports suggested an association between cranial nerve palsy and M. pneumoniae infection. Patients with a BP
C. Völter; J. Helms; B. Weissbrich; P. Rieckmann; M. Abele-Horn
This paper presents a study of two intellectually gifted students (ages 6 and 14) who have cerebral palsy and are unable to communicate orally. Results of participant observation, interviews, and document analysis revealed that: (1) gifted students who have cerebral palsy and do not speak exhibit indicators of cognitive ability that are similar to…
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
This study examines the effects of long-term training program on balance and center of pressure (COP) for four male children (13 years of age) with cerebral palsy (CP). These children were classified into one hemiplegic (level II), one diplegic (level II) and two quadriplegic children (levels III and II) using the Gross Motor Function…
We describe a patient in whom bilateral congenital third cranial nerve palsy was diagnosed at 2 weeks of age. The ptosis was treated at 3 weeks with bilateral eyelid suspension surgery, and surgical repair of the exotropia was done at 4 months. To our knowledge this is the fourth reported case of this condition. It was probably caused by a single lesion involving the oculomotor and possibly the trochlear nuclei in the brain stem. Magnetic resonance imaging scans supported this hypothesis and suggested other central nervous system anomalies. PMID:2713752
Bell's palsy (idiopathic facial paralysis) is caused by the acute onset of lower motor neurone weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of untreated cases. In the remainder facial nerve function will be impaired in the long term. We summarise current published articles regarding early management strategies to maximise recovery of facial nerve function and minimise long-term sequelae in the condition. PMID:24685475
McCaul, James A; Cascarini, Luke; Godden, Daryl; Coombes, Darryl; Brennan, Peter A; Kerawala, Cyrus J
The purpose of this study was to evaluate various parameters potentially influencing poor prognosis in Bell's palsy and to assess the predictive value for Bell's palsy. A single-center prospective patient collected observation and validation study was conducted. To evaluate the correlation between patient characteristics and poor prognosis, we performed univariate and multivariate analyzes of age, gender, side of palsy, diabetes mellitus, hypertension, and facial grading score 1 week after onset. To evaluate the accuracy of the facial grading score, we prepared a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUROC). We also calculated sensitivity, specificity, positive/negative likelihood ratio, and positive/negative predictive value. We included Bell's palsy patients who attended Ehime University Hospital within 1 week after onset between 1977 and 2011. We excluded patients who were less than 15 years old and lost-to-follow-up within 6 months. The main outcome was defined as non-recovery at 6 months after onset. In total, 679 adults with Bell's palsy were included. The facial grading score at 1 week showed a correlation with non-recovery in the multivariate analysis, although age, gender, side of palsy, diabetes mellitus, and hypertension did not. The AUROC of the facial grading score was 0.793. The Y-system score at 1 week moderate accurately predicted non-recovery at 6 months in Bell's palsy. PMID:23995770
... be affected. Many people with this disorder experience carpal tunnel syndrome when a nerve in the wrist (the median nerve) is involved. Carpal tunnel syndrome is characterized by numbness, tingling, and weakness ...
Perimesencephalic subarachnoid haemorrhage is usually asymptomatic other than meningeal irritation sign. The authors report a case of subarachnoid haemorrhage at the quadrigeminal cistern showing ipsilateral trochlear nerve palsy and discuss the pathogenesis. A 71-year-old man with a history of diabetes mellitus and acute myocardial infarction presented with diplopia. He underwent CT, which revealed subarachnoid haemorrhage at the left quadrigeminal cistern. Neurological examination revealed left isolated trochlear nerve palsy, with results otherwise normal. The diagnosis of perimesencephalic subarachnoid haemorrhage was established on neuroimaging. The amount of haemorrhage is related to symptoms. A dense clot in the quadrigeminal cistern might have been the cause of trochlear nerve palsy.
Repetitive finger tapping is commonly used to assess bradykinesia in Parkinson's disease. The Queen Square Brain Bank diagnostic criterion of Parkinson's disease defines bradykinesia as 'slowness of initiation with progressive reduction in speed and amplitude of repetitive action'. Although progressive supranuclear palsy is considered an atypical parkinsonian syndrome, it is not known whether patients with progressive supranuclear palsy have criteria-defined bradykinesia. This study objectively assessed repetitive finger tap performance and handwriting in patients with Parkinson's disease (n?=?15), progressive supranuclear palsy (n?=?9) and healthy age- and gender-matched controls (n?=?16). The motion of the hand and digits was recorded in 3D during 15-s repetitive index finger-to-thumb tapping trials. The main finding was hypokinesia without decrement in patients with progressive supranuclear palsy, which differed from the finger tap pattern in Parkinson's disease. Average finger separation amplitude in progressive supranuclear palsy was less than half of that in controls and Parkinson's disease (P?0.001 in both cases). Change in tap amplitude over consecutive taps was computed by linear regression. The average amplitude slope in progressive supranuclear palsy was nearly zero (0.01°/cycle) indicating a lack of decrement, which differed from the negative slope in patients with Parkinson's disease OFF levodopa (-0.20°/cycle, P?=?0.002). 'Hypokinesia', defined as <50% of control group's mean amplitude, combined with 'absence of decrement', defined as mean positive amplitude slope, were identified in 87% of finger tap trials in the progressive supranuclear palsy group and only 12% in the Parkinson's disease OFF levodopa group. In progressive supranuclear palsy, the mean amplitude was not correlated with disease duration or other clinimetric scores. In Parkinson's disease, finger tap pattern was compatible with criteria-defined bradykinesia, characterized by slowness with progressive reduction in amplitude and speed and increased variability in speed throughout the tap trial. In Parkinson's disease, smaller amplitude, slower speed and greater speed variability were all associated with a more severe Unified Parkinson's Disease Rating Scale motor score. Analyses of handwriting showed that micrographia, defined as smaller than 50% of the control group's mean script size, was present in 75% of patients with progressive supranuclear palsy and 15% of patients with Parkinson's disease (P?=?0.022). Most scripts performed by patients with progressive supranuclear palsy did not exhibit decrements in script size. In conclusion, patients with progressive supranuclear palsy have a specific finger tap pattern of 'hypokinesia without decrement' and they do not have criteria-defined limb bradykinesia. Similarly, 'micrographia' and 'lack of decrement in script size' are also more common in progressive supranuclear palsy than in Parkinson's disease. PMID:22396397
Ling, Helen; Massey, Luke A; Lees, Andrew J; Brown, Peter; Day, Brian L
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 defects (11%). A number of other ocular abnormalities were found, the majority of which were not amenable to any form of treatment. Early identification of treatable ocular defects and their treatment along conventional lines is emphasised. It is also important to identify untreatable defects that may have a bearing on the child's education. These children need all the help available, and visual function should be at its best. A diagnosis of cerebral palsy has usually been made by the time such a child reaches 18 months of age. In view of the high incidence of ocular defects a full ophthalmological assessment should be part of the routine assessment of the child.
Five patients presented in infancy or early childhood with various combinations of pyramidal and extrapyramidal signs with normal cognitive function. Their perinatal courses were unremarkable. In each patient, initial impressions listed by several examiners included spastic diplegia or cerebral palsy. Later in each course, either extrapyramidal features or progression suggested dopa-responsive dystonia. In 4 of the 5 children, cerebrospinal fluid was obtained and disclosed reduced levels of biopterin, neopterin, and homovanillic acid in all 4. Levodopa therapy resulted in prompt improvement with normal function returning within 6 months. The disappearance of the "spasticity," extensor plantar responses, and extrapyramidal signs, following levodopa therapy, confirmed the diagnosis of doparesponsive dystonia in these patients. Three had apparently sporadic disease; the other 2 were siblings with an affected paternal grandmother. Three had onset in infancy with delayed sitting and walking before the appearance of overt dystonia; infantile onset is infrequent in dopa-responsive dystonia. The other 2 had normal milestones, but developed gait disorders with prominent imbalance in early childhood. The diagnosis of dopa-responsive dystonia should be considered in children with unexplained or atypical "cerebral palsy." PMID:7880338
Nygaard, T G; Waran, S P; Levine, R A; Naini, A B; Chutorian, A M
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.
Background and Objectives:Surgical treatment of jugular foramen tumors can have significant complications such as facial nerve palsy due to complicated regional anatomy. In this study, we investigated the outcomes and complications of surgical approach to the jugular foramen tumors. Subjects and Method:Thirteen patients had operations for their tumors around jugular foramen with a mean follow-up period of 52 months. We
Yoon Kyoung So; Yang-Sun Cho; Chung-Hwan Baek; Han-Shin Jeong; Kye Hoon Park; Woo Young Lee
... us Bell's Palsy Questions to Discuss with Your Doctor: Do you have weakness or paralysis of the ... cold)? Have you had a recent immunization? Your Doctor Might Examine the Following Body Structures or Functions: ...
... cerebral palsy [12.7 MB] Free developmental milestone Checklists CDC's "Learn the Signs. Act Early" program American Academy of Pediatrics' recent clinical report, â??Motor Delays: Early Identification ...
The authors describe a case of compression-induced peroneal nerve palsy with isolated extensor hallucis longus dysfunction that resulted in hallux lag without gross drop foot deformity. Level of Clinical Evidence: 4. PMID:19577724
Chickenpox, resulting from primary infection by the varicella-zoster virus, is an exanthematous disease very common during childhood and with good prognosis. However, serious complications, namely, neurological syndromes, may develop during its course, especially in risk groups, including adolescents. Peripheral facial palsy is a rare neurologic complication that has been previously described. Conclusion. We report the case of a teenager with peripheral facial palsy as a complication of chickenpox, aiming to increase the awareness of this rare association.
The CT findings in 120 cerebral palsied children are analysed. The 72.5% positive findings are correlated with the clinical types, as well as the aetiological basis for the cerebral palsy. The spastic type, 83.3% of the total number of children, had the highest positive findings. The yield was increased in children with seizures (91.3%) and those in the postnatal group
Objective Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve ( VI, VII, and VIII ) palsy following MVD and its clinical courses. Methods Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss. Results DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve. Conclusion Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.
Objective: The current study sought to describe the functional profiles of patients with early-stage progressive supranuclear palsy (PSP) in a large prospective, multisite study. Methods: Using data from 202 individuals meeting criteria for clinically definite or probable PSP, 3 functional scales were examined. Functional scores were then compared to measures of motor, cognition, and psychiatric symptoms. Results: Functional disability was high in early-stage PSP, with 100% of patients having less than perfect scores on all functional scales. Whereas functional scores tended not to be related to cognition or psychiatric symptoms, they were strongly related to motoric ratings. Conclusions: Both clinically and in research settings, the definition of functional intactness/impairment has important implications. Future studies should examine if functional impairment is this high in PSP or if new scales of functional abilities need to be developed for this condition.
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 education, equine-assisted therapy, craniosacral therapy, Feldenkrais therapy, and acupuncture. Unfortunately, these modalities have different degrees of published evidence to support or refute their effectiveness. Uncontrolled and controlled trials of hippotherapy have shown beneficial effects on body structures and functioning. Studies of acupuncture are promising, but more studies are required before specific recommendations can be made. Most studies of patterning have been negative and its use cannot be recommended. However, for the other interventions, such as hyperbaric oxygen, more evidence is required before recommendations can be made. The individual with CP and his or her family have a right to full disclosure of all possible treatment options and whatever knowledge currently is available regarding these therapies. PMID:15977320
The rate of patients' decline is critical to properly design trials of disease-modifying agents. We prospectively quantified the progression of 27 progressive supranuclear palsy (PSP) patients for at least 1 year to determine the rate of decline of motor, ocular-motor, neuropsychological, and neuropsychiatric features. PSP patients meeting the National Institute of Neurological Disorders and the Society for Progressive Supranuclear Palsy criteria were assessed using the PSP Rating Scale (PSP-RS) and modified UPDRS. The Mini-Mental State Examination (MMSE) and Frontal Assessment Battery assessed cognitive decline, the Neuropsychiatric Inventory assessed behavior, and the modified Schwab and England scale and UPDRS ADL assessed activities of daily living (ADL). The rate of change of each score was calculated as 1-year worsening score. Power and sample sizes were estimated. PSP patients showed a significant yearly decline in total and subtotal scores of the PSP-RS and UPDRS, as well as in MMSE, and UPDRS and Schwab and England ADL scores. In addition, they had significant deterioration of individual item scores reflecting major aspects of the disease (i.e., ocular-motor). The rate of decline reflected in the UPDRS mirrored that of the PSP-RS. The worsening of the ADL score was positively correlated with the PSP-RS progression of falls and ocular-motor subitem scores and with executive dysfunction. PSP patients showed a significant yearly decline in motor, ocular-motor, and ADL functions. Our findings suggest that using more-advanced technology to measure ocular-motor, postural instability, and ADL will be helpful in planning future therapeutic trials. PMID:24615741
Charcot-Marie-Tooth (CMT) syndrome type 1 and tomaculous neuropathy, also called hereditary neuropathy with liability to\\u000a pressurepalsies (HNPP), represent two groups of neurological disorders with different subtypes, which can be distinguished\\u000a at the molecular level. It is known that a 1.5-mb region on chromosome 17p11.2– 12, which includes the gene for the peripheral\\u000a myelin protein 22 kDa (PMP22), is duplicated
Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent episodes of migraine-like headaches associated with extrinsic ocular musculature palsy. In this article, we report a patient with OM that presented recurrent palsy of the abducens nerve and other atypical features. Case reports of OM with abducens nerve palsy were also reviewed. PMID:18549374
Vasconcelos, Luiz Paulo; Stancioli, Felipe Galvão; Leal, Juliana Cardoso; da Silva, Ariovaldo; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio
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
AIMSTo report on the epidemiology of cerebral palsy in England and Scotland, to provide information on the prevalence of cerebral palsy and the severity of the disability or any co-morbidity.METHODSCerebral palsy registers were compiled from multiple sources of ascertainment covering all of Scotland and the counties of Merseyside, Cheshire, Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire in England. All cases of cerebral
P O D Pharoah; T Cooke; M A Johnson; R King; L Mutch
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
Objective To investigate risks of recurrence of cerebral palsy in family members with various degrees of relatedness to elucidate patterns of hereditability. Design Population based cohort study. Setting Data from the Medical Birth Registry of Norway, linked to the Norwegian social insurance scheme to identify cases of cerebral palsy and to databases of Statistics Norway to identify relatives. Participants 2?036?741 Norwegians born during 1967-2002, 3649 of whom had a diagnosis of cerebral palsy; 22?558 pairs of twins, 1?851?144 pairs of first degree relatives, 1?699?856 pairs of second degree relatives, and 5?165?968 pairs of third degree relatives were identified. Main outcome measure Cerebral palsy. Results If one twin had cerebral palsy, the relative risk of recurrence of cerebral palsy was 15.6 (95% confidence interval 9.8 to 25) in the other twin. In families with an affected singleton child, risk was increased 9.2 (6.4 to 13)-fold in a subsequent full sibling and 3.0 (1.1 to 8.6)-fold in a half sibling. Affected parents were also at increased risk of having an affected child (6.5 (1.6 to 26)-fold). No evidence was found of differential transmission through mothers or fathers, although the study had limited power to detect such differences. For people with an affected first cousin, only weak evidence existed for an increased risk (1.5 (0.9 to 2.7)-fold). Risks in siblings or cousins were independent of sex of the index case. After exclusion of preterm births (an important risk factor for cerebral palsy), familial risks remained and were often stronger. Conclusions People born into families in which someone already has cerebral palsy are themselves at elevated risk, depending on their degree of relatedness. Elevated risk may extend even to third degree relatives (first cousins). The patterns of risk suggest multifactorial inheritance, in which multiple genes interact with each other and with environmental factors. These data offer additional evidence that the underlying causes of cerebral palsy extend beyond the clinical management of delivery.
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.
There are no published studies specifically addressing complementary and alternative treatments in adults with cerebral palsy (CP). However, national surveys of adults with chronic disabilities document that a majority of them use such treatments, that they are willing to pay out of pocket, if necessary, and that they believe that pursuing such treatment relieves pain, reduces stress and anxiety, and leads to improved feelings of fitness and well-being. Individuals enjoy taking charge of their own health care decisions, and frequently feel more in control with these therapies than with more traditional methods. In contrast to adults, there is some information on complementary and alternative methods (CAM) in children with CP. This article discusses some of the CAM used in children that may be carried over into adulthood, as well as the pitfalls for patients and conventional physicians as they try to sort out what might be helpful and what might be harmful in this arena. Practitioners of both conventional and CAM therapies believe that exercise can be beneficial; accordingly, activities such as recreational sports, yoga, and hippotherapy may be continued from childhood into adulthood. General treatments for stress and anxiety, through such activities as yoga and meditation, though not directed at CP per se, may be more popular for adults than children. Research in this area should first identify what methods are being utilized and then subject these methods to well-designed outcome studies that take into account any associated risks. PMID:19740219
The aim of this study is to describe motivation in adolescents with cerebral palsy (CP) and factors associated with motivation level. The Dimensions of Mastery Questionnaire (DMQ) measures motivation in mastering challenging tasks and expressive elements. It was completed by 153 parents and 112 adolescents with CP. Adolescents (GMFCS in n=146 - I:50, II:43, III:13, IV:15, V:25) were assessed using the Leiter IQ and Gross Motor Function Measure. Parents completed the Vineland Adaptive Behavior Scale and the Strengths and Difficulties Questionnaire. Motivation scores were highest for mastery pleasure and social persistence with adults and lowest for gross motor and object-oriented persistence. Socio-demographic factors were not strongly correlated with DMQ. Higher gross motor ability (r=0.24-0.52) and fewer activity limitations (r=0.30-0.64, p<.001) were associated with persistence in cognitive, motor and social tasks, but not mastery pleasure. Higher IQ was associated with persistence in object-oriented tasks (r=0.42, p<.001). Prosocial behaviors correlated with high motivation (r=0.39-0.53, p<.001). Adolescents' motivation scores were higher than parents' scores. Adolescents with CP express high mastery pleasure, not related to abilities. High motivation was associated with fewer activity limitations and prosocial behaviors and aspects of family environment. Findings elucidate those at-risk for low motivation, which can influence treatment adherence and participation in challenging but meaningful activities. PMID:23911644
Definite diagnosis of cerebral palsy is usually possible during the first six months of life in the hemiplegic child, but in the paraplegic or quadriplegic it may not be clear until the second half of the first year or later. Diagnosis should include not only type, degree and extent of motor handicap, but also intelligence, personality factors, sensory deficits, seizures and other physical problems. Diagnosis depends on detecting deviations from normal growth and development, of being aware of a multitude of progressive and other lesions which may simulate, at least early, the “static” group of conditions characterized by motor deficit due to central nervous system disease. Management involves early positioning, use of special equipment (mainly improvised), sensory stimulation and experience, as well as motor training, evaluation of intelligence and special learning situations to assist in discrimination learning and lengthening of attention span. Nursery schools for mentally capable children from 18 months to 3 years of age assist in developing independence, maturity and growth of personality. Except for patients with very severe mental or physical involvement, competitive employment in adult life is not related so much to the physical handicap as to personality characteristics, traits which are formed in early years. ImagesFigure 1.Figure 2.Figure 3.
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 (~5cm) were much larger. These results suggest that the FPE may be used to quantify gait stability in TD children and children with CP.
Bruijn, Sjoerd M.; Millard, Matthew; van Gestel, Leen; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat
In isolated high radial nerve palsy, it is traditionally taught that one should not use both wrist flexors for tendon transfers. Over the last 17 years, the author has encountered 4 unusual cases of high radial nerve palsy with concurrent direct injury to the pronator teres, flexor digitorum superficialis, and the palmaris longus in the proximal forearm. In these cases, the author used both wrist flexors, namely, the flexor carpi radialis to restore wrist extension and the flexor carpi ulnaris to restore finger/thumb extension as well as thumb radial abduction. Despite the major loss of wrist flexion, all patients had a good overall function as per the modified Bincaz scale. It was concluded that this "double wrist flexor" transfer remains to be an acceptable option for high radial nerve palsy when the pronator teres, flexor digitorum superficialis, and the palmaris longus tendons are not available. PMID:23123604
Background We report on a workplace cluster of Bell’s palsy that occurred within a four-month period in 2011 among employees of a three-story office building in Lima, Peru and our investigation to determine the etiology and associated risk factors. Findings An outbreak investigation was conducted to identify possible common infectious or environmental exposures and included patient interviews, reviews of medical records, an epidemiologic survey, serological analysis for IgM and IgG antibodies to putative Bell’s palsy-inducing pathogens, and an environmental exposure assessment of the office building. Three cases of Bell’s palsy were reported among 65 at-risk employees, attack rate 4.6%. Although two patients had underlying risk factors, there was no clear association or common identifiable risk factor among all cases. Serologic analysis showed no evidence of recent infections, and air and water sample measures of all known chemical or neurotoxins were below maximum allowable concentrations for exposure. Conclusions An infection spread among workplace employees could not be excluded as a potential cause of this cluster; however, it was unlikely a pathogen commonly associated with individual cases of Bell’s palsy. Although a specific etiology was not identified among all cases, we believe this methodology will aid future outbreak investigations of Bell’s palsy and a better understanding of its etiology. While environmental assessments may be useful in their ability to ascertain the cause of clusters of Bell’s palsy, future investigations should prioritize focus on common infectious etiology.
The objectives of this study were to evaluate the clinical and electrophysiological findings in peroneal mononeuropathies following a weight-reduction diet. Thirty patients with acute peroneal palsy and weight loss were studied. Complete nerve conduction studies (NCS) were performed in upper and lower limbs. NCS showed conduction block (CB) of the peroneal nerve at the fibular head that recovered in 29 patients within 3 weeks to 3 months. Severity of CB was correlated with clinical weakness. Three patients had abnormalities consistent with polyneuropathy (PNP). NCS in asymptomatic relatives confirmed familial neuropathy. Nerve biopsy and molecular study were consistent with hereditary neuropathy with liability to pressurepalsies (HNPP). One of these peroneal palsies (6 months) recovered after neurolysis. Weight loss might be a risk factor in peroneal mononeuropathies. NCS is a tool in the diagnosis of the site and severity of the nerve injury. Testing should be considered for relatives of patients with PNP because peroneal mononeuropathies may be the first expression of HNPP. PMID:10905469
Swan neck deformity in patients with cerebral palsy can result from hand intrinsic muscle spasticity or overpull of the digital extensors. After accurate identification of the etiology of the deformity, surgical treatment is directed at correcting the underlying muscle imbalance. Intrinsic lengthening can be used to treat intrinsic muscle spasticity, whereas central slip tenotomy is employed when digital extensor overpull is the deforming force. Accurate diagnosis and application of the proper surgical technique are essential when treating swan neck deformity in patients with cerebral palsy. PMID:24613587
We report the case of a patient with unilateral tongue weakness secondary to an isolated lower motor neuron hypoglossal nerve palsy that was caused by a right vertebral artery dissection in the lower neck. The patient had a boggy tongue with a deviation to the right side but an otherwise normal neurological examination. Magnetic resonance angiography showed a narrow lumen of the right vertebral artery in the neck. After initially treating the patient with aspirin in the emergency room and later with warfarin for three months, there was complete recanalization of the right vertebral artery. Only one other case of vertebral artery dissection and twelfth nerve palsy has been reported before.
Mahadevappa, Karthik; Chacko, Thomas; Nair, Anil K.
Paralysis of the hypoglossal nerve, the twelfth (XII) cranial nerve, leads to atrophy, deviation of the tongue to the affected side, and varying degrees of fasciculation. The injury to the nerve can occur from its origin to the tongue itself. The causes of hypoglossal nerve palsy are well documented, but idiopathic, isolated nerve palsy that does not recover, is rare. To our knowledge we describe the first case that failed to resolve, and discuss the importance of meticulous investigation to make a diagnosis and rule out sinister disease. PMID:24834809
Sayan, Anna; Abeysinghe, A H M K; Brennan, Peter A; Ilankovan, Velupillai
Objectives To evaluate, in extremely low gestational age newborns (ELGANs), relationships between indicators of early postnatal hypotension and cranial ultrasound indicators of cerebral white matter damage imaged in the nursery and cerebral palsy diagnoses at 24 month follow-up. Methods The 1041 infants in this prospective study were born at < 28 weeks gestation, were assessed for 3 indicators of hypotension in the first 24 postnatal hours, had at least one set of protocol cranial ultrasound scans, and were evaluated with a structured neurologic exam at 24 months corrected age. Indicators of hypotension included: 1) lowest mean arterial pressure (MAP) in the lowest quartile for gestational age; 2) treatment with a vasopressor; and 3) blood pressure lability, defined as the upper quartile of the difference between each infant’s lowest and highest MAP. Outcomes included indicators of cerebral white matter damage, i.e. moderate/severe ventriculomegaly or an echolucent lesion on cranial ultrasound, and cerebral palsy diagnoses at 24 months gestation. Logistic regression was used to evaluate relationships among hypotension indicators and outcomes, adjusting for potential confounders. Results Twenty-one percent of surviving infants had a lowest blood pressure in the lowest quartile for gestational age, 24% were treated with vasopressors, and 24% had labile blood pressure. Among infants with these hypotension indicators, 10% percent developed ventriculomegaly and 7% developed an echolucent lesion. At 24-months follow-up, 6% had developed quadriparesis, 4% diparesis, and 2% hemiparesis. After adjusting for confounders, we found no association between indicators of hypotension, and indicators of cerebral white matter damage or a cerebral palsy diagnosis. Conclusions The absence of an association between indicators of hypotension and cerebral white matter damage and or cerebral palsy suggests that early hypotension may not be important in the pathogenesis of brain injury in ELGANs.
Logan, J. Wells; O'Shea, T. Michael; Allred, Elizabeth N.; Laughon, Matthew M.; Bose, Carl L.; Dammann, Olaf; Batton, Daniel G.; Kuban, Karl C.; Paneth, Nigel; Leviton, Alan
A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensory-neural deafness and speech disorders. In all 250 childern were treated and the data was gathered during a period of 3 years from December 2003 till December 2006. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for minimum 6 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 171 children with Spasticity and Stiffness 147 showed marked improvement showing 87% success rate, out of 126 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 91 children showing 72% success rate, out of 48 children with Cortical Blindness 30 children showed improvement accounting for 63% efficacy rate, out of 105 children with Hearing Difficulties, 63 showed marked improvement accounting for 60% improvement rate, out of 190 children with Speech Disorders 122 showed improvement reflecting 64% improvement rate, out of 96 children with Hemiplegia 71 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 76 children with Quadriplegia 52 showed improvement in gross and fine motor functions showing 69% success rate and out of 58 children with Paraplegia of lower limbs 44 showed improvement in weight bearing, standing and movement accounting for 76% improvement rate.
Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Dar, Irfan
Over the last 25 years the definition and classification of cerebral palsy (CP) have evolved, as well as the approach to rehabilitation. CP is a disorder of the development of movement and posture, causing activity limitations attributed to nonprogressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. Motor control during reaching, grasping, and walking are disturbed by spasticity, dyskinesia, hyperreflexia, excessive coactivation of antagonist muscles, retained developmental reactions, and secondary musculoskeletal malformations, together with paresis and defective programing. Weakness and hypoextensibility of the muscles are due not only to inadequate recruitment of motor units, but also to changes in mechanical stresses and hormonal factors. Two methods, the General Movements Assessment and the Test of Infant Motor Performance, now permit the early detection of CP, while the development of valid and reliable outcome measures, particularly the Gross Motor Function Measure (GMFM), have made it possible to evaluate change over time and the effects of clinical interventions. The GMFM has further led to the development of predictive curves of motor function while the Gross Motor Classification System and the Manual Ability Classification System provide standardized means to classify the severity of the movement disability. With the emergence of the task-oriented approach, the focus of therapy in rehabilitation has shifted from eliminating deficits to enhancing function across all performance domains by emphasizing fitness, function, participation, and quality of life. There is growing evidence supporting selected interventions and interest for the therapy and social integration of adults with CP. PMID:23622163
Fractures in children with cerebral palsy (CP) constitute a common clinical problem. The purpose of this retrospective study is to analyze the demographics, identify risk factors, and delineate guidelines for treatment in 156 children with CP who were treated for fractures. To identify changes in demographics, children treated before 1992 (56 patients) were compared with those treated from 1992 to 2000. The latter group of children was compared with an age- and gender-matched group of CP children without fractures. Ambulatory status, the presence of contractures, nutritional status, seizure medication, the type of treatment received, final outcomes, and complications were recorded and statistically analyzed. The mean age at the time of the first fracture was 10 years. Sixty-six percent of patients had spastic quadriplegia, of whom 83% were nonambulatory. Eighty-two percent of fractures occurred in the lower limbs. Forty-eight percent were delayed in diagnosis with no cause determined. Children treated after 1992 had higher incidence of multiple fractures, lower incidence contractures, and a younger age at first fracture. This group showed a statistically significant difference for anticonvulsant therapy (P=0.001), CP pattern (P=0.005), ambulatory status (P=0.001), and osteopenia (P=0.001) when compared with the group of CP patients without fractures. Eighty percent of fractures were treated with a soft bulky dressing. Complications occurred in 17% of patients. The greatest risk factor for fracture is the nonambulatory CP child on anticonvulsant therapy. These risk factors seem to have increased, resulting in a higher prevalence of low energy fractures. Future research must focus on the underlying mechanisms and prevention of this condition. PMID:17314638
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 of…
A procedure was devised in which message content was provided to four nonvocal, severely palsied quadriplegic adults in advance, and investigators elicited the messages via subjects' yes/no gestures. Results indicated reasonably high correspondence between stimulus messages and messages elicited. (Author/JDD)
This paper describes and evaluates an intelligent wheelchair, adapted for users with cognitive disabilities and mobility impairment. The study focuses on patients with cerebral palsy, one of the most common disorders affecting muscle control and coordination, thereby impairing movement. The wheelchair concept is an assistive device that allows the user to select arbitrary local destinations through a tactile screen interface.
Luis Montesano; Marta Díaz; Sonu Bhaskar; Javier Minguez
This paper describes and evaluates an intelligent wheelchair, adapted for cognitively disabled subjects with mo- bility impairement. The study focused on cerebral palsy pa- tients, one of the most common congenital disorders that affect muscle control and coordination, thereby impairing movement. The wheelchair concept is an assistive device that allows the subject to select arbitrary local destinations through a tactile
Aim: This study investigated the reliability and validity of the Barry-Albright Dystonia Scale (BADS), the Burke-Fahn-Marsden Movement Scale (BFMMS), and the Unified Dystonia Rating Scale (UDRS) in patients with bilateral dystonic cerebral palsy (CP). Method: Three raters independently scored videotapes of 10 patients (five males, five females;…
Monbaliu, E.; Ortibus, E.; Roelens, F.; Desloovere, K.; Deklerck, J.; Prinzie, P.; De Cock, P.; Feys, H.
Results from multiple tests including somatosensory evoked potentials, passive resistance to motion, upper extremity motor skills evaluation, neuromuscular examination, and parental interview were evaluated in 13 children with cerebral palsy (CP) who received chronic cerebellar stimulation (CCS) for reduction of spasticity and movement disorders during the past 14 years. The prospective study included immediate postoperative follow-up data as well as
Gerald F. Harris; Edward A. Miliar; David C. Hemmy; Robert C. Lochner
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,…
A method is presented to restore dynamic eyelid function in facial palsy with the implantation of 2 permanent magnets near the upper and lower eyelid margin. The attractive force characteristics of the double magnet system closely simulate the action of the paralyzed orbicularis sphincter. Normal lid opening is accomplished by the intact levators. The width and contour of the palpebral
Wolfgang D. Miihlbauer; Heinz Segeth; Annegret Viessmann
This pamphlet offers general rules and specific suggestions for people who are dressing children with cerebral palsy. Common dressing problems are examined, such as the child becoming stiff, crossing the legs, or curling the toes, and possible solutions are outlined step-by-step and accompanied by illustrations. Guidelines are also provided for…
The present study focuses on the ability of participants with spastic hemiparesis caused by cerebral palsy to adjust an ongoing movement. Typical symptoms associated with the disorder would lead one to expect that people with spastic hemiparesis would be unable to adjust their movements quickly and proportionally to a sudden change in the environment with their spastic arm. The results
Edwin Van Thiel; Ruud G. J. Meulenbroek; Jeroen B. J. Smeets; Wouter Hulstijn
Through content analysis, employing qualitative and quantitative methods, Canadian media representation of people with cerebral palsy (PWCP) in public life was examined. Canadian NewsDisc, an online biographic database service, was used to examine the use of stigmatizing language such as afflicted by, afflicted with, suffered from, suffers from,…
Intended for parents of cerebral palsied children, the manual discusses special communication problems that often accompany the condition, and describes various strategies for helping such children communicate. A chapter on positioning for speech diagrams 14 different positions to help facilitate better functioning in many areas, including speech.…
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
In a series of 126 patients with Bell's palsy, chemical or overt diabetes mellitus was found in 39% of the cases. A high frequency of disturbances of taste was found in the patients who had no diabetes (83%), as compared to only 14% of diabetic patients whose taste was affected (p less than 0 .001). Thus, the usual site of
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 unilateral…
Bottcher, Louise; Flachs, Esben Meulengracht; Uldall, Peter
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 clinical subgroup of cerebral palsy and subtype of epileptic seizures. We looked for possible risk factors including the presence of neonatal seizures, the imaging findings, the gestational age at delivery, the adjusted birth weight, the mode of delivery, the Apgar scores, and the head size as well as the presence of consanguinity. Epilepsy occurred in 33% of the studied children. Almost 50% of the epileptic children had their first seizure within the first 12 months of life. Neonatal seizures were strong predictors for epilepsy (p<0.001). Presence of at least one abnormal structural finding (particularly brain atrophy) was also a significant predictor of epilepsy (p<0.003). Low Apgar score at 5 min after birth and birth at term were also found more frequently among patients with epilepsy, although when adjusted with other risk factors, Apgar score did not reach statistical significance. The mode of delivery, head circumference, adjusted birth weight, gender and ethnic group, consanguineous marriage and prematurity were not found to be risk factors for the occurrence of epilepsy in these children. PMID:19576827
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
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.…
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
This study of 22 individuals (ages 13-20) with cerebral palsy investigated the use of scanning, an interface technique that allows access to assistive devices such as communication boards, electronic augmentative communication devices, and computers by using a pointer, either a finger or a cursor. This packet of information includes the findings…
The incidence of pudendal nerve palsy following routine trauma and elective orthopaedic surgery procedures ranges from 1.9% to 27.6%. Excessive and/or prolonged traction against the perineal post of a traction table, leading to direct compression and localised ischaemia to the nerve are suggested mechanisms of injury. Misuse of traction and the inappropriate placement of the perineal post, leading to crushing and stretching of the pudendal nerve, are two main contributing factors leading to its postoperative palsy. The sequelae may be sensory, motor or mixed. In most cases, these injuries are transient and tend to resolve within several weeks or months. However, complete neurological recovery may be unpredictable and the effects of ongoing dysfunction potentially disastrous for the individual. In terms of preventative measures, magnitude and duration of traction time should be minimised; traction should be limited to the critical operative steps only. Additionally, the perineal post should be placed between the genitalia and the contralateral leg. A well-padded, large-diameter perineal post should be used (>10cm). Adequate muscle relaxation during anaesthesia is particularly important in young men who have strong muscles and thus require larger traction forces when compared to elderly patients. Orthopaedic surgeons should be aware of the pathophysiology behind the development of this palsy and the measures that can be employed to reduce its occurrence. In procedures where a traction table is employed, consenting for pudendal nerve palsy should be considered by the surgical team. PMID:24054001
Polyzois, Ioannis; Tsitskaris, Konstantinos; Oussedik, Sam
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…
Vocal cord paralysis associated with goiter usually indicates the presence of a malignancy. Pediatric patients retain significant thymic tissue that regresses only later in life. This thymic tissue can develop significant hyperplasia during an acute autoimmune process. We describe a case of a 17-year-old girl who presented with a goiter secondary to severe Graves' disease and a 2-month history of hoarseness, choking on liquid intake, and small-volume vomiting especially after eating. She demonstrated a left vocal cord paralysis probably secondary to a unilateral left recurrent laryngeal nerve palsy. A marked enlargement of the thymus was discovered on thoracic imaging. Treatment was initiated with methimazole, with near complete remission of her vocal cord paralysis within 3 months. Given the immunomodulatory effects of methimazole, a potential mechanism of the left recurrent laryngeal nerve palsy was autoimmune hyperstimulation of the thymus and consequent hyperplasia, resulting in distension of the nerve. Attenuation of the hyperactive immune process with methimazole may have resulted in regression of the mass effect of the thymus and associated reduction of the nerve distension. This case illustrates the unique risk of left recurrent laryngeal nerve palsy in pediatric patients with an acute immune stimulation and hyperplasia of the thymus and the reversibility in the context of mitigation of the immune hyperactivity. Methimazole may be an optimal initial treatment choice in pediatric patients with Graves' disease and left recurrent laryngeal nerve palsy. PMID:24249820
Chiu, Harvey K; Ledbetter, Daniel; Richter, Monica W; Iyer, Ramesh S; Merati, Albert L
The aim of the study was to describe behavioural problems in children with cerebral palsy (CP) with and without epilepsy. The children were sampled from the Western Sweden CP register and were part of a European Union project. The Strength and Difficulties Questionnaire and questions on epilepsy were answered by one parent of each child. Medical…
Carlsson, Malin; Olsson, Ingrid; Hagberg, Gudrun; Beckung, Eva
A device is developed to improve the walking ability of children with Spastic Cerebral Palsy, who have damages to the area of their brain which controls the muscle tone and that causes trouble walking like moving by using their toes instead of applying a ...
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…
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...
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,…
Twenty young children (mean age = 32 months) with cerebral palsy (CP) recruited from early intervention programs received 30 minutes of massage or reading twice weekly for 12 weeks. The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms, and improved fine…
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…
Perinatal brain injury results in one of the highest burdens of disease in view of the lifelong consequences and is of enormous cost to society. This makes it imperative to develop better animal models that mimic the human condition. Many neurodevelopmental deficits, such as cerebral palsy, are believed to be a result of prenatal hypoxia-ischemia in humans. Fetal global hypoxia-ischemia
Sidhartha Tan; Alexander Drobyshevsky; Tamas Jilling; Xinhai Ji; Lauren M. Ullman; Ila Englof; Matthew Derrick
BACKGROUND: Cerebral palsy (CP) is an upper motor neuron disease that results in a progressive movement disorder. Secondary to the neurological insult, muscles from CP patients often become spastic. Spastic muscle is characterized by an increased resistance to stretch, but often develops the further complication of contracture which represents a prominent disability in children with CP. This study's purpose is
Lucas R Smith; Eva Pontén; Yvette Hedström; Samuel R Ward; Henry G Chambers; Shankar Subramaniam; Richard L Lieber
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…
There have been very few reports about results of tendon transfers carried out in very old radial palsies affecting the hand. We present two cases of radial palsy operated 52 and 30 years after the original injury, which also had after-effects in pronosupination due to elbow injuries. In the first patient, with high radial-nerve palsy, we made a triple transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi ulnaris to the extensor digitorum communis and the palmaris longus to the extensor pollicis longus. In the second case, which had posterior interosseous nerve palsy, we transferred the flexor carpi radialis to the extensor digitorum communis, and the brachiorradialis to the extensor pollicis longus. The surgical findings showed a 'gelatinous degeneration' in some of the receiving tendons, which did not prevent the sutures from being resistant. The first patient, who had a stiff elbow, with pronosupination blocked since childhood, showed disuse atrophy of the pronator teres, which conditioned a late rupture of the tenomuscular junction and required a second surgery for wrist arthrodesis. Results after postoperative period of 30 months after surgery in the first patient, and 14 months after surgery in the second one, showed functional recovery in finger range of extension, grip and key-pinch strength and a significantly higher QuickDASH score, restoring the natural aesthetical appearance of the limb. This facilitated the return to professional and daily activities, re-establishing a fine ability to grab and release objects. PMID:22771086
Martínez-Villén, G; Muñoz-Marín, J; Pérez-Barrero, P
This study examines corpus callosum pathology in children with spastic cerebral palsy aged 7 to 15 years and to investigates the relation between corpus callosum areas and clinical picture. Magnetic resonance images of 46 patients were reviewed prospectively. Twenty-two patients with cerebral palsy were age and gender matched with the control patients. The cerebral palsy group had a significantly smaller mean corpus callosum surface area than did the control group. The cerebral palsy group also had a significantly smaller mean internal skull surface area measurement than did the control group. The corpus callosum/internal skull surface area ratio was also smaller for those with cerebral palsy. Wechsler Intelligence Scale Verbal IQ scores were associated with the surface area of the corpus callosum in cerebral palsy patients. A significant relationship between corpus callosum surface area and IQ scores in children with cerebral palsy was found. A positive correlation between internal skull surface area and IQ scores in children with cerebral palsy was noted. A significant correlation between Apgar score and corpus callosum surface area in the cerebral palsy group was found. A negative correlation between corpus callosum surface area and the Gross Motor Function Classification System in patients with cerebral palsy was noted. PMID:17621513
Ku?ak, Wojciech; Sobaniec, Wojciech; Kubas, Bozena; Walecki, Jerzy
PURPOSE: To investigate the etiology, sensory, motor, and cosmetic results of treatment for oculomotor (CNIII) palsy in children. METHODS: We conducted a retrospective review of the clinical records of children with a diagnosis of CNIII palsy who were followed up in our practice between 1981 and 1996. RESULTS: During the 15-year period, 49 children with 53 affected eyes were followed for a mean of 5.5 years. CNIII palsy was congenital in one third of cases and secondary to postnatal trauma in another third. Thirty-three of the eyes were affected before visual maturation (age 8 years) and 27 eyes developed amblyopia. None of the 6 eyes with amblyopia in which visual acuity could be quantitated had measurable improvement of Snellen acuity after treatment. Overall, visual acuity was between 6/5 and 6/12 at the last follow-up visit in 56% of affected eyes. Ocular alignment was greatly improved after recess-resect procedures on the horizontal rectus muscles, but binocular function was difficult to preserve or restore. Blepharoptosis improved after levator palpebrae muscle resection or eyelid suspension procedures. CONCLUSIONS: CNIII palsy may undergo partial resolution in children, but surgical treatment is frequently necessary. Although surgery can result in cosmetically acceptable alignment of the eyes, it rarely results in restoration or achievement of binocular function. Multiple procedures are often necessary to maintain good ocular alignment. Several surgical procedures may be needed to correct related blepharoptosis and maintain an acceptable eyelid position. Treatment of amblyopia is only effective in maintaining the level of visual acuity present at the onset of the CNIII palsy, and improvement in acuity is difficult to achieve.
Schumacher-Feero, L A; Yoo, K W; Solari, F M; Biglan, A W
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder with diverse clinical phenotypes characterized by supranuclear gaze palsy, parkinsonism with postural instability, and frontal dementia. The early and accurate diagnosis of PSP remains difficult because of the variable combination of symptoms and frequent lack of gaze abnormalities early in the disease course. Moreover, a subset of PSP shows behavioral changes as the initial presentation, which considerably overlaps with the clinical picture of frontotemporal dementia (FTD). Thus, this subgroup possibly needs psychiatric assessments. Here, we describe a clinical case of PSP difficult to differentiate from FTD because the frontal presentation persisted without gaze palsy until the late stage of the clinical course. A 58-year-old man was admitted to our hospital for the reconsideration of a diagnosis of FTD. Disinhibited and gambling behaviors inconsistent with his previous personality first appeared at around the age of 45, with gradual progression, followed by memory deficits, executive dysfunction, and a slowing of mental processes. Recurrent sexual disinhibition led him to undergo psychiatric consultation at the age of 57. Downward gaze palsy and postural instability with recurrent falls emerged 8 months after the first psychiatric examination, and he was clinically diagnosed with PSP 13 years after the initial frontal presentation. PSP should be considered in the differential diagnosis of patients presenting with frontal lobe symptoms, even in psychiatric practice. PMID:24992742
[Purpose] The purpose of this study was to compare differences in respiratory pressure and pulmonary function and the effectiveness of respiratory feedback training according to walking ability in children with cerebral palsy (CP). [Subjects and Methods] Twenty-three children with spastic CP were enrolled in the final analysis and were divided into an independent walking group (n=12) and non-independent walking group. All children received respiratory feedback training for four weeks. Before and after the training, respiratory muscle strength was measured and a pulmonary function test was performed. [Results] Comparison of respiratory pressure and pulmonary function test results between the two revealed that the independent walking group had significantly higher respiratory function than the other group in all variables except peak expiratory flow. In comparison of changes in respiratory function between the two groups, the independent walking group showed significantly higher improvement of respiratory function in terms of maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity. [Conclusion] These findings showed that children with independent walking ability had better respiratory muscle strength and pulmonary function compared with children without independent walking ability. Understanding respiratory function and the effectiveness of respiratory training according to walking ability will be valuable clinical information for respiratory assessment and therapy in children with CP.
Summary We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with On- yx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous em- bolization may be safer. Furthermore, pred- nisolone therapy should be carried out in the prophase of nerve palsy.
Pei, W.; Huai-Zhang, S.; Shan-Cai, X.; Cheng, G.; Di, Z.
Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation. PMID:24457866
Summary Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11 (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients
Acute lymphoblastic leukaemia and acute myeloblastic leukaemia are the most common malignancies diagnosed in children. Facial palsy is an acute peripheral palsy involving the facial nerve and is an unusual presentation of childhood acute leukaemia. We present three cases (a 9-year-old boy, a 14-year-old boy and a 10-year-old boy) of acute leukaemia with initial presentation of facial palsy. It is important for physicians to recognise the neurological manifestations of childhood leukaemia and extensive work-up should be carried out to exclude secondary causes of facial palsy.
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.
A 68-year-old man had an unremitting left sixth cranial nerve palsy immediately after completing a long bicycle trip. High-resolution (3 Tesla) magnetic resonance imaging disclosed a dolichoectatic vertebral artery that compressed the left sixth cranial nerve against the belly of the pons at its root exit zone. It was postulated that increased blood flow in the vessel during the unusually prolonged aerobic exercise precipitated the palsy. Compressive palsies of cranial nerves caused by a dolichoectatic basilar artery have often been documented; compressive palsy caused by a dolichoectatic vertebral artery is less well-recognized. PMID:15937439
Zhu, Ying; Thulborn, Keith; Curnyn, Kimberlee; Goodwin, James
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
Acute myeloid leukemia (AML) is a malignant disease of the hematopoietic tissue. The disease presentation may be related to the loss of bone marrow function or with general symptoms of neoplastic diseases. Extramedullary involvement is responsible for less frequent presentations that may hinder early diagnosis. Gingival enlargement is not uncommon in AML but cases of bilateral facial palsy are rare. In this article the authors present the case of a man of 70 who comes up with gingival hypertrophy that initially was not valued and that developed after three weeks, a bilateral facial palsy. The myelogram revealed an AML. With directed chemotherapy the patient reached complete remission but kept the symptoms of disease presentation. PMID:23079253
Pereira, Marta Sofia; Faria, Frederica; Menezes Falcão, Luiz
The overall rate of cerebral palsy excluding post-neonatal cases, has remained relatively constant, varying between 1.93 and 2.27 per 1000 births over the 20-year period between 1969 and 1988 in Avon. The rate of the subgroup of spastic cerebral palsy varied from 1.40 to 1.78 per 1000 births over the same time period. In singletons the corresponding figures were 1.80-2.17 per 1000 births and 1.28-1.67 per 1000 births, and in multiple births the figures were 7.12-8.80 per 1000 births and 7.12-8.44 per 1000 births. Although the overall rates have remained fairly constant there was an increase in incidence in the later years among children with low birthweight and short gestation. PMID:7596892
BACKGROUND—Congenital facial palsy (CFP) is clinically defined as facial palsy present at birth. It is associated with considerable disfigurement and causes functional and emotional problems for the affected child. The aetiology of the majority of cases however, remains elusive.?AIMS—To investigate the role of a neuroanatomical abnormality as a cause of unilateral CFP.?METHODS—Magnetic resonance imaging (MRI) scans were performed on 21 patients with unilateral CFP. Fifteen patients had unilateral CFP only; six suffered from syndromes which can include unilateral CFP.?RESULTS—Of the 15 patients with unilateral CFP only, four (27%) had an abnormal nucleus or an abnormal weighting of this area on the MRI scan, compared to one (17%) of the remaining six patients.?CONCLUSION—Developmental abnormalities of the facial nucleus itself constitute an important, and previously ignored, cause of monosymptomatic unilateral CFP.??
We describe an infant with molybdenum cofactor deficiency, initially diagnosed as cerebral palsy. Clinical features of molybdenum cofactor deficiency, e.g., neonatal seizures, hypertonus/hypotonus, and feeding and respiratory difficulties, resemble those of neonatal hypoxic-ischemic encephalopathy. Our patient, a 2-year-old boy, presented with spastic quadriplegia and mental retardation. He manifested intractable neonatal seizures and diffuse cerebral atrophy. When admitted with bronchitis at age 18 months, his uric acid levels in blood and urine were undetectable. A urinary sulfite test revealed positive results. Further tests revealed elevated urinary levels of xanthine, hypoxanthine, and S-sulfocystein. Sequencing of the MOCS2A gene revealed heterozygosity for c.[265T>C] + [266A>G], diagnosed as molybdenum cofactor deficiency type B. Neonatal seizures, progressive cerebral atrophy, and low serum levels of uric acid may provide diagnostic clues in patients with cerebral palsy of undetermined cause. PMID:22759696
Cerebral palsy (CP) is one of the most severe childhood disabilities due to a lesion in the developing brain. Oral conditions often observed in this pathogenic are a tendency for the delayed eruption of permanent molars, higher percentages of malocclusion and parafunctional habits, including bruxism. The significance of oral conditions observed in CP patients demonstrates the need for intensive home and professional care for these individuals. This paper presents a 7-year-old boy, with cerebral palsy, severe mental retardation, who had high abrasion wear of the primary teeth related to bruxism. Dental care was carried out under oxide-induced sedation, and management of the bruxism was achieved after the use of a resin acrylic protective appliance fixed on both sides of the mandibula. The treatment performed offered efficiency advantages, was clinically viable, and should be a valuable option to practitioners considering appliance therapy to control parafunctional behavior.
Oliveira, Cristiana Aroeira G. R.; de Paula, Viviane Andrade Cancio; Portela, Maristela Barbosa; Primo, Laura Salignac Guimaraes; Castro, Gloria Fernanda
An application of computed tomography (CT) is described in which multiplanar high resolution images of the terminal carotid and basilar arteries are obtained. This has been applied in a series of 32 patients with IIIrd nerve palsy in whom the underlying pathology was thought to be a posterior communicating artery aneurysm. The results of the CT were compared with conventional angiography. Seventeen aneurysms were detected in 13 patients by CT and all were confirmed by angiography. Vessels considered to be normal on CT were confirmed to be normal by angiography. This CT technique is a simple non invasive first line investigation for IIIrd nerve palsy with the ability to exclude or predict an aneurysm. Images
Teasdale, E; Statham, P; Straiton, J; Macpherson, P
Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy. PMID:22967702
Synovial oteochondromatosis has been described in the knee joint commonly but this case was in the elbow and was associated with ulnar nerve palsy. Generally it has been the belief that synovial osteochondromatosis is not associated with ostearthritis of the joint but, in this case it was clearly associated with osteoarthritis of the elbow. Therefore the authors wish to report this case of a rare condition with an unusual association.
Synovial oteochondromatosis has been described in the knee joint commonly but this case was in the elbow and was associated with ulnar nerve palsy. Generally it has been the belief that synovial osteochondromatosis is not associated with ostearthritis of the joint but, in this case it was clearly associated with osteoarthritis of the elbow. Therefore the authors wish to report this case of a rare condition with an unusual association. PMID:22673717
Objectives Intrapartum foetal monitoring goal is to prevent foetal asphyxia and its most severe consequence: cerebral palsy (CP). In\\u000a this paper we describe the detection methods and the criteria needed to assess asphyxia during labour for preventing CP. Foetal\\u000a cerebral damage assessment is considered from the medical-legal point of view. CP represents the most frequent pathology of\\u000a childhood related to pregnancy
The objective of the research is to develop a new method of human-machine interaction that reflects and harnesses the multimodal expressive abilities and potentials of people with severe speech and motor impairment due to cerebral palsy. Human-human interaction within the framework of drama and mime was used to elicit gestural behavior suitable for human-machine interaction and to explore human factors
While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle\\u000a imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing\\u000a scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation\\u000a and Rotation. Multiple anatomic parameters
\\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
A 16-year-old girl presented with a large-angle exotropia due to congenital third nerve palsy. She had undergone recession/resection surgery as a child. A nasal transposition of the superior oblique and the lateral rectus produced some improvement but the result was still cosmetically unacceptable. Subsequent surgery to permanently secure the globe to the medial orbital wall using an intraoperatively adjustable nonabsorbable traction suture produced a satisfactory outcome. PMID:15498054
Background and Purpose—The objective of the present study was to investigate the neural mechanisms of dysphagia in suprabulbar palsy (SBP) with multiple lacunar infarct. Methods—We evaluated the swallowing disorders of patients with SBP (n 534) and age-matched healthy control subjects (n535) by means of an electrophysiological method that recorded the oropharyngeal swallowing patterns. With this method, dysphagia limit, the triggering
Cumhur Ertekin; Ibrahim Aydogdu; Sultan Tarlaci; A. Bulent Turman; Nefati Kiylioglu
This case report describes the clinical course of a patient with Ramsay Hunt Syndrome. Partial recovery of the lower motor neuron facial palsy was associated with decreased hearing and a reduction of the middle ear compliance on voluntary contraction of the facial musculature. It is suggested that this is due to misdirection of regenerating nerve fibres, normally destined for facial muscles, to stapedius muscle. PMID:2926271
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.
There are 3 surgical procedures that patients with cerebral palsy (CP) undergo that may be considered major procedures: femoral osteotomies combined with pelvic osteotomies, spine fusion, and intrathecal baclofen pump implant for the treatment of spasticity. Many complications are known to occur at a higher rate in this population, and some may be avoided with prior awareness of the preoperative pathophysiology of the patient with CP. PMID:24491650
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
Objective: To determine clinical effectiveness of strength training in children with spastic cerebral palsy.Design: Prospective before and after trial in which subjects participated in a 6-week strength training program. All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a hand-held dynamometer, 3-D gait analysis at free and fast speeds, administration of the
While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months-10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients. PMID:17262175
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
Ophthalmoplegic migraine (OM) is a rare form of primary headache. Because of its rarity, only a few cases, mostly symptomatic, are reported. We analyse nine cases among 52 973 adults who suffer from headaches with an oculomotor palsy firstly considered as OM. The study was retrospective and multicentric in a database set up in France. The aim of our investigation was to describe the clinical and radiological aspects of these cases and to discuss the diagnosis of OM. We demonstrate that the characteristics of the headaches were identical to usual migraine without oculomotor nerve palsy for each case. The study emphasises the difficulty of the OM diagnosis even with the new IHS criteria because of the rarity of having all characteristics. A wide heterogeneity was noted in cranial imagery and blood tests. We suggest adding the code of probable OM in the IHS classification to increase the knowledge and detection of this type of headache. A biological blood test and an MRI are systematically required to help clinicians in their diagnosis and to exclude alternative aetiology of headache with palsy. PMID:17497265
As an improved maintenance therapy for Bell's palsy, Stennert recently introduced large-dose steroid administration in the early stage of the disease with i.v. infusion of low-molecular dextran. The steroid administration aims at improving the microcirculation. This therapy achieved a 96% complete healing rate. However, because of side-effects such as hepatic and renal disorders or gastric ulcer, this therapy has not been widely used. In the present study, we investigated an improved treatment method based on Stennert's method. It has a much lower incidence of side effects, and can be used in routine clinical practice. The medicines employed in our therapy were hydrocortisone sodium succinate (Solu-cortef), hydroxymethylated starch (Hespander) and D-mannitol (Manitol). Subjects were 53 Bell's palsy patients for whom treatment could be started within 2 weeks from the onset of the disease. Curative rate in the patients who received large-dose administration of Solu-cortef was 96.2% in the 24th week, and the therapy was considered to be applicable in routine clinical practice for Bell's palsy. PMID:8740822
A population-based registry was used to ascertain whether neuroimaging findings of children with cerebral palsy could predict the occurrence of certain comorbidities. Neuroimaging findings and comorbidities data were extracted from the Quebec Cerebral Palsy Registry for children born in a 4-year birth interval (1999-2002) covering half of the province's population. Neuroimaging studies were classified into 10 mutually exclusive categories (periventricular white matter injury/leukomalacia, cerebral malformation, cerebral vascular accident, deep gray matter injury, superficial gray matter injury, diffuse gray matter injury, intracranial hemorrhage, infection, nonspecific findings, and normal). Comorbidities studied included cortical blindness, severe auditory impairment, inability to communicate verbally, assisted feeding, and the presence of afebrile seizures in the prior 12 months. Neuroimaging results were available for a total of 213 children. Only deep gray matter injury (defined as signal abnormality or volume loss in subcortical gray matter, n = 9) was significantly (P < 0.05) linked with the occurrence of both the inability to communicate verbally (n = 5, 55.6% vs n = 46, 22.5%, P = 0.04) and with a higher mean number of comorbidities (1.67 vs 0.70, P < 0.01), and therefore with increased burden of comorbidities. These findings may improve our ability to prognosticate the outcome of children with cerebral palsy, enabling targeted early direct interventions. PMID:21907883
Legault, Geneviève; Shevell, Michael I; Dagenais, Lynn
A 69-year-old woman developed ptosis and diplopia due to an isolated pupil-involving left oculomotor nerve palsy. General examination was unremarkable. Initial workup showed a mild increase in cerebrospinal fluid proteins. Imaging studies were remarkable for a left oculomotor nerve enhancement in brain MRI and hyperfixation along the nerve's pathway in full body single-photon emission CT. Assuming the possible diagnosis of neurosarcoidosis, the patient was started on high-dose methylprednisolone. Three months later she developed pancytopenia. A bone marrow biopsy was performed and histopathology revealed infiltration by Hodgkin's lymphoma. Adriamycin, bleomycin, vinblastine, dacarbazine protocol chemotherapy was started and full haematological remission obtained after four cycles, despite mild oculomotor nerve palsy persisted. Isolated oculomotor palsy as the first presenting manifestation of a lymphoma is rare and alternative differential diagnosis must be considered in the absence of other lymphoma manifestations. In this case as with many rare initial manifestations of common diseases watchful waiting was crucial to the correct diagnosis and treatment strategy. PMID:24759607
Meireles, Joana; Garrett, Maria Carolina; Abreu, Pedro
The aim of this study is an evaluation of the results of The Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS), and muscle strength examination measured by dynamometer in children with cerebral palsy. We examined 51 patients with cerebral palsy in the age ranging from 8 years to 26 years (average age 17.3 ± 4.2) living in
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
Intended for professionals and parents, this monograph focuses on the service needs of young children with cerebral palsy. Section I presents an overview of cerebral palsy, including etiology, incidence, and history of management. Section II describes service needs in the following areas: prevention; early identification; treatment; the…
A new multisensory system that aims at fostering the interaction of people with cerebral palsy is presented. This article describes the strategies and technologies used to provide people who have moderate to severe cerebral palsy with playful and fun activities designed according to their abilities. These activities are based on interactive systems that use computer vision and generate graphics and
A new multi-sensory system that aims at fostering the interaction of people with cerebral palsy is presented. This article describes the strategies and technologies used to provide people who have moderate to severe cerebral palsy with playful and fun activities designed according to their abilities. These activities are based on interactive systems that use computer vision and generate graphics and
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 conduct a systematic review and meta-analysis using the International Classification of Functioning to determine the summary effect of electrical stimulation on impairment and activity limitations relevant to gait problems of children with cerebral palsy.Methods: We identified 40 cerebral palsy and electrical stimulation studies, and 17 gait studies qualified for inclusion. Applying enablement classification methods to walking abnormalities created
James H Cauraugh; Sagar K Naik; Wen Hao Hsu; Stephen A Coombes; Kenneth G Holt
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
Children with cerebral palsy participate less in everyday activities than children in the general populations. During adolescence, rapid physical and psychological changes occur which may be more difficult for adolescents with impairments. Within the European SPARCLE project we measured frequency of participation of adolescents with cerebral palsy by administering the Questionnaire of Young People’s Participation to 667 adolescents with cerebral palsy or their parents from nine European regions and to 4666 adolescents from the corresponding general populations. Domains and single items were analysed using respectively linear and logistic regression. Adolescents with cerebral palsy spent less time with friends and had less autonomy in their daily life than adolescents in the general populations. Adolescents with cerebral palsy participated much less in sport but played electronic games at least as often as adolescents in the general populations. Severity of motor and intellectual impairment had a significant impact on frequency of participation, the more severely impaired being more disadvantaged. Adolescents with an only slight impairment participated in some domains as often as adolescents in the general populations. Regional variation existed. For example adolescents with cerebral palsy in central Italy were most disadvantaged according to decisional autonomy, while adolescents with cerebral palsy in east Denmark and northern England played sports as often as their general populations. Participation is an important health outcome. Personal and environmental predictors of participation of adolescents with cerebral palsy need to be identified in order to design interventions directed to such predictors; and in order to inform the content of services.
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…
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
Objective: To describe in detail the health-related physical fitness of adolescents and young adults with cerebral palsy, compared with able-bodied references, and to assess differences related to Gross Motor Functioning Classification System (GMFCS) level and distribution of cerebral palsy. Design: Cross-sectional. Subjects: Fifty ambulatory persons with spastic cerebral palsy, GMFCS level I or II, aged 16-24 years. Methods: Physical fitness measures were: (i) cardiopulmonary fitness by maximal cycle ergometry, (ii) muscle strength, (iii) body mass index and waist circumference, (iv) skin-folds, and (v) lipid profile. Results: Regression analyses, corrected for age and gender, showed that persons with bilateral cerebral palsy had lower cardiopulmonary fitness and lower hip abduction muscle strength than those with unilateral cerebral palsy. Comparisons between persons with GMFCS levels I and II showed a difference only in peak power during cycle ergometry. Cardiopulmonary fitness, hip flexion and knee extension strength were considerably lower (75%) in persons with cerebral palsy than reference values. Conclusion: The distribution of cerebral palsy affects fitness more than GMFCS level does. Furthermore, adolescents and young adults with cerebral palsy have reduced health-related physical fitness compared with able-bodied persons. This stage of life has a strong influence on adult lifestyle, thus it is an important period for intervention. PMID:24714702
Nooijen, Carla; Slaman, Jorrit; van der Slot, Wilma; Stam, Henk; Roebroeck, Marij; van den Berg-Emons, Rita
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…
Children with cerebral palsy participate less in everyday activities than children in the general populations. During adolescence, rapid physical and psychological changes occur which may be more difficult for adolescents with impairments. Within the European SPARCLE project we measured frequency of participation of adolescents with cerebral palsy by administering the Questionnaire of Young People's Participation to 667 adolescents with cerebral palsy or their parents from nine European regions and to 4666 adolescents from the corresponding general populations. Domains and single items were analysed using respectively linear and logistic regression. Adolescents with cerebral palsy spent less time with friends and had less autonomy in their daily life than adolescents in the general populations. Adolescents with cerebral palsy participated much less in sport but played electronic games at least as often as adolescents in the general populations. Severity of motor and intellectual impairment had a significant impact on frequency of participation, the more severely impaired being more disadvantaged. Adolescents with an only slight impairment participated in some domains as often as adolescents in the general populations. Regional variation existed. For example adolescents with cerebral palsy in central Italy were most disadvantaged according to decisional autonomy, while adolescents with cerebral palsy in east Denmark and northern England played sports as often as their general populations. Participation is an important health outcome. Personal and environmental predictors of participation of adolescents with cerebral palsy need to be identified in order to design interventions directed to such predictors; and in order to inform the content of services. PMID:24412031
Michelsen, Susan I; Flachs, Esben M; Damsgaard, Mogens T; Parkes, Jacqueline; Parkinson, Kathryn; Rapp, Marion; Arnaud, Catherine; Nystrand, Malin; Colver, Allan; Fauconnier, Jerome; Dickinson, Heather O; Marcelli, Marco; Uldall, Peter
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
A prospective study was undertaken of 129 children with spastic cerebral palsy to clarify the relationship between magnetic resonance imaging (MRI) findings and clinical features of cerebral palsy. Low birth weight, asphyxia, prematurity, seizures, mental development, Gross Motor Function Classification System, and MRI findings were analyzed. Significant abnormalities relevant to the cerebral palsy were evident on imaging in 123 (95.3%). A similar percentage of MRI abnormalities were detected in the groups, 45 (100%) in patients with tetraplegic cerebral palsy, 37 (92.5%) in children with diplegic cerebral palsy, and 42 (95.4%) with hemiplegic cerebral palsy. Periventricular leukomalacia was detected more frequently in the children with spastic diplegia than in the patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more frequently in children with spastic hemiplegia. Congenital brain anomalies were found in a higher proportion in tetraplegic children. Significant correlations between the MRI findings and Gross Motor Function Classification System in the diplegic and tetraplegic patients were found. No correlations between the MRI results and risk factors for cerebral palsy in the tetraplegic patients were noted. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the initiation of appropriate therapy PMID:17608298
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.
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…
We report what may be overlooked evidence of the effects of intrauterine maladaptation as a cause of brachial plexus palsy. A case of total brachial plexus palsy in the posterior arm associated with Horner’s syndrome and severe demineralization of the bones of the affected arm is analyzed. In this litigated case, a report of marked demineralization of the bones of
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…
Directed to persons in voluntary or official agencies and to planning groups whose decisions determine or affect the extent, coverage, content, and operation of community services to children who are handicapped by cerebral palsy, this guide has as its objectives (1) to present background information on cerebral palsy as it affects the individual…
American Public Health Association, Inc., New York, NY. Program Area Committee on Child Health.
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…
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.
The Charcot-Marie-Toothtype 1A (CMT1 A) duplication was the first recurrent, large (>1 Mb), submicroscopic DNA duplication\\u000a rearrangement found to be associated with a common auto-somal dominant trait. Mechanistic studies of the CMT1A duplication\\u000a have set the paradigm for genomic disorders. The CMT1A-REP low-copy repeats (LCRs) were among the first identified nongenic\\u000a genomic architectural features that could act as substrates for
Purpose: A young patient of ophthalmoplegic migraine with recurrent oculomotor nerve palsy is reported.Case: A 4-year-old girl came to our hospital complaining of recurrent left ptosis and double vision which completely resolved within a few days. She had a history of drowsiness after vomiting every two months. Left oculomotor nerve palsy with internal ophthalmoplegia was observed. Electroencephalography revealed mild changes, but computed tomography, single photon emission computed tomography, and cerebrovascular Doppler-ultrasound examination demonstrated no abnormalities. This oculomotor nerve palsy completely improved on the next day.Results: Thereafter, left episodic mydriasis and oculomotor nerve palsy occurred twice each. However, the frequency and symptoms of migraine were remarkably reduced by topical administration of 0.25% timolol maleate twice daily to both eyes.Conclusion: In isolated oculomotor nerve palsy in childhood, ophthalmoplegic migraine should be also considered. We emphasize that a detailed case history is very important to its diagnosis. PMID:11033160
At present in medical field, the 40 point method and facial nerve grading system (House-Brackmann method) are generally used for assessment of facial palsy. However, those methods have limitation in the precise assessment, because of subjectivity in diagnosis. Purpose of this paper is to propose objective and quantitative assessment of facial palsy based on the amount of feature point movements on the face. Facial nerve symptoms generally appear in either of right and left side on the face. In facial expression of palsy subjects, the motion on the diseased side becomes smaller than that on the healthy side. We defined some indices of palsy severity from the observation of facial expression. Those indices showed the asymmetry of the facial motion quantitatively. We confirmed that our proposed method was valid for assessment of the facial palsy by comparison with the 40 point method.
Sphenoidal sinus mucoceles are indolent lesions that, when sufficiently large, can compress on the optic canal or superior orbital fissure, rapidly causing loss of vision, optic neuropathy, ptosis, pain, ophthalmoplegia, and diplopia. We herein report a 72-year-old gentleman who presented acutely with Cranial Nerve II, III, and IV palsies secondary to a sphenoidal sinus mucocele that was confirmed on magnetic resonance imaging and successfully treated with endoscopic drainage. This cause of orbital apex syndrome is important for clinicians to know as early diagnosis and treatment is critical in recovering visual potential.
Interpreting gestures from retarded, nonvocal subjects is scientifically risky. Investigators must construe the subject's meaning without reference to an external validity measure. A procedure was devised in which message content was provided to nonvocal, severely palsied quadriplegic subjects in advance. Subjects' responses were limited to yes/no gestures. Another investigator elicited the messages without prior knowledge of their content. Results, which indicated reasonably high correspondence between stimulus messages and messages elicited, suggest that such subjects can present the content of their own phenomenal field accurately and that investigators' interpretations need not be considered imaginary. PMID:2526648
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.
Cerebral palsy is a common neurologic problem in children and is reported as occurring in approximately 2-2.5 of 1000 live births globally. As is the case with many pediatric neurologic conditions, very little has been reported on this condition in the African context. Resource-limited settings such as those found across the continent are likely to result in a different spectrum of etiologies, prevalence, severity as well as management approaches. This review aims to establish what has been reported on this condition from the African continent so as to better define key clinical and research questions. PMID:24655402
Donald, Kirsten A; Samia, Pauline; Kakooza-Mwesige, Angelina; Bearden, David
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.
This case report presents a 28-year-old man with foot drop 48 hours after a grade I inversion ankle sprain. Clinical examination and electrodiagnostic studies showed common peroneal nerve palsy. The patient was managed with conservative treatment and rehabilitation and recovered completely 4 months after the injury. Physicians should be aware of the possibility of delayed peroneal nerve injury after grade I ankle sprain. Function of the peroneal nerve should be evaluated in all patients with inversion ankle sprain as part of initial and follow-up evaluations. Early electrodiagnostic studies are helpful to localize and provide indications of the severity of the injury. PMID:23327853
Forefoot deformities in cerebral palsy include cavus, metatarsus adductus, hallux valgus and bunion, dorsal bunion, and toe flexion contractures. Both prevention and correction of these deformities are surgical. Some can be prevented by lengthening or tenotomy of the spastic muscle that causes the dynamic deformity which eventually becomes the fixed skeletal deformity. Fixed deformities need osteotomies and arthrodesis of the bones in addition to removing the force of the deforming muscle. Some forefoot problems are related to the mid and hind foot, e.g., hallux valgus due to spastic pes valgus. Severe cavus can develop after overzealous Achilles tendon lengthening and failure to separate forefoot from hindfoot equinus. PMID:6714860
3-Methylglutaconic aciduria is a rare hereditary metabolic disorder characterized by increased urinary excretion of 3-methylglutaconic and 3-methylglutaric acids. Four clinical forms are recognized. This study presents the case of a 5-year-old male with type IV 3-methylglutaconic aciduria, initially diagnosed as "static encephalopathy." The slow evolution and other clinical characteristics, together with cerebral magnetic resonance imaging (MRI) findings, eventually directed the diagnosis to organic aciduria that was confirmed by urine test. This study proposes that the clinical criteria for childhood cerebral palsy should be rigorously respected; neuroimaging studies, particularly MRI, should be conducted to confirm the diagnosis, especially in atypical cases. PMID:11118804
Pantaleoni, C; D'Arrigo, S; D'Incerti, L; Rimoldi, M; Riva, D
We report an atypical case of cysticercosis of the left levator-superior rectus complex, mimicking a painful partial third nerve palsy. The patient presented with painful diplopia, with limitation of elevation, depression and adduction of the left eye, associated with a ptosis of the upper left eyelid. Magnetic resonance imaging revealed two cysts, located within the left levator-superior rectus complex, and nine parenchymal cysts located in both hemispheres of the brain. Antibody titers directed against Cysticercus cellulosae were elevated as confirmed by Elisa and Immunoblot. Diplopia and local inflammation resolved after albendazole and systemic steroid treatment. Surgical resection of the cysts was unnecessary. PMID:23122837
Transverse plane deviations are significant contributors to pathologic gait in children with cerebral palsy (CP). Due to limitations in neuromuscular control, balance, strength and coordination, transverse plane gait deviations are poorly tolerated in these children. Transverse plane malalignment results in lever arm dysfunction and can be seen with either intoeing or out-toeing. Frequent causes of transverse plane problems and lever arm dysfunction include long bone (femoral and/or tibial) torsion, pelvic rotation, and pes varus or valgus. Computerized motion analysis facilitates accurate identification of transverse plane abnormalities. This article addresses appropriate identification and treatment of transverse plane gait deviations in children with CP. PMID:23653033
Superior mesenteric artery syndrome involves compression of the third part of the duodenum due to narrowing of the area between the aorta and the superior mesenteric artery (SMA). We will describe the case of a 34-year-old with cerebral palsy who presented with abdominal pain, nausea, vomiting, and weight loss and was diagnosed with SMA syndrome via CT-imaging. With failure of conservative measures, our patient underwent a duodenojejunostomy after which improvement in her weight as well as relief of her abdominal symptoms was noted. Given the rarity of this syndrome, physicians need to keep a high index of suspicion in order to prevent the damaging consequences.
A life care plan may be useful to plan the needs of the disabled child with cerebral palsy. A cost analysis for a life care plan depends on the life expectancy of the child, and careful review of the needs of the child. A wide variety of support services may be available in the public sector. Key physical disabilities are associated with diminished life span, as are diminished cognitive abilities, even in the absence of physical impairment. The life care plan must follow the generally accepted and peer-reviewed methodology, with an appropriate foundation for each item recommended. PMID:23910487
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
[Purpose] The current study was designed to investigate the difference in lung capacity and muscle strengthening related to respiration depending on the level of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) through tests of respiratory function and respiratory pressure. [Subjects and Methods] A total of 49 children with CP who were classified as below level III of the GMFCS were recruited for this study. They were divided into three groups (i.e., GMFCS level I, GMFCS level II, and GMFCS level III). All children took the pulmonary function test (PFT) and underwent respiratory pressure testing for assessment of respiratory function in terms of lung capacity and respiratory muscle strength. [Results] The GMFCS level III group showed significantly lower scores for all tests of the PFT (i.e., forced vital capacity (FVC), forced expiratory volume at one second (FEV1), and slow vital capacity (SVC)) and testing for respiratory pressures (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) compared with the other two groups. The results of post hoc analysis indicated that the GMFCS level III group differed significantly from the other two groups in terms of FVC, FEV1, MIP, and MEP. In addition, a significant difference in SVC was observed between GMFCS level II and III. [Conclusion] Children with CP who had relatively low motor function showed poor pulmonary capacity and respiratory muscle weakness. Therefore, clinical manifestations regarding lung capacity and respiratory muscle will be required in children with CP who demonstrate poor physical activity.
Neurological manifestations in patients infected with human immunodeficiency virus can significantly increase overall morbidity and mortality. These complications are neither limited to a specific location in the nervous system nor a focal time period in the disease's progression. A literature review yielded several cases of peripheral facial palsy associated with HIV seropositivity, but few cases have been reported where the patient had bilateral peripheral facial palsy. In this paper, we present a patient with bilateral peripheral facial palsy and aseptic meningitis in the context of newly diagnosed HIV.
Neurological manifestations in patients infected with human immunodeficiency virus can significantly increase overall morbidity and mortality. These complications are neither limited to a specific location in the nervous system nor a focal time period in the disease's progression. A literature review yielded several cases of peripheral facial palsy associated with HIV seropositivity, but few cases have been reported where the patient had bilateral peripheral facial palsy. In this paper, we present a patient with bilateral peripheral facial palsy and aseptic meningitis in the context of newly diagnosed HIV. PMID:22934208
Background Retained oesophageal foreign bodies must be urgently removed to prevent potentially serious complications. Recurrent laryngeal nerve palsy is rare and has not been reported in association with a foreign body in the thoracic oesophagus. Case presentation We present a case of a dental plate in the thoracic oesophagus that caused high dysphagia. Delayed diagnosis led to a recurrent laryngeal nerve palsy, which persisted despite successful surgical removal of the foreign body. Conclusion Oesophagoscopy is essential to fully assess patients with persistent symptoms after foreign body ingestion, irrespective of the level of dysphagia. Recurrent laryngeal nerve palsy may indicate impending perforation and should prompt urgent evaluation and treatment.
Sutcliffe, Robert P; Rohatgi, Ashish; Forshaw, Matthew J; Mason, Robert C
Median nerve to biceps nerve transfer in the arm has been reported only in adults. The following paper reports on 10 cases of this transfer in obstetric brachial plexus palsy. All patients had upper palsy (ERb's or extended ERb's palsy) and presented to the author late (13–19 months of age) with poor or no recovery of elbow flexion. Following the nerve transfer, nine children recovered elbow flexion (a score of 6 in one child and a score of 7 in eight children by the Toronto scale). The remaining child did not recover elbow flexion.
Anterior plagiocephaly due to unicoronal craniosynostosis is commonly associated with an ipsilateral hypertropia and a contralateral head tilt. The ipsilateral superior oblique weakness has been attributed to the shortening of the orbital roof with retroplacement of the trochlea, and to heterotopic positioning of the vertical rectus muscles within the orbit. These anatomical aberrations may alter ocular rotations to mimic a true congenital superior oblique palsy. This paper describes two siblings with synostotic plagiocephaly and simulated superior oblique palsy with ocular torticollis successfully managed by strabismus surgery. Synostotic plagiocephaly should be included in the differential diagnosis of familial congenital superior oblique palsy. PMID:24141756
Matalia, Jyoti; Kasturi, Nirupama; Brodsky, Michael C
Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone lesions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach. PMID:24652558
Objective To test the hypothesis that pre-eclampsia is a risk factor for cerebral palsy mediated through preterm birth and being born small for gestational age. Design Population based cohort study. Setting Clinical data from the Norwegian Cerebral Palsy Registry were linked with perinatal data prospectively recorded by the Medical Birth Registry of Norway. Participants All singleton babies who survived the neonatal period during 1996-2006 (849 children with cerebral palsy and 616?658 control children). Main outcome measures Cerebral palsy and cerebral palsy subtypes. Results Children exposed to pre-eclampsia had an excess risk of cerebral palsy (unadjusted odds ratio 2.5, 95% confidence interval 2.0 to 3.2) compared with unexposed children. Among children born at term (?37 weeks), exposure to pre-eclampsia was not associated with an excess risk of cerebral palsy in babies not born small for gestational age (1.2, 0.7 to 2.0), whereas children exposed to pre-eclampsia and born small for gestational age had a significantly increased risk of cerebral palsy (3.2, 1.5 to 6.7). Non-small for gestational age babies born very preterm (<32 weeks) and exposed to pre-eclampsia had a reduced risk of cerebral palsy compared with unexposed children born at the same gestational age (0.5, 0.3 to 0.8), although the risk was not statistically significantly reduced among children exposed to pre-eclampsia and born small for gestational age (0.7, 0.4 to 1.3). Exposure to pre-eclampsia was not associated with a specific cerebral palsy subtype. Conclusions Exposure to pre-eclampsia was associated with an increased risk of cerebral palsy, and this association was mediated through the children being born preterm or small for gestational age, or both. Among children born at term, pre-eclampsia was a risk factor for cerebral palsy only when the children were small for gestational age.
Electrodiagnostic testing (electromyography, electroneuronography, and blink reflex) and cerebrospinal fluid (CSF) examination (cell count, immunoglobulins, and antigen-specific intrathecal immunoglobulin G synthesis against herpes simplex virus, varicella zoster virus, cytomegalovirus, and Borrelia burgdorferi sensu latu) were performed in 56 patients with Bell's palsy. The CSF was normal in 45 patients and abnormal in 11 patients. Acute borreliosis was the most common specific pathological CSF finding (4 of 11). Electromyography revealed abolished volitional activity in 22% of patients with normal CSF and in 36% with pathological CSF. Electroneuronographic tests with an amplitude decrease of more than 90% on the affected side or abolished responses were found in 20% of patients with normal CSF and in 18% with pathological CSF. Abolished orbicularis oculi reflexes were seen in 67% of patients with normal CSF and in 82% with pathological CSF Concerning electrodiagnostic testing, no statistically significant difference between patients with normal and abnormal CSF was found, so we conclude that electrodiagnostic testing has no indicative value for abnormal CSF in Bell's palsy. PMID:11407851
Birkmann, C; Bamborschke, S; Halber, M; Haupt, W F
Progressive supranuclear palsy (PSP) is the most common atypical parkinsonian syndrome comprising two main clinical subtypes: Richardson's syndrome (RS), characterized by prominent postural instability, supranuclear vertical gaze palsy and frontal dysfunction; and PSP-parkinsonism (PSP-P) which is characterized by an asymmetric onset, tremor and moderate initial therapeutic response to levodopa. The early clinical features of PSP-P are often difficult to discern from idiopathic Parkinson's disease (PD), and other atypical parkinsonian disorders, including multiple system atrophy (MSA) and corticobasal syndrome (CBS). In addition, rare PSP subtypes may be overlooked or misdiagnosed if there are atypical features present. The differentiation between atypical parkinsonian disorders and PD is important because the prognoses are different, and there are different responses to therapy. Structural and functional imaging, although currently of limited diagnostic value for individual use in early disease, may contribute valuable information in the differential diagnosis of PSP. A growing body of evidence shows the importance of CSF biomarkers in distinguishing between atypical parkinsonian disorders particularly early in their course when disease-modifying therapies are becoming available. However, specific diagnostic CSF biomarkers have yet to be identified. In the absence of reliable disease-specific markers, we provide an update of the recent literature on the assessment of clinical symptoms, pathology, neuroimaging and biofluid markers that might help to distinguish between these overlapping conditions early in the course of the disease. PMID:23406296
Liscic, R M; Srulijes, K; Gröger, A; Maetzler, W; Berg, D
The present study focuses on the ability of participants with spastic hemiparesis caused by cerebral palsy to adjust an ongoing movement. Typical symptoms associated with the disorder would lead one to expect that people with spastic hemiparesis would be unable to adjust their movements quickly and proportionally to a sudden change in the environment with their spastic arm. The results of the present experiment, however, prove otherwise. Eight hemiparetic adolescents with cerebral palsy and eight healthy control participants were asked to quickly hit a target projected onto a fronto-parallel screen. The target either remained stationary or started to move immediately after hand movement onset. Participants needed to adapt the ongoing movement to hit moving targets. The task was performed with the spastic and non-spastic arm by the hemiparetic participants and with the dominant arm by the healthy participants. Kinematic analyses showed that although the spastic arm of the hemiparetic participants displayed a significant increase in spatial variability which led to more errors, they were capable of successfully adapting their movement in a qualitative manner. The latency of the response to the change in target position was longer for the hemiparetic participants compared to the healthy control participants, but only 25 ms. Surprisingly, no between arm latency difference was found in the hemiparetic participants. Given the commonly observed movement deficits of the spastic arm, these results show that participants with spastic hemiparesis displayed a remarkable ability in adjusting movements quickly. PMID:11595259
Van Thiel, Edwin; Meulenbroek, Ruud G J; Smeets, Jeroen B J; Hulstijn, Wouter
A nine-week-old Caucasian male presented with right ptosis and right exotropia due to a third cranial nerve palsy. Symmetrical macular lesions and a paramacular hyperpigmented lesion with overlying vitreous cells in the left eye were compatible with congenital toxoplasmosis. Computer tomography demonstrated calcifications in the periventricular and midbrain regions where the oculomotor nerve exits the brainstem. The diagnosis was confirmed by the toxoplasma indirect fluorescent antibody titer greater than 1:2048 for the infant and greater than 1:512 for the mother. Treatment was instituted with pyrimethamine, sulfadiazine and folinic acid. Neurologic sequelae included a right hemiparesis, infantile seizures, and generalized developmental delay. A Mueller's muscle resection (RUL) combined with 9-mm recession of the right lateral rectus and 7-mm resection of the right medial rectus muscles produced minimal ptosis and right exotropia one year later. the child now prefers to fix with the right eye and a vertical nystagmus is evident in the left eye. To our knowledge this is the first reported case of an infant with noncomitant strabismus due to congenital toxoplasma cranial nerve involvement. The finding of an acquired third cranial nerve palsy accompanied by progressive neurologic sequelae warrants consideration of congenital toxoplasmosis. PMID:7175624
Perry, D D; Marritt, J C; Greenwood, R S; Collier, A M; Tennison, M B
Selecting and evaluating appropriate treatments for children with cerebral palsy has been challenging. One difficulty is in the ability to quantify the presence and importance of coexisting motor signs. This study presents quantitative measures developed to assess spasticity and dystonia. Children diagnosed with extrapyramidal or spastic cerebral palsy and matched control children were studied. Spasticity was measured as the slope of the force-velocity relationship from a test where we measured the forces required to passively extend the elbow at different velocities. Dystonia was assessed by measuring "overflow" movements of arm during active movement of the other arm. Measures of dystonia and spasticity did not correlate with one another, but did correlate with their respective clinical measurement tools, the Modified Ashworth scale and the Barry-Albright Dystonia scale. Most children had a combination of both spasticity and dystonia, despite diagnosis. Our measures also related to different aspects of reaching: children with increased dystonia made more curved paths, and children with increased spasticity hit higher peak velocities. These measurements allow us to distinguish between different motor disorders and the degree to which each contributes to reaching performance. Use of quantitative measures should improve selection and evaluation of treatments for childhood motor disorders. PMID:17138005
Gordon, Laurie M; Keller, Jennifer L; Stashinko, Elaine E; Hoon, Alec H; Bastian, Amy J
Peroneal nerve palsy is one of the more common entrapment neuropathies of the lower limb and can be a result of a multitude of causes. Compression stockings are commonly used for prophylaxis of deep venous thromboembolism after surgery. The entrapment on the head and the neck of the fibula caused by compression stockings is uncommon. In this article, the authors report a 46-yr-old male patient who was operated on for postauricular squamous cell carcinoma of the skin. On the third postoperative day, it was noticed that compression stockings had rolled down, and a linear impression mark was observed under its upper edge at the proximal part of the left cruris. He had left foot drop and difficulty in walking during gait assessment. The needle electromyography confirmed total axonal degeneration of the left peroneal nerve with denervation potentials. The aim of this report was to emphasize the importance of the size and length of the compression stockings and regular skin control in avoiding the risk for peroneal nerve palsy. PMID:24743458
Adults with cerebral palsy (CP) are known to participate in reduced levels of total physical activity. There is no information available however, regarding levels of moderate-to-vigorous physical activity (MVPA) in this population. Reduced participation in MVPA is associated with several cardiometabolic risk factors. The purpose of this study was firstly to compare levels of sedentary, light, MVPA and total activity in adults with CP to adults without CP. Secondly, the objective was to investigate the association between physical activity components, sedentary behavior and cardiometabolic risk factors in adults with CP. Adults with CP (n=41) age 18-62yr (mean±SD=36.5±12.5yr), classified in Gross Motor Function Classification System level I (n=13), II (n=18) and III (n=10) participated in this study. Physical activity was measured by accelerometry in adults with CP and in age- and sex-matched adults without CP over 7 days. Anthropometric indicators of obesity, blood pressure and several biomarkers of cardiometabolic disease were also measured in adults with CP. Adults with CP spent less time in light, moderate, vigorous and total activity, and more time in sedentary activity than adults without CP (p<0.01 for all). Moderate physical activity was associated with waist-height ratio when adjusted for age and sex (?=-0.314, p<0.05). When further adjustment was made for total activity, moderate activity was associated with waist-height ratio (?=-0.538, p<0.05), waist circumference (?=-0.518, p<0.05), systolic blood pressure (?=-0.592, p<0.05) and diastolic blood pressure (?=-0.636, p<0.05). Sedentary activity was not associated with any risk factor. The findings provide evidence that relatively young adults with CP participate in reduced levels of MVPA and spend increased time in sedentary behavior, potentially increasing their risk of developing cardiometabolic disease. PMID:24864052
Ryan, Jennifer M; Crowley, Vivion E; Hensey, Owen; Broderick, Julie M; McGahey, Ailish; Gormley, John
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.
Postural sway during arm movements were related to the size of the base of support (BOS) and the limits of stability (LOS) of children with unilateral cerebral palsy (USCP) and typically developing (TD) children. For half of the trials the mechanical disturbance due to the rapid arm movement was increased by attaching small weights at the wrists. The participants stood with both feet on a large force plate, which recorded the displacements of the center of pressure (CoP). The results showed that in the children with USCP the LOS forward and toward the non-dominant (more-affected) side were smaller than in the TD children whereas the LOS backward and toward the dominant (less-affected) side did not differ between the two groups. When rapidly moving the arms the children with USCP swayed over a larger portion of their base of support in the forward direction and toward their more-affected side. In addition, the maximal sway toward the more-affected side during arm movement exceeded the LOS while balance was maintained. These effects increased when the movements were performed with the weights at the wrists. These results show that an area of permissible sway, which was not spontaneously explored during the leaning task, was required to maintain balance during the supra-postural task. Training to enlarge the LOS that includes weight shifts toward the more-affected side might reduce the area of the BOS that is self-perceived as less secure. PMID:24670884
Extracorporeal shock wave therapy is a treatment of choice in patients with musculoskeletal disorders. The aim of this study was to investigate the effect of radial shock wave therapy (RSWT) on muscle spasticity of plantar flexor muscles in children with cerebral palsy. This was an open, controlled, observational study with one placebo treatment session, followed 4 weeks later by one active treatment session. Procedures and measurements were performed on inpatients of the Physical and Rehabilitation department of the Medical University Hospital, Plovdiv, Bulgaria. Twenty-five children, mean age 4.84±3.11 years, with spastic diplegia and hemiplegia participated in the study. They received a single session of RSWT to the plantar flexors of the foot. The following clinical methods were used for outcome assessment before, after, and 2 and 4 weeks later: passive range of motion, Modified Ashworth Scale. Baropodometric measurements were performed before and after the placebo and active session. After placebo application, no changes measured by clinical or instrumental methods were found. After RSWT, a significant increase in passive range of motion was observed: 47.00±2.29° versus 33.25±2.20° (P<0.001), which persisted at the second (46.87±2.08°, P<0.001) and fourth week (44.12±1.93°, P<0.001) after treatment. The Modified Ashworth Scale score decreased from 2.77 to 2.00 points (P<0.001), which persisted at the second (mean 2.05±0.07 points, P<0.001) and fourth week (2.15±0.76 points, P<0.001) after treatment. Baropodometric measurement showed a significant increase in the contact plantar surface area of the affected foot (from 81.32±6.14 to 101.58±5.41 cm, P<0.001) and in heel pressure (from 50.47±6.61 to 75.17±3.42 N/cm, P<0.001). There is a significant reduction in the spasticity of plantar flexor muscles in children with cerebral palsy after a single session of RSWT and this improvement remains at the 4-week follow-up. PMID:23603803
Gonkova, Mariya I; Ilieva, Elena M; Ferriero, Giorgio; Chavdarov, Ivan
34 children with cerebral palsy had operations to correct flexion deformities of the wrist and fingers. 30 out of 34 patients were improved functionally and cosmetically. Zancolli’s classification provides sound guidelines on which to base surgical decisions.
The relationships between specific aspects of peripheral ocular defects and perceptual deficits were investigated in a cerebral palsied population of 60 spastics, 60 athetoids, and 60 non-neurologically impaired Ss, 7 to 21 years of age. (Author/MC)
Constipation affects 74% of individuals with cerebral palsy. This study aimed to evaluate the results of nursing interventions for treating intestinal constipation associated with cerebral palsy. This quantitative, prospective, comparative study included 50 patients with quadriplegic cerebral palsy and constipation. The main conservative measures included daily consumption of laxative foods and vegetable oils, increase in fluid intake, and daily intestinal massage. Total or partial constipation relief was observed in 90% of the patients, with improvement in quality-of-life aspects such as sleep, appetite, and irritability, and a significant decrease in rectal bleeding, anal fissure, voluntary retention of stools, crying, and pain on defecation. Only 10% of the patients required laxative medications. It is recommended that conservative measures be used for treating cerebral palsy-related constipation and medications be used solely as adjuvants, if needed. PMID:24310680
Faleiros-Castro, Fabiana Santana; de Paula, Elenice Dias Ribeiro
Dynamic characteristics of motor control system of adults with cerebral palsy was examined by a compensatory tracking task with step wave, sine wave and random wave targets. The velocity of responses to step wave targets by the cerebral palsy subjects was lower than that by the normal subjects. In terms of the closed-loop transfer functions in responses to sine wave targets compared with those to random wave targets, it was revealed that the normal subjects could switch their feedback tracking behavior to precognitive control behavior in order to reduce their tracking phase lag which was greater with random wave targets than with sine wave targets, while the cerebral palsy subjects could not do so. These results suggest that the cerebral palsy subjects have difficulty in generating precognitive control behavior to match sine wave targets. PMID:6521085
Predictors of reading comprehension were evaluated in 41 children with cerebral palsy and 74 typically developing children between the ages of 6 and 12 years. Regression analyses were conducted to determine the relative contributions of measures of phonemic awareness, receptive vocabulary, and general reasoning to variance in reading comprehension. All three independent variables were statistically significant predictors of reading comprehension in both groups of participants. The impact of phonemic awareness on reading comprehension was moderated by age, but only in the typically developing group. Within the group with cerebral palsy, there was an indirect effect of functional expressive ability on reading comprehension, mediated by phonemic awareness. It is concluded that largely the same variables predict reading comprehension in children with cerebral palsy as in typically developing children, but that children with cerebral palsy continue to rely on phonological processing for a more protracted period of time.
Asbell, Shana; Donders, Jacobus; Van Tubbergen, Marie; Warschausky, Seth
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...
This paper analyzes and discusses the research advances of acupuncture in the treatment of childhood cerebral palsy from the\\u000a perspectives of clinical treatment and its mechanism. Acupuncture has great advantages in the treatment of childhood cerebral\\u000a palsy, however, there are methodological problems in current researches, clinical researches in particular. High-quality clinical\\u000a researches should be conducted to improve clinical efficacy fully.
He Jing; Huang Chang-qiong; Zhang Yong-ling; Liu Yi
We present a 77-year-old woman with levodopa-nonresponsive parkinsonism, dementia, and supranuclear gaze palsy on vertical and horizontal gaze. Laboratory findings were consistent with idiopathic hypoparathyroidism, and brain computed tomography showed extensive bilateral calcifications of the basal ganglia, centrum semiovale, dentate nuclei, and cerebellar white matter. These results illustrate that striopallidodentate calcification due to hypoparathyroidism may present with symptoms mimicking progressive supranuclear palsy.
Kim, Tae-Won; Park, In-Seok; Kim, Sung-Hoon; Lee, Kwang-Soo; Kim, Yeong-In
Purpose To report isolated upgaze palsy in a patient with a dolichoectatic vertebrobasilar artery. Case Report We report a 48-year-old man who showed upgaze palsy and convergence insufficiency. The left vertebral artery and basilar artery were shown to be greatly expanded, elongated and tortuous in cranial magnetic resonance imaging (MRI). The vertebrobasilar artery runs along the sulcus basilaris superior to the pontomesencephalic junction. Conclusion A dolichoectatic basilar artery may result in compression of midbrain structures related to vertical gaze.
Ortak, Huseyin; Tas, Ufuk; Aksoy, Durdane Bekar; Ayan, Erdogan
Goldenhar's Syndrome (oculo-auriculo-vertebral dysplasia) is a wide spectrum of congenital anomalies that involves structures arising from the first and second branchial arches. In this report, a case of a male infant, with the features of hemi facial microsomia, anotia, vertebral anomalies, congenital facial nerve palsy and lagophthalmos is described. Although the syndrome itself is not uncommon, the presence of congenital facial nerve palsy, which has been reported in rare cases, prompted this case report. PMID:15004885
Multiple system atrophy and progressive supranuclear palsy are disabling neurodegenerative disorders, also known as atypical\\u000a parkinsonian syndromes. Currently, no health economic evaluations of these diseases are available. The objective of this study\\u000a was to evaluate disease-related costs in German patients with multiple system atrophy and progressive supranuclear palsy and\\u000a to identify cost-driving factors. We recruited 101 consecutive patients with multiple
Yaroslav Winter; Maria Stamelou; Nicole Cabanel; Friedericke Sixel-Döring; Karla Eggert; Günter U. Höglinger; Birgit Herting; Thomas Klockgether; Heinz Reichmann; Wolfgang H. Oertel; Richard Dodel; Annika E. Spottke
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. During…
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
Pierce SR, Daly K, Gallagher KG, Gershkoff AM, Schaumburg SW. Constraint-induced therapy for a child with hemiplegic cerebral palsy: a case report. Arch Phys Med Rehabil 2002;83:1462-3. A 12-year-old boy with hemiplegic cerebral palsy (CP) presented with decreased function in his left upper extremity. He was treated with a 3-week protocol of constraint-induced therapy (CIT) consisting of six 2-hour sessions
Samuel R. Pierce; Kendall Daly; Kara G. Gallagher; Arthur M. Gershkoff; Susan W. Schaumburg
Leukemia cutis and facial nerve palsy are rare presenting symptoms of leukemia. This report describes a case of acute T-cell lymphoblastic leukemia (ALL) presenting with only these two symptoms, a presentation of ALL that, to our knowledge, has not been previously described. It serves to alert physicians to look for underlying malignancy in the setting of cutaneous findings associated with facial nerve palsy. PMID:24602170
Common peroneal nerve palsy has been reported to be the most frequent lower extremity palsy characterized by a supinated equinovarus\\u000a foot deformity and foot drop. Dynamic tendon transposition represents the gold standard for surgical restoration of dorsiflexion\\u000a of a permanently paralyzed foot. Between 1998 and 2005, we operated on a selected series of 16 patients with traumatic complete\\u000a common peroneal
Adolfo Vigasio; Ignazio Marcoccio; Alberto Patelli; Valerio Mattiuzzo; Greta Prestini
Oculomotor nerve palsy due to a venous varix arising from flow anomalies caused by a dural arteriovenous fistula (AVF) is\\u000a a rare phenomenon. We report a case of surgical third nerve palsy with a rare underlying AVF as the cause and discuss in detail\\u000a the patho-anatomy and its significance. A tentorial dural AVF mimicking the arterial circle was found with
Nitin Mukerji; Julian Cahill; Nikolaos Tzerakis; Fred P. Nath; James E. Dervin
OBJECTIVE: Our purpose was to examine the association of cerebral palsy with conditions that can interrupt oxygen supply to the fetus as a primary pathogenetic event.STUDY DESIGN: A population-based case-control study was performed in four California counties, 1983 through 1985, comparing birth records of 46 children with disabling spastic cerebral palsy without recognized prenatal brain lesions and 378 randomly selected
We report three unrelated patients with congenital facial nerve palsy and chromosome 22q11 deletion, a condition hitherto poorly recognized. In the first case, facial palsy was associated with aortic coarctation, ductus arteriosus, and ostium secundum atrial septal defect. In the second case, facial palsy was associated with ostium secundum atrial septal defect, obstruction of the ureteropelvic junction, double ureteropelvic-calicial system, and distal metaphyseal widening of the forearm and leg bones. In both cases, facial palsy was the presenting feature. In the third case, an ostium secundum atrial septal defect was also present, but involvement of cranial nerves III, VI, and VIII, in addition to hypoplastic structures of cerebellar and cerebral peduncles, were the predominant features. There were no inherited deletions within chromosome band 22q11 and the de novo deletions detected in each case belonged to the paternally derived chromosome 22. Association of facial nerve palsy and congenital heart disease versus cardiofacial syndrome are different only on clinical grounds, so both conditions can be genetically identical and form part of the spectrum of defects associated with chromosome 22q11 deletions. We recommend investigation for chromosome 22q11 deletions in patients with complete nerve facial palsy. PMID:11417615
Puñal, J E; Siebert, M F; Angueira, F B; Lorenzo, A V; Castro-Gago, M
Antenatal tobacco and alcohol exposure are established risk factors for premature birth and an independent risk factor for cerebral palsy. Both exert adverse effects on fetal development. In children with cerebral palsy, whether antenatal exposure to tobacco or alcohol is associated with a difference in clinical profile remains unknown. The Quebec Cerebral Palsy Registry was used to compare neurologic subtypes, gross motor functional impairment, and comorbidities in children with cerebral palsy who were or were not prenatally exposed to alcohol or tobacco. Information on in utero exposure was available in 249 children with cerebral palsy born from 1999-2002, of whom 77 were exposed to alcohol and 62 to tobacco in utero. No association was evident between exposure to tobacco or alcohol during pregnancy and neurologic subtype, Gross Motor Function Classification System score, mean number of comorbidities experienced, or each of eight comorbidities explored. Adjusting for prematurity or low birth weight exerted no effect on these results. In utero exposure to tobacco or alcohol does not assist in predicting clinical profiles of cerebral palsy. PMID:23044017
Kyriakopoulos, Paulina; Oskoui, Maryam; Dagenais, Lynn; Shevell, Michael I
Background Primary progressive apraxia of speech, a motor speech disorder of planning and programming is a tauopathy that has overlapping histological features with progressive supranuclear palsy. We aimed to compare, for the first time, atrophy patterns, as well as white matter tract degeneration, between these two syndromes. Methods Sixteen primary progressive apraxia of speech subjects were age and gender-matched to 16 progressive supranuclear palsy subjects and 20 controls. All subjects were prospectively recruited, underwent neurological and speech evaluations, and 3.0 Tesla magnetic resonance imaging. Grey and white matter atrophy was assessed using voxel-based morphometry and atlas-based parcellation, and white matter tract degeneration was assessed using diffusion tensor imaging. Results All progressive supranuclear palsy subjects had typical occulomotor/gait impairments but none had speech apraxia. Both syndromes showed grey matter loss in supplementary motor area, white matter loss in posterior frontal lobes and degeneration of the body of the corpus callosum. While lateral grey matter loss was focal, involving superior premotor cortex, in primary progressive apraxia of speech, loss was less focal extending into prefrontal cortex in progressive supranuclear palsy. Caudate volume loss and tract degeneration of superior cerebellar peduncles was also observed in progressive supranuclear palsy. Interestingly, area of the midbrain was reduced in both syndromes compared to controls, although this was greater in progressive supranuclear palsy. Discussion Although neuroanatomical differences were identified between these distinctive clinical syndromes, substantial overlap was also observed, including midbrain atrophy, suggesting these two syndromes may have common pathophysiological underpinnings.
Whitwell, Jennifer L.; Duffy, Joseph R.; Strand, Edythe; Machulda, Mary M.; Senjem, Matthew L.; Gunter, Jeffrey L.; Kantarci, Kejal; Eggers, Scott D.; Jack, Clifford R.; Josephs, Keith 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 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 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. PMID:11087279
Diplopia is one of the most vexing problems to confront a physician. When diplopia is binocular, it commonly results from dysfunction of one or more of the ocular motor nerves. Ocular motor dysfunction may result from injury anywhere along the neuraxis, from the ocular motor nucleus to the myoneural junction. Identifying the location of the lesion is important for determining the etiology and prognosis of third-, fourth-, and sixth-nerve injuries. In this article, an anatomic approach is presented for the diagnosis and treatment of ocular motor nerve lesions. Emphasis is placed on the identification of associated neurologic and ophthalmologic findings that are critical for management of patients with acquired and congenital ocular motor palsies. PMID:11370565
The aim of this study was to describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. Forty non-ambulatory children and adolescents (47 hips) were consecutively treated with percutaneous pelvic osteotomy. The mean preoperative Reimers' migration percentage improved from 66.2% to 4.9% at the final follow-up. The mean preoperative acetabular angle (AA) improved from 32.4° to 13.2° at last follow-up. Percutaneous pelvic osteotomy is a less invasive surgical approach and appears to be a valid option with similar outcomes to standard techniques.This method results in less muscle stripping and blood loss and a shorter operating time. PMID:24684863
The evaluation of balance in children with cerebral palsy (CP) is an extremely difficult and complex procedure. The purpose of the present study was the evaluation of three balance tests: Berg Balance Scale (BBS), time up and go (TUG) and Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and their reliability in children with CP. The control of the reliability of the tests was based on the successive application to twenty children with CP within a short period in order to substantiate their ability to give the same results in a stable sample. No difference was found according to scores between the measures but important statistical differences were found of the scores of the children in all tests. The tests BBS, TUG and BOTMP are considered to be reliable and valid tests, able to objectively define the quantitative mutation of the balance of the child in test with CP.
This paper reports the correspondence between different measures of parental compliance and the relationship of these compliance measures to change in hand function after therapy intervention. 72 children with cerebral palsy, aged 18 months to eight years, participated in a clinical trial of neurodevelopmental therapy (NDT) and upper-limb casting; home programmes were part of each intervention. Measures of parental compliance comprised: self-rating of understanding and skill using a questionnaire, therapist's rating of parental compliance, attendances, mean time of cast wear and number of days completed home-programme log-book. Parent ratings were the only significant predictor of change in hand function. Parent self-rating was the most useful measure, since it correlated moderately with two other compliance measures and was predictive of change in hand function. PMID:8224565
Diagnosis of progressive supranuclear palsy (PSP) remains challenging because of the clinical overlap with Parkinson's disease (PD). To date, disease-specific biomarkers have yet to be identified. In the absence of reliable biomarkers, we used an integrated network approach to identify genes and related biological pathways associated with PSP. We tested a highly ranked gene in cellular whole-blood samples from 122 patients enrolled in the Prognostic Biomarker Study. Biological and functional analysis identified 13 modules related to activation of leukocytes and lymphocytes, protein dephosphorylation, and phosphatase activity. Integration of these results with those from microarrays identified ptpn1 as a potential biomarker for PSP. Assessment of biomarker performance revealed that ptpn1 could be used to distinguish PSP patients from PD patients with 86% diagnostic accuracy. Ptpn1 may be a diagnostic marker useful for distinguishing PSP and PD. Further evaluation in a larger well-characterized prospective study is warranted. PMID:24347522
Occipital condylar fractures (OCFs) are rare and difficult to diagnose. The routine use of computed tomography (CT) scan in traumatology has however now made their diagnosis easier, with an estimated frequency of 4 to 19% of craniospinal traumatized patients and 0.4 to 0.7% of all severe traumatized patients in emergencies. This paper describes a patient who was not diagnosed with OCF during his first hospitalization after a road accident. However, 15 days later a left sided hypoglossal nerve palsy occurred. In this case report, we underline that an examination of the cranial nerve is a quick and easy procedure to screen each head trauma patient for occipital foramen fractures. Also, careful attention must be paid to X-Rays, CT scans and magnetic resonance imaging of the craniocervical junction. PMID:24475495
Background Children and adolescents with cerebral palsy suffer from higher levels of pain than their peers without disability. The aim of this study was to explore the impact of pain on health-related quality of life and motor function in individuals with cerebral palsy as reported by health professionals. Methods Cross-sectional study carried out in Associations for Care of Individuals with Cerebral Palsy and Related Disabilities (ASPACE) in Balearic Islands and Castile Leon (Spain). Thirty-five physiotherapists rated pain, health-related quality of life and motor function in 91 children and adolescents with cerebral palsy [8-19y]. A semi-structured interview was used to collect demographic and clinical data according with the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE). Results Physiotherapists reported that 51% of individuals with cerebral palsy suffered from pain. Physiotherapists also perceived that pain in individuals with cerebral palsy was responsible for reductions of psychological but not physical domains of health-related quality of life. According with physiotherapists’ estimations, motor impairment scores were not correlated with pain scores in individuals with cerebral palsy, but they were significantly associated with physical and autonomy domains of health-related quality of life. Conclusions These findings highlighted the importance of assessing and providing interventions for pain relief in persons with cerebral palsy even at an early age.
Aims: To determine benefits and risks for gastrostomy or jejunostomy feeding compared with oral feeding for children with cerebral palsy. Methods: Systematic review. Search strategy: electronic databases—Cochrane Library, Medline, Embase, Cinahl, Lilacs, databases of theses, grey literature. Included: relevant systematic reviews, randomised controlled trials, observational studies, case reports. Excluded: non-systematic reviews and qualitative research. Participants: children with cerebral palsy. Intervention: use of gastrostomy or jejunostomy tube to provide nutrition. Outcome: evaluated outcome measures included death, growth, gastro-oesophageal reflux, other complications, psychosocial aspects, and caregiver wellbeing. Results: No relevant systematic reviews or randomised controlled trials were found. Two cohort studies, 15 case series, and eight case reports met the inclusion criteria. Eight studies specifically described percutaneous endoscopic gastrostomy as the intervention. Weight gain resulted from gastrostomy feeding in most cases. There was an approximately fourfold increased risk of death reported in one cohort study for the gastrostomy fed children. Many complications were reported, including potential for increased gastro-oesophageal reflux and fluid aspiration into the lungs. Conclusions: Benefits associated with gastrostomy or jejunostomy feeding are difficult to assess from the available evidence. Risks of gastrostomy, particularly in relation to surgical complications, have been described but the size of the risk could not be quantified. The finding of a higher death rate for children fed by gastrostomy may merely reflect the greater disability of these compared with orally fed children. Lack of available evidence and the substantial risk of bias in observational studies suggests that a well conducted randomised controlled trial of sufficient size will be needed to answer these problems.
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
Objective: to determine the prevalence of restless legs syndrome (RLS) in a cohort of patients with demyelinating neuropathies. Methods: Patients were retrospectively recruited from our cohort of different forms of demyelinating neuropathies, including chronic inflammatory demyelinating neuropathy (CIDP), Charcot-Marie-Tooth 1A (CMT1A), and hereditary neuropathy with liability to pressurepalsies (HNPP) referred to our Department of Neurology in a 10-year period. The validated 4-item RLS questionnaire was used for diagnosis of RLS. All patients with RLS who fulfilled criteria underwent a suggested immobilization test to confirm the diagnosis. A group of outpatients referred to the sleep disorders unit and data from published literature were used as controls. Results: Prevalence of RLS in demyelinating neuropathy group was higher than prevalence observed in control population (p = 0.0142) or in the literature data (p = 0.0007). In particular, in comparison with both control population and literature data, prevalence of RLS was higher in CIDP group (p = 0.0266 and p = 0.0063, respectively) and in CMT1A group (p = 0.0312 and p = 0.0105, respectively), but not in HNPP (p = 1.000 and p = 0.9320, respectively). Conclusions: our study confirms a high prevalence of RLS in inflammatory neuropathies as CIDP and, among inherited neuropathies, in CMT1A but not in HNPP. Considering that this is only a small cohort from a single-center retrospective experience, the link between RLS and neuropathy remains uncertain, and larger multicenter studies are probably needed to clarify the real meaning of the association between RLS and neuropathy. Citation: Luigetti M; Del Grande A; Testani E; Bisogni G; Losurdo A; Giannantoni NM; Mazza S; Sabatelli M; Della Marca G. Restless leg syndrome in different types of demyelinating neuropathies: a single-center pilot study. J Clin Sleep Med 2013;9(9):945-949.
The management of radial nerve palsy associated with fractures of the shaft of the humerus has been disputed for several decades. This study has systematically reviewed the published evidence and developed an algorithm to guide management. We searched web-based databases for studies published in the past 40 years and identified further pages through manual searches of the bibliography in papers identified electronically. Of 391 papers identified initially, encompassing a total of 1045 patients with radial nerve palsy, 35 papers met all our criteria for eligibility. Meticulous extraction of the data was carried out according to a preset protocol. The overall prevalence of radial nerve palsy after fracture of the shaft of the humerus in 21 papers was 11.8% (532 palsies in 4517 fractures). Fractures of the middle and middle-distal parts of the shaft had a significantly higher association with radial nerve palsy than those in other parts. Transverse and spiral fractures were more likely to be associated with radial nerve palsy than oblique and comminuted patterns of fracture (p < 0.001). The overall rate of recovery was 88.1% (921 of 1045), with spontaneous recovery reaching 70.7% (411 of 581) in patients treated conservatively. There was no significant difference in the final results when comparing groups which were initially managed expectantly with those explored early, suggesting that the initial expectant treatment did not affect the extent of nerve recovery adversely and would avoid many unnecessary operations. A treatment algorithm for the management of radial nerve palsy associated with fracture of the shaft of the humerus is recommended by the authors. PMID:16326879
Shao, Y C; Harwood, P; Grotz, M R W; Limb, D; Giannoudis, P V
Introduction: This study examined the associations between characteristics of the parent caregiver and health care service utilization by children with cerebral palsy enrolled in Medicaid. Methods: A questionnaire was administered to the parents of children with cerebral palsy being treated in a North Carolina hospital, and the responses were linked with health services claims data from Medicaid. Data were available
Rajesh Balkrishnan; Michelle Naughton; Beth P. Smith; Janeen Manuel; L. Andrew Koman
We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES
Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. We tested voluntary
Johan van Doornik; Sahana Kukke; Kevin McGill; Jessica Rose; Sara Sherman-Levine; Terence D. Sanger
We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES
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…
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 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
Our aim is to create a more adapted animal model to experiment FES's methods in spastic cerebral palsy .Classically, decerebrated animal by mesencephalic lesion is considered as the paradigm for experimental study of spasticity accompanying cerebral palsy, but, this situation is not corresponding with anatomo-pathological reality, so we needed to create a new model simulating more precisely the common findings
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…
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...
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 mail.…
The aim of this retrospective multicenter study was to verify whether the substernal goiter and the type of surgical access could be risk factors for recurrent laryngeal nerve palsy during total thyroidectomy. Between 1999-2008, 14,993 patients underwent total thyroidectomy. Patients were divided into three groups: group A (control; n=14.200, 94.7%), cervical goiters treated through collar incision; group B (n=743, 5.0%) substernal goiters treated by cervical approach; group C (n=50, 0.3%) in which a manubriotomy was performed. Transient and permanent unilateral palsy occurred significantly more frequently in B+C vs. A (P?.001) and in B vs. A (P?.001). Transient bilateral palsy was significantly more frequent in B+C vs. A (P?.043) and in C vs. A (P?.016). Permanent bilateral palsy was significantly more frequent in B+C vs. A (P?.041), and in B vs. A (P?.037). Extension of the goiter into the mediastinum was associated to increased risk of recurrent nerve palsy during total thyroidectomy. PMID:24880605
Testini, M; Gurrado, A; Bellantone, R; Brazzarola, P; Cortese, R; De Toma, G; Fabiola Franco, I; Lissidini, G; Pio Lombardi, C; Minerva, F; Di Meo, G; Pasculli, A; Piccinni, G; Rosato, L
The third nerve palsies are not uncommon in adults and are usually the result of vascular or compressive lesions. However, they are uncommon in children and are usually congenital. Congenital oculomotor nerve palsies were generally thought to exist in isolation without associated abnormalities; however, there have been conflicting reports in the literature as to the associations of congenital oculomotor palsies. In this report, we present 2 cases of congenital third cranial nerve palsy with neurological deficits and central nervous system abnormalities. The first patient had initial presentations of inequality in pupil size, exodeviation of the affected eye, and extreme hypotropia of the contralateral eye, which was also complicated by profound neurological deficits. Magnetic resonance imaging (MRI) scans disclosed hypoplasia of the right midbrain and corpus callosum. The second patient presented with an exodeviated right eye, and pupils non-reactive to light since birth. Computed tomography scans showed ventricular dilatation and absence of the septum pellucidum, which is compatible with septo-optic dysplasia (de Morsier syndrome). The clinical courses are presented, and we also review the literature concerning congenital third cranial nerve palsy associated with central nervous system anomalies. PMID:11416899
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.
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
We describe an unusual case of viper (Daboia russelii) bite in a 48-year-old man from the state of Karnataka in southern India. He presented in a hypotensive state with a left lower motor neuron-type of facial palsy, necrosis at the site of the bite and acute renal failure. His laboratory parameters revealed renal failure and deranged coagulation parameters. He was treated with intravenous antibiotics and polyvalent antiserum venom, and dialysed in view of the renal failure. His renal function and coagulation abnormalities improved, and the facial palsy recovered with the treatment. The snake bite located away from the face, the facial palsy occurring a few hours after the venom injection and the rapid recovery following antivenin administration, support that the palsy was a direct result of systemic envenomation. To the best of our knowledge, an isolated lower motor neuron-type of facial palsy as a manifestation of systemic toxicity of a viper bite, has not been previously reported. PMID:19907878
About 17 million people worldwide live with cerebral palsy, the most common disability in childhood, with hypoxic-ischemic encephalopathy, preterm birth, and low birth weight being the most important risk factors. This review will focus on recent developments in cell therapy for infantile cerebral palsy by transplantation of autologous umbilical cord blood. There are only 4 publications available at present; however, the observations made along with experimental data in vivo and in vitro may be of utmost importance clinically, so that a review at an early developmental stage of this new therapeutic concept seems justified. Particularly, since the first published double-blind randomized placebo-controlled trial in a paradigm using allogeneic cord blood and erythropoietin to treat cerebral palsy under immunosuppression showed beneficial therapeutic effects in infantile cerebral palsy, long-held doubts about the efficacy of this new cell therapy are dispelled and a revision of therapeutic views upon an ailment, for which there is no cure at present, is warranted. Hence, this review will summarize the available information on autologous cord blood therapy for cerebral palsy and that on the relevant experimental work as far as potential mechanisms and modes of action are concerned.
Cerebral palsy are found as a result of these disorders, along with associated neuromuscular functional alterations that affect the resting position of the head. In this context, the resting position of the head could be responsible for several skeletal and dental occlusal disorders among patients with cerebral palsy. Objective: To assess the presence of malocclusions in patients with cerebral palsy, define the most frequent types of malocclusions, and evaluate how the resting position of the head may be implicated in the development of such malocclusions. Study design: Forty-four patients aged between 12-55 years (18 males and 26 females) were studied. Occlusal conditions, the Dental Aesthetic Index (DAI), changes in the resting position of the head, and breathing and swallowing functions were assessed. Results: Orthodontic treatment was required by 70.8% of the patients, the most frequent malocclusions being molar class II, open bite and high overjet. These individuals showed altered breathing and swallowing functions, as well as habit and postural disorders. The resting position of the head, especially the hyperextended presentation, was significantly correlated to high DAI scores. Conclusions: The results obtained suggest that patients with cerebral palsy are more susceptible to present malocclusions, particularly molar class II malocclusion, increased open bite, and high overjet. Such alterations in turn are more common in patients with a hyperextended position of the head. Key words:Cerebral palsy, malocclusion, head position, disabled patients.
Martinez-Mihi, Victoria; Orellana, Lorena M.; Silvestre-Rangil, Javier
Background Motor imagery is considered as a promising therapeutic tool for rehabilitation of motor planning problems in patients with cerebral palsy. However motor planning problems may lead to poor motor imagery ability. Aim The aim of this functional magnetic resonance imaging study was to examine and compare brain activation following motor imagery tasks in patients with hemiplegic cerebral palsy with left or right early brain lesions. We tested also the influence of the side of imagined hand movement. Method Twenty patients with clinical hemiplegic cerebral palsy (sixteen males, mean age 12 years and 10 months, aged 6 years 10 months to 20 years 10 months) participated in this study. Using block design, brain activations following motor imagery of a simple opening-closing hand movement performed by either the paretic or nonparetic hand was examined. Results During motor imagery tasks, patients with early right brain damages activated bilateral fronto-parietal network that comprise most of the nodes of the network well described in healthy subjects. Inversely, in patients with left early brain lesion brain activation following motor imagery tasks was reduced, compared to patients with right brain lesions. We found also a weak influence of the side of imagined hand movement. Conclusion Decreased activations following motor imagery in patients with right unilateral cerebral palsy highlight the dominance of the left hemisphere during motor imagery tasks. This study gives neuronal substrate to propose motor imagery tasks in unilateral cerebral palsy rehabilitation at least for patients with right brain lesions.
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
Background Cerebral palsy (CP) is an upper motor neuron disease that results in a progressive movement disorder. Secondary to the neurological insult, muscles from CP patients often become spastic. Spastic muscle is characterized by an increased resistance to stretch, but often develops the further complication of contracture which represents a prominent disability in children with CP. This study's purpose is to characterize alterations of spastic muscle on the transcriptional level. Increased knowledge of spastic muscle may lead to novel therapies to improve the quality of life for children with CP. Method The transcriptional profile of spastic muscles were defined in children with cerebral palsy and compared to control patients using Affymetrix U133A chips. Expression data were verified using quantitative-PCR (QPCR) and validated with SDS-PAGE for select genes. Significant genes were determined using a 2 × 2 ANOVA and results required congruence between 3 preprocessing algorithms. Results CP patients clustered independently and 205 genes were significantly altered, covering a range of cellular processes. Placing gene expression in the context of physiological pathways, the results demonstrated that spastic muscle in CP adapts transcriptionally by altering extracellular matrix, fiber type, and myogenic potential. Extracellular matrix adaptations occur primarily in the basal lamina although there is increase in fibrillar collagen components. Fiber type is predominately fast compared to normal muscle as evidenced by contractile gene isoforms and decrease in oxidative metabolic gene transcription, despite a paradoxical increased transcription of slow fiber pathway genes. We also found competing pathways of fiber hypertrophy with an increase in the anabolic IGF1 gene in parallel with a paradoxical increase in myostatin, a gene responsible for stopping muscle growth. We found evidence that excitation-contraction coupling genes are altered in muscles from patients with CP and may be a significant component of disease. Conclusion This is the first transcriptional profile performed on spastic muscle of CP patients and these adaptations were not characteristic of those observed in other disease states such as Duchenne muscular dystrophy and immobilization-induced muscle atrophy. Further research is required to understand the mechanism of muscle adaptation to this upper motor neuron lesion that could lead to the development of innovative therapies.
Smith, Lucas R; Ponten, Eva; Hedstrom, Yvette; Ward, Samuel R; Chambers, Henry G; Subramaniam, Shankar; Lieber, Richard L
Carrying a heavy backpack exerts compression on shoulders, with the potential to cause brachial plexopathy. We evaluated the incidence and predisposing factors of compression plexopathy of the shoulder region in 152,095 military conscripts, hypothesizing that a low body mass index and poor physical fitness predispose to the plexus lesion. Reports of conscripts with neural lesions of the upper arm associated with load carriage were reviewed retrospectively for details associated with the condition onset, symptoms, signs, nerve conduction studies, and electromyographic examinations. Height, weight, and physical fitness scores were obtained from their military training data. The incidence of neural compression after shoulder load carriage in Finnish soldiers was 53.7 (95% confidence interval, 39.5-67.8) per 100,000 conscripts per year. The long thoracic nerve was affected in 19, the axillary nerve in 13, the suprascapular nerve in seven, and the musculocutaneous nerve in six patients. Four patients (7%) had hereditary neuropathy with susceptibility to pressurepalsies (HNPP). Symptoms were induced by lighter loads in patients with HNPP. Vulnerability to brachial plexopathy was not predictable from body structure or physical fitness level. To prevent these lesions, awareness of the condition and its symptoms should be increased and backpack designs should be improved. PMID:16906084
Mäkelä, Jyrki P; Ramstad, Raimo; Mattila, Ville; Pihlajamäki, Harri
The ability to control voluntary weight shifting is crucial in many functional tasks. To our knowledge, weight shifting ability in response to a visual stimulus has never been evaluated in children with cerebral palsy (CP). The aim of the study was (1) to propose a new method to assess visually guided medio-lateral (M/L) weight shifting ability and (2) to compare weight-shifting ability in children with CP and typically developing (TD) children. Ten children with spastic diplegic CP (Gross Motor Function Classification System level I and II; age 7-12 years) and 10 TD age-matched children were tested. Participants played with the skiing game on the Wii Fit game console. Center of pressure (COP) displacements, trunk and lower-limb movements were recorded during the last virtual slalom. Maximal isometric lower limb strength and postural control during quiet standing were also assessed. Lower-limb muscle strength was reduced in children with CP compared to TD children and postural control during quiet standing was impaired in children with CP. As expected, the skiing game mainly resulted in M/L COP displacements. Children with CP showed lower M/L COP range and velocity as compared to TD children but larger trunk movements. Trunk and lower extremity movements were less in phase in children with CP compared to TD children. Commercially available active video games can be used to assess visually guided weight shifting ability. Children with spastic diplegic CP showed impaired visually guided weight shifting which can be explained by non-optimal coordination of postural movement and reduced muscular strength. PMID:24858794
Ballaz, Laurent; Robert, Maxime; Parent, Audrey; Prince, François; Lemay, Martin
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
Two tracking experiments were carried out to investigate the motor control system in adults with cerebral palsy. The first experiment analysed the frequency response characteristics and the surface electromyogram from biceps brachii and triceps brachii, when the cerebral palsy subjects made isometric contractions during the pursuit tracking task with sine wave targets. Patterns of reciprocal innervation of the antagonists explained the frequency response characteristics of tracking behavior of the cerebral palsy subjects. The second experiment analysed perceived response velocity during the compensatory tracking task by means of magnitude estimation method. Fitting power function to the relation between the input frequency and the perceived response velocity, coefficients of determination for the cerebral palsy subjects were found to be lower than those for the normal subjects. It suggests that the cerebral palsy subjects can discriminate their response velocity less exactly than the normal subjects in manual tracking system. PMID:4046239
Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05. Results: Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3rd and 6th cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7th cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01). Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6th cranial nerve palsy.
Pedro-Egbe, Chinyere Nnenne; Fiebai, Bassey; Awoyesuku, Elizabeth Akon
Children with cerebral palsy (CP) often have atypical body posture patterns and abnormal gait patterns resulting from functional strategies to compensate for primary anomalies that are directly attributable to damage to the central nervous system. Our previous study revealed two different postural patterns in children with unilateral CP: (1) a pattern with overloading of the affected body side and (2) a pattern with under-loading of the affected side. The purpose of present study was to test whether different gait patterns dependent on weight distribution between the affected and unaffected body sides could be detected in these children. The study included 45 outpatients with unilateral CP and 51 children with mild scoliosis (reference group). The examination consisted of two inter-related parts: paedobarographic measurements of the body mass distribution between the body sides and three-dimensional instrumented gait analysis. Using cluster analysis based on the Gillette Gait Index (GGI) values, three gait patterns were described: a scoliotic gait pattern and two hemiplegic gait patterns, corresponding to overloading/under-loading of the hemi-side, which are the pro-gravitational gait pattern (PGP) and the anti-gravitational gait pattern (AGP), respectively. The results of this study showed that subjects with AGP presented a higher degree of deviation from the normal gait than children with PGP. This proof that there are differences in the GGI between the AGP and PGP could be a starting point to identify kinematic differences between these gaits in a follow-up study. PMID:24946266
Szopa, Andrzej; Domagalska-Szopa, Ma?gorzata; Czamara, Andrzej
Objective Progressive supranuclear palsy (PSP) has been conceptualized as a large-scale network disruption, but the specific network targeted has not been fully characterized. We sought to delineate the affected network in patients with clinical PSP. Methods Using task-free fMRI, we mapped intrinsic connectivity to the dorsal midbrain tegmentum (dMT), a region which shows focal atrophy in PSP. Two healthy control groups (1 young, 1 older) were used to define and replicate the normal connectivity pattern, and patients with PSP were compared to an independent matched healthy control group on measures of network connectivity. Results Healthy young and older subjects showed a convergent pattern of connectivity to the dMT, including brainstem, cerebellar, diencephalic, basal ganglia, and cortical regions involved in skeletal, oculomotor, and executive control. Patients with PSP showed significant connectivity disruptions within this network, particularly within cortico-subcortical and cortico-brainstem interactions. Patients with more severe functional impairment showed lower mean dMT network connectivity scores. Interpretation This study defines a PSP-related intrinsic connectivity network in the healthy brain and demonstrates the sensitivity of network-based imaging methods to PSP-related physiological and clinical changes.
Gardner, Raquel C.; Boxer, Adam L.; Trujillo, Andrew; Mirsky, Jacob B.; Guo, Christine C.; Gennatas, Efstathios D.; Heuer, Hilary W.; Fine, Eric; Zhou, Juan; Kramer, Joel H.; Miller, Bruce L.; Seeley, William W.
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.
Corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) represent challenging neurodegenerative disorders for clinicians and nonclinical scientists alike. Although initially lumped together as "Parkinson's-Plus" syndromes, CBS and PSP are clinically and pathologically distinct from Parkinson's disease. It is now clear that behavioral and cognitive changes are common in both syndromes and affect impact quality of life and carer burden considerably. We briefly review the clinical, pathological, and neuroradiological features of each syndrome, followed by more detailed descriptions of the behavioral and cognitive deficits encountered in CBS and PSP. Clinically and pathologically heterogeneous, CBS is characterized by a wide range of cognitive and behavioral disturbances. impairments in executive function and memory are common, but nonspecific. In contrast, deficits in language and visuospatial abilities appear to be more distinctive features of CBS; the relevance of specific patterns of impairment to the underlying histopathology, or prognosis, remains to be fully elucidated. As in CBS, behavioral and cognitive changes are almost universal in PSP, with a wide range of reported deficits. Apathy is very common, often paradoxically accompanied by impulsivity. Executive dysfunction is prominent, but memory and visuospatial deficits also occur. An emerging field is the study of social cognition, which appears impaired in both syndromes. As therapeutic strategies for neurodegenerative pathologies emerge, more specific diagnostic tools in CBS and PSP will be required. Careful clinicopathological correlation, and the development of biomarkers for specific histopathologies, will be important milestones on the road to effective treatments. PMID:24757116
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 of poor growth has led to a variety of interventions to improve growth. One of the major causes of poor growth, malnutrition, is the best-studied contributor to poor growth; scientific evidence regarding malnutrition has contributed to improvements in clinical management and, in turn, survival over the last 20 years. Increased recognition and understanding of neurological, endocrinological, and environmental factors have begun to shape care for children with CP, as well. The investigation of these factors relies on advances made in the assessment methods available to address the challenges inherent in measuring growth in children with CP. Descriptive growth charts and norms of body composition provide information that may help clinicians to interpret growth and intervene to improve growth and nutrition in children with CP. Linking growth to measures of health will be necessary to develop growth standards for children with CP in order to optimize health and well-being.
In patients with progressive supranuclear palsy (PSP), previous reports have shown a severe white matter (WM) damage involving supra and infratentorial regions including cerebellum. In the present study, we investigated potential correlations between WM integrity loss and clinical-cognitive features of patients with PSP. By using magnetic resonance imaging and diffusion tensor imaging with tract based spatial statistic analysis, we analyzed WM volume in 18 patients with PSP and 18 healthy controls (HCs). All patients and HCs underwent a detailed clinical and neuropsychological evaluation. Relative to HCs, patients with PSP showed WM changes encompassing supra and infratentorial areas such as corpus callosum, fornix, midbrain, inferior fronto-occipital fasciculus, anterior thalamic radiation, superior cerebellar peduncle, superior longitudinal fasciculus, uncinate fasciculus, cingulate gyrus, and cortico-spinal tract bilaterally. Among different correlations between motor-cognitive features and WM structural abnormalities, we detected a significant association between fronto-cerebellar WM loss and executive cognitive impairment in patients with PSP. Our findings, therefore, corroborate the hypothesis that cognitive impairment in PSP may result from both "intrinsic" and "extrinsic" frontal lobe dysfunction, likely related to cerebellar disconnection. PMID:24786632
A 4.5-month-old female baby, presenting with complete paralysis of right upper limb with typical waiter's tip deformity, diagnosed as Erb's palsy was brought to Sri Ganapati Sachchidananda Hospital. Patient was treated with an integrated approach of physiotherapy and Ayurvedic treatment with an intention of aiding faster recovery of the patient to lead a near normal life. As per Ayurvedic classics, this condition can be correlated to Ekangavata (Vata effecting any one part of the body), which is Apatarpana in nature (diseases with deprived growth of body tissue). Hence, the choice of treatment is Santarpana Chikitsa (nourishing treatment). Santarpana Bahyopakramas (nourishing external treatment modalities) such as Ashwagandhabalalakshadi Taila (Ayurvedic medicated oil) Abhyanga (oleation therapy) and Shastikashali Anna Lepa (application of processed rice paste) were administered along with electrical stimulation (physiotherapy modality), both galvanic and faradic current in three sessions. Appreciable results were observed in the form of reduction of disparity in length and mid-arm circumference of right upper limb compared to unaffected left upper limb and the muscle power too improved from zero to four, facilitating patient to near normal movement.
Successful treatment of patients with neonatal brachial plexus palsy (NBPP) begins with a thorough understanding of the anatomy of the brachial plexus and of the pathophysiology of nerve injury via which the brachial plexus nerves stretched in the perinatal period manifest as a weak or paralyzed upper extremity in the newborn. NBPP can be classified by systems that can guide the prognosis and the management as these systems are based on the extent and severity of nerve injury, anatomy of nerve injury, and clinical presentation. Serial physical examinations, supplemented by a thorough maternal and perinatal history, are critical to the formulation of the treatment plan that relies upon occupational/physical therapy and rehabilitation management but may include nerve reconstruction and secondary musculoskeletal surgeries. Adjunctive imaging and electrodiagnostic studies provide additional information to guide prognosis and treatment. As research improves not only the technical aspects of NBPP treatment but also the ability to assess the activity and participation as well as body structure and function of NBPP patients, the functional outcomes for affected infants have an overall optimistic prognosis, with the majority recovering adequate functional use of the affected arm. Of importance are (i) early referral to interdisciplinary specialty clinics that can provide up-to-date advances in clinical care and (ii) increasing research/awareness of the psychosocial and patient-reported quality-of-life issues that surround the chronic disablement of NBPP. PMID:24863029
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
Objectives To evaluate a quantitative, velocity-based assessment of spasticity in the quadriceps and hamstrings muscles of children with cerebral palsy (CP) and to show the effects of spasticity in constraining knee velocities during fast gait. Design A quantitative comparison of neuromuscular and biomechanical performance in patients with CP and controls without CP. Setting Movement analysis laboratory within a university clinical referral center. Participants A convenience sample of 18 ambulatory patients with CP and 11 control subjects without CP. Interventions Not applicable. Main Outcome Measures Spastic threshold velocity recorded from electromyographic response during passive isovelocity knee movement was compared with knee angular velocity during fast walking, Gross Motor Function Measure (GMFM) scores, and Ashworth Scale score. Results Patients with measurable spasticity showed slower peak knee angular velocity during walking than patients without spasticity (P<.005). A significant correlation existed between spastic threshold velocity and peak knee angular velocity during fast walking (r=.85, P<.001). Spastic threshold velocity correlated significantly with GMFM (r=.58, P<.05) but not with Ashworth score. Conclusions The velocity dependency of spasticity can be measured by electromyograph and dynamometer to determine spastic threshold velocity. Spastic threshold velocity correlated with limitations in joint angular velocity during walking and functional performance.
Cerebral palsy (CP) is a non-progressive injury of the brain that affects muscle movement and coordination secondary to anoxia that occurred during the perinatal period. Babies who are premature, low birth weight, and those who sustained perinatal infection, seizure, or intracranial hemorrhage are at an increase risk of being affected. The injury mainly involves the motor control center of the brain; therefore, presents clinically with variable physical impairments, ranging from delayed gross or fine motor development to altered muscle tone and gait. With public awareness and research, the full spectrum of intelligence and capabilities of these children is now being appreciated. Studies have shown that with supportive caretakers, many of these children go on to enjoy near-normal adult lives. Therefore, it is imperative that their physical disabilities are identified and managed properly. In this review, we will focus primarily on urologic evaluation and management of patients with CP, with a brief review of normal bladder physiology and voiding pattern. PMID:21791755
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
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 Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and developmental quotient (DQ) was obtained using various developmental scales. Physiological classification of CP in the children was: spasticity, n=104 (82%); dyskinesia, n=14 (11%); ataxia, n=six (4.7%), and unclassified CP, n=3 (2.3%). Spastic diplegia was the most prevalent subtype (35%) followed by hemiplegia and quadriplegia. Forty-five per cent of the group were at Level I of the Gross Motor Function Classification System, 32% were at Levels II and III, and 23% were at Levels IV and V. Sixty per cent of the children had an IQ or DQ >70. Median scores on the WPPSI were Full-scale IQ 84, Verbal IQ (VIQ) 92, and Performance IQ (PIQ) 77. Children with spastic diplegia and quadriplegia had a significantly lower PIQ than VIQ. Of the children who failed to complete the WPPSI, 20% had DQ >85. Thus, cognitive skills can be masked by limitations of movement and motor control in children with CP. PMID:18355334
A 4.5-month-old female baby, presenting with complete paralysis of right upper limb with typical waiter's tip deformity, diagnosed as Erb's palsy was brought to Sri Ganapati Sachchidananda Hospital. Patient was treated with an integrated approach of physiotherapy and Ayurvedic treatment with an intention of aiding faster recovery of the patient to lead a near normal life. As per Ayurvedic classics, this condition can be correlated to Ekangavata (Vata effecting any one part of the body), which is Apatarpana in nature (diseases with deprived growth of body tissue). Hence, the choice of treatment is Santarpana Chikitsa (nourishing treatment). Santarpana Bahyopakramas (nourishing external treatment modalities) such as Ashwagandhabalalakshadi Taila (Ayurvedic medicated oil) Abhyanga (oleation therapy) and Shastikashali Anna Lepa (application of processed rice paste) were administered along with electrical stimulation (physiotherapy modality), both galvanic and faradic current in three sessions. Appreciable results were observed in the form of reduction of disparity in length and mid-arm circumference of right upper limb compared to unaffected left upper limb and the muscle power too improved from zero to four, facilitating patient to near normal movement. PMID:24459391
The aim of this work is to elucidate underlying etiologies, lesion locations, and outcomes of inferior rectus (IR) palsy of acquired origin. Retrospective search identified 44 patients with acquired IR palsy between April 2006 and May 2011 from four Neurology and two Ophthalmology Clinics in Korea. We analyzed clinical features, the results of radiological and laboratory evaluation, and prognosis. The most common causes were vascular (n = 16, 36 %) and trauma (n = 12, 27 %). Vascular disorders included microvascular ischemia (n = 10, 23 %), cerebral infarction (n = 5, 11 %), and dural arterio-venous fistula (n = 1, 2 %). Other causes were inflammation (n = 7, 16 %), myasthenia gravis (n = 5, 11 %), and thyroid ophthalmopathy (n = 1, 2 %). We were unable to determine the etiology in the remaining three patients (7 %). Most patients (95 %) showed a complete recovery with or without treatment. Acquired IR palsy mostly occurs with brainstem or orbital lesions, and has an excellent prognosis. PMID:22743791
Choi, Kwang-Dong; Choi, Jae-Hwan; Choi, Hee Young; Huh, Young-Eun; Kim, Hyo Jung; Oh, Sun-Young; Jeong, Seong-Hae; Hwang, Jeong-Min; Kim, Ji Soo
Cerebral palsy is a permanent neuromuscular motor disorder that results from injury in the developing brain during the prenatal or postnatal period. Common functional and craniofacial problems related to cerebral palsy include impaired swallowing, chewing, and speech; maxillary transverse deficiency; excessive anterior facial height; and Class II malocclusion. This article reports the treatment of a 12-year-old girl with ataxic cerebral palsy; she had a dental and skeletal Class II malocclusion, maxillary transverse deficiency, and severe crowding in both arches. Treatment included rapid maxillary expansion with simultaneous functional therapy and fixed orthodontic extraction therapy in a period of 2 years 3 months. Vertical control was maintained by a vertical chincap. An acceptable occlusion and improvements in facial esthetics, speech, and oral function were achieved. PMID:24703291
Anti-ganglioside antibodies have been associated with acquired neuropathies, including Guillain-Barré syndrome. We describe a case of acute abducens nerve palsy acquired 2 weeks after symptoms of upper respiratory tract infection and rash in a 6-month-old. Elevated anti-GM2 ganglioside immunoglobulin M antibodies were detected in the serum. The palsy slowly improved over time, although eventually surgical intervention was required. Elevated anti-GM2 immunoglobulin M antibodies have previously been reported in Guillain-Barré syndrome variants involving sensory and cranial neuropathies, but never in isolated unilateral cranial nerve VI mononeuropathy. Anti-ganglioside antibodies may play a role in the pathogenesis of postinfectious isolated abducens palsy in young children. PMID:21555058
The features and management of two adult patients with ophthalmoplegic migraine and longlasting sixth nerve palsies are described. Both had had previous shorter episodes of diplopia following migraine-like headaches. One recovered following an injection of botulinum toxin to the medial rectus of her affected eye 11 months after the onset of diplopia. The other patient had previously had surgery for a consecutive divergent squint and required further squint surgery to realign his eyes 1 year after the onset of his sixth nerve palsy. Both botulinum toxin and squint surgery may be useful in the management of longstanding sixth nerve palsy in patients with ophthalmoplegic migraine. The aetiology of ophthalmoplegic migraine is discussed. PMID:17381560
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.
Progressive changes in perinatal and neonatal intensive care of preterm infants since the late 1960s have led to an increase in survival and had an effect on the rates of neonatal morbidity, including brain injury, chronic lung disease, and sepsis. These have influenced the rates of neurodevelopmental impairment, including cerebral palsy. There was initially an increase in neonatal morbidity and rates of cerebral palsy associated with the increased survival of extremely low birth weight and low gestation infants. However, since the late 1990s and especially since the year 2000, the rates of neonatal morbidity have decreased with evidence of a decrease in the rates of cerebral palsy. Efforts to further decrease neonatal morbidity should continue to improve the outcomes of preterm children. PMID:18981801
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
Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewed. There were 20 C5-C6 palsies and ten C5-C6-C7 palsies in which recovery of C7 occurred by the end of the first month. Recovery of elbow flexion at 3 months, C7 involvement and high birthweight were the best early predictors of outcome, but all were unreliable when used separately. In combination, recovery of elbow flexion and birthweight predicted the final outcome reasonably satisfactorily, particularly when elbow flexion at 9 months, and not 3 months was considered (risk of error = 13%). Brachial plexus reconstruction may therefore be justified when there was initial C7 involvement associated with increased birthweight and poor elbow flexion at 6-9 months. PMID:11895338
Although progressive supranuclear palsy is defined by its akinetic rigidity, vertical supranuclear gaze palsy and falls, cognitive impairments are an important determinant of patients' and carers' quality of life. Here, we investigate whether there is a broad deficit of modality-independent social cognition in progressive supranuclear palsy and explore the neural correlates for these. We recruited 23 patients with progressive supranuclear palsy (using clinical diagnostic criteria, nine with subsequent pathological confirmation) and 22 age- and education-matched controls. Participants performed an auditory (voice) emotion recognition test, and a visual and auditory theory of mind test. Twenty-two patients and 20 controls underwent structural magnetic resonance imaging to analyse neural correlates of social cognition deficits using voxel-based morphometry. Patients were impaired on the voice emotion recognition and theory of mind tests but not auditory and visual control conditions. Grey matter atrophy in patients correlated with both voice emotion recognition and theory of mind deficits in the right inferior frontal gyrus, a region associated with prosodic auditory emotion recognition. Theory of mind deficits also correlated with atrophy of the anterior rostral medial frontal cortex, a region associated with theory of mind in health. We conclude that patients with progressive supranuclear palsy have a multimodal deficit in social cognition. This deficit is due, in part, to progressive atrophy in a network of frontal cortical regions linked to the integration of socially relevant stimuli and interpretation of their social meaning. This impairment of social cognition is important to consider for those managing and caring for patients with progressive supranuclear palsy. PMID:22637582
Ghosh, Boyd C P; Calder, Andrew J; Peers, Polly V; Lawrence, Andrew D; Acosta-Cabronero, Julio; Pereira, João M; Hodges, John R; Rowe, James B
OBJECTIVE: To identify neonatal risk factors for cerebral palsy among very preterm babies and in particular the associations independent of the coexistence of antenatal and intrapartum factors. DESIGN: Case-control study. SETTING: Oxford health region. SUBJECTS: Singleton babies born between 1984 and 1990 at less than 32 weeks' gestation who survived to discharge from hospital: 59 with cerebral palsy and 234 randomly selected controls without cerebral palsy. MAIN OUTCOME MEASURES: Adverse neonatal factors expressed as odds ratios and 95% confidence intervals. RESULTS: Factors associated with an increased risk of cerebral palsy after adjustment for gestational age and the presence of previously identified antenatal and intrapartum risk factors were patent ductus arteriosus (odds ratio 2.3; 95% confidence interval 1.2 to 4.5), hypotension (2.3; 1.3 to 4.7), blood transfusion (4.8; 2.5 to 9.3), prolonged ventilation (4.8; 2.5 to 9.0), pneumothorax (3.5; 1.6 to 7.6), sepsis (3.6; 1.8 to 7.4), hyponatraemia (7.9; 2.1 to 29.6) and total parenteral nutrition (5.5; 2.8 to 10.5). Seizures were associated with an increased risk of cerebral palsy (10.0; 4.1 to 24.7), as were parenchymal damage (32; 12.4 to 84.4) and appreciable ventricular dilatation (5.4; 3.0 to 9.8) detected by cerebral ultrasound. CONCLUSION: A reduction in the rate of cerebral palsy in very preterm babies requires an integrated approach to management throughout the antenatal, intrapartum, and neonatal periods.
Background Dystonic cerebral palsy is primarily caused by damage to the basal ganglia and central cortex. The daily care of these patients can be difficult due to dystonic movements. Intrathecal baclofen treatment is a potential treatment option for dystonia and has become common practice. Despite this widespread adoption, high quality evidence on the effects of intrathecal baclofen treatment on daily activities is lacking and prospective data are needed to judge the usefulness and indications for dystonic cerebral palsy. The primary aim of this study is to provide level one clinical evidence for the effects of intrathecal baclofen treatment on the level of activities and participation in dystonic cerebral palsy patients. Furthermore, we hope to identify clinical characteristics that will predict a beneficial effect of intrathecal baclofen in an individual patient. Methods/Design A double blind placebo-controlled multi-center randomized clinical trial will be performed in 30 children with dystonic cerebral palsy. Patients aged between 4 and 25 years old with a confirmed diagnosis of dystonic cerebral palsy, Gross Motor Functioning Classification System level IV or V, with lesions in the cerebral white matter, basal ganglia or central cortex and who are eligible for intrathecal baclofen treatment will be included. Group A will receive three months of continuous intrathecal baclofen treatment and group B will receive three months of placebo treatment, both via an implanted pump. After this three month period, all patients will receive intrathecal baclofen treatment, with a follow-up after nine months. The primary outcome measurement will be the effect on activities of and participation in daily life measured by Goal Attainment Scaling. Secondary outcome measurements on the level of body functions include dystonia, spasticity, pain, comfort and sleep-related breathing disorders. Side effects will be monitored and we will study whether patient characteristics influence outcome. Discussion The results of this study will provide data for evidence-based use of intrathecal baclofen in dystonic cerebral palsy. Trial registration Nederlands Trial Register, NTR3642
Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.
Purpose A pilot study with short-term outcomes of a combined surgical and medical intervention for management of generalized lower\\u000a limb spasticity, hip displacement and contractures of adductors in children with bilateral spastic cerebral palsy.\\u000a \\u000a \\u000a \\u000a Methods A prospective cohort study of 16 children (9 boys and 7 girls) aged 2–6 years with bilateral spastic cerebral palsy was performed.\\u000a At entry, 5 were classified as
Abhay Khot; Samuel Sloan; Sameer Desai; Adrienne Harvey; Rory Wolfe; H. Kerr Graham
Although glufosinate ammonium herbicides are considered safe when used properly, ingestion of the undiluted form can cause grave outcomes. Recently, we treated a 34-yr-old man who ingested glufosinate ammonium herbicide. In the course of treatment, the patient developed apnea, mental deterioration, and sixth cranial nerve palsy; he has since been discharged with full recovery after intensive care. This case report describes the clinical features of glufosinate intoxication with a focus on sixth cranial nerve palsy. Our observation suggests that neurologic manifestations after ingestion of a "low-grade toxicity herbicide" are variable and more complex than that was previously considered. PMID:24265537
Park, Jae-seok; Kwak, Soo-Jung; Gil, Hyo-wook; Kim, So-Young; Hong, Sae-yong
Fifty-four parents/caretakers of children with cerebral palsy were surveyed regarding their use of antisialorrheic medication for excessive drooling. Glycopyrrolate was used by 37 of 41 respondents, with significant improvement in drooling noted in the vast majority (95%) of cases as indicated by a five-point rating scale. Side effects (dry mouth, thick secretions, urinary retention, or flushing) surfaced in almost half (44%) of the patients but necessitated discontinuation of pharmacologic treatment in less than a third. While larger clinical studies are needed, our preliminary data indicate a trial of glycopyrrolate should be considered in children with cerebral palsy where drooling is a significant problem. PMID:9729704
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.
We present a case of oculomotor palsy due to hypertensive hemorrhage in the caudate nucleus, with intraventricular extension. To our knowledge, this is the only instance of this complication occurring due to hypertensive hemorrhage. Our patient initially developed headache at the time of her hemorrhage; 8 days later, she developed complete third nerve palsy, which showed improvement at follow-up 4 months later. This was due to tracking of blood into the perimesencephalic cistern. The presence of hemorrhage in the basal cisterns was not visible on the initial CT scans and highlights the role of MRI in evaluating the brainstem for the presence of blood products.
Psoas muscle spasticity is hypothesised as a rare cause of low back pain in patients with infantile cerebral palsy. The authors describe a new manoeuvre for the study of psoas tenderness and ultrasound (US)-guided transabdominal botulinum toxin injection technique. A possible causal relationship between psoas tension and low back pain was found incidentally in two examined cases. In subsequent patients, botulinum toxin was injected and, in cases of disappearance of symptoms, the psoas tendon was sectioned at the pelvic brim with definitive disappearance of pain. The relationship between psoas tension and low back pain in patients with infantile cerebral palsy seems likely, given the result in the four patients. PMID:19384481
Marrè-Brunenghi, G; Camoriano, R; Valle, M; Boero, S
This case report describes a 15-year-old male patient with spastic diplegic cerebral palsy, Gross Motor Function Classification System Level III, who developed severe new cognitive and motoric impairments after the administration of haloperidol. He received this dopamine antagonist and typical antipsychotic medication for an acute postoperative episode of agitation. He improved when he received the dopamine agonists amantadine and carbidopa/levodopa. This case suggests that dopamine blockade may be deleterious for individuals with cerebral palsy. Potential explanations for the events observed in this case are also presented. PMID:24332231
Mortimer, Diane; Gelfius, Carl D; Potts, Michelle A
Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology (AAN) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published clinical practice guidelines aimed to improve the quality of care and outcomes for patients diagnosed with Bell's palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group. PMID:24789656
Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S
Bell palsy, named after the Scottish anatomist Sir Charles Bell, is the most common acute mononeuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. In the past 2 years, both the American Academy of Neurology and the Academy of Otolaryngology-Head and Neck Surgery Foundation have published clinical practice guidelines aimed at improving the quality of care and outcomes for patients diagnosed with Bell palsy. This commentary aims to address the similarities and differences in the scope and final recommendations made by each guideline development group. PMID:24793182
Schwartz, Seth R; Jones, Stephanie L; Getchius, Thomas S D; Gronseth, Gary S
Neurovascular compression is assumed to cause symptoms like trigeminal neuralgia, hemifacial spasm and vestibular paroxysmia. We present a patient with recurrent episodes of transient dysarthria due to isolated right hypoglossal nerve (HN) palsy. We describe the first case of a calcified persistent hypoglossal artery (PHA) as the putative cause of a hypoglossal neurovascular compression syndrome. Our patient received a daily low-dose medication of carbamazepine resulting in complete relief of symptoms. In conclusion, PHA is not only an anatomic variation but also a possible cause of a neurovascular compression syndrome leading to intermittent HN palsy. PMID:23020989
Meila, Dan; Wetter, Axel; Brassel, Friedhelm; Nacimiento, Wilhelm
We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy.
We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy. PMID:24926263
An 87-year-old man presented with a 1-week history of transient facial numbness, followed by the onset of left diplopia 1 month later. In the neurological examination, he was found to have left abducens nerve palsy. A brain MRI showed an infiltrative lesion invading the left posterior nasal cavity and pterygopalatine fossa, and extending into the left paracavernous region. The histological diagnosis was diffuse large B-cell lymphoma. We report an unusual case of diffuse large B-cell lymphoma occurring in the sinonasal tract with unilateral abducens nerve palsy presenting as an early feature. PMID:24220442
AIM To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors. METHODS Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student's t tests were used in the statistical analysis. RESULTS The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5%) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6%) had nystagmus and 107 children (55.2%) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2%). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000). CONCLUSION Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.
To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4 degrees (range 25 to 131 degrees). The mean correction in orthosis was 25 degrees (range 3 to 60 degrees). Seventy-two patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1 degrees (range 40 to 145 degrees). The mean progression per year was 4.2 degrees (range -3 to 21 degrees). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0 degrees per year. Correction in orthosis was the only variable that predicted progression <1.0 degrees per year in both age groups (<15 years and > or =15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function. PMID:10972416
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.
Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things. First, the rate of NBPP in the US and other countries is comparable: 1.5 vs. 1.3 per 1000 total births, respectively. Second, the rate of NBPP may be decreasing: 0.9, 1.0 and 0.5 per 1,000 births for publications before 1990, 1990-2000, and after 2000, respectively. Third, the likelihood of not having concomitant shoulder dystocia with NBPP was 76% overall, though it varied by whether the publication was from the US (78%) vs. other countries (47%). Fourth, the likelihood of NBPP being permanent (lasting at least 12 months) was 10-18% in the US-based reports and 19-23% in other countries. Fifth, in studies from the US, the rate of permanent NBPP is 1.1-2.2 per 10,000 births and 2.9-3.7 per 10,000 births in other nations. Sixth, we estimate that approximately 5000 NBPPs occur every year in the US, of which over 580-1050 are permanent, and that since birth, 63,000 adults have been afflicted with persistent paresis of their brachial plexus. The exceedingly infrequent nature of permanent NBPP necessitates a multi-center study to improve our understanding of the antecedent factors and to abate the long-term sequela. PMID:24863027
Chauhan, Suneet P; Blackwell, Sean B; Ananth, Cande V
Objective To investigate neuroradiological and neurophysiological characteristics of patients with dyskinetic cerebral palsy (CP), by using magnetic resonance imaging (MRI), voxel-based morphometry (VBM), diffusion tensor tractography (DTT), and motor evoked potential (MEP). Methods Twenty-three patients with dyskinetic CP (13 males, 10 females; mean age 34 years, range 16-50 years) were participated in this study. Functional evaluation was assessed by the Gross Motor Functional Classification System (GMFCS) and Barry-Albright Dystonia Scale (BADS). Brain imaging was performed on 3.0 Tesla MRI, and volume change of the grey matter was assessed using VBM. The corticospinal tract (CST) and superior longitudinal fasciculus (SLF) were analyzed by DTT. MEPs were recorded in the first dorsal interossei, the biceps brachii and the deltoid muscles. Results Mean BADS was 16.4±5.0 in ambulatory group (GMFCS levels I, II, and III; n=11) and 21.3±3.9 in non-ambulatory group (GMFCS levels IV and V; n=12). Twelve patients showed normal MRI findings, and eleven patients showed abnormal MRI findings (grade I, n=5; grade II, n=2; grade III, n=4). About half of patients with dyskinetic CP showed putamen and thalamus lesions on MRI. Mean BADS was 20.3±5.7 in normal MRI group and 17.5±4.0 in abnormal MRI group. VBM showed reduced volume of the hippocampus and parahippocampal gyrus. In DTT, no abnormality was observed in CST, but not in SLF. In MEPs, most patients showed normal central motor conduction time. Conclusion These results support that extrapyramidal tract, related with basal ganglia circuitry, may be responsible for the pathophysiology of dyskinetic CP rather than CST abnormality.
Park, Byung-Hyun; Seo, Jeong-Hwan; Ko, Myoung-Hwan; Chung, Gyung-Ho
Objective Genes associated with cardiovascular disease may also be risk factors for congenital cerebral palsy (CP) and these associations may be modified by sex, since there is an increased risk of CP in male children. We investigated the association between CP of the child with cardiovascular disease in parents, taking sex of the child into consideration. Methods All parents of non-adopted singletons born in Denmark between 1973 and 2003 were included. Parents of a child with CP, confirmed by the Danish National CP registry, were considered exposed. Cox proportional hazards regressions were used to model risk of cardiovascular outcomes for exposed parents compared to all other parents beginning at the child’s 10th birthday. Results We identified 733,730 mothers and 666,652 fathers among whom 1,592 and 1,484, respectively, had a child with CP. The mean age for mothers at end of follow up was 50±8 years. After adjustment for maternal age, parental education, child’s sex, child’s residence, child being small for gestational age and maternal hypertensive disorder during pregnancy, mothers of CP male children had an excess risk of cardiovascular disease (HR: 1.52, 95% CI: 1.16-2.00), attributable mostly to an increased incidence of hypertension and cerebrovascular disease. After additional adjustment for preterm birth, the association was markedly attenuated for cardiovascular disease (1.34, 95%CI: 1.02 - 1.76), became nonsignificant for hypertension, but remained significant for cerebrovascular disease (HR: 2.73, 95% CI: 1.45- 5.12). There was no increased risk of cardiovascular events in mothers of female CP children, or fathers of CP children of any sex. Conclusions Women that have a male child with CP are at increased risk for premature cardiovascular disease. Part of this association may be related to risk factors for preterm births.
A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensoryneural deafness and speech disorders. In all 500 children were treated and the data was gathered during a period of 4 years from December 2006 till December 2010. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for a minimum of 08 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 342 children with Spasticity and Stiffness 294 showed marked improvement showing 87% success rate, out of 252 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 182 children showing 72% success rate, out of 96 children with Cortical Blindness 60 children showed improvement accounting for 63% efficacy rate, out of 210 children with Hearing Difficulties, 126 showed marked improvement accounting for 60% improvement rate, out of 380 children with Speech Disorders 244 showed improvement reflecting 64 % improvement rate, out of 192 children with Hemiplegia 142 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 152 children with Quadriplegia 104 showed improvement in gross and fine motor functions showing 69% success rate and out of 116 children with Paraplegia of lower limbs 88 showed improvement in weight bearing, standing and movement accounting for 76% improvement rate.
Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Ammad, Haseeb U.
Background Cerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP. Methods We conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002–2008, and who survived ?28 days after birth. Each child was assessed for CP up to age 4 years, based on either a single inpatient or ?2 outpatient pediatric diagnoses of CP. Relative to non-immigrants (n?=?566,668), the risk of CP was assessed for all immigrants (n?=?177,390), and further evaluated by World region of origin. Cox proportional hazard ratios (aHR) were adjusted for maternal age, income, diabetes mellitus, obesity, tobacco use, Caesarean delivery, year of delivery, physician visits, twin pregnancy, preterm delivery, as well as small- and large-for-gestational age birthweight. Results There were 1346 cases of CP, with a lower rate among immigrants (1.45 per 1000) than non-immigrants (1.92 per 1000) (aHR 0.77, 95% confidence interval [CI] 0.67 to 0.88). Mothers from East Asia and the Pacific (aHR 0.54, 95% CI 0.39 to 0.77) and the Caribbean (aHR 0.58, 95% CI 0.37 to 0.93) were at a significantly lower risk of having a child with CP. Whether further adjusting for preeclampsia, gestational hypertension, placental abruption or placental infraction, or upon using a competing risk analysis that further accounted for stillbirth and neonatal death, these results did not change. Conclusions Immigration and ethnicity appear to attenuate the risk of CP, and this effect is not fully explained by known risk factors.
Ray, Joel G.; Redelmeier, Donald A.; Urquia, Marcelo L.; Guttmann, Astrid; McDonald, Sarah D.; Vermeulen, Marian J.
Of 319 patients with cerebral palsy recalled for reevaluation 15 years after the initial visit, 10 percent had died. Of the living, 55 percent had spasticity, 32 percent had athetosis, 4 percent had ataxia and 9 percent had mixed spasticity and athetosis; 38 percent had an intelligence quotient (IQ) less than 50, 24 percent between 50 and 79, and 38 percent had IQ above 80. There was a high correlation between overall functional outcome and intellectual level. Severity of physical disability, as measured by hand use, mobility and speech, also correlated with dependence, in part because increased severity of the disability was associated with decreased intellectual capacity generally. Twenty-five years after the initial visit, parental attitudes and personality intactness were evaluated (using the Minnesota Multiphasic Personality Inventory [MMPI]) and were correlated with satisfaction with status in life in 28 persons predicted to be independent on the 15-year study. Twenty (72 percent) of the 28 were satisfied with their status in life and of these, 16 were evaluated (with the MMPI) with 70 percent scoring in the normal range; 13 (65 percent) had parents with a positive attitude. Positive attitude was defined as parental feelings that the handicapped child was a worthy, valuable person, to be encouraged and assisted but not isolated from the world of nonhandicapped people. Careful serial assessment by professional teams combined with repeated long-term counseling of families can result in optimal outcome for the disability level involved, due to the primary role parents play in the development of a child's character and behavior.
Although tick-borne encephalitis (TBE) has been recognized in Europe for more than 70 years and has been the topic of numerous reports, information on the involvement of facial nerves in the course of the disease is limited. Our study conducted at a single medical centre revealed that facial nerve involvement in the course of TBE in Central Europe is (i) infrequent--it was found in only 11 of 1218 (0.9%) consecutive adult patients diagnosed with TBE; (ii) manifests with unilateral or rarely bilateral peripheral facial palsy (PFP) (nine and two patients, respectively); (iii) appears late in the course of acute illness--in our patients 10-20 days after the onset of the meningoencephalitic phase of TBE, and often after defervescence (in 8/11 patients; 6-13 days after normalization of body temperature); (iv) develops more often in patients with more severe illness, i.e. more frequently in those with encephalitic than in those with meningitic clinical presentation, and more commonly in patients with monophasic than biphasic illness; and (v) has a favourable outcome--our patients had a clinically complete recovery from PFP within 7-90 (median 30) days after its onset. Moreover, the finding of Borrelia infection in 3/11 (27.3%) patients (diagnosis of confirmed Lyme neuroborreliosis was established in 1/11 patients and two patients fulfilled criteria for possible Lyme neuroborreliosis) suggests that in countries where TBE and Lyme borreliosis are endemic, concomitant infection with Borrelia burgdorferi sensu lato should be considered and searched for in patients who develop PFP in the course of TBE. PMID:22192120
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.
Aim: To examine the evidence of the effectiveness of different feeding interventions for children with cerebral palsy. Methods: A search of 12 electronic databases identified all relevant studies. For each study, the quality of the methods was assessed according to the study design. A total of 33 articles were retrieved, and 21 studies were…
The new Australian National Disability Insurance Scheme is set to revolutionise disability support for an estimated 440,000 disabled persons and in particular for over 35,000 victims of cerebral palsy. The current support for sufferers of cerebral palsy is fragmented and their families and carers expend great time and effort accessing a range of different support agencies. The present "forensic lottery" means that only a small percentage of cerebral palsy victims whose injuries have been caused by medical negligence can secure large settlements under civil tort litigation. The NDIS promises a much more equitable scheme where severely disabled children can receive the necessary early intervention, which is so important to their long-term outcome. Such support will be provided irrespective of "fault", although recouping the costs of lifelong care through civil litigation in medical negligence remains an option. Debate continues about the affordability of such an ambitious Scheme. This is no doubt fuelled by the perceived New Zealand experience of its no-fault Accident Compensation Scheme. The NDIS advantage over almost all "no fault" schemes internationally is that it provides unified comprehensive care and support to cerebral palsy sufferers irrespective of a "treatment injury". Determinations for eligibility will no doubt involve extensive medical documentation. Uncertainty remains about the preparedness of the Chief Executive Officer of the NDIS to pursue health providers in civil negligence where treatment injuries may have been causative. PMID:24804524
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,
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
The association of unilateral trochlear nerve palsy with Claude Bernard-Horner syndrome represents a rare clinical condition. We present the case of a patient with this unusual presentation. The investigation performed implicated cerebrovascular disease as the underlying cause of the condition in this patient.
Bazan, Rodrigo; Braga, Gabriel Pereira; Gomes, Daniela Laranja; Yamashita, Seizo; Betting, Luiz Eduardo; Resende, Luiz Antonio de Lima
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
In this paper we describe a system that leverages accelerometers to recognize a particular involuntary gesture in babies that have been born preterm. These gestures, known as cramped-synchronized general movements are highly correlated with a diagnosis of Cerebral Palsy. In order to test our system we recorded data from 10 babies admitted to the newborn intensive care unit at the
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
This study, involving a 10-year-old child with cerebral palsy and autism, found that the use of headphones resulted in an increase in on-task behavior whether stimuli were presented in an audiovisual mode, an audio-only mode, or a visual-only mode. Preference was for the auditory only or the mixed audiovisual stimuli. (DB)
Children diagnosed with cerebral palsy (CP) often show difficulties in arithmetic compared to their typically developing peers. The present study explores whether cognitive and motor variables are related to arithmetic performance of a large group of primary school children with CP. More specifically, the relative influence of non-verbal…
Cerebral palsy (CP) is a common childhood disorder characterized by motor disability. Children with CP are at risk of developing significant respiratory problems associated with insufficient respiratory muscle strength. It is crucial to identify important factors which are associated with the limitations in daily living function in such children.…
OBJECTIVE: Acute rectus muscle palsy caused by orbital myositis is often confused with infectious orbital cellulitis. The purpose of this article is to clarify the former condition by explaining how it is manifested and treated. METHODS: The seven children less than age 11 years in this study were examined after having an acute onset of ocular pain. Physical examination indicated
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…
Ten children with spastic diplegic cerebral palsy underwent a 12-week strengthening program and were assigned to either a group that used neuromuscular electrical stimulation (NMES) or voluntary effort (VE) to strengthen the quadriceps femoris (QF) and the triceps surae (TS). Both groups had muscle strength testing, assessment of voluntary muscle activation, MRI of the right lower extremity to determine muscle
Lee SCK; Stackhouse SK; Stackhouse CA; Schaefer M; McCarthy JJ; Smith BT
Purpose: This pilot study examined the effects of neuromuscular electrical stimulation (NMES) therapy on upper limb impairment in children with cerebral palsy, specifically addressing spasticity, heightened passive resistance to wrist rotation, coactivation, and weakness. Methods: Eight subjects, aged five to 15 years, with spastic hemiparesis subsequent to brain injury, participated in three months of NMES therapy, targeting the wrist flexor
Derek G. Kamper; Audrey M. Yasukawa; Kenley M. Barrett; Deborah J. Gaebler-Spira
Cerebral palsy (CP) may lead to profound weakness in af- fected portions of the extremities and trunk. Knowing the mechanisms underlying muscle weakness will help to better design interventions for increasing force production in children with CP. This study quantified volun- tary muscle activation, contractile properties, and fatigability of the quadri- ceps femoris and triceps surae in children with and
Scott K. Stackhouse; Stuart A. Binder-Macleod; Samuel C. K. Lee
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 (SD…
Eating impairments in children with cerebral palsy (CP) may vary widely from mild to severe. Accurate diagnosis of the severity of eating has been hampered by the lack of a classification system which would permit stratification of this wide range of problems into mild, moderate, and severe. We propose such a classification system based on measures of (1) growth: weight,
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.
Abstract Conclusion: Stellate ganglion block (SGB) is effective for treatment of Bell's palsy in patients with diabetes mellitus. Background: Corticosteroids are widely used for treatment of Bell's palsy in patients with diabetes mellitus but may induce complications like hyperglycemia, which calls for an alternative therapy. This study aimed to ascertain the effect of SGB on Bell's palsy in patients with diabetes mellitus. Methods: This randomized and single-blinded clinical trial involved 96 diabetic patients with Bell's palsy that were randomly divided into a control group (n = 48) and a treatment group (SGB group, n = 48). The House-Brackmann scale and facial disability index (FDI, including FDIP and FDIS) were observed before treatment and at 1 and 3 months after treatment for assessment of the outcome. Results: No statistically significant difference was found between the two groups before treatment as regards the House-Brackmann scale and FDI. There was a statistically significant difference in FDIP score in the two groups after treatment in comparison with before treatment. The FDIS score showed a statistical difference between the two groups after treatment. PMID:24547956
This systematic review aimed to establish the current knowledge about brain structure and executive function (EF) in children with cerebral palsy (CP). Five databases were searched (up till July 2012). Six articles met the inclusion criteria, all included structural brain imaging though no functional brain imaging. Study quality was assessed using…
Weierink, Lonneke; Vermeulen, R. Jeroen; Boyd, Roslyn N.
A multimodal approach combining acoustics, intelligibility ratings, articulography and surface electromyography was used to examine the characteristics of dysarthria due to cerebral palsy (CP). CV syllables were studied by obtaining the slope of F2 transition during the diphthong, tongue-jaw kinematics during the release of the onset consonant,…
Rong, Panying; Loucks, Torrey; Kim, Heejin; Hasegawa-Johnson, Mark
This study explored the experience and impact of chronic pain on the lives of adolescents and young adults with cerebral palsy (CP). Six participants with CP (four males, two females; age range 14-24y) who were known to experience chronic pain participated in individual in-depth interviews. Five participants had quadriplegia and used wheelchairs;…
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.
The objective of this study was to characterize participation in leisure activities in children with cerebral palsy (CP) and identify determinants of greater involvement. Ninety-five children of school age (9y 7mo [SD 2y 1mo]) with CP were recruited, and participation was evaluated with the Children's Assessment of Participation and Enjoyment in a…
A study involving 20 Afrikaans-speaking children with cerebral palsy found that recurrent otitis media in early childhood had a negative effect on articulation abilities of the 7 to 11-year-old children but that other factors such as intelligence also played a role. (JDD)
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 to…
The study of heart rate variability is an important tool for a noninvasive evaluation of the neurocardiac integrity. The present study aims to evaluate the autonomic heart rate modulation in supine and standing positions in 12 children diagnosed with cerebral palsy and 16 children with typical motor development (control group), as well as to…
Zamuner, Antonio Roberto; Cunha, Andrea Baraldi; da Silva, Ester; Negri, Ana Paola; Tudella, Eloisa; Moreno, Marlene Aparecida
BACKGROUND: To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP). METHODS: A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality
Heidi Anttila; Ilona Autti-Rämö; Jutta Suoranta; Marjukka Mäkelä; Antti Malmivaara
Eighteen studies (1952-1982) evaluating early therapeutic intervention for children with cerebral palsy are reviewed. Studies are explained to feature provisions of some type of traditional, neurophysiological/sensorimotor, or eclectic therapy and to have excluded pharmacological, dietary, or other specialized treatment procedures. Analysis is…
32 patients with cerebral palsy underwent operations for pronation deformity. The deformity is classified into four groups. Patients in group 1 are capable of supination beyond neutral. No surgery is necessary. Those in group 2 are able to supinate to the neutral position. A pronator quadratus release is advised and may be combined with a flexor aponeurotic release. In group
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…
The client with cerebral palsy often shows signs of problems integrating sensory information in combination with a motor disorder. This may be, in part, due to the initial insult or cause of the CP, but may be made worse by the lack of independent movement and absence of typical development that helps children learn to integrate sensory inputs. Medical issues
Recounts the experiences of a student with cerebral palsy in a college-level, first-semester chemistry laboratory course. Explains how a laboratory assistant worked with the handicapped student in assembling apparatus and manipulating some of the smaller equipment. Discusses the outstanding work performed by the student. (TW)
In this observational pilot study, we investigated the effect of swallowing pudding and liquids of different viscosity on the breath–swallow pattern of young people with quadriparetic cerebral palsy (CP) and normal controls. A noninvasive acoustical technique was used to monitor breaths and swallows while the individuals were drinking thin and thick liquids and consuming pudding. The results showed that subjects
Very little has been published about the characteristics and sequelae of dysphagia in children with neurological impairment. The swallowing difficulties encountered by children with spastic cerebral palsy are particularly debilitating and potentially lethal. However, aggressive evaluation and management of their feeding is typically deferred until they are medically or nutritionally compromised. Reports of the use of videofluoroscopy to analyze the
Penny L. Mirrett; John E. Riski; Judith Glascott; Valen Johnson
This paper aimed to review studies that assessed postural control (PC) in children with cerebral palsy (CP) and describe the methods used to investigate postural control in this population. It also intended to describe the performance of children with CP in postural control. An extensive database search was performed using the keywords: postural…
Standardized scales to evaluate qualities of trunk movements in children with dysfunction are sparse. An examination of the reliability of scales that may be useful in the clinic is important. The aim of this study was to examine the reliability of the Trunk Impairment Scale (TIS) for children with cerebral palsy (CP). Standardized scales are…
This study aimed to investigate the evidence that strengthening interventions can improve muscle strength and activity in individuals with cerebral palsy. The search focused on studies that employed strength training for children with cerebral palsy for which six electronic databases were used to extract literature published from 2001 to 2012. The key terms used in these searches were combined strength training, strengthening, weight training, weight lifting, resistance, and cerebral palsy. The quality of each study was assessed using the PEDro (Physiotherapy Evidence Database) scale. Thirteen randomized controlled trial studies were selected and divided into categories according to program type, mode, and outcome measures. The overall effect sizes of each study and types of strengthening were large. Strengthening exercise improved muscle strength to a greater degree, when practiced 3 times per week in 40-50 min sessions than in other categories of session length, and greater improvement was observed in younger children than in older. The effect size of the activities and variables related to gait, except for gait endurance, were medium to large. The effect size of individual muscles was large, but the effect sizes for ankle plantar flexor, hip abductor/adductor, and extensor were insignificant. Strengthening interventions are useful for increasing muscle strength in individuals with cerebral palsy, specifically in youth and children, and optimal exercise consisted of 40- to 50-min sessions performed 3 times per week. Although strengthening interventions may improve activities, including gait, more studies that are rigorous are needed to determine the contributions to gross motor function. PMID:24291625
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 report the prevalence, clinical associations, and trends over time of oromotor dysfunction and communication impairments in children with cerebral palsy (CP). Method: Multiple sources of ascertainment were used and children followed up with a standardized assessment including motor speech problems, swallowing/chewing difficulties,…
Parkes, Jackie; Hill, Nan; Platt, Mary Jane; Donnelly, Caroline
The different classes of handicaps, the size of the problem, the causes, and the principles and methods of psychological and educational care concerning children with partial and total blindness, cerebral palsy, deafness, or autism are discussed. Concepts treated include incidence, etiology, diagnosis, learning difficulties, social and emotional…
This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). A neurologist classified CP subtype. Most…
The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of…
Moreira, Rafaela Nogueira; Alcantara, Carlos Eduardo Pinto; Mota-Veloso, Isabella; Marinho, Sandra Aparecida; Ramos-Jorge, Maria L.; Oliveira-Ferreira, Fernanda
PURPOSE: To investigate the feasibility and effect of a functional physical training program on aerobic endurance and walking ability of children with cerebral palsy. METHODS: Thirteen children (8-13 years, Gross Motor Function Classification System level I or II, with normal intelligence or mild retardation) participated in this study. A functional physical training program addressing aerobic endurance, walking distance, walking velocity,
Hetty Gorter; Lian Holty; Eugène E. A. Rameckers; J. W. H. Elvers; Rob A. B. Oostendorp
The purpose of this study was to determine the relationship of both sport classification and gender to injury in the athlete with cerebral palsy (CP). Of 217 participants, 54 (25%) reported an injury episode. A relationship between both gender and sport classification to injury (p = 0.001) was discovered. For the nonambulatory, a female was more likely than a male
Summary: We present the MR imaging findings of a girl with horizontal gaze palsy and progressive scoliosis (HGPPS). HGPPS is a rare congenital disorder character- ized by absence of conjugate horizontal eye movements and accompanied by progressive scoliosis developing in child- hood and adolescence. MR imaging depicted brain-stem hypoplasia with absence of the facial colliculi, presence of a deep midline
Andrea Rossi; Martin Catala; Roberta Biancheri; Raffaella Di Comite; Paolo Tortori-Donati
Aim: Abnormal general movements at around 3 months corrected age indicate a high risk of cerebral palsy (CP). We aimed to determine whether specific movement characteristics can improve the predictive power of definitely abnormal general movements. Method: Video recordings of 46 infants with definitely abnormal general movements at 9 to 13 weeks…
BACKGROUND: The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years
Background Recurrent benign 6th nerve palsy in the paediatric age group is uncommon, but has been described following viral and bacterial infections. It has also been temporally associated with immunization, but has not been previously described following two different live attenuated vaccines. Case presentation A case is presented of a 12 month old Caucasian boy with recurrent benign 6th nerve palsy following measles-mumps-rubella and varicella vaccines, given on separate occasions with complete recovery following each episode. No alternate underlying etiology was identified despite extensive investigations and review. Conclusions The majority of benign 6th nerve palsies do not have a sinister cause and have an excellent prognosis, with recovery expected in most cases. The exact pathophysiology is unknown, although hypotheses including autoimmune mechanisms and direct viral invasion could explain the pathophysiology behind immunization related nerve palsies. It is important to rule out other aetiologies with thorough history, physical examination and investigations. There is limited information in the literature regarding the safety of a repeat dose of a live vaccine in this setting. Future immunizations should be considered on a case-by-case basis.
This paper aims to analyze the frequency of occurrence of different forms of communication in nonspeaking children during activities with digital games. The participants in this study were three children with multiple disabilities, whose limitations were due to cerebral palsy. All the children had severe oral communication disabilities. Three…
Ferreira, Maria Inês Jesus; Travassos, Xisto Lucas; Sampaio, Renelson; Pereira-Guizzo, Camila de Sousa
Objectives: Physicians may be asked by attorneys or other patient advocates to help plan for the long-term needs of children with cerebral palsy (CP) and developmental disability (DD). The first step in such planning is to thoroughly examine the literature dealing with life expectancy in these populations. This review paper comprehensively reviews the literature relating to survival in children with
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…
This study examined whether the self-concept of children with cerebral palsy (CP) differed from that of children without impairment. Forty-seven children (24 males, 23 females; mean age 11y 8mo [SD 2y 6mo]) with spastic diplegia or hemiplegia were matched with children without impairment. The level of disability of the children with CP was…
Aim: To describe trends in cerebral palsy (CP) prevalence, severity, and associated impairments among 139 Icelandic children (65 males, 74 females) born from 1990 to 1996 (period one) and 1997 to 2003 (period two). Method: A population-based study using systematically collected data on motor functioning and associated impairments of children with…
The purpose of this cross-sectional study was to determine what participation issues are important to adolescents with cerebral palsy (CP). Two hundred and three adolescents with CP (mean age 16.0 [plus or minus] 1.8 years) were assessed using the Canadian Occupational Performance Measure (COPM). This was done through semistructured interviews by…
Livingston, Michael H.; Stewart, Debra; Rosenbaum, Peter L.; Russell, Dianne J.
To explore the efficacy of improving the dysarthria of cerebral palsy under conditions of aural stimulation, visual stimulation, and combined aural-visual stimulation, 22 subjects (aged 7.6 to 19.0 years) received intensive stimulation for word limitation for 22 consecutive school days. The 87 words of the Irwin Integrated Articulation Test were…
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
The current study aims to describe the cognitive profile, autism profile, medical and behavioral presentation of children with a dual diagnosis of cerebral palsy (CP) and autism spectrum disorder (ASD). Little is known about the dual presentation of CP and ASD. Timely diagnosis is imperative as early intervention may impact a child's developmental…
Smile, S.; Dupuis, A.; MacArthur, C.; Roberts, W.; Fehlings, D.
Aim: The objective was to describe leisure activity preferences of children with cerebral palsy (CP) and their relationship to participation. Factors associated with greater interest in leisure activities were identified. Method: Fifty-five school-aged children (36 males, 19 females; mean age 9y 11mo; range 6y 1mo-12y 11mo) with CP (Gross Motor…
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.
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
This paper presents the current status and use of virtual reality (VR) for children with attention deficit hyperactivity disorder (ADHD), autism and cerebral palsy. This literature review explores how VR systems have been used as treatment tools to address the primary impairments of these disorders. Three major classes of VR display systems are identified that can be characterized by the
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
In the present study we tested 13 children with cerebral palsy (CP) and 24 typically developing children (7-12 years old) in a unimanual and bimanual motor planning task. We focused on two research questions: (1) How does motor planning develop in children with and without CP? and (2) Is motor planning facilitated when the task is performed with…
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.
Anticipatory gaze behaviour during interceptive movements was investigated in children with Spastic Unilateral Cerebral Palsy (SUCP), and related to the side of the intracerebral lesion. Five children with lesions of the right hemisphere (RHL) and five children with lesions of the left hemisphere (LHL) had to walk towards and intercept a ball that…
van Kampen, P. M.; Ledebt, A.; Smorenburg, A. R. P.; Vermeulen, R. J.; Kelder, M. E.; van der Kamp, J.; Savelsbergh, G. J. P.
Children with cerebral palsy (CP) show alteration of perceptual and cognitive abilities in addition to motor and sensory deficits, which may include altered sense of agency. The aim of this study was to evaluate whether 20 weeks of internet-based motor, perceptual and cognitive training enhances the ability of CP children to determine whether they…
Ritterband-Rosenbaum, A.; Christensen, M. S.; Nielsen, J. B.
Background and Purpose. The Bobath neurodevelopmental treatment approach advised against the use of resistive exercise, as proponents felt that increased effort would increase spasticity. The purpose of this study was to test the premise that the performance of exercises with maximum efforts will increase spasticity in people with cerebral palsy (CP). Spasticity, in the present study, was defined as a
Eileen G Fowler; Teresa W Ho; Azuka I Nwigwe; Fredrick J Dorey
Introduction Cerebral palsy (CP) is a condition resulting from damage to the brain. This damage can occur either in-utero, during childbirth, or after birth in the first months of life. The causes of brain damage range from uterine infection, trauma during or after childbirth, to illness or infection as an infant. Current research estimates that 70% of CP cases originate
This case-control study investigated risk factors for cerebral palsy in a Palestinian population. Cases were 107 children aged 1-15 years at a cerebral palsy referral centre in Jerusalem; controls were 233 children without cerebral palsy from West Bank outpatient clinics. Data were collected from medical records and a structured questionnaire to parents. In stepwise logistical regression, consanguinity and birth deficits in other family members were positively associated with cerebral palsy (OR = 4.62; 95% CI: 2.07-10.3 and OR = 12.7; 95% CI: 3.13-51.7 respectively), suggesting a possible genetic link. Other risk factors were: perinatal hypoxia (OR = 92.5; 95% CI: 24.5-350), low birth weight (OR = 4.98; 95% CI: 2.01-12.3), twin births (OR = 9.25; 95% CI: 1.29-66.8) and no prenatal medical care (OR = 5.22; 95% CI: 1.18-23.1). This first stepwise model of significant and modifiable risk factors in our population provides useful evidence for policy-makers. PMID:25023773
Background: Remarkably few studies have investigated the nature and origin of learning difficulties in children with cerebral palsy (CP). Aims: To investigate math achievement in terms of word-problem solving ability in children with CP and controls. Because of the potential importance of reading for word-problem solving, we investigated reading…
Jenks, Kathleen M.; van Lieshout, Ernest C. D. M.; de Moor, Jan M. H.
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.
A man aged 65 receiving low-dose anticoagulant therapy for a previous myocardial infarction suddenly developed a bilateral femoral nerve palsy. An abdominal CT scan showed small hemorrhages in both iliac muscles with consequent compression of the femoral nerves. The case is reported for its exceptional bilaterality.
The goal of the present 1-year long longitudinal study was to determine which home literacy variables were effective in stimulating early reading skills of children with cerebral palsy (CP) directly or indirectly via the reading precursors. Parents of 35 children with CP completed questionnaires regarding aspects of the home literacy environment…
Peeters, Marieke; Verhoeven, Ludo; de Moor, Jan; van Balkom, Hans; van Leeuwe, Jan
The goal of the present study was to get an overview of the emergent literacy activities, instructional adaptations and school absence of children with cerebral palsy (CP) compared to normally developing peers. The results showed that there were differences between the groups regarding the amount of emergent literacy instruction. While time…
We examined how children with Spastic Hemiparetic Cerebral Palsy (SHCP) perform interceptive actions they experience in daily life. Children were required to walk towards and intercept a stationary ball or a moving ball, with either their impaired or non-impaired arm. In the stationary ball condition the child was free to determine the speed of their response (internal timing), whereas in
Annieck X. C. Ricken; G. J. P. Savelsbergh; S. J. Bennett
This study estimated medical expenditures attributable to cerebral palsy (CP) among children enrolled in Medicaid, stratified by the presence of co-occurring intellectual disability (ID), relative to children without CP or ID. The MarketScan[R] Medicaid Multi-State database was used to identify children with CP for 2003-2005 by using the…
Kancherla, Vijaya; Amendah, Djesika D.; Grosse, Scott D.; Yeargin-Allsopp, Marshalyn; Van Naarden Braun, Kim
This article explains dynamic systems theory (DST), a theoretical framework for the management of children with a diagnosis of cerebral palsy. Three tenets of DST (self-organization of movement, transition, and rate-limiting factors) are examined in light of potential intervention strategies. The need for research to evaluate DST assumptions and…
An interdisciplinary group of experienced botulinum toxin users and experts in the field of movement disorders was assembled, to develop a consensus on best practice for the treatment of cerebral palsy using a problem-orientated approach to integrate theories and methods. The authors tabulated the supporting evidence to produce a condensed but comprehensive information base, pooling data and experience from nine
Florian Heinen; Guy Molenaers; Charlie Fairhurst; Lucinda J. Carr; Kaat Desloovere; Emmanuelle Chaleat Valayer; Edith Morel; Antigone S. Papavassiliou; Kristina Tedroff; S. Ignacio Pascual-Pascual; Günther Bernert; Steffen Berweck; Guiseppe Di Rosa; Elisabeth Kolanowski; Ingeborg Krägeloh-Mann
The purpose of this study was to assess whether reduction of muscle tone by continuous intrathecal baclofen infusion affects the progression of hip subluxation in persons with cerebral palsy. This prospective, open-label, case series was conducted at multiple specialty referral centers. There were 33 subjects, ages 4 to 31 years. All had a pretreatment lower extremity Ashworth score of ?3;
Linda E Krach; Robert L Kriel; Richard C Gilmartin; Dale M Swift; Bruce B Storrs; Rick Abbott; John D Ward; Karen K Bloom; William H Brooks; Joseph R Madsen; John F McLaughlin; Joseph M Nadell
Aim: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method: A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD…
ABSTRACT. Objectives. Regional variation in sur- vival of people who have cerebral palsy (CP) has been observed but not previously investigated in detail. In addition to true differences, variations in the methods and definitions used, completeness of ascertainment, and the role of potential confounding factors all have been proposed as possible explanations for these observed variations. Our aim was to
The clinical and radiological findings of a patient affected by apoplexy of an adenoma located within cavernous sinus and presenting isolated Cranial Nerve (CN) VI palsy are reported. The differential diagnosis with other pathologies is debated, and pathogenesis of isolated abducens nerve palsy is investigated. The pertinent literature of this uncommon case of apoplexy is reviewed. A 59-year-old female presented sudden appearance of CN VI palsy associated to violent headache. Endocrinological assessment did not show pituitary insufficiency; MRI depicted an adenoma located within the left CS. She underwent an endoscopic endonasal procedure with extensive opening of the cavernous sinus, occupied by an ischemic adenoma. Afterward, neurological symptoms promptly resolved and the patient was discharged after 5 days. At 3 months follow-up MRI radical tumor removal was assessed, and the patient resulted neurologically intact. The review of the pertinent literature shows that apoplexy of pituitary tumor exclusively located within the Cavernous Sinus is a very uncommon event. The distinctive clinical presentation is represented by the sudden abducens nerve palsy and the absence of pituitary insufficiency and it could be explained by the vulnerability of the nerve along its course within the cavernous sinus, and by the sparing of the sellar content by the adenoma. PMID:21503686
Zoli, Matteo; Mazzatenta, Diego; Pasquini, Ernesto; Ambrosetto, Paolo; Frank, Giorgio
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…
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…
Objective: To document the development of work participation in young adults with cerebral palsy who are transitioning into adulthood, examine associated characteristics, and investigate work limitations and barriers among employed persons. Design: Observational longitudinal cohort study. Subjects: Seventy-four young adults with cerebral palsy of average intelligence, aged 16-20 years at baseline. Methods: Work participation in 3 categories (employed, unemployed, studying) was assessed at baseline, 2-year and 4-year follow-ups using structured interviews. At 4-year follow-up, associations of work participation with demographic and clinical characteristics were examined using multinomial logistic regression. Work limitations and barriers among employed persons were evaluated using questionnaires. Results: From age range 16-20 years to age range 20-24 years the proportions of subjects who were employed and unemployed increased from 12% to 49% and 3% to 17%, respectively; the proportion who were students decreased from 85% to 34%. In the age range 20-24 years, the employment rate of young adults with cerebral palsy was lower and the unemployment rate higher, than that of the general population. A lower level of gross motor function and younger age were associated with unemployment. Employed persons experienced few work limitations; 28% experienced situational or health barriers. Conclusion: Young adults with cerebral palsy and average intelligence are at risk of experiencing unfavourable developments in work participation. Rehabilitation services should offer support to prevent unemployment and occupational disability. PMID:24858956
Verhoef, Joan A C; Bramsen, Inge; Miedema, Harald S; Stam, Henk J; Roebroeck, Marij E
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…
Botulinum toxin type A (BTX-A) is increasingly being used for the treatment of childhood spasticity, particularly cerebral palsy. However, until very recently, all such use in this indication has been unapproved with no generally accepted treatment protocols, resulting in considerable uncertainty and variation in its use as a therapeutic agent. In view of the increasing awareness of, and interest in,
H. Kerr Graham; K. Roger Aoki; Ilona Autti-Rämö; Roslyn N Boyd; Mauricio R Delgado; Deborah J Gaebler-Spira; Mark E Gormley; Barry M Guyer; Florian Heinen; Andrew F Holton; Dennis Matthews; Guy Molenaers; Francesco Motta; Pedro J Garc??a Ruiz; Jörg Wissel
A project was devised to evaluate rehabilitation services provided to persons with cerebral palsy and/or epilepsy, and to assess the unmet human needs of this population. The evaluation process consisted of a study of 1499 case records, and a follow-up st...
OBJECTIVE: To determine the prevalence and nature of feeding difficulties and oral motor dysfunction among a representative sample of 49 children with cerebral palsy (12 to 72 months of age). STUDY DESIGN: A population survey was undertaken by means of a combination of interview and home observational measures. RESULTS: Sucking (57%) and swallowing (38%) problems in the first 12 months
With medical advances, more individuals with cerebral palsy (CP) syndromes who reside in developed countries are surviving to adolescence and adulthood. However, there continues to be a paucity of research examining long-term health, functional activities, and participatory outcomes over their life-course. This article reviews the current…
OBJECTIVE. To identify prenatal and perinatal characteristics associated with cerebral palsy (CP) in infants born weighing <1500 gm (very low birth weight, VLBW). DESIGN. All 42 VLBW singleton infants with CP born in the period from 1983 to 1985 in a defined population were compared with 75 randomly selected VLBW control infants. RESULTS. Birth in a level I facility was
Judith K. Grether; Karin B. Nelson; E. Stanley Emery; Susan K. Cummins
Aim: The aim of this study was to describe the course of motor performance and analyse its relationship with motor capacity over a period of 3 years in 104 children (66 males, 38 females; 43% of those initially invited) with cerebral palsy (CP) aged 9, 11, and 13 years at the start of the study. Forty-one had hemiplegia, 42 diplegia, 21…
van Eck, Mirjam; Dallmeijer, Annet J.; Voorman, Jeanine M.; Becher, Jules G.