Vertical muscle transposition with silicone band belting in VI nerve palsy

PubMed Central

Freitas, Cristina

2016-01-01

A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary. PMID:27974341

Quantitative Magnetic Resonance Imaging Volumetry of Facial Muscles in Healthy Patients with Facial Palsy

PubMed Central

Volk, Gerd F.; Karamyan, Inna; Klingner, Carsten M.; Reichenbach, Jürgen R.

2014-01-01

Background: Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for facial muscles. Methods: Ten healthy subjects and 5 patients with facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory muscles for control. Results: All muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side. Conclusions: First systematic quantitative MRI volume measures of 5 different clinical presentations of facial paralysis are provided. PMID:25289366

A View of the Therapy for Bell's Palsy Based on Molecular Biological Analyses of Facial Muscles.

PubMed

Moriyama, Hiroshi; Mitsukawa, Nobuyuki; Itoh, Masahiro; Otsuka, Naruhito

2017-12-01

Details regarding the molecular biological features of Bell's palsy have not been widely reported in textbooks. We genetically analyzed facial muscles and clarified these points. We performed genetic analysis of facial muscle specimens from Japanese patients with severe (House-Brackmann facial nerve grading system V) and moderate (House-Brackmann facial nerve grading system III) dysfunction due to Bell's palsy. Microarray analysis of gene expression was performed using specimens from the healthy and affected sides, and gene expression was compared. Changes in gene expression were defined as an affected side/healthy side ratio of >1.5 or <0.5. We observed that the gene expression in Bell's palsy changes with the degree of facial nerve palsy. Especially, muscle, neuron, and energy category genes tended to fluctuate with the degree of facial nerve palsy. It is expected that this study will aid in the development of new treatments and diagnostic/prognostic markers based on the severity of facial nerve palsy.

Trunk and Hip Muscle Activation Patterns Are Different During Walking in Young Children With and Without Cerebral Palsy

PubMed Central

Lee, Samuel C.K.; VanSant, Ann F.; Barbe, Mary F.; Lauer, Richard T.

2010-01-01

Background Poor control of postural muscles is a primary impairment in people with cerebral palsy (CP). Objective The purpose of this study was to investigate differences in the timing characteristics of trunk and hip muscle activity during walking in young children with CP compared with children with typical development (TD). Methods Thirty-one children (16 with TD, 15 with CP) with an average of 28.5 months of walking experience participated in this observational study. Electromyographic data were collected from 16 trunk and hip muscles as participants walked at a self-selected pace. A custom-written computer program determined onset and offset of activity. Activation and coactivation data were analyzed for group differences. Results The children with CP had greater total activation and coactivation for all muscles except the external oblique muscle and differences in the timing of activation for all muscles compared with the TD group. The implications of the observed muscle activation patterns are discussed in reference to existing postural control literature. Limitations The potential influence of recording activity from adjacent deep trunk muscles is discussed, as well as the influence of the use of an assistive device by some children with CP. Conclusions Young children with CP demonstrate excessive, nonreciprocal trunk and hip muscle activation during walking compared with children with TD. Future studies should investigate the efficacy of treatments to reduce excessive muscle activity and improve coordination of postural muscles in CP. PMID:20430948

A Case of Blunt Trauma of the Eyeball Associated With an Inferior Oblique Muscle and an Inferior Rectus Muscle Rupture.

PubMed

Nitta, Keisuke; Kashima, Tomoyuki; Miura, Fumihide; Hiroe, Takashi; Akiyama, Hideo; Kishi, Shoji

2016-01-01

Rupture of the extraocular muscle in the absence of significant injury to the eyeball and adnexa is uncommon. The authors report a case of blunt trauma of the eyeball associated with an inferior oblique muscle and an inferior rectus muscle rupture. A 55-year-old man slipped and fell down hitting his eye on an extended windshield wiper blade. Although he had treatment in the emergency room, he complained of diplopia in the primary position 1 day postoperatively. After noticing ruptures of the inferior oblique muscle and an inferior rectus muscle during exploratory surgery, the authors carefully repaired it. Diplopia in the primary position had disappeared within 1 month after the operation and by 6 months postoperatively. The movement of the eye had almost completely recovered.

Lower limb muscle volume estimation from maximum cross-sectional area and muscle length in cerebral palsy and typically developing individuals.

PubMed

Vanmechelen, Inti M; Shortland, Adam P; Noble, Jonathan J

2018-01-01

Deficits in muscle volume may be a significant contributor to physical disability in young people with cerebral palsy. However, 3D measurements of muscle volume using MRI or 3D ultrasound may be difficult to make routinely in the clinic. We wished to establish whether accurate estimates of muscle volume could be made from a combination of anatomical cross-sectional area and length measurements in samples of typically developing young people and young people with bilateral cerebral palsy. Lower limb MRI scans were obtained from the lower limbs of 21 individuals with cerebral palsy (14.7±3years, 17 male) and 23 typically developing individuals (16.8±3.3years, 16 male). The volume, length and anatomical cross-sectional area were estimated from six muscles of the left lower limb. Analysis of Covariance demonstrated that the relationship between the length*cross-sectional area and volume was not significantly different depending on the subject group. Linear regression analysis demonstrated that the product of anatomical cross-sectional area and length bore a strong and significant relationship to the measured muscle volume (R 2 values between 0.955 and 0.988) with low standard error of the estimates of 4.8 to 8.9%. This study demonstrates that muscle volume may be estimated accurately in typically developing individuals and individuals with cerebral palsy by a combination of anatomical cross-sectional area and muscle length. 2D ultrasound may be a convenient method of making these measurements routinely in the clinic. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy).

PubMed

Benda, William; McGibbon, Nancy H; Grant, Kathryn L

2003-12-01

To evaluate the effect of hippotherapy (physical therapy utilizing the movement of a horse) on muscle activity in children with spastic cerebral palsy. Pretest/post-test control group. Therapeutic Riding of Tucson (TROT), Tucson, AZ. Fifteen (15) children ranging from 4 to 12 years of age diagnosed with spastic cerebral palsy. Children meeting inclusion criteria were randomized to either 8 minutes of hippotherapy or 8 minutes astride a stationary barrel. Remote surface electromyography (EMG) was used to measure muscle activity of the trunk and upper legs during sitting, standing, and walking tasks before and after each intervention. After hippotherapy, significant improvement in symmetry of muscle activity was noted in those muscle groups displaying the highest asymmetry prior to hippotherapy. No significant change was noted after sitting astride a barrel. Eight minutes of hippotherapy, but not stationary sitting astride a barrel, resulted in improved symmetry in muscle activity in children with spastic cerebral palsy. These results suggest that the movement of the horse rather than passive stretching accounts for the measured improvements.

Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique.

PubMed

Leclère, F M; Badur, N; Mathys, L; Vögelin, E

2015-08-01

Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion. The transposition of the lateral head of the gastrocnemius muscle to the tendons of the anterior tibial muscle group, with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy is performed in one stage. It includes 10 key steps which are described in this article. Since 1994, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We review the indications and limitations of the technique. Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study.

PubMed

Volk, Gerd Fabian; Pohlmann, Martin; Finkensieper, Mira; Chalmers, Heather J; Guntinas-Lichius, Orlando

2014-01-01

While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study

PubMed Central

2014-01-01

Background While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. Methods A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. Results The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. Conclusion 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment. PMID:24782657

Evaluation of the internal oblique, external oblique, and transversus abdominalis muscles in patients with ankylosing spondylitis: an ultrasonographic study.

PubMed

Üşen, Ahmet; Kuran, Banu; Yılmaz, Figen; Aksu, Neşe; Erçalık, Cem

2017-11-01

The objectives of the study are to compare abdominal muscle thickness in ankylosing spondylitis (AS) patients with healthy subjects and determine the factors affecting these muscle thickness. Thirty-five male patients with a previous diagnosis of AS according to the Modified New York criteria and a control group consisting of 35 healthy male individuals were included in this cross-sectional and case-control study. Thicknesses of the internal oblique (IO), external oblique (EO), and transversus abdominalis (TrA) muscles were measured with ultrasound (US). AS patients were classified according to the International Physical Activity Questionnaire (IPAQ). There were 35 AS patients with a mean age of 35.17 ± 8.05 years and 35 healthy subjects with a mean age 32.57 ± 7.05 years. No significant difference was observed between the groups in terms of abdominal muscle thicknesses (p > 0.005). When the AS patients were classified according to the IPAQ scores, thicknesses of the IO and TrA muscles were significantly lower in patients who had the low level of IPAQ scores (p < 0.05). In the light of our first and preliminary results, muscle thickness of the IO, EO, and TrA muscles were similar in AS patients to healthy subjects. However, AS patients who had lower level of physical activity have also reduced thickness of IO and TrA muscles.

Does long-term passive stretching alter muscle-tendon unit mechanics in children with spastic cerebral palsy?

PubMed

Theis, Nicola; Korff, Thomas; Mohagheghi, Amir A

2015-12-01

Cerebral palsy causes motor impairments during development and many children may experience excessive neural and mechanical muscle stiffness. The clinical assumption is that excessive stiffness is thought to be one of the main reasons for functional impairments in cerebral palsy. As such, passive stretching is widely used to reduce stiffness, with a view to improving function. However, current research evidence on passive stretching in cerebral palsy is not adequate to support or refute the effectiveness of stretching as a management strategy to reduce stiffness and/or improve function. The purpose was to identify the effect of six weeks passive ankle stretching on muscle-tendon unit parameters in children with spastic cerebral palsy. Thirteen children (8-14 y) with quadriplegic/diplegic cerebral palsy were randomly assigned to either an experimental group (n=7) or a control group (n=6). The experimental group underwent an additional six weeks of passive ankle dorsiflexion stretching for 15 min (per leg), four days per week, whilst the control group continued with their normal routine, which was similar for the two groups. Measures of muscle and tendon stiffness, strain and resting length were acquired pre- and post-intervention. The experimental group demonstrated a 3° increase in maximum ankle dorsiflexion. This was accompanied by a 13% reduction in triceps surae muscle stiffness, with no change in tendon stiffness. Additionally, there was an increase in fascicle strain with no changes in resting length, suggesting muscle stiffness reductions were a result of alterations in intra/extra-muscular connective tissue. The results demonstrate that stretching can reduce muscle stiffness by altering fascicle strain but not resting fascicle length. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of deep breathing on internal oblique and multifidus muscle activity in three sitting postures

PubMed Central

Ko, Min-Joo; Jung, Eun-Joo; Kim, Moon-Hwan; Oh, Jae-Seop

2018-01-01

[Purpose] This study was to investigate differences in the level of activity of the external oblique (EO), internal oblique (IO), and multifidus (MF) muscles with deep breathing in three sitting postures. [Subjects and Methods] Sixteen healthy women were recruited. The muscle activity (EO, IO, MF) of all subjects was measured in three sitting postures (slumped, thoracic upright, and lumbo-pelvic upright sitting postures) using surface electromyography. The activity of the same muscles was then remeasured in the three sitting postures during deep breathing. [Results] Deep breathing significantly increased activity in the EO, IO, and MF compared with normal breathing. Comparing postures, the activity of the MF and IO muscles was highest in the lumbo-pelvic upright sitting posture. [Conclusion] An lumbo-pelvic upright sitting posture with deep breathing could increase IO and MF muscle activity, thus improving lumbo-pelvic region stability. PMID:29706695

Implications of Anomalous Pectoralis Muscle in Reconstructive Breast Surgery: The Oblique Pectoralis Anterior

PubMed Central

Huber, Katherine Marie; Boyd, Travis Guthrie; Quillo, Amy R; Wilhelmi, Bradon J

2012-01-01

Introduction: Many case reports have described anatomical variants of the pectoralis muscles. However, there is a paucity of published literature on the consequence of such presentations in reconstructive breast surgery. Methods: A 45-year-old female patient with breast cancer presented for left mastectomy and immediate reconstruction with tissue expander. During mastectomy, she was noted to have an extra muscle anterior to her pectoralis major muscle. This variant had not previously been described in the literature and was therefore named the oblique pectoralis anterior. After inspection of the aberrant musculature, the decision was made to release the inferolateral insertion of the accessory muscle with the inferior edge of pectoralis major. An adequate pocket for the expander was created. Results: After routine expansion and implant exchange, muscular coverage of the implant from pectoralis major and the oblique pectoralis anterior muscle approximated 70%. The patient was left with good symmetry and a cosmetic result, despite the challenges presented by her anomalous chest wall musculature. Discussion: Prior knowledge of the various anatomic aberrations described in the literature can prepare a surgeon to properly incorporate and utilize the variant anatomy, should it be encountered, to benefit the outcome of the operation. PMID:22977679

[Effects of a Facial Muscle Exercise Program including Facial Massage for Patients with Facial Palsy].

PubMed

Choi, Hyoung Ju; Shin, Sung Hee

2016-08-01

The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher's exact test and independent sample t-test with the SPSS 18.0 program. Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.

A Predictive Mathematical Model of Muscle Forces for Children with Cerebral Palsy

ERIC Educational Resources Information Center

Lee, Samuel C. K.; Ding, Jun; Prosser, Laura A.; Wexler, Anthony S.; Binder-Macleod, Stuart A.

2009-01-01

Aim: The purpose of this study was to determine if our previously developed muscle model could be used to predict forces of the quadriceps femoris and triceps surae muscles of children with spastic diplegic cerebral palsy (CP). Method: Twenty-two children with CP (12 males, 10 females; mean age 10y, SD 2y, range 7-13y; Gross Motor Function…

[Foster Modification of Full Tendon Transposition of Vertical Rectus Muscles for Sixth Nerve Palsy].

PubMed

Heede, Santa

2018-04-11

Since 1907 a variety of muscle transposition procedures for the treatment of abducens nerve palsy has been established internationally. Full tendon transposition of the vertical rectus muscle was initially described by O'Connor 1935 and then augmented by Foster 1997 with addition of posterior fixation sutures on the vertical rectus muscle. Full tendon transposition augmented by Foster belongs to the group of the most powerful surgical techniques to improve the abduction. Purpose of this study was to evaluate the results of full tendon vertical rectus transposition augmented with lateral fixation suture for patients with abducens nerve palsy. Full tendon transpositions of vertical rectus muscles augmented with posterior fixation suture was performed in 2014 on five patients with abducens nerve palsy. Two of the patients received Botox injections in the medial rectus muscle: one of them three months after the surgery and another during the surgery. One of the patients had a combined surgery of the horizontal muscles one year before. On three of the patients, who received a pure transposition surgery, the preoperative deviation at the distance (mean: + 56.6 pd; range: + 40 to + 80 pd) was reduced by a mean of 39.6 pd (range 34 to 50 pd), the abduction was improved by a mean of 3 mm (range 2 to 4 mm). The other two patients, who received besides the transposition procedure additional surgeries of the horizontal muscles, the preoperative deviation at the distance (+ 25 and + 126 pd respectively) was reduced by 20 and 81 pd respectively. The abduction was improved by 4 and 8 mm respectively. After surgery two patients developed a vertical deviation with a maximum of 4 pd. None of the patients had complications or signs of anterior segment ischemia. The elevation and/or depression was only marginally affected. There was no diplopia in up- or downgaze. Full tendon transposition of vertical rectus muscles, augmented with lateral posterior fixation suture is

[Contralateral Recession of the Inferior Oblique Muscle in Grave's Disease Patients with Mild M. rectus inferior fibrosis].

PubMed

Eckstein, A; Raczynski, S; Dekowski, D; Esser, J

2015-10-01

The aim of this study was to evaluate the dose effect and the resulting binocular single vision for inferior oblique muscle recession in patients with Grave's orbitopathy. The evaluation covered all patients (n = 13) between 2010-2013 treated with recession of the inferior oblique muscle for vertical deviation caused by inferior fibrosis of the contralateral eye. The inclusion criterion was a small vertical squint angle with excyclotorsion. The corrected vertical squint angle was 3.75° [7 pdpt] (median, min 1.5° [3 pdpt], max 8° [16 pdpt]) in primary position and 5.5° in adduction [11pdpt] (median, min 3°[6 pdpt], max 9°[18pdpt]). Excyclotorsion was 4° [8 pdpt] (median, min 1° [2 pdpt], max 9° [18 pdpt]). Elevation was only slightly impaired and the side difference was 5° (median). The recession distance was preoperatively determined: 0.5° squint angle reduction per mm recession distance (calculation from patients who received surgery before 2010). Inferior oblique recession generated a good field of binocular single vision (BSV) for all patients. All patients reached BSV in the central area (20°) and within 30° of downgaze. Sixty nine percent of the patients were completely diplopia free in downgaze. Diplopia persisted in more than half of the patients in up gaze outside 15°. Squint reduction was 0.5° [1 pdpt] [0.45-0.67]/per mm recession distance in primary position and 0.65° [1.3 pdpt] [0.55-0.76]/per mm for the vertical deviation in adduction. Excyclotorsion was reduced to ≤ 2° in 77 % of the patients. Inferior oblique muscle recession can be very successfully performed on the contralateral eye in patients with mild inferior rectus muscle fibrosis. Surgery at the contralateral yoke muscle prevents the risk of overeffect with resulting diplopia in downgaze, which could occur if small distance recession had been performed at the inferior rectus muscle. An overeffect in relation to inferior oblique recession will only

The vestibulo-ocular reflex in fourth nerve palsy: deficits and adaptation.

PubMed

Wong, Agnes M F; Sharpe, James A; Tweed, Douglas

2002-08-01

The effects of fourth nerve palsy on the vestibulo-ocular reflex (VOR) had not been systematically investigated. We used the magnetic scleral search coil technique to study the VOR in patients with unilateral fourth nerve palsy during sinusoidal head rotations in yaw, pitch and roll at different frequencies. In darkness, VOR gains are reduced during incyclotorsion, depression and abduction of the paretic eye, as anticipated from paresis of the superior oblique muscle. VOR gains during excyclotorsion, elevation and adduction of the paretic eye are also reduced, whereas gains in the non-paretic eye remain normal, indicating a selective adjustment of innervation to the paretic eye. In light, torsional visually enhanced VOR (VVOR) gains in the paretic eye remain reduced; however, visual input increases vertical and horizontal VVOR gains to normal in the paretic eye, without a conjugate increase in VVOR gains in the non-paretic eye, providing further evidence of selective adaptation in the paretic eye. Motions of the eyes after fourth nerve palsy exemplify monocular adaptation of the VOR, in response to peripheral neuromuscular deficits.

Isometric muscle strength and mobility capacity in children with cerebral palsy.

PubMed

Dallmeijer, Annet J; Rameckers, Eugene A; Houdijk, Han; de Groot, Sonja; Scholtes, Vanessa A; Becher, Jules G

2017-01-01

To determine the relationship between isometric leg muscle strength and mobility capacity in children with cerebral palsy (CP) compared to typically developing (TD) peers. Participants were 62 children with CP (6-13 years), able to walk with (n = 10) or without (n = 52) walking aids, and 47 TD children. Isometric muscle strength of five muscle groups of the leg was measured using hand-held dynamometry. Mobility capacity was assessed with the 1-min walk, the 10-m walk, sit-to-stand, lateral-step-up and timed-stair tests. Isometric strength of children with CP was reduced to 36-82% of TD. When adjusted for age and height, the percentage of variance in mobility capacity that was explained by isometric strength of the leg muscles was 21-24% (walking speed), 25% (sit-to-stand), 28% (lateral-step-up) and 35% (timed-stair) in children with CP. Hip abductors and knee flexors had the largest contribution to the explained variance, while knee extensors showed the weakest correlation. Weak or no associations were found between strength and mobility capacity in TD children. Isometric strength, especially hip abductor and knee flexor strength, is moderately related to mobility capacity in children with CP, but not in TD children. To what extent training of these muscle groups will lead to better mobility capacity needs further study. Implications for Rehabilitation Strength training in children with cerebral palsy (CP) may be targeted more specifically at hip abductors and knee flexors. The moderate associations imply that large improvements in mobility capacity may not be expected when strength increases.

Activities of the Vastus Lateralis and Vastus Medialis Oblique Muscles during Squats on Different Surfaces.

PubMed

Hyong, In Hyouk; Kang, Jong Ho

2013-08-01

[Purpose] The purpose of the present study was to examine the effects of squat exercises performed on different surfaces on the activity of the quadriceps femoris muscle in order to provide information on support surfaces for effective squat exercises. [Subjects and Method] Fourteen healthy subjects performed squat exercises for five seconds each on three different support surfaces: hard plates, foam, and rubber air discs. Their performance was measured using electromyography. As the subjects performed the squat exercises on each surface, data on the activity of the vastus medialis oblique and the vastus lateralis, and the vastus medials oblique/vastus lateralis ratio, were collected. [Results] The activity of the vastus medialis oblique and the vastus medialis oblique/vastus lateralis ratio were found to be statistically significantly higher on rubber air discs than when the squats were performed on hard plates or foam. [Conclusion] To activate the vastus medialis obilique, and to enhance the vastus medialis oblique/vastus lateralis ratio, unstable surfaces that are highly unstable should be selected.

Lower Extremity Muscle Activity during Cycling in Adolescents with and without Cerebral Palsy

PubMed Central

Lauer, Richard T.; Johnston, Therese E.; Smith, Brian T.; Lee, Samuel C.K.

2008-01-01

Background In individuals with cerebral palsy (CP), adaptation and plasticity in the neuromuscular system can lead to detrimental changes affecting gait. Cycling may be an effective method to improve mobility. The biomechanics of cycling in adolescents with CP have been studied, but further analysis of the frequency and amplitude characteristics of the electromyographic (EMG) signals can assist with interpretation of the cycling kinematics. Methods Data were analyzed from ten adolescents with typical development (TD) (mean = 14.9 SD = 1.4 years) and ten adolescents with CP (mean = 15.6 SD = 1.8 years) as they cycled at two different cadences. Analyses of the lower extremity EMG signals involved frequency and amplitude analysis across the cycling revolution. Findings Examination of cycling cadence revealed that adolescents with CP had altered EMG characteristics in comparison to adolescents with typical development across the entire crank revolution for all muscles. Analyses of individual muscles indicated both inappropriate muscle activation and weakness. Interpretation A more comprehensive analysis of EMG activity has the potential to provide insight into how a task is accomplished. In this study, the control of the several muscles, especially the rectus femoris, was significantly different in adolescents with cerebral palsy. This, combined with muscle weakness, may have contributed to the observed deviations in joint kinematics. Interventions that increase muscle strength with feedback to the nervous system about appropriate activation timing may be beneficial to allow individuals with CP to cycle more efficiently. PMID:18082920

Hip dysplasia, pelvic obliquity, and scoliosis in cerebral palsy: a qualitative analysis using 3D CT reconstruction

NASA Astrophysics Data System (ADS)

Russ, Mark D.; Abel, Mark F.

1998-06-01

Five patients with cerebral palsy, hip dysplasia, pelvic obliquity, and scoliosis were evaluated retrospectively using three dimensional computed tomography (3DCT) scans of the proximal femur, pelvis, and lumbar spine to qualitatively evaluate their individual deformities by measuring a number of anatomical landmarks. Three dimensional reconstructions of the data were visualized, analyzed, and then manipulated interactively to perform simulated osteotomies of the proximal femur and pelvis to achieve surgical correction of the hip dysplasia. Severe deformity can occur in spastic cerebral palsy, with serious consequences for the quality of life of the affected individuals and their families. Controversy exists regarding the type, timing and efficacy of surgical intervention for correction of hip dysplasia in this population. Other authors have suggested 3DCT studies are required to accurately analyze acetabular deficiency, and that this data allows for more accurate planning of reconstructive surgery. It is suggested here that interactive manipulation of the data to simulate the proposed surgery is a clinically useful extension of the analysis process and should also be considered as an essential part of the pre-operative planning to assure that the appropriate procedure is chosen. The surgical simulation may reduce operative time and improve surgical correction of the deformity.

Activities of the Vastus Lateralis and Vastus Medialis Oblique Muscles during Squats on Different Surfaces

PubMed Central

Hyong, In Hyouk; Kang, Jong Ho

2013-01-01

[Purpose] The purpose of the present study was to examine the effects of squat exercises performed on different surfaces on the activity of the quadriceps femoris muscle in order to provide information on support surfaces for effective squat exercises. [Subjects and Method] Fourteen healthy subjects performed squat exercises for five seconds each on three different support surfaces: hard plates, foam, and rubber air discs. Their performance was measured using electromyography. As the subjects performed the squat exercises on each surface, data on the activity of the vastus medialis oblique and the vastus lateralis, and the vastus medials oblique/vastus lateralis ratio, were collected. [Results] The activity of the vastus medialis oblique and the vastus medialis oblique/vastus lateralis ratio were found to be statistically significantly higher on rubber air discs than when the squats were performed on hard plates or foam. [Conclusion] To activate the vastus medialis obilique, and to enhance the vastus medialis oblique/vastus lateralis ratio, unstable surfaces that are highly unstable should be selected. PMID:24259884

Stiff muscle fibers in calf muscles of patients with cerebral palsy lead to high passive muscle stiffness.

PubMed

Mathewson, Margie A; Chambers, Henry G; Girard, Paul J; Tenenhaus, Mayer; Schwartz, Alexandra K; Lieber, Richard L

2014-12-01

Cerebral palsy (CP), caused by an injury to the developing brain, can lead to alterations in muscle function. Subsequently, increased muscle stiffness and decreased joint range of motion are often seen in patients with CP. We examined mechanical and biochemical properties of the gastrocnemius and soleus muscles, which are involved in equinus muscle contracture. Passive mechanical testing of single muscle fibers from gastrocnemius and soleus muscle of patients with CP undergoing surgery for equinus deformity showed a significant increase in fiber stiffness (p<0.01). Bundles of fibers that included their surrounding connective tissues showed no stiffness difference (p=0.28).). When in vivo sarcomere lengths were measured and fiber and bundle stiffness compared at these lengths, both fibers and bundles of patients with CP were predicted to be much stiffer in vivo compared to typically developing (TD) individuals. Interestingly, differences in fiber and bundle stiffness were not explained by typical biochemical measures such as titin molecular weight (a giant protein thought to impact fiber stiffness) or collagen content (a proxy for extracellular matrix amount). We suggest that the passive mechanical properties of fibers and bundles are thus poorly understood. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Muscle synergy analysis in children with cerebral palsy

NASA Astrophysics Data System (ADS)

Tang, Lu; Li, Fei; Cao, Shuai; Zhang, Xu; Wu, De; Chen, Xiang

2015-08-01

Objective. To explore the mechanism of lower extremity dysfunction of cerebral palsy (CP) children through muscle synergy analysis. Approach. Twelve CP children were involved in this study, ten adults (AD) and eight typically developed (TD) children were recruited as a control group. Surface electromyographic (sEMG) signals were collected bilaterally from eight lower limb muscles of the subjects during forward walking at a comfortable speed. A nonnegative matrix factorization algorithm was used to extract muscle synergies. In view of muscle synergy differences in number, structure and symmetry, a model named synergy comprehensive assessment (SCA) was proposed to quantify the abnormality of muscle synergies. Main results. There existed larger variations between the muscle synergies of the CP group and the AD group in contrast with the TD group. Fewer mature synergies were recruited in the CP group, and many abnormal synergies specific to the CP group appeared. Specifically, CP children were found to recruit muscle synergies with a larger difference in structure and symmetry between two legs of one subject and different subjects. The proposed SCA scale demonstrated its great potential to quantitatively assess the lower-limb motor dysfunction of CP children. SCA scores of the CP group (57.00 ± 16.78) were found to be significantly less (p < 0.01) than that of the control group (AD group: 95.74 ± 2.04; TD group: 84.19 ± 11.76). Significance. The innovative quantitative results of this study can help us to better understand muscle synergy abnormality in CP children, which is related to their motor dysfunction and even the physiological change in their nervous system.

Bell's Palsy (For Teens)

MedlinePlus

... español Parálisis de Bell What Is Bell's Palsy? Bell's palsy is a temporary weakness or paralysis of the muscles on one side of the ... of your body. Some other conditions can cause paralysis that's more serious than Bell's palsy. Tell the doctor if you are having ...

Compartmental Innervation of the Superior Oblique Muscle in Mammals.

PubMed

Le, Alan; Poukens, Vadims; Ying, Howard; Rootman, Daniel; Goldberg, Robert A; Demer, Joseph L

2015-10-01

Intramuscular innervation of mammalian horizontal rectus extraocular muscles (EOMs) is compartmental. We sought evidence of similar compartmental innervation of the superior oblique (SO) muscle. Three fresh bovine orbits and one human orbit were dissected to trace continuity of SO muscle and tendon fibers to the scleral insertions. Whole orbits were also obtained from four humans (two adults, a 17-month-old child, and a 33-week stillborn fetus), two rhesus monkeys, one rabbit, and one cow. Orbits were formalin fixed, embedded whole in paraffin, serially sectioned in the coronal plane at 10-μm thickness, and stained with Masson trichrome. Extraocular muscle fibers and branches of the trochlear nerve (CN4) were traced in serial sections and reconstructed in three dimensions. In the human, the lateral SO belly is in continuity with tendon fibers inserting more posteriorly on the sclera for infraducting mechanical advantage, while the medial belly is continuous with anteriorly inserting fibers having mechanical advantage for incycloduction. Fibers in the monkey superior SO insert more posteriorly on the sclera to favor infraduction, while the inferior portion inserts more anteriorly to favor incycloduction. In all species, CN4 bifurcates prior to penetrating the SO belly. Each branch innervates a nonoverlapping compartment of EOM fibers, consisting of medial and lateral compartments in humans and monkeys, and superior and inferior compartments in cows and rabbits. The SO muscle of humans and other mammals is compartmentally innervated in a manner that could permit separate CN4 branches to selectively influence vertical versus torsional action.

[Bell's palsy].

PubMed

Prud'hon, S; Kubis, N

2018-03-30

Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Relationships between Lower Limb Muscle Strength and Locomotor Capacity in Children and Adolescents with Cerebral Palsy Who Walk Independently

ERIC Educational Resources Information Center

Ferland, Chantale; Lepage, Celine; Moffet, Helene; Maltais, Desiree B.

2012-01-01

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip…

Treatment of inferior oblique paresis with superior oblique silicone tendon expander.

PubMed

Greenberg, Marc F; Pollard, Zane F

2005-08-01

Patients with inferior oblique eye muscle paresis may show hypotropia and apparent superior oblique muscle overaction on the side of the presumed weak inferior oblique (IO) muscle. We report 8 such patients successfully treated using unilateral silicone superior oblique (SO) tendon expanders. Eight consecutive cases over the course of 6 years from the authors' private practice are described. None had a history of head trauma or a significant neurologic event. All patients showed IO paresis by 3-step test, with incyclotorsion and SO overacton of the hypotropic (paretic) eye. Forced ductions of the hypotropic eye were normal in all cases, and the vertical strabismus was treated with placement of a 7- mm silicone SO tendon expander in the hypotropic (paretic) eye. Mean preoperative primary position hypotropia was 6.5 prism diopters (PD); mean postoperative was 0.5 PD. Seven of 8 patients had resolution of primary position hypotropia, whereas the eighth was reduced. Mean preoperative SO overaction was 3+; all patients had postoperative resolution of SO overaction. Of 4 patients with preoperative ocular torticollis, mean preoperative head tilt was 9.3 degrees; mean postoperative tilt was 2.9 degrees. Two patients' head tilts had resolved, the other 2 showed improvement. All patients showed preoperative incylclotorsion of the hypotropic (paretic) eye; inclyclotorsion resolved in all patients after the placement of a SO tendon expander. The silicone SO tendon expander effectively restores ocular alignment in IO paresis with apparent SO overaction. Associated ocular torticollis can also be improved.

Relationships between Respiratory Muscle Strength and Daily Living Function in Children with Cerebral Palsy

ERIC Educational Resources Information Center

Wang, Hui-Yi; Chen, Chien-Chih; Hsiao, Shih-Fen

2012-01-01

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.…

Pathophysiology of dysarthria in cerebral palsy.

PubMed Central

Neilson, P D; O'Dwyer, N J

1981-01-01

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. PMID:7334387

The effects of a multisensory dynamic balance training on the thickness of lower limb muscles in ultrasonography in children with spastic diplegic cerebral palsy.

PubMed

Nam, Seung-Min; Kim, Won-Hyo; Yun, Chang-Kyo

2017-04-01

[Purpose] This study aimed to investigate the effects of multisensory dynamic balance training on muscles thickness such as rectus femoris, anterior tibialis, medial gastrocnemius, lateral gastrocnemius in children with spastic diplegic cerebral palsy by using ultrasonography. [Subjects and Methods] Fifteen children diagnosed with spastic diplegic cerebral palsy were divided randomly into the balance training group and control group. The experimental group only received a multisensory dynamic balance training, while the control group performed general physiotherapy focused balance and muscle strengthening exercise based Neurodevelopmental treatment. Both groups had a therapy session for 30 minutes per day, three times a week for six weeks. The ultrasonographic muscle thickness were obtained in order to compare and analyze muscle thickness before and after in each group. [Result] The experimental group had significant increases in muscle thickness in the rectus femoris, tibialis anterior, medial gastrocnemius and lateral gastrocnemius muscles. The control group had significant increases in muscle thickness in the tibialis anterior. The test results of the rectus femoris, medial gastrocnemius and lateral gastrocnemius muscle thickness values between the groups showed significant differences. [Conclusion] In conclusion, a multisensory dynamic balance training can be recommended as a treatment method for patients with spastic diplegic cerebral palsy.

Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.

PubMed

Mostafa, Attiat M; Kassem, Rehab R

2018-05-01

To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction. Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis. A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient. The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Influence of modified muscle morphology and activity pattern on the results of musculoskeletal system modelling in cerebral palsy patient.

PubMed

Ogrodnik, Justyna; Piszczatowski, Szczepan

2017-01-01

The aim of the present study was to evaluate the influence of modified morphological parameters of the muscle model and excitation pattern on the results of musculoskeletal system numerical simulation in a cerebral palsy patient. The modelling of the musculoskeletal system was performed in the AnyBody Modelling System. The standard model (MoCap) was subjected to modifications consisting of changes in morphological parameters and excitation patterns of selected muscles. The research was conducted with the use of data of a 14-year-old cerebral palsy patient. A reduction of morphological parameters (variant MI) caused a decrease in the value of active force generated by the muscle with changed geometry, and as a consequence the changes in active force generated by other muscles. A simulation of the abnormal excitation pattern (variant MII) resulted in the muscle's additional activity during its lengthening. The simultaneous modification of the muscle morphology and excitation pattern (variant MIII) points to the interdependence of both types of muscle model changes. A significant increase in the value of the reaction force in the hip joint was observed as a consequence of modification of the hip abductor activity. The morphological parameters and the excitation pattern of modelled muscles have a significant influence on the results of numerical simulation of the musculoskeletal system functioning.

Primary position and listing's law in acquired and congenital trochlear nerve palsy.

PubMed

Straumann, Dominik; Steffen, Heimo; Landau, Klara; Bergamin, Oliver; Mudgil, Ananth V; Walker, Mark F; Guyton, David L; Zee, David S

2003-10-01

In ocular kinematics, the primary position (PP) of the eye is defined by the position from which movements do not induce ocular rotations around the line of sight (Helmholtz). PP is mathematically linked to the orientation of Listing's plane. This study was conducted to determine whether PP is affected differently in patients with clinically diagnosed congenital (conTNP) and acquired (acqTNP) trochlear nerve palsy. Patients with unilateral conTNP (n = 25) and acqTNP (n = 9) performed a modified Hess screen test. Three-dimensional eye positions were recorded with dual search coils. PP in eyes with acqTNP was significantly more temporal (mean: 21.2 degrees ) than in eyes with conTNP (6.8 degrees ) or healthy eyes (7.2 degrees ). In the pooled data of all patients, the horizontal location of PP significantly correlated with vertical noncomitance with the paretic eye in adduction (R = 0.59). Using a computer model, PP in acqTNP could be reproduced by a neural lesion of the superior oblique (SO) muscle. An additional simulated overaction of the inferior oblique (IO) muscle moved PP back to normal, as in conTNP. Lengthening the SO and shortening the IO muscles could also simulate PP in conTNP. The temporal displacement of PP in acqTNP is a direct consequence of the reduced force of the SO muscle. The reversal of this temporal displacement of PP, which occurs in some patients with conTNP, can be explained by a secondary overaction of the IO muscle. Alternatively, length changes in the SO and IO muscles, or other anatomic anomalies within the orbit, without a neural lesion, may also explain the difference in location of PP between conTNP and acqTNP.

Motor mechanisms of vertical fusion in individuals with superior oblique paresis.

PubMed

Mudgil, Ananth V; Walker, Mark; Steffen, Heimo; Guyton, David L; Zee, David S

2002-06-01

We wanted to determine the mechanisms of motor vertical fusion in patients with superior oblique paresis and to correlate these mechanisms with surgical outcomes. Ten patients with superior oblique paresis underwent 3-axis, bilateral, scleral search coil eye movement recordings. Eye movements associated with fusion were analyzed. Six patients had decompensated congenital superior oblique paresis and 4 had acquired superior oblique paresis. All patients with acquired superior oblique paresis relied predominantly on the vertical rectus muscles for motor fusion. Patients with congenital superior oblique paresis were less uniform in their mechanisms for motor fusion: 2 patients used predominantly the oblique muscles, 2 patients used predominantly the vertical recti, and 2 patients used predominantly the superior oblique in the hyperdeviated eye and the superior rectus in the hypodeviated eye. The last 2 patients developed the largest changes in torsional eye alignment relative to changes in vertical eye alignment and were the only patients to develop symptomatic surgical overcorrections. There are 3 different mechanisms for vertical fusion in individuals with superior oblique paresis, with the predominant mechanism being the vertical recti. A subset of patients with superior oblique paresis uses predominantly the superior oblique muscle in the hyperdeviated paretic eye and the superior rectus muscle in the fellow eye for fusion. This results in intorsion of both eyes, causing a large change in torsional alignment. The consequent cyclodisparity, in addition to the existing vertical deviation, may make fusion difficult. The differing patterns of vertical fusional vergence may have implications for surgical treatment.

Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy.

PubMed

Martín Lorenzo, Teresa; Rocon, Eduardo; Martínez Caballero, Ignacio; Ramírez Barragán, Ana; Lerma Lara, Sergio

2017-11-01

Tissue related ankle hyper-resistance has been reported to contribute to equinus gait in children with spastic cerebral palsy. Hence, ankle plantarflexor stretching programs have been developed in order to restore passive ankle dorsiflexion. Despite high quality evidence on the limited effects of stretching on passive joint mobility, further muscle-tendon adaptations have been reported which may impact gait performance. As such, children with spastic cerebral palsy subject to long-term manual static stretching achieved dorsiflexion gains through the reduction of muscle and fascicle strain whilst preserving tendon strain, and prolonged use of ankle-foot orthoses achieved similar dorsiflexion gains through increased tendon strain whilst preserving muscle and fascicle strain. The latter concurred with normalization of early stance plantarflexor moment yet reductions in push-off plantarflexor moment given the increase in tendon compliance. Therefore, similar limited gains in passive ankle joint mobility in response to stretching may be achieved either by preserving/restoring optimal muscle-tendon function, or at the expense of muscle-tendon function and thus contributing gait impairments. The largest increase in ankle passive joint mobility in children with SCP has been obtained through prolonged plantarflexor stretching through ankle casting combined with botulinum neurotoxin type A. However, to our knowledge, there are no published studies on muscle-tendinous adaptations to ankle casting combined with botulinum toxin type A and its effect on ankle joint gait kinetics. Therefore, we hypothesized that ankle casting elicits muscle-tendon adaptations which concur with altered ankle joint kinetics during the stance phase of gait in children with SCP. More information is needed about the relationships between muscle structure and function, and the effect of specific interventions designed to alter muscle properties and associated functional outcomes in children with

Differences in descending control of external oblique and latissimus dorsi muscles in humans: a preliminary study.

PubMed

Wightman, Francesca; Delves, Suzanne; Alexander, Caroline M; Strutton, Paul H

2011-07-01

Descending bilateral control of external oblique (EO) and latissimus dorsi (LD) was investigated using transcranial magnetic stimulation. Contralateral (CL) motor evoked potential (MEP) thresholds were lower and latencies were shorter than for ipsilateral (IL) MEPs. Hotspots for EO were symmetrical; this was not the case for LD. The volumes of drive to the left and right muscles were not different. The laterality index was not different between the left and right muscles. The average index for the EO muscles was closer to zero than that for LD, suggesting a stronger IL drive to EO. The symmetry of drive to each muscle did not differ; however, the symmetry of drive varies within a subject for different muscles and between subjects for the same muscle. The findings may be useful in understanding a number of clinical conditions relating to the trunk and also for predicting the outcome of rehabilitative strategies.

[Palsy of the upper limb: Obstetrical brachial plexus palsy, arthrogryposis, cerebral palsy].

PubMed

Salazard, B; Philandrianos, C; Tekpa, B

2016-10-01

"Palsy of the upper limb" in children includes various diseases which leads to hypomobility of the member: cerebral palsy, arthrogryposis and obstetrical brachial plexus palsy. These pathologies which differ on brain damage or not, have the same consequences due to the early achievement: negligence, stiffness and deformities. Regular entire clinical examination of the member, an assessment of needs in daily life, knowledge of the social and family environment, are key points for management. In these pathologies, the rehabilitation is an emergency, which began at birth and intensively. Splints and physiotherapy are part of the treatment. Surgery may have a functional goal, hygienic or aesthetic in different situations. The main goals of surgery are to treat: joints stiffness, bones deformities, muscles contractures and spasticity, paresis, ligamentous laxity. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Surgical planning and innervation in pontine gaze palsy with ipsilateral esotropia.

PubMed

Somer, Deniz; Cinar, Fatma Gul; Kaderli, Ahmet; Ornek, Firdevs

2016-10-01

To discuss surgical intervention strategies among patients with horizontal gaze palsy with concurrent esotropia. Five consecutive patients with dorsal pontine lesions are presented. Each patient had horizontal gaze palsy with symptomatic diplopia as a consequence of esotropia in primary gaze and an anomalous head turn to attain single binocular vision. Clinical findings in the first 2 patients led us to presume there was complete loss of rectus muscle function from rectus muscle palsy. Based on this assumption, medial rectus recessions with simultaneous partial vertical muscle transposition (VRT) on the ipsilateral eye of the gaze palsy and recession-resection surgery on the contralateral eye were performed, resulting in significant motility limitation. Sequential recession-resection surgery without simultaneous VRT on the 3rd patient created an unexpected motility improvement to the side of gaze palsy, an observation differentiating rectus muscle palsy from paresis. Recession combined with VRT approach in the esotropic eye was abandoned on subsequent patients. Simultaneous recession-resection surgery without VRT in the next 2 patients resulted in alleviation of head postures, resolution of esotropia, and also substantial motility improvements to the ipsilateral hemifield of gaze palsy without limitations in adduction and vertical deviations. Ocular misalignment and abnormal head posture as a result of conjugate gaze palsy can be successfully treated by basic recession-resection surgery, with the advantage of increasing versions to the ipsilateral side of the gaze palsy. Improved motility after surgery presumably represents paresis, not "paralysis," with residual innervation in rectus muscles. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Muscle Strength Enhancement Following Home-Based Virtual Cycling Training in Ambulatory Children with Cerebral Palsy

ERIC Educational Resources Information Center

Chen, Chia-Ling; Hong, Wei-Hsien; Cheng, Hsin-Yi Kathy; Liaw, Mei-Yun; Chung, Chia-Ying; Chen, Chung-Yao

2012-01-01

This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n = 13) or a…

Co-Activity during Maximum Voluntary Contraction: A Study of Four Lower-Extremity Muscles in Children with and without Cerebral Palsy

ERIC Educational Resources Information Center

Tedroff, Kristina; Knutson, Loretta M.; Soderberg, Gary L.

2008-01-01

This study was designed to determine whether children with cerebral palsy (CP) showed more co-activity than comparison children in non-prime mover muscles with regard to the prime mover during maximum voluntary isometric contraction (MVIC) of four lower-extremity muscles. Fourteen children with spastic diplegic CP (10 males, four females; age…

Passive stiffness of the gastrocnemius muscle in athletes with spastic hemiplegic cerebral palsy.

PubMed

Hussain, A W; Onambele, G L; Williams, A G; Morse, C I

2013-09-01

The passive properties of the muscle-tendon unit are regularly assessed in individuals with cerebral palsy (CP). However, no information is available on the passive properties of adult muscle, and whether any differences exist between the paretic and control muscles. Eleven ambulant male athletes with spastic hemiplegic CP (21.2 ± 3.0 years) and controls without neurological impairment (age = 21.8 ± 2.2 years) completed two and one passive stretch session, respectively. During each session, the ankle was passively dorsiflexed until end range of motion (ROM), whilst recording passive ankle angle, torque and gastrocnemius medialis (GM) myotendinous junction (MTJ) displacement. In addition, GM cross-sectional area (CSA) and length were measured. Subsequently, in vivo stress and strain were determined to calculate elastic modulus. Passive stiffness, MTJ displacement and ROM of the paretic GM were not different from the control muscles. However, the elastic modulus of the paretic GM was two times stiffer than the control GM muscles. In conclusion, athletes with CP exhibit absolute passive muscle stiffness similar to the controls; however, the elastic modulus of the CP muscle was significantly greater. Therefore, throughout the same ROM a smaller GM CSA in CP athletes has to dissipate larger relative torque compared to the control muscles, consequently causing the muscle to elongate to the same extent as the non-paretic muscle under stretch.

Can activity within the external abdominal oblique be measured using real-time ultrasound imaging?

PubMed

John, E K; Beith, I D

2007-11-01

Differences in the function of the anterolateral abdominal muscles have been the subject of much investigation, but primarily using electromyography. Recently changes in thickness of transversus abdominis and internal oblique measured from real-time ultrasound images have been shown to represent activity within these muscles. However it is still unclear if such a change in thickness in external oblique similarly represents activity within that muscle. The purpose of this study was to investigate the relationship between change in thickness and muscle activity in the external oblique using real-time ultrasound and surface electromyography. Simultaneous measurements of electromyography and real-time ultrasound images of external oblique were studied in up to 24 subjects during two tasks compared to the muscle at rest (1) isometric trunk rotation and (2) drawing in the lower abdomen. Changes in muscle thickness correlated significantly with electromyography during isometric trunk rotation in the majority of subjects but with a significant difference between subjects. In contrast, the relationship between change in thickness and electrical activity in the muscle when drawing in the lower abdomen was significant in less than 50% of subjects and the muscle often got thinner. Thickness changes of external oblique can be used as a valid indicator of electromyography activity during isometric trunk rotation, though the relationship is not as good as previously published data for transversus abdominis. Thickness changes of external oblique measured during lower abdominal drawing in cannot be used to detect activity within this muscle.

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed

Porter, David; Michael, Shona; Kirkwood, Craig

2007-12-01

To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/ dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Cross-sectional observational study. Posture management services in three centres in the UK. Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. A total of 747 participants were included in the study, aged 6-80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P<0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P=0.007), hips subluxed on the left (P=0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P=0.03) were observed. The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed.

Effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy

PubMed Central

Choi, Jong-Bae

2016-01-01

[Purpose] The aim of this study was to investigate the effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy. [Subjects and Methods] Nine subjects received the electrical stimulation and traditional dysphagia therapy. Electrical stimulation was applied to stimulate each subject’s facial muscles 30 minutes a day, 5 days a week, for 4 weeks. [Results] Subjects showed significant improvement in cheek and lip strength and oral function after the intervention. [Conclusion] This study demonstrates that electrical stimulation improves facial muscle strength and oral function in stroke patients with dysphagia. PMID:27799689

Management of birth brachial plexus palsy.

PubMed

O'Brien, Donncha F; Park, T S; Noetzel, Michael J; Weatherly, Trisha

2006-02-01

The indications for surgical repair of congenital brachial plexus palsy are controversial. Our objective was to determine the results of early brachial plexus surgery following obstetric-induced brachial plexus palsy. We performed a retrospective analysis of the outcome of 58 cases of brachial plexus surgery. The indication for operation consisted of the presence of less than antigravity strength in the biceps, triceps, and deltoid muscle groups at 6 months of age. Data gathered prospectively, previously, showed the likelihood of improvement with less than antigravity strength in these cases to be poor. Follow-up data were obtained on 52 of the 58 cases. Overall mean follow-up was 2 years. Twelve patients had more than 3 years follow-up (mean 5.5 years, range 3-11.5 years). Significant improvement was seen in all injury patterns i.e., C5-C6, C5-C7, and C5-C8, T1. Greater than antigravity strength in the biceps, triceps, and deltoid muscle groups was seen in the majority of cases at follow-up. Repair of obstetrical brachial plexus palsy in children at 6 months of age that is based on less than antigravity strength in the biceps, triceps, and deltoid muscle groups produces improvement in functional capabilities. Children with obstetrical brachial plexus palsy should be referred soon after birth to a center that specializes in the treatment of this type of palsy.

Classification and development of myofiber types in the superior oblique extraocular muscle of chicken.

PubMed

Baryshnikova, Larisa M; Croes, Scott A; von Bartheld, Christopher S

2007-12-01

Precise control of contractile force of extraocular muscles is required for appropriate movements and alignment of the eyes. It is unclear how such precise regulation of contractile force is achieved during development and maturation. By using the posthatch chicken as a model, we describe and quantify critical parameters of the developing superior oblique extraocular muscle from hatching to 16 weeks of age, including contractile force, muscle mass, myofiber diameters, classification of fiber types, and distribution and quantification of mitochondria. Analysis at the light- and electron microscopic levels shows that chicken myofiber types largely correspond to their mammalian counterparts, with four fiber types in the orbital and four types in the global layer. Twitch tension muscle force and muscle mass gradually increase and stabilize at approximately 11 weeks. Tetanic tension continues to increase between 11 and 16 weeks. Myofiber diameters in both the orbital and global layer increase from hatching to six weeks, and then stabilize, whereas the myofiber number is constant after hatching. This finding suggests that muscle mass increases during late maturation due to increasing fiber length rather than fiber diameter. Quantitative ultrastructural analysis reveals continuing changes in the composition of the four muscle fiber types, suggesting ongoing fiber type conversion or differential replacement of myofiber types. Muscle fiber composition continues to change into late juvenile and adult age. Our study provides evidence for gradual, incremental, and continuing changes in avian myofiber composition and function that is similar to postnatal oculomotor maturation in visually oriented mammals such as kitten.

Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy.

PubMed

Stark, C; Nikopoulou-Smyrni, P; Stabrey, A; Semler, O; Schoenau, E

2010-06-01

The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children. In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training. Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training. The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

Activity of periscapular muscles and its correlation with external oblique during push-up: Does scapular dyskinesis change the electromyographic response?

PubMed

de Araújo, Rodrigo Cappatode; Pirauá, André Luiz Torres; Beltrão, Natália Barros; Pitangui, Ana Carolina Rodarti

2018-03-01

Scapular dyskinesis is the term used to describe changes in the positioning or movement of the scapula. Such dysfunction is associated with changes in the activation of the scapular muscles. However, the influence of the axial muscles on the scapular muscles activity of subjects with scapular dyskinesis is unknown. This study aimed to compare the electromyography (EMG) activity of periscapular muscles and its correlation with the external oblique muscle during the execution of push-up performed in different surfaces, in volunteers with and without scapular dyskinesis. Thirty-six men, divided in two groups (control and dyskinesis), performed push-up on stable and unstable surface. The EMG activity of serratus anterior (SA_5th and SA_7th fibers), upper (UT) and lower (LT) trapezius, external oblique (EO) was recorded during execution of each task condition. Statistical analyzes were performed using two way ANOVA repeated measures and Pearson correlation. It was observed effect of interaction between factors, being evidenced increased activity of UT, SA_7th and OE for the control group and decreased activity of SA_5th, SA_7th and EO for dyskinesis group during execution of push-up on unstable surface. In both groups positive correlations (r > 0.47) were observed between EMG activity of SA and EO. In the exercises tested, there seems to be an anatomical and functional relationship between the SA and EO muscles. The use of the unstable surface promotes increased neuromuscular demand, but the neuromuscular strategies appear to differ between groups.

Anteriorization of the Normally Acting Inferior Oblique Muscles to Treat Dissociated Vertical Deviation Associated With Juvenile Glaucoma.

PubMed

Kassem, Rehab Rashad

2017-10-09

A case of dissociated vertical deviation, ptosis, and juvenile glaucoma is described. J deformity anteriorization of the normally acting inferior oblique muscles was chosen to preserve the superior fornix for glaucoma surgeries by avoiding superior rectus recession and to prevent narrowing of the palpebral fissure by avoiding an inferior rectus tuck. [J Pediatr Ophthalmol Strabismus. 2017;54:e63-e66.]. Copyright 2017, SLACK Incorporated.

Preoperative botulinum toxin test injections before muscle lengthening in cerebral palsy.

PubMed

Rutz, Erich; Hofmann, Eva; Brunner, Reinald

2010-09-01

Muscle weakening is a well-known side effect of muscle-tendon lengthening. Botulinum toxin A (BTX-A) weakens the muscle temporarily by blocking the neuromuscular junction. Hence application of the drug is a logical step to test whether weakness deteriorates function prior to an operation. In the present study, BTX-A application is used to test preoperatively whether the gait pattern depends on the strength of the tested muscle. Since 1999, instrumented gait analysis, including kinematic, kinetic, and dynamic electromyographic data, is routinely used to define the individual surgical program. In our series of 110 consecutive patients with cerebral palsy (CP) considered for surgical muscle lengthening from 1999 to 2008, BTX-A was applied to identify patients at risk for functional deterioration. Gait analysis was repeated 6 weeks (maximum effect of BTX-A) and 12 weeks (follow-up) after the test injection to check for loss of joint control (excessive ankle dorsiflexion, knee flexion, increased anterior pelvic tilt). In all, 20.9% (n = 23) showed deterioration in gait after preoperative BTX-A test injections (n = 112, two patients had two test trials) in all muscles considered for lengthening. As a consequence, their lengthening surgery was canceled. A total of 68 patients underwent surgery as planned, and in none of them did gait function deteriorate. These clinical data were compared to those of a historical group (n = 105) before this test, where 18% showed functional deterioration after surgery. The similar percentage of patients filtered out by the test suggests that there could be a context to the number of poor results in the historical group. We conclude that preoperative BTX-A test injection is a reliable tool for filtering out patients with risk of deterioration after muscle lengthening surgery in patients with CP and can be helpful to avoid poor outcomes.

Radio-opaque modification/substitute for the wright superior oblique tendon extender for superior oblique muscle overaction strabismus.

PubMed

Arnold, Robert W; Leman, Rachel E

2007-01-01

Kenneth Wright developed a technique for graded weakening of the superior oblique by increasing the effective length of this extraocular muscle's long tendon with a piece of silicone rubber retinal encircling band commonly used by eye surgery for retinal detachment repairs. In the absence of any specific retinal bands in our Children's Hospital, the following technique was developed affording a non-invasive ability to monitor, which was less intricate than the technique so well described by Demer. We substituted the "Mini Vessel Loop" (by Maaxxim Medical or Henley International). It is an elastic smooth silicone rubber cord that is radio-opaque, and can easily be seen on X-rays and CT scans. It is not an ophthalmologic medical device but it rather is designed to loop around and identify and gently retract blood vessels and nerves in any form of surgery where needed. We demonstrated success similar to that achieved by Wright in 43 patients using these radio-opaque, silicon Mini Vessel loops.

The First Experience of Triple Nerve Transfer in Proximal Radial Nerve Palsy.

PubMed

Emamhadi, Mohammadreza; Andalib, Sasan

2018-01-01

Injury to distal portion of posterior cord of brachial plexus leads to palsy of radial and axillary nerves. Symptoms are usually motor deficits of the deltoid muscle; triceps brachii muscle; and extensor muscles of the wrist, thumb, and fingers. Tendon transfers, nerve grafts, and nerve transfers are options for surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcomes. We present a patient with proximal radial nerve palsy following a blunt injury undergoing triple nerve transfer. The patient was involved in a motorcycle accident with complete palsy of the radial and axillary nerves. After 6 months, on admission, he showed spontaneous recovery of axillary nerve palsy, but radial nerve palsy remained. We performed triple nerve transfer, fascicle of ulnar nerve to long head of the triceps branch of radial nerve, flexor digitorum superficialis branch of median nerve to extensor carpi radialis brevis branch of radial nerve, and flexor carpi radialis branch of median nerve to posterior interosseous nerve, for restoration of elbow, wrist, and finger extensions, respectively. Our experience confirmed functional elbow, wrist, and finger extensions in the patient. Triple nerve transfer restores functions of the upper limb in patients with debilitating radial nerve palsy after blunt injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

Patterns of postural deformity in non-ambulant people with cerebral palsy: what is the relationship between the direction of scoliosis, direction of pelvic obliquity, direction of windswept hip deformity and side of hip dislocation?

PubMed Central

Michael, Shona; Kirkwood, Craig

2008-01-01

Objective: To investigate: (a) associations between the direction of scoliosis, direction of pelvic obliquity, direction of windswept deformity and side of hip subluxation/dislocation in non-ambulant people with cerebral palsy; and (b) the lateral distribution of these postural asymmetries. Design: Cross-sectional observational study. Setting: Posture management services in three centres in the UK. Subjects: Non-ambulant people at level five on the gross motor function classification system for cerebral palsy. Main measures: Direction of pelvic obliquity and lateral spinal curvature determined from physical examination, direction of windswept hip deformity derived from range of hip abduction/adduction, and presence/side of unilateral hip subluxation defined by hip migration percentage. Results: A total of 747 participants were included in the study, aged 6–80 years (median 18 years 10 months). Associations between the direction of scoliosis and direction of pelvic obliquity, and between the direction of windswept hip deformity and side hip subluxation/dislocation were confirmed. A significant association was also seen between the direction of scoliosis and the direction of the windswept hip deformity (P < 0.001) such that the convexity of the lateral spinal curve was more likely to be opposite to the direction of windsweeping. Furthermore, significantly more windswept deformities to the right (P = 0.007), hips subluxed on the left (P = 0.002) and lateral lumbar/lower thoracic spinal curves convex to the left (P = 0.03) were observed. Conclusions: The individual asymmetrical postural deformities are not unrelated in terms of direction and not equally distributed to the left/right. A pattern of postural deformity was observed. PMID:18042604

Contribution of sensory feedback to plantar flexor muscle activation during push-off in adults with cerebral palsy.

PubMed

Frisk, Rasmus F; Jensen, Peter; Kirk, Henrik; Bouyer, Laurent J; Lorentzen, Jakob; Nielsen, Jens B

2017-12-01

Exaggerated sensory activity has been assumed to contribute to functional impairment following lesion of the central motor pathway. However, recent studies have suggested that sensory contribution to muscle activity during gait is reduced in stroke patients and children with cerebral palsy (CP). We investigated whether this also occurs in CP adults and whether daily treadmill training is accompanied by alterations in sensory contribution to muscle activity. Seventeen adults with CP and 12 uninjured individuals participated. The participants walked on a treadmill while a robotized ankle-foot orthosis applied unload perturbations at the ankle, thereby removing sensory feedback naturally activated during push-off. Reduction of electromyographic (EMG) activity in the soleus muscle caused by unloads was compared and related to kinematics and ankle joint stiffness measurements. Similar measures were obtained after 6 wk of gait training. We found that sensory contribution to soleus EMG activation was reduced in CP adults compared with uninjured adults. The lowest contribution of sensory feedback was found in participants with lowest maximal gait speed. This was related to increased ankle plantar flexor stiffness. Six weeks of gait training did not alter the contribution of sensory feedback. We conclude that exaggerated sensory activity is unlikely to contribute to impaired gait in CP adults, because sensory contribution to muscle activity during gait was reduced compared with in uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory feedback during gait so that a larger part of plantar flexor muscle activity must be generated by descending motor commands. NEW & NOTEWORTHY Findings suggest that adults with cerebral palsy have less contribution of sensory feedback to ongoing soleus muscle activation during push-off than uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory

Characteristics of Lower Leg Muscle Activity in Patients with Cerebral Palsy during Cycling on an Ergometer.

PubMed

Roy, Susmita; Alves-Pinto, Ana; Lampe, Renée

2018-01-01

Cycling on ergometer is often part of rehabilitation programs for patients with cerebral palsy (CP). The present study analyzed activity patterns of individual lower leg muscle during active cycling on ergometer in patients with CP and compared them to similar recordings in healthy participants. Electromyographic (EMG) recordings of lower leg muscle activity were collected from 14 adult patients and 10 adult healthy participants. Activity of the following muscles was recorded: Musculus tibialis anterior, Musculus gastrocnemius, Musculus rectus femoris, and Musculus biceps femoris. Besides qualitative analysis also quantitative analysis of individual muscle activity was performed by computing the coefficient of variation of EMG signal amplitude. More irregular EMG patterns were observed in patients in comparison to healthy participants: agonist-antagonist cocontractions were more frequent, muscle activity measured at specific points of the cycle path was more variable, and dynamic range of muscle activity along the cycle path was narrower in patients. Hypertonicity was also more frequent in patients. Muscle activity patterns during cycling differed substantially across patients. It showed irregular nature and occasional sharp high peaks. Dynamic range was also narrower than in controls. Observations underline the need for individualized cycling training to optimize rehabilitation effects.

Functional Capacity in Adults With Cerebral Palsy: Lower Limb Muscle Strength Matters.

PubMed

Gillett, Jarred G; Lichtwark, Glen A; Boyd, Roslyn N; Barber, Lee A

2018-05-01

To investigate the relation between lower limb muscle strength, passive muscle properties, and functional capacity outcomes in adults with cerebral palsy (CP). Cross-sectional study. Tertiary institution biomechanics laboratory. Adults with spastic-type CP (N=33; mean age, 25y; range, 15-51y; mean body mass, 70.15±21.35kg) who were either Gross Motor Function Classification System (GMFCS) level I (n=20) or level II (n=13). Not applicable. Six-minute walk test (6MWT) distance (m), lateral step-up (LSU) test performance (total repetitions), timed up-stairs (TUS) performance (s), maximum voluntary isometric strength of plantar flexors (PF) and dorsiflexors (DF) (Nm.kg -1 ), and passive ankle joint and muscle stiffness. Maximum isometric PF strength independently explained 61% of variance in 6MWT performance, 57% of variance in LSU test performance, and 50% of variance in TUS test performance. GMFCS level was significantly and independently related to all 3 functional capacity outcomes, and age was retained as a significant independent predictor of LSU and TUS test performance. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not significantly related to functional capacity measures in any of the multiple regression models. Low isometric PF strength was the most important independent variable related to distance walked on the 6MWT, fewer repetitions on the LSU test, and slower TUS test performance. These findings suggest lower isometric muscle strength contributes to the decline in functional capacity in adults with CP. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy

PubMed Central

Gusso, Silmara; Munns, Craig F; Colle, Patrícia; Derraik, José G B; Biggs, Janene B; Cutfield, Wayne S; Hofman, Paul L

2016-01-01

We performed a clinical trial on the effects of whole-body vibration training (WBVT) on muscle function and bone health of adolescents and young adults with cerebral palsy. Forty participants (11.3–20.8 years) with mild to moderate cerebral palsy (GMFCS II–III) underwent 20-week WBVT on a vibration plate for 9 minutes/day 4 times/week at 20 Hz (without controls). Assessments included 6-minute walk test, whole-body DXA, lower leg pQCT scans, and muscle function (force plate). Twenty weeks of WBVT were associated with increased lean mass in the total body (+770 g; p = 0.0003), trunk (+410 g; p = 0.004), and lower limbs (+240 g; p = 0.012). Bone mineral content increased in total body (+48 g; p = 0.0001), lumbar spine (+2.7 g; p = 0.0003), and lower limbs (+13 g; p < 0.0001). Similarly, bone mineral density increased in total body (+0.008 g/cm2; p = 0.013), lumbar spine (+0.014 g/cm2; p = 0.003), and lower limbs (+0.023 g/cm2; p < 0.0001). Participants reduced the time taken to perform the chair test, and improved the distance walked in the 6-minute walk test by 11% and 35% for those with GMFCS II and III, respectively. WBVT was associated with increases in muscle mass and bone mass and density, and improved mobility of adolescents and young adults with cerebral palsy. PMID:26936535

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy.

PubMed

Gusso, Silmara; Munns, Craig F; Colle, Patrícia; Derraik, José G B; Biggs, Janene B; Cutfield, Wayne S; Hofman, Paul L

2016-03-03

We performed a clinical trial on the effects of whole-body vibration training (WBVT) on muscle function and bone health of adolescents and young adults with cerebral palsy. Forty participants (11.3-20.8 years) with mild to moderate cerebral palsy (GMFCS II-III) underwent 20-week WBVT on a vibration plate for 9 minutes/day 4 times/week at 20 Hz (without controls). Assessments included 6-minute walk test, whole-body DXA, lower leg pQCT scans, and muscle function (force plate). Twenty weeks of WBVT were associated with increased lean mass in the total body (+770 g; p = 0.0003), trunk (+410 g; p = 0.004), and lower limbs (+240 g; p = 0.012). Bone mineral content increased in total body (+48 g; p = 0.0001), lumbar spine (+2.7 g; p = 0.0003), and lower limbs (+13 g; p < 0.0001). Similarly, bone mineral density increased in total body (+0.008 g/cm(2); p = 0.013), lumbar spine (+0.014 g/cm(2); p = 0.003), and lower limbs (+0.023 g/cm(2); p < 0.0001). Participants reduced the time taken to perform the chair test, and improved the distance walked in the 6-minute walk test by 11% and 35% for those with GMFCS II and III, respectively. WBVT was associated with increases in muscle mass and bone mass and density, and improved mobility of adolescents and young adults with cerebral palsy.

Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy

ERIC Educational Resources Information Center

Hong, Wei-Hsien; Chen, Hseih-Ching; Shen, I-Hsuan; Chen, Chung-Yao; Chen, Chia-Ling; Chung, Chia-Ying

2012-01-01

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n =…

Contributions of muscle imbalance and impaired growth to postural and osseous shoulder deformity following brachial plexus birth palsy: a computational simulation analysis.

PubMed

Cheng, Wei; Cornwall, Roger; Crouch, Dustin L; Li, Zhongyu; Saul, Katherine R

2015-06-01

Two potential mechanisms leading to postural and osseous shoulder deformity after brachial plexus birth palsy are muscle imbalance between functioning internal rotators and paralyzed external rotators and impaired longitudinal growth of paralyzed muscles. Our goal was to evaluate the combined and isolated effects of these 2 mechanisms on transverse plane shoulder forces using a computational model of C5-6 brachial plexus injury. We modeled a C5-6 injury using a computational musculoskeletal upper limb model. Muscles expected to be denervated by C5-6 injury were classified as affected, with the remaining shoulder muscles classified as unaffected. To model muscle imbalance, affected muscles were given no resting tone whereas unaffected muscles were given resting tone at 30% of maximal activation. To model impaired growth, affected muscles were reduced in length by 30% compared with normal whereas unaffected muscles remained normal in length. Four scenarios were simulated: normal, muscle imbalance only, impaired growth only, and both muscle imbalance and impaired growth. Passive shoulder rotation range of motion and glenohumeral joint reaction forces were evaluated to assess postural and osseous deformity. All impaired scenarios exhibited restricted range of motion and increased and posteriorly directed compressive glenohumeral joint forces. Individually, impaired muscle growth caused worse restriction in range of motion and higher and more posteriorly directed glenohumeral forces than did muscle imbalance. Combined muscle imbalance and impaired growth caused the most restricted joint range of motion and the highest joint reaction force of all scenarios. Both muscle imbalance and impaired longitudinal growth contributed to range of motion and force changes consistent with clinically observed deformity, although the most substantial effects resulted from impaired muscle growth. Simulations suggest that treatment strategies emphasizing treatment of impaired longitudinal

Research on the performance of the spastic calf muscle of young adults with cerebral palsy.

PubMed

Lampe, Renee; Mitternacht, Jurgen

2011-02-12

The aim of this study was to find an objective graduation of pes equinus in infantile cerebral palsy, especially with regard to functional aspects, to allow a differentiated choice of the therapeutic options. Very often raises the question of whether a surgical lengthening of the Achilles tendon may let expect a functional improvement. For this documentation 17 patients with pes equinus and a diagnosis of spastic cerebral palsy, primarily of the lower limbs, and hemiplegia were examined first clinically and then by a procedure for calculating the functional kinetic parameters from an in-shoe plantar pressure distribution measurement (novel pedar-X system), which is used in many orthopedic practices and clinics as a standard measuring device. Using additional video motion analysis, the flexion in the ankle joint and the ankle joint torque were determined. From this the physical performance of the spastically shortened calf muscle was calculated. The course of the curves of torque and joint performance allows a functional classification of the pes equinus. Approximately three quarters of all pes equinus demonstrated functional activity of the most part of the normal push-off propulsion power. Even the rigid pes equinus was capable of performing push-off propulsion work, provided it converted energy that was absorbed during the heel-strike phase and released it again during the push-off phase. This suggests that the function of paretic ankle joint is better than its kinematics of motion. A heel strike with a pes equinus triggers via stretching stimuli in the muscle-ligament structure reflex motor functions, thereby causing the typical spastic gait pattern. This remarkable gait pattern is often evaluated as dysfunctional and as absolutely requiring correction. However, an aspect possibly neglected in this instance is the fact that this gait pattern may be efficient for the patient and may in fact be a suitable means allowing for economic locomotion despite the cerebral

Managing Bell's palsy.

PubMed

2006-07-01

Each year in the UK, around 1 in 5,000 people develop Bell's palsy--a unilateral lower motor neurone facial weakness of rapid onset that can be physically and psychologically disabling. While around 71% of patients recover normal function of the facial muscles without treatment, 13% are left with slight weakness and 16% with moderate to severe weakness resulting in major facial dysfunction. People who recover usually do so quickly, with 85% of them reporting some improvement in the first 3 weeks. There is longstanding controversy about what, if any, treatment should be initiated for Bell's palsy. Here we discuss the management of patients with this condition.

Pretreatment Hematologic Findings as Novel Predictive Markers for Facial Palsy Prognosis.

PubMed

Wasano, Koichiro; Kawasaki, Taiji; Yamamoto, Sayuri; Tomisato, Shuta; Shinden, Seiichi; Ishikawa, Toru; Minami, Shujiro; Wakabayashi, Takeshi; Ogawa, Kaoru

2016-10-01

To examine the relationship between prognosis of 2 different facial palsies and pretreatment hematologic laboratory values. Multicenter case series with chart review. Three tertiary care hospitals. We examined the clinical records of 468 facial palsy patients who were treated with an antiviral drug in combination with either oral or intravenous corticosteroids in participating hospitals between 2010 and 2014. Patients were divided into a Bell's palsy group or a Hunt's palsy group. We used the Yanagihara facial nerve grading system to grade the severity of facial palsy. "Recovery" from facial palsy was defined as achieving a Yanagihara score ≥36 points within 6 months of onset and having no accompanying facial contracture or synkinesis. We collected information about pretreatment hematologic findings, demographic data, and electrophysiologic test results of the Bell and Hunt group patients who recovered and those who did not. We then compared these data across the 2 palsy groups. In the Bell's palsy group, recovered and unrecovered patients differed significantly in age, sex, electroneuronography score, stapedial muscle reflex, neutrophil rate, lymphocyte rate, neutrophil-to-lymphocyte ratio, and initial Yanagihara score. In the Hunt's palsy group, recovered and unrecovered patients differed in age, electroneuronography score, stapedial muscle reflex, monocyte rate, platelet count, mean corpuscular volume, and initial Yanagihara score. Pretreatment hematologic findings, which reflect the severity of inflammation and bone marrow dysfunction caused by a virus infection, are useful for predicting the prognosis of facial palsy. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Double Elevator Palsy, Subtypes and Outcomes of Surgery

PubMed Central

Bagheri, Abbas; Sahebghalam, Ramin; Abrishami, Mohammad

2008-01-01

Purpose To describe the clinical manifestations of subtypes of double elevator palsy and to report the outcomes of surgery in these patients. Methods This retrospective study was conducted on hospital records of patients with double elevator palsy at Labbafinejad Medical Center over a ten-year period from 1994 to 2004. Patients were classified into three subgroups of primary elevator muscle palsy (9 subjects), primary supranuclear palsy with secondary inferior rectus restriction (4 subjects) and pure inferior rectus restriction (7 subjects) according to forced duction test (FDT), force generation test (FGT) and Bell’s reflex. Patients in the first group underwent Knapp procedure, the second group received Knapp procedure and inferior rectus recession simultaneously and in the third group vertical recess-resect or mere inferior rectus recess operation was performed. Success was defined as final residual deviation ≤5 PD and ≥25% improvement in restriction after all operations. Results Overall 20 subjects including 10 male and 10 female patients with mean age of 12.6±9.3 (range 1.5–32) years were operated during the mentioned period which included 9 cases of primary elevator muscle palsy, 4 patients with primary supranuclear palsy and secondary inferior rectus restriction, and 7 subjects with pure inferior rectus restriction. Mean follow-up was 22.0±20.0 (range 3–63.5) months. Mean pre and postoperative deviation was 32.0±8.0 PD and 3.8±8.0 PD (P<0.001) respectively, and mean restriction before and after the operation(s) was −3.5±0.7 and −2.3±1.2 (P<0.001), respectively. Success rate was 77% for correction of deviation and 80% for improvement in muscle restriction. Conclusion Surgery for double elevator palsy must be individualized according to FDT, FGT and Bell’s reflex. The outcomes are favorable with appropriate surgical planning. PMID:23479532

Loss of myogenic potential and fusion capacity of muscle stem cells isolated from contractured muscle in children with cerebral palsy.

PubMed

Domenighetti, Andrea A; Mathewson, Margie A; Pichika, Rajeswari; Sibley, Lydia A; Zhao, Leyna; Chambers, Henry G; Lieber, Richard L

2018-04-25

Cerebral palsy (CP) is the most common cause of pediatric neurodevelopmental and physical disability in the United States. It is defined as a group of motor disorders caused by a non-progressive perinatal insult to the brain. While the brain lesion is non-progressive, there is a progressive, lifelong impact on skeletal muscles, which are shorter, spastic, and may develop debilitating contractures. Satellite cells are resident muscle stem cells that are indispensable for postnatal growth and regeneration of skeletal muscles. Here we measured the myogenic potential of satellite cells isolated from contractured muscles in children with CP. When compared to typically developing (TD) children, satellite cell-derived myoblasts from CP differentiated more slowly (Slope: 0.013{plus minus}0.013 CP vs. 0.091{plus minus}0.024 TD over 24 hours, P<0.001) and fused less (Fusion Index: 21.3{plus minus}8.6 CP vs. 81.3{plus minus}7.7 TD after 48 hours, P<0.001) after exposure to low-serum conditions that stimulated myotube formation. This impairment was associated with downregulation of several markers important for myoblast fusion and myotube formation, including DNA methylation-dependent inhibition of pro-myogenic Integrin Beta 1D (ITGB1D) protein expression levels (-50% at 42 hours), and ~25% loss of integrin-mediated FAK kinase phosphorylation. The cytidine analog 5-Azacytidine (5-AZA), a demethylating agent, restored ITGB1D levels and promoted myogenesis in CP cultures. Our data demonstrate that muscle contractures in CP are associated with loss of satellite cell myogenic potential that is dependent on DNA methylation patterns affecting expression of genetic programs associated with muscle stem cell differentiation and muscle fiber formation.

Managing Lower Extremity Muscle Tone and Function in Children with Cerebral Palsy via Eight-Week Repetitive Passive Knee Movement Intervention

ERIC Educational Resources Information Center

Cheng, Hsin-Yi Kathy; Ju, Yan-Ying; Chen, Chia-Ling; Chang, Ya-Ju; Wong, Alice May-Kuen

2013-01-01

This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 [plus or minus] 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3…

The functional muscle-bone unit in children with cerebral palsy.

PubMed

Duran, I; Schütz, F; Hamacher, S; Semler, O; Stark, C; Schulze, J; Rittweger, J; Schoenau, E

2017-07-01

Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using only age- and height-adjusted bone mineral content (BMC) and areal bone mineral density (aBMD). When applying the functional muscle-bone unit diagnostic algorithm (FMBU-A), the prevalence of positive results decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP. The prevalence of bone health deficits in children with cerebral palsy (CP) might be overestimated because age- and height-adjusted reference percentiles for bone mineral content (BMC) and areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry (DXA) do not consider reduced muscle activity. The aim of this study was to compare the prevalence of positive DXA-based indicators for bone health deficits in children with CP to the prevalence of positive findings after applying a functional muscle-bone unit diagnostic algorithm (FMBU-A) considering reduced muscle activity. The present study was a monocentric retrospective analysis of 297 whole body DXA scans of children with CP. The prevalence of positive results of age- and height-adjusted BMC and aBMD defined as BMC and aBMD below the P3 percentile and of the FMBU-A was calculated. In children with CP, the prevalence of positive results of age-adjusted BMC were 33.3% and of aBMD 50.8%. Height-adjusted results for BMC and aBMD were positive in 16.8 and 36.0% of cases. The prevalence of positive results applying the FMBU-A regarding BMC and aBMD were significantly (p < 0.001) lower than using age- and height-adjusted BMC and aBMD (8.8 and 14.8%). Our results suggest that the prevalence of bone health deficits in children with CP was overestimated, when using age- and height-adjusted BMC and aBMD. When applying the FMBU-A, the prevalence decreased significantly. We recommend applying the FMBU-A when assessing bone health in children with CP.

Inferior Oblique Overaction: Anterior Transposition Versus Myectomy.

PubMed

Rajavi, Zhale; Feizi, Mohadeseh; Behradfar, Narges; Yaseri, Mehdi; Sayanjali, Shima; Motevaseli, Tahmine; Sabbaghi, Hamideh; Faghihi, Mohammad

2017-07-01

To compare the efficacy of inferior oblique myectomy and anterior transposition for correcting inferior oblique overaction (IOOA). This retrospective study was conducted on 56 patients with IOOA who had either myectomy or anterior transposition of the inferior oblique muscle from 2010 to 2015. The authors compared preoperative and postoperative inferior oblique muscle function grading (-4 to +4) as the main outcome measure and vertical and horizontal deviation, dissociated vertical deviation (DVD), and A- and V-pattern between the two surgical groups as secondary outcomes. A total of 99 eyes of 56 patients with a mean age of 5.9 ± 6.5 years were included (47 eyes in the myectomy group and 52 eyes in the anterior transposition group). There were no differences in preoperative best corrected visual acuity, amblyopia, spherical equivalent, and primary versus secondary IOOA between the two groups. Both surgical procedures were effective in reducing IOOA and satisfactory results were similar between the two groups: 61.7% and 67.3% in the myectomy and anterior transposition groups, respectively (P = .56). After adjustment for the preoperative DVD, there was no statistically significant difference between the two groups postoperatively. The preoperative hypertropia was 6 to 14 and 6 to 18 prism diopters (PD) in the myectomy and anterior transposition groups, respectively. After surgery, no patient had a vertical deviation greater than 5 PD. Both the inferior oblique myectomy and anterior transposition procedures are effective in reducing IOOA with similar satisfactory results. DVD and hypertropia were also corrected similarly by these two surgical procedures. [J Pediatr Ophthalmol Strabismus. 2017;54(4):232-237.]. Copyright 2017, SLACK Incorporated.

Core Muscle Activation in Suspension Training Exercises.

PubMed

Cugliari, Giovanni; Boccia, Gennaro

2017-02-01

A quantitative observational laboratory study was conducted to characterize and classify core training exercises executed in a suspension modality on the base of muscle activation. In a prospective single-group repeated measures design, seventeen active male participants performed four suspension exercises typically associated with core training (roll-out, bodysaw, pike and knee-tuck). Surface electromyographic signals were recorded from lower and upper parts of rectus abdominis, external oblique, internal oblique, lower and upper parts of erector spinae muscles using concentric bipolar electrodes. The average rectified values of electromyographic signals were normalized with respect to individual maximum voluntary isometric contraction of each muscle. Roll-out exercise showed the highest activation of rectus abdominis and oblique muscles compared to the other exercises. The rectus abdominis and external oblique reached an activation higher than 60% of the maximal voluntary contraction (or very close to that threshold, 55%) in roll-out and bodysaw exercises. Findings from this study allow the selection of suspension core training exercises on the basis of quantitative information about the activation of muscles of interest. Roll-out and bodysaw exercises can be considered as suitable for strength training of rectus abdominis and external oblique muscles.

To What Extent Is Mean EMG Frequency during Gait a Reflection of Functional Muscle Strength in Children with Cerebral Palsy?

ERIC Educational Resources Information Center

Van Gestel, L.; Wambacq, H.; Aertbelien, E.; Meyns, P.; Bruyninckx, H.; Bar-On, L.; Molenaers, G.; De Cock, P.; Desloovere, K.

2012-01-01

The aim of the current paper was to analyze the potential of the mean EMG frequency, recorded during 3D gait analysis (3DGA), for the evaluation of functional muscle strength in children with cerebral palsy (CP). As walking velocity is known to also influence EMG frequency, it was investigated to which extent the mean EMG frequency is a reflection…

Graded versus ungraded inferior oblique anterior transposition in patients with asymmetric dissociated vertical deviation.

PubMed

Rajavi, Zhale; Feizi, Mohadeseh; Naderi, Ali; Sabbaghi, Hamideh; Behradfar, Narges; Yaseri, Mehdi; Faghihi, Mohammad

2017-12-01

To report the surgical outcomes of graded versus ungraded inferior oblique anterior transposition (IOAT) in treatment of patients with asymmetric dissociated vertical deviation (DVD) and bilateral inferior oblique overaction (IOOA). A total of 74 eyes of 37 patients with asymmetric DVD (interocular difference of ≥5 Δ ) and bilateral IOOA of > +1 were included in this randomized clinical trial. In the ungraded group (n = 18), both inferior oblique muscles were sutured at the inferior rectus level; in the graded group (n = 19), the inferior oblique muscles of eyes with more DVD were sutured at the level of the inferior rectus and inferior oblique muscles of eyes with less DVD were sutured 2 mm posterior to the level of the inferior rectus muscle. DVD was significantly reduced in each group (P < 0.001 for both). Although the postoperative mean difference of asymmetry of DVD was less in the ungraded group compared to the graded group (1.2 ± 1.9 vs 3.2 ± 1.2 [P = 0.001]), the absolute amounts of reduction of DVD asymmetry were similar (4.3 ± 2.3 vs 4.4 ± 3.1 [P = 0.78]). IOOA and V patterns were also reduced postoperatively. Each method of IOAT was effective in reducing DVD, asymmetry, IOOA, and V patterns. Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

The effects of surgical lengthening of hamstring muscles in children with cerebral palsy--the consequences of pre-operative muscle length measurement.

PubMed

Laracca, Ettore; Stewart, Caroline; Postans, Neil; Roberts, Andrew

2014-03-01

Children with cerebral palsy often undergo multiple orthopaedic surgical procedures in a single episode. Evidence of the effectiveness of individual components within the overall package is sparse. The introduction of musculoskeletal modelling in Oswestry has led to a more conservative management approach being taken with hamstring muscles for children walking in a degree of crouch. Muscles which were shown to be of at least normal length at initial contact were not surgically lengthened, as would have been the case previously. A retrospective review of 30 such patients was therefore possible, comparing 15 patients treated before the policy change who had their hamstrings lengthened with 15 treated after who did not. All patients had pre and post operative gait assessments and significant changes were observed for each group separately and for the two groups when compared. The comparison revealed that preserving the hamstrings does tend to reduce, and therefore normalize, the dynamic muscle length. Examination of the two patient groups separately, however, reveals a more complex picture with more global gait improvements seen when the hamstrings were lengthened. No absolute recommendation can be made to inform the clinical management of all children with normal to long hamstring muscles during gait. The final decision of whether to include a hamstring lengthening will need to take into account the characteristics of the individual child. Copyright © 2013 Elsevier B.V. All rights reserved.

Acupuncture treatment of facial palsy.

PubMed

Bokhari, Syed Zahid Hussain; Zahid, Syeda Samina

2010-01-01

Bell's palsy is an idiopathic, acute peripheral-nerve palsy involving the facial nerve which supplies all the muscles of facial expression. This study was conducted to evaluate the effects of electro-A=acupuncture on patients with facial palsy. This study was conducted on patients with facial palsy at a private clinic at Peshawar during 1999-2009, and 49 cases were included in the study. All those cases that were within first two weeks of illness or who had related history of stroke or they had upper motor neuron lesion were not included in the study. Electroacupuncture was used as the main therapeutic technique to treat these cases. Patients were subjected to acupuncture treatment at four major points on the face for 20-25 minutes everyday for 10 days. Specific points were used for nasolabial fold and watering of the eye. After rest for a week patients were again evaluated and another course of treatment comprising of 5-10 days was sufficient in most cases. Frequency of electro-acupuncture is kept at 60-80 cycles per minute. Total number of patients studied was 49 with duration of illness as early as 3 weeks to a year and above. Cases with duration of illness from 3 weeks onward showed rapid recovery of palsy symptoms with electro-acupuncture. All cases showed recovery. Palsy of the angle of the mouth did not recover completely. Electro-acupuncture is effective in treating facial palsy cases.

Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy.

PubMed

Dallmeijer, A J; Baker, R; Dodd, K J; Taylor, N F

2011-03-01

The purpose of this study was to determine the association between isometric muscle strength of the lower limbs and gait joint kinetics in adolescents and young adults with cerebral palsy (CP). Twenty-five participants (11 males) with bilateral spastic CP, aged 14-22 years (mean: 18.9, sd: 2.0 yr) and Gross Motor Function Classification System (GMFCS) level II (n=19) and III (n=6) were tested. Hand held dynamometry was used to measure isometric strength (expressed in Nm/kg) of the hip, knee, and ankle muscles using standardized testing positions and procedures. 3D gait analysis was performed with a VICON system to calculate joint kinetics in the hip, knee and ankle during gait. Ankle peak moments exceeded by far the levels of isometric strength of the plantar flexors, while the knee and hip peak moments were just at or below maximal isometric strength of knee and hip muscles. Isometric muscle strength showed weak to moderate correlations with peak ankle and hip extension moment and power during walking. Despite considerable muscle weakness, joint moment curves were similar to norm values. Results suggest that passive stretch of the muscle-tendon complex of the triceps surae contributes to the ankle moment during walking and that muscle strength assessment may provide additional information to gait kinetics. Copyright © 2010 Elsevier B.V. All rights reserved.

Bell's Palsy as a Possible Complication of Hepatitis B Vaccination in A Child

PubMed Central

Tan, Hüseyin; Orbak, Zerrin

2009-01-01

Bell's Palsy is the sudden onset of unilateral temporary paralysis of facial muscles resulting from seventh cranial nerve dysfunction. Presented here is a two-year old female patient with right peripheral facial palsy following hepatitis B vaccination. Readers’ attention is drawn to an uncommon cause of Bell's Palsy, as a rare complication of hepatitis B vaccination. PMID:19902808

Muscle synergies and complexity of neuromuscular control during gait in cerebral palsy.

PubMed

Steele, Katherine M; Rozumalski, Adam; Schwartz, Michael H

2015-12-01

Individuals with cerebral palsy (CP) have impaired movement due to a brain injury near birth. Understanding how neuromuscular control is altered in CP can provide insight into pathological movement. We sought to determine if individuals with CP demonstrate reduced complexity of neuromuscular control during gait compared with unimpaired individuals and if changes in control are related to functional ability. Muscle synergies during gait were retrospectively analyzed for 633 individuals (age range 3.9-70y): 549 with CP (hemiplegia, n=122; diplegia, n=266; triplegia, n=73; quadriplegia, n=88) and 84 unimpaired individuals. Synergies were calculated using non-negative matrix factorization from surface electromyography collected during previous clinical gait analyses. Synergy complexity during gait was compared with diagnosis subtype, functional ability, and clinical examination measures. Fewer synergies were required to describe muscle activity during gait in individuals with CP compared with unimpaired individuals. Changes in synergies were related to functional impairment and clinical examination measures including selective motor control, strength, and spasticity. Individuals with CP use a simplified control strategy during gait compared with unimpaired individuals. These results were similar to synergies during walking among adult stroke survivors, suggesting similar neuromuscular control strategies between these clinical populations. © 2015 Mac Keith Press.

The history of facial palsy and spasm

PubMed Central

Sajadi, Mohamad-Reza M.; Tabatabaie, Seyed Mahmoud

2011-01-01

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. PMID:21747074

Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study.

PubMed

Martín Lorenzo, Teresa; Rocon, Eduardo; Martínez Caballero, Ignacio; Lerma Lara, Sergio

2018-05-01

To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.

Effects of squats accompanied by hip joint adduction on the selective activity of the vastus medialis oblique.

PubMed

Hyong, In Hyouk

2015-06-01

[Purpose] This study evaluated the effective selective activation method of the vastus medialis oblique for knee joint stabilization in patients with patellofemoral pain syndrome. [Subjects and Methods] Fifteen healthy college students (9 males, 6 females); mean age, height, and weight: 22.2 years, 167.8 cm, and 61.4 kg, respectively) participated. The knee angle was held at 60°. Muscle activities were measured once each during an ordinary squat and a squat accompanied by hip joint adduction. The muscle activities of the vastus medialis oblique and vastus lateralis were measured by electromyography for five seconds while maintaining 60° knee flexion. Electromyography signals were obtained at a sampling rate of 1,000 Hz and band pass filtering at 20-50 Hz. The obtained raw root mean square was divided by the maximal voluntary isometric contraction and expressed as a percentage. The selective activity of the vastus medialis oblique was assessed according to the muscle activity ratio of the vastus medialis oblique to the vastus lateralis. [Results] The activity ratio of the vastus medialis oblique was higher during a squat with hip joint adduction than without. [Conclusion] A squat accompanied by hip joint adduction is effective for the selective activation of the vastus medialis oblique.

Relationships of muscle strength and bone mineral density in ambulatory children with cerebral palsy.

PubMed

Chen, C-L; Lin, K-C; Wu, C-Y; Ke, J-Y; Wang, C-J; Chen, C-Y

2012-02-01

This work explores the relationships of muscle strength and areal bone mineral density (aBMD) in ambulatory children with cerebral palsy (CP). The knee extensor strength, but not motor function, was related to aBMD. Thus, muscle strength, especially antigravity muscle strength, was more associated with aBMD in these children than motor function. Muscle strength is related to bone density in normal children. However, no studies have examined these relationships in ambulatory children with CP. This work explores the relationships of muscle strength and aBMD in ambulatory children with CP. Forty-eight ambulatory children with spastic CP, aged 5-15 years, were classified into two groups based on Gross Motor Function Classification System levels: I (n = 28) and II (n = 20). Another 31 normal development (ND) children were recruited as the comparison group for the aBMD. Children with CP underwent assessments of growth, lumbar and distal femur aBMD, Gross Motor Function Measure-66 (GMFM-66), and muscle strength of knee extensor and flexor by isokinetic dynamometer. The distal femur aBMD, but not lumbar aBMD, was lower in children with CP than in ND children (p < 0.05). Children with level I had greater knee flexor strength and GMFM-66 scores than those with level II (p < 0.001). However, the knee extensor strength and distal femur and lumbar aBMD did not differ between two groups. Regression analysis revealed the weight and knee extensor strength, but not GMFM-66 scores, were related positively to the distal femur and lumbar aBMD (adjusted r (2) = 0.56-0.65, p < 0.001). These results suggest the muscle strength, especially antigravity muscle strength, were more associated with the bone density of ambulatory children with CP than motor function. The data may allow clinicians for early identifying the ambulatory CP children of potential low bone density.

Usefulness of BFB/EMG in facial palsy rehabilitation.

PubMed

Dalla Toffola, Elena; Bossi, Daniela; Buonocore, Michelangelo; Montomoli, Cristina; Petrucci, Lucia; Alfonsi, Enrico

2005-07-22

To analyze and to compare the recovery and the development of synkinesis in patients with idiopathic facial palsy (Bell's palsy) following treatment with two methods of rehabilitation, kinesitherapy (KT) and biofeedback/EMG (BFB/EMG). Retrospective cases--series review. Seventy-four patients with Bell' palsy were clinically evaluated within 1 month from onset of palsy and at 12 months after palsy (House scale and synkinesis evaluation). Electromyography (EMG) and Electroneurography (ENG) were performed about 4 weeks after palsy to better evaluate functional abnormalities due to facial nerve lesion. The patients followed two different protocols for rehabilitation: the first 32 patients were treated with therapeutic exercises performed by therapists (KT group), the latter 42 patients were treated using BFB/EMG methods (BFB group) with inhibition of synkinetic movement as the primary goal. KT and BFB patients were evaluated for clinical and neurophysiological characteristics before rehabilitative treatment. BFB patients showed better clinical recovery and minor synkinesis than KT patients. BFB/EMG seems to be more useful than KT in Bell's palsy treatment. This could be due to the fact that BFB/EMG gives more accurate information than KT on muscle activation with better modulation in voluntary recruitment of motor unit.

Role of electrical stimulation added to conventional therapy in patients with idiopathic facial (Bell) palsy.

PubMed

Tuncay, Figen; Borman, Pinar; Taşer, Burcu; Ünlü, İlhan; Samim, Erdal

2015-03-01

The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy. This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles. Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1. The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at

Effects of interactive games on motor performance in children with spastic cerebral palsy

PubMed Central

AlSaif, Amer A.; Alsenany, Samira

2015-01-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy. PMID:26180367

Effects of interactive games on motor performance in children with spastic cerebral palsy.

PubMed

AlSaif, Amer A; Alsenany, Samira

2015-06-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6-10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.

Measurement of superficial and deep abdominal muscle thickness: an ultrasonography study.

PubMed

Tahan, Nahid; Khademi-Kalantari, Khosro; Mohseni-Bandpei, Mohammad Ali; Mikaili, Saeed; Baghban, Alireza Akbarzadeh; Jaberzadeh, Shapour

2016-08-23

Real-time ultrasound imaging is a valid method in the field of rehabilitation. The ultrasound imaging allows direct visualization for real-time study of the muscles as they contract over the time. Measuring of the size of each abdominal muscle in relation to the others provides useful information about the differences in structure, as well as data on trunk muscle activation patterns. The purpose of this study was to assess the size and symmetry of the abdominal muscles at rest in healthy adults and to provide a reference range of absolute abdominal muscle size in a relatively large population. A total 156 healthy subjects with the age range of 18-44 years were randomly recruited. The thickness of internal oblique, external oblique, transverse abdominis, and rectus abdominis muscles was measured at rest on both right and left sides using ultrasound. Independent t test was used to compare the mean thickness of each abdominal muscle between males and females. Differences on side-to-side thicknesses were assessed using paired t test. The association between abdominal muscle thicknesses with gender and anthropometric variables was examined using the Pearson correlation coefficient. A normal pattern of increasing order of mean abdominal muscle thickness was found in both genders at both right and left sides: transverse abdominis < external oblique < internal oblique < rectus abdominis. There was a significant difference on the size of transverse abdominis, internal oblique, and external oblique muscles between right and left sides in both genders. Males had significantly thicker abdominal muscles than females. Age was significantly correlated with the thickness of internal oblique, external oblique, and rectus abdominis muscles. Body mass index was also positively correlated with muscle thickness of rectus abdominis and external oblique. The results provide a normal reference range for the abdominal muscles in healthy subjects and may be used as an index to

EMG and mechanical changes during sprint starts at different front block obliquities.

PubMed

Guissard, N; Duchateau, J; Hainaut, K

1992-11-01

The effect of decreased front block obliquity on start velocity was studied during sprint starts. The electromyographic (EMG) activity of the medial gastrocnemius (MG), the soleus (Sol), and the vastus medialis (VM) was recorded and analyzed at a 70 degrees, a 50 degrees, and a 30 degrees angle between the foot plate surface and the horizontal. Integrated EMGs (IEMG) were compared with muscle length changes in the MG and Sol in relation to foot and knee movements. The results indicate that decreasing front block obliquity significantly (P < 0.05) increases the start velocity without any change to the total duration of the pushing phase and the overall EMG activity. This improvement in sprint start performance is associated with the enhanced contribution of the MG during eccentric and concentric phases of calf muscles contraction. In the "set position" the initial length of MG and Sol is increased at 50 degrees and 30 degrees as compared with 70 degrees. The subsequent stretch-shortening cycle is improved and contributes more effectively to the speed of the muscle shortening. Moreover, lengthening these muscles during the eccentric phase stretches the muscle spindles, and the reflex activities that contribute to the observed increase in the MG IEMG, are present when the slope of the block is reduced. The results indicate that decreasing front block obliquity induces neural and mechanical modifications that contribute to increasing the sprint start velocity without any increase in the duration of the pushing phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Recovery from Bell Palsy after Transplantation of Peripheral Blood Mononuclear Cells and Platelet-Rich Plasma.

PubMed

Seffer, Istvan; Nemeth, Zoltan

2017-06-01

Peripheral blood mononuclear cells (PBMCs) are multipotent, and plasma contains growth factors involving tissue regeneration. We hypothesized that transplantation of PBMC-plasma will promote the recovery of paralyzed facial muscles in Bell palsy. This case report describes the effects of PBMC-plasma transplantations in a 27-year-old female patient with right side Bell palsy. On the affected side of the face, the treatment resulted in both morphological and functional recovery including voluntary facial movements. These findings suggest that PBMC-plasma has the capacity of facial muscle regeneration and provides a promising treatment strategy for patients suffering from Bell palsy or other neuromuscular disorders.

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

PubMed

Nowak, Dennis A; Linder, Stefan; Topka, Helge

2005-09-01

Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

Relationship between abdominal and pelvic floor muscle activation and intravaginal pressure during pelvic floor muscle contractions in healthy continent women.

PubMed

Madill, Stéphanie J; McLean, Linda

2006-01-01

Activation of the abdominal muscles might contribute to the generation of a strong pelvic floor muscle contraction, and consequently may contribute to the continence mechanism in women. The purpose of this study was to determine the abdominal muscle activation levels and the patterns of muscle activity associated with voluntary pelvic floor muscle (PFM) contractions in urinary continent women. Fifteen healthy continent women participated. They performed three maximal contractions of each of the four abdominal muscles and of their PFMs while in supine. Abdominal and PFM activity was recorded using electromyography (EMG), and intravaginal pressure was recorded using a custom modified Femiscan probe. During voluntary maximal PFM contractions, rectus abdominus was activated to 9.61 (+/-7.42)% maximal voluntary electrical activity (MVE), transversus abdominus was activated to 224.30(+/-47.4)% MVE, the external obliques were activated to 18.72(+/-13.33)% MVE, and the internal obliques were activated to 81.47(+/-63.57)% MVE. A clear pattern of activation emerged, whereby the transversus abdominus, internal oblique, and rectus abdominus muscles worked with the PFM in the initial generation of maximal intravaginal pressure. PFM activity predominated in the initial rise in lower vaginal pressure, with later increases in pressure (up to 70% maximum pressure) being associated with the combined activation of the PFM, rectus abdominus, internal obliques, and transverses abdominus. These abdominal muscles were the primary source of intravaginal pressure increases in the latter 30% of the task, whereas there was little increase in PFM activation from this point on. The external oblique muscles showed no clear pattern of activity, but worked at approximately 20% MVE throughout the PFM contractions, suggesting that their role may be predominantly in postural setting prior to the initiation of intravaginal pressure increases. Defined patterns of abdominal muscle activity were found

Body mass index in ambulatory cerebral palsy patients.

PubMed

Feeley, Brian T; Gollapudi, Kiran; Otsuka, Norman Y

2007-05-01

Malnutrition is a common problem in children with cerebral palsy. Although malnutrition is often recognized in patients with severe cerebral palsy, it can be unrecognized in less severely affected patients. The consequences of malnutrition are serious, and include decreased muscle strength, poor immune status, and depressed cerebral functioning. Low body mass index has been used as a marker for malnutrition. The purpose of this study was to determine which patients in an ambulatory cerebral palsy patient population were at risk for low body mass index. A retrospective chart review was performed on 75 patients. Age, sex, height, weight, type of cerebral palsy, and functional status [gross motor functional classification system (GMFCS) level] was recorded from the chart. Descriptive statistics with bivariate and multivariate regression analyses were performed. Thirty-eight boys and 37 girls with an average age of 8.11 years were included in the study. Unique to our patient population, all cerebral palsy patients were independent ambulators. Patients with quadriplegic cerebral palsy had a significantly lower body mass index than those with diplegic and hemiplegic cerebral palsy. Patients with a GMFCS III had significantly lower body mass index than those with GMFCS I and II. When multivariate regression analysis to control for age and sex was performed, low body mass index remained associated with quadriplegic cerebral palsy and GMFCS III. Malnutrition is a common health problem in patients with cerebral palsy, leading to significant morbidity in multiple organ systems. We found that in an ambulatory cerebral palsy population, patients with lower functional status or quadriplegia had significantly lower body mass index, suggesting that even highly functioning ambulatory cerebral palsy patients are at risk for malnutrition.

Assessment of muscle endurance of the knee extensor muscles in adolescents with spastic cerebral palsy using a submaximal repetitions-to-fatigue protocol.

PubMed

Eken, Maaike M; Dallmeijer, Annet J; Doorenbosch, Caroline A; Dekkers, Hurnet; Becher, Jules G; Houdijk, Han

2014-10-01

To compare muscle endurance in adolescents with spastic cerebral palsy (CP) with typically developing (TD) peers using a submaximal repetitions-to-fatigue (RTF) protocol. Cross sectional. Human motion laboratory. Adolescents with spastic CP (n=16; Gross Motor Function Classification System levels I or II) and TD adolescents (n=18) within the age range of 12 to 19 years old. Not applicable. Each participant performed 3 RTF tests at different submaximal loads, ranging from 50% to 90% of their maximal voluntary knee extension torque. The relation between the number of repetitions (repetition maximum [RM]) and imposed submaximal relative (percent of maximal voluntary torque [%MVT]) and absolute (Nm/kg) torque was quantified. To compare adolescents with CP with TD adolescents, a mixed linear model was used to construct load endurance curves. Surface electromyography of quadriceps muscles was measured to assess changes in normalized amplitude and median frequency (MF) as physiological indicators of muscle fatigue. Adolescents with CP showed a larger decrease in %MVT per RM than TD adolescents (P<.05). TD adolescents showed substantial higher absolute (Nm/kg) load endurance curves than adolescents with CP (P<.001), but they did not show a difference in slope. Electromyographic normalized amplitude increased significantly (P<.05) in the quadriceps muscles in all tests for both groups. Electromyographic MF decreased significantly (P<.05) in tests with the low and medium loads. Electromyographic responses did not differ between groups, indicating that similar levels of muscle fatigue were reached. Adolescents with CP show slightly lower muscle endurance compared with TD adolescents on a submaximal RTF protocol, which is in contrast with earlier findings in a maximal voluntary fatigue protocol. Accordingly, adolescents with CP have a reduced capacity to endure activities at similar relative loads compared with TD adolescents. Copyright © 2014 American Congress of

Trunk extensor muscle fatigue influences trunk muscle activities.

PubMed

Hoseinpoor, Tahere Seyed; Kahrizi, Sedighe; Mobini, Bahram

2015-01-01

Trunk muscles fatigue is one of the risk factors in workplaces and daily activities. Loads would be redistributed among active and passive tissues in a non-optimal manner in fatigue conditions. Therefore, a single tissue might be overloaded with minimal loads and as a result the risk of injury would increase. The goal of this paper was to assess the electromyographic response of trunk extensor and abdominal muscles after trunk extensor muscles fatigue induced by cyclic lifting task. This was an experimental study that twenty healthy women participated. For assessing automatic response of trunk extensor and abdominal muscles before and after the fatigue task, electromyographic activities of 6 muscles: thorasic erector spine (TES), lumbar erector spine (LES), lumbar multifidus (LMF), transverse abdominis/ internal oblique (TrA/IO), rectus abdominis (RA) and external oblique (EO) were recorded in standing position with no load and symmetric axial loads equal to 25% of their body weights. Statistical analysis showed that all the abdominal muscles activity decreased with axial loads after performing fatigue task but trunk extensor activity remained constant. Results of the current study indicated that muscle recruitment strategies changed with muscle fatigue and load bearing, therefore risks of tissue injury may increase in fatigue conditions.

Botulinum toxin to improve lower facial symmetry in facial nerve palsy

PubMed Central

Sadiq, S A; Khwaja, S; Saeed, S R

2012-01-01

Introduction In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public. Methods We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles. Results A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House–Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days). Conclusion The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient. PMID:22975654

Clinical practice guideline: Bell's palsy.

PubMed

Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

2013-11-01

Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging

Gastrocnemius operating length with ankle foot orthoses in cerebral palsy.

PubMed

Choi, Hwan; Wren, Tishya Anne Leong; Steele, Katherine Muterspaugh

2017-06-01

Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation. This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy. Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses. We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis. Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait. Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life. Clinical relevance Determining whether ankle foot orthoses stretch tight muscles can

Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers

PubMed Central

Li, Jinling; Guan, Buyun; Tang, Hongmei

2018-01-01

Objective To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. Methods This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. Results The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). Conclusions Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle. PMID:29304114

Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers.

PubMed

Chen, Ying; He, Lu; Xu, Kaishou; Li, Jinling; Guan, Buyun; Tang, Hongmei

2018-01-01

To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle.

Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study.

PubMed

Karabay, İlkay; Öztürk, Gökhan Tuna; Malas, Fevziye Ünsal; Kara, Murat; Tiftik, Tülay; Ersöz, Murat; Özçakar, Levent

2015-09-01

The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. Cross-sectional area values of tibialis anterior (238.7 ± 61.5 vs. 282.0 ± 67.1 mm) and gastrocnemius (207.9 ± 48.0 vs. 229.5 ± 52.4 mm) (P < 0.001 and P = 0.008, respectively) muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 ± 64.7 vs. 239.7 ± 60.0 mm) after treatment in group B (P < 0.001), and the rest of the measurements were found not to have changed significantly in either group. These results have shown that cross-sectional area of both the agonist and antagonist muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.

Anatomical study of the opossum (Didelphis albiventris) extraocular muscles.

PubMed Central

Matheus, S M; Soares, J C; da Silva, A M; Seullner, G

1995-01-01

The anatomy of the extraocular muscles was studied in 10 adult opossums (Didelphis albiventris) of both sexes. Eight extraocular muscles were identified: 4 rectus muscles, 2 oblique muscles, the levator palpebrae superioris and the retractor ocular bulbi. The rectus muscles originate very close one to another between the orbital surfaces of the presphenoid and palatine bones. These muscles diverge on the way to their insertion which occurs at about 2 mm from the limbus. The levator palpebrae superioris originates with the dorsal rectus and is positioned dorsally in relation to it. The retractor ocular bulbi forms a cone which embraces the optic nerve and is located internally in relation to the rectus muscles. The dorsal oblique originates on the presphenoid bone and after a tendinous trajectory through a trochlea on the medial wall of the orbit, inserts into the ocular bulb. The only muscle arising from the anterior orbital floor is the ventral oblique. The main nerve supply for these muscles is the oculomotor, except for the dorsal oblique which is innervated by the trochlear nerve, and the lateral rectus which is innervated by the abducens nerve. The retractor ocular bulbi receives branches from the inferior division of the oculomotor nerve and some branches from the abducens nerve. Images Fig. 1 Fig. 2 Fig. 3 PMID:7649843

Thyrotoxicosis presenting as acute bulbar palsy.

PubMed

Mathew, Betsy; Devasia, Anup J; Ayyar, Vaggesh; Thyagaraj, Vijayasree; Francis, Geetha Ann

2011-06-01

Myopathy chiefly affecting the proximal muscles of the limbs is frequently seen in hyperthyroidism. But isolated acute bulbar palsy without skeletal muscle involvement is rare in thyrotoxicosis. We report the case of a 52 year old man who presented with severe dysphagia, dysphonia and bouts of aspiration. Laboratory testing revealed an underlying Graves' thyrotoxicosis. His symptoms recovered dramatically within 6 weeks with treatment of hyperthyroidism. This case is reported to emphasize that thyrotoxicosis should be considered in the differential diagnosis of dysphagia of obscure etiology.

TREATMENT OF THE SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

PubMed Central

Meholjić-Fetahović, Ajša

2007-01-01

Botulinum toxin is a natural purified protein and one of the strongest biological poisons - neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine. As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy - spasticity Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles. It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects. This work shows a case of a boy with spastic form of cerebral palsy. After being habilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs’ muscles and kinezitherapy intensified

Position as a Cause of Deformity in Children with Cerebral Palsy (1976)

ERIC Educational Resources Information Center

Scrutton, David

2008-01-01

Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It…

Common questions about Bell palsy.

PubMed

Albers, Janet R; Tamang, Stephen

2014-02-01

Bell palsy is an acute affliction of the facial nerve, resulting in sudden paralysis or weakness of the muscles on one side of the face. Testing patients with unilateral facial paralysis for diabetes mellitus or Lyme disease is not routinely recommended. Patients with Lyme disease typically present with additional manifestations, such as arthritis, rash, or facial swelling. Diabetes may be a comorbidity of Bell palsy, but testing is not needed in the absence of other indications, such as hypertension. In patients with atypical symptoms, magnetic resonance imaging with contrast enhancement can be used to rule out cranial mass effect and to add prognostic value. Steroids improve resolution of symptoms in patients with Bell palsy and remain the preferred treatment. Antiviral agents have a limited role, and may improve outcomes when combined with steroids in patients with severe symptoms. When facial paralysis is prolonged, surgery may be indicated to prevent ocular desiccation secondary to incomplete eyelid closure. Facial nerve decompression is rarely indicated or performed. Physical therapy modalities, including electrostimulation, exercise, and massage, are neither beneficial nor harmful.

Meta-analysis of the effect of strengthening interventions in individuals with cerebral palsy.

PubMed

Park, Eun-Young; Kim, Won-Ho

2014-02-01

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Inferior oblique muscle origin: horizontal location in relation to ala nasi and its gender difference.

PubMed

Takahashi, Yasuhiro; Kakizaki, Hirohiko; Kohjima, Kiwamu; Nakano, Takashi; Asamoto, Ken; Ichinose, Akihiro; Iwaki, Masayoshi

2013-01-01

We studied the horizontal location of the inferior oblique muscle (IOM) origin in relation to the ipsilateral ala nasi and compared the results between genders in 76 orbits of 38 Japanese cadavers. Consequently, the IOM origin was located 1.2 mm laterally to the vertical line through the lateral margin of the ipsilateral ala nasi. No significant difference was noted between genders (males, 1.3 mm; females, 0.9 mm; P = 0.257, Student t test) or between sides (right, 1.1 mm; left, 1.3 mm; P = 0.570, Student t test). In contrast, the mean interalae-nasi distance was 39.8 mm and was significantly greater in males than that in females (males, 40.8 mm; females, 38.6 mm; P = 0.049, Student t test). The ala nasi can be used as a reference point irrespective of gender or side for identifying the IOM origin during oculoplastic surgery.

Anticipatory and compensatory postural adjustments in sitting in children with cerebral palsy.

PubMed

Bigongiari, Aline; de Andrade e Souza, Flávia; Franciulli, Patrícia Martins; Neto, Semaan El Razi; Araujo, Rubens Correa; Mochizuki, Luis

2011-06-01

The aim of this study was to examine postural control in children with cerebral palsy performing a bilateral shoulder flexion to grasp a ball from a sitting posture. The participants were 12 typically developing children (control) without cerebral palsy and 12 children with cerebral palsy (CP). We analyzed the effect of ball mass (1 kg and 0.18 kg), postural adjustment (anticipatory, APA, and compensatory, CPA), and groups (control and CP) on the electrical activity of shoulder and trunk muscles with surface electromyography (EMG). Greater mean iEMG was seen in CPA, with heavy ball, and for posterior trunk muscles (p<.05). The children with CP presented the highest EMG and level of co-activation (p<.05). Linear regression indicated a positive relationship between EMG and aging for the control group, whereas that relationship was negative for participants with CP. We suggest that the main postural control strategy in children is based on corrections after the beginning of the movement. The linear relationship between EMG and aging suggests that postural control development is affected by central nervous disease which may lead to an increase in muscle co-activation. Copyright © 2011 Elsevier B.V. All rights reserved.

Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy.

PubMed

Yilmaz, Volkan; Umay, Ebru; Tezel, Nihal; Gundogdu, Ibrahim

2018-06-01

The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.

[Treatment of idiopathic peripheral facial nerve paralysis (Bell's palsy)].

PubMed

Meyer, Martin Willy; Hahn, Christoffer Holst

2013-01-28

Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.

Biomechanical bases of rehabilitation of children with cerebral palsy

NASA Astrophysics Data System (ADS)

Davlet'yarova, K. V.; Korshunov, S. D.; Kapilevich, L. V.

2015-11-01

Biomechanical analysis and the study results of children's with cerebral palsy (CP) muscles bioelectrical activity while walking on a flat surface are represented. Increased flexion in the hip and shoulder joints and extension in the elbow joint in children with cerebral palsy were observed, with the movement of the lower limbs had less smooth character in comparison with the control group. Herewith, the oscillation amplitude was significantly increased, and the frequency in the m. gastrocnemius and m. lateralis was decreased. It was shown, that the dynamic stereotype of walking in children with cerebral palsy was characterized by excessive involvement of m. gastrocnemius and m.latissimus dorsi in locomotion. Thus, resulting biomechanical and bioelectrical parameters of walking should be considered in the rehabilitation programs development.

Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

PubMed

Paul, R; Stassen, L F A

2014-01-01

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.

Health-related physical fitness for children with cerebral palsy

PubMed Central

Maltais, Désirée B.; Wiart, Lesley; Fowler, Eileen; Verschuren, Olaf; Damiano, Diane L.

2014-01-01

Low levels of physical activity are a global health concern for all children. Children with cerebral palsy have even lower physical activity levels than their typically developing peers. Low levels of physical activity, and thus an increased risk for related chronic diseases, are associated with deficits in health-related physical fitness. Recent research has provided therapists with the resources to effectively perform physical fitness testing and physical activity training in clinical settings with children who have cerebral palsy, although most testing and training data to date pertains to those who walk. Nevertheless, based on the present evidence, all children with cerebral palsy should engage, to the extent they are able, in aerobic, anaerobic and muscle strengthening activities. Future research is required to determine the best ways to evaluate health-related physical fitness in non-ambulatory children with cerebral palsy and foster long-term changes in physical activity behavior in all children with this condition. PMID:24820339

Peripheral magnetic stimulation to decrease spasticity in cerebral palsy.

PubMed

Flamand, Véronique H; Beaulieu, Louis-David; Nadeau, Line; Schneider, Cyril

2012-11-01

Muscle spasticity in pediatric cerebral palsy limits movement and disrupts motor performance, thus its reduction is important in rehabilitation to optimize functional motor development. Our pilot study used repetitive peripheral magnetic stimulation, because this emerging technology influences spinal and cerebral synaptic transmission, and its antispastic effects were reported in adult neurologic populations. We tested whether five sessions of tibial and common peroneal nerve stimulation exerted acute and long-term effects on spasticity of the ankle plantar flexor muscles in five spastic diparetic children (mean age, 8 years and 3 months; standard deviation, 1 year and 10 months). Muscle resistance to fast stretching was measured with a manual dynamometer as a spasticity indicator. A progressive decrease was observed for the more impaired leg, reaching significance at the third session. This sustained reduction of spasticity may reflect that the peripheral stimulation improved the controls over the spinal circuitry. It thus suggests that a massive stimulation-induced recruitment of sensory afferents may be able to influence central nervous system plasticity in pediatric cerebral palsy. Copyright © 2012 Elsevier Inc. All rights reserved.

Corticospinal activation of internal oblique muscles has a strong ipsilateral component and can be lateralised in man.

PubMed

Strutton, Paul H; Beith, Iain D; Theodorou, Sophie; Catley, Maria; McGregor, Alison H; Davey, Nick J

2004-10-01

Trunk muscles receive corticospinal innervation ipsilaterally and contralaterally and here we investigate the degree of ipsilateral innervation and any cortical asymmetry in pairs of trunk muscles and proximal and distal limb muscles. Transcranial magnetic stimulation (TMS) was applied to left and right motor cortices in turn and bilateral electromyographic (EMG) recordings were made from internal oblique (IO; lower abdominal), deltoid (D; shoulder) and first dorsal interosseus (1DI; hand) muscles during voluntary contraction in ten healthy subjects. We used a 7-cm figure-of-eight stimulating coil located 2 cm lateral and 2 cm anterior to the vertex over either cortex. Incidence of ipsilateral motor evoked potentials (MEPs) was 85% in IO, 40% in D and 35% in 1DI. Mean (+/- S.E.M.) ipsilateral MEP latencies were longer ( P<0.05; paired t-test) than contralateral MEP latencies (contralateral vs. ipsilateral; IO: 16.1+/-0.4 ms vs. 19.0+/-0.5 ms; D: 9.7+/-0.3 ms vs. 15.1+/-1.9 ms; 1DI: 18.3+/-0.6 ms vs. 23.3+/-1.4 ms), suggesting that ipsilateral MEPs were not a result of interhemispheric current spread. Where data were available, we calculated a ratio (ipsilateral MEP areas/contralateral MEP areas) for a given muscle (IO: n=16; D: n=8; 1DI: n=7 ratios). Mean values for these ratios were 0.70+/-0.20 (IO), 0.14+/-0.05 (D) and 0.08+/-0.02 (1DI), revealing stronger ipsilateral drive to IO. Comparisons of the sizes of these ratios revealed a bias towards one cortex or the other (four subjects right; three subjects left). The predominant cortex showed a mean ratio of 1.21+/-0.38 compared with 0.26+/-0.06 in the other cortex ( P<0.05). It appears that the corticospinal control of IO has a strong ipsilateral component relative to the limb muscles and also shows hemispheric asymmetry.

Bell's palsy and partial hypoglossal to facial nerve transfer: Case presentation and literature review

PubMed Central

Socolovsky, Mariano; Páez, Miguel Domínguez; Masi, Gilda Di; Molina, Gonzalo; Fernández, Eduardo

2012-01-01

Background: Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure. Case Description: A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face. Conclusions: Partial hypoglossal–facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique. PMID:22574255

Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy

NASA Astrophysics Data System (ADS)

Santos, Maria Teresa Botti Rodrigues; Diniz, Michele Baffi; Gouw-Soares, Sheila Cynthia; Lopes-Martins, Rodrigo Alvaro Brandão; Frigo, Lucio; Baeder, Fernando Martins

2016-02-01

Spasticity is a motor disorder frequently present in individuals with cerebral palsy (CP). This study aimed to evaluate the effect of low-level laser therapy (LLLT) on the spasticity of the masseter and anterior temporal muscle fibers in children with CP over three weeks of intermittent laser exposures. The bite force (BF) of the masticatory muscles and the amplitude of mouth opening were evaluated before and after laser irradiation in 30 children with CP. Both sides of the masseter and temporalis muscles were irradiated with low-intensity diode laser pulses of 808-nm wavelength six times over three consecutive weeks. During the subsequent three weeks of postlaser exposures, although no laser treatment was applied, the evaluation parameters were measured and recorded. A significant improvement in the amplitude of mouth opening and a decrease in the BF were observed in the weeks following LLLT (P<0.05). However, by the sixth week post-LLLT, the BF and the amplitude of mouth opening reverted to values equivalent to those obtained before the first application of LLLT. Our investigation revealed low-level energy exposures from a 808-nm diode laser to be an effective short-term therapeutic tool. This method increased the amplitude of mouth opening and decreased the muscle tonus of children with spastic CP over a time course of three weeks of intermittent laser applications.

The Influence of Hip Abductor Weakness on Frontal Plane Motion of the Trunk and Pelvis in Patients with Cerebral Palsy

ERIC Educational Resources Information Center

Krautwurst, Britta K.; Wolf, Sebastian I.; Heitzmann, Daniel W. W.; Gantz, Simone; Braatz, Frank; Dreher, Thomas

2013-01-01

Trendelenburg walking pattern is a common finding in various disorders, including cerebral palsy (CP), where it is seen in children and adults. Clinically, this deviation is viewed as a consequence of hip abductor weakness resulting in pelvic obliquity. Trunk lean to the ipsilateral side is a common compensatory mechanism to counteract pelvic…

Medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion following passive stretching in children with cerebral palsy.

PubMed

Kalkman, Barbara M; Bar-On, Lynn; Cenni, Francesco; Maganaris, Constantinos N; Bass, Alfie; Holmes, Gill; Desloovere, Kaat; Barton, Gabor J; O'Brien, Thomas D

2018-03-01

What is the central question of this study? Can the increased range of motion seen acutely after stretching in children with cerebral palsy be explained by changes in the stiffness of the medial gastrocnemius fascicles? What is the main finding and its importance? We show, for the first time, that passive muscle and tendon properties are not changed acutely after a single bout of stretching in children with cerebral palsy and, therefore, do not contribute to the increase in range of motion. This contradicts common belief and what happens in healthy adults. Stretching is often used to increase or maintain the joint range of motion (ROM) in children with cerebral palsy (CP), but the effectiveness of these interventions is limited. Therefore, our aim was to determine the acute changes in muscle-tendon lengthening properties that contribute to increased ROM after a bout of stretching in children with CP. Eleven children with spastic CP [age 12.1 (3 SD) years, 5/6 hemiplegia/diplegia, 7/4 gross motor function classification system level I/II] participated. Each child received three sets of five × 20 s passive, manual static dorsiflexion stretches separated by 30 s rest, with 60 s rest between sets. Before and immediately after stretching, ultrasound was used to measure medial gastrocnemius fascicle lengthening continuously over the full ROM and an individual common ROM pre- to post-stretching. Simultaneously, three-dimensional motion of two marker clusters on the shank and the foot was captured to calculate ankle angle, and ankle joint torque was calculated from manually applied torques and forces on a six degrees-of-freedom load cell. After stretching, the ROM was increased [by 9.9 (12.0) deg, P = 0.005]. Over a ROM common to both pre- and post-measurements, there were no changes in fascicle lengthening or torque. The maximal ankle joint torque tolerated by the participants increased [by 2.9 (2.4) N m, P = 0.003], and at this highest passive torque the

[Facial palsy].

PubMed

Cavoy, R

2013-09-01

Facial palsy is a daily challenge for the clinicians. Determining whether facial nerve palsy is peripheral or central is a key step in the diagnosis. Central nervous lesions can give facial palsy which may be easily differentiated from peripheral palsy. The next question is the peripheral facial paralysis idiopathic or symptomatic. A good knowledge of anatomy of facial nerve is helpful. A structure approach is given to identify additional features that distinguish symptomatic facial palsy from idiopathic one. The main cause of peripheral facial palsies is idiopathic one, or Bell's palsy, which remains a diagnosis of exclusion. The most common cause of symptomatic peripheral facial palsy is Ramsay-Hunt syndrome. Early identification of symptomatic facial palsy is important because of often worst outcome and different management. The prognosis of Bell's palsy is on the whole favorable and is improved with a prompt tapering course of prednisone. In Ramsay-Hunt syndrome, an antiviral therapy is added along with prednisone. We also discussed of current treatment recommendations. We will review short and long term complications of peripheral facial palsy.

Laughing: a demanding exercise for trunk muscles.

PubMed

Wagner, Heiko; Rehmes, Ulrich; Kohle, Daniel; Puta, Christian

2014-01-01

Social, psychological, and physiological studies have provided evidence indicating that laughter imposes an increased demand on trunk muscles. It was the aim of this study to quantify the activation of trunk muscles during laughter yoga in comparison with crunch and back lifting exercises regarding the mean trunk muscle activity. Muscular activity during laughter yoga exercises was measured by surface electromyography of 5 trunk muscles. The activation level of internal oblique muscle during laughter yoga is higher compared to the traditional exercises. The multifidus, erector spinae, and rectus abdominis muscles were nearly half activated during laughter yoga, while the activation of the external oblique muscle was comparable with the crunch and back lifting exercises. Our results indicate that laughter yoga has a positive effect on trunk muscle activation. Thus, laughter seems to be a good activator of trunk muscles, but further research is required whether laughter yoga is a good exercise to improve neuromuscular recruitment patterns for spine stability.

Relations between muscle endurance and subjectively reported fatigue, walking capacity, and participation in mildly affected adolescents with cerebral palsy.

PubMed

Eken, Maaike M; Houdijk, Han; Doorenbosch, Caroline A M; Kiezebrink, Francisca E M; van Bennekom, Coen A M; Harlaar, Jaap; Dallmeijer, Annet J

2016-08-01

To investigate the relation between muscle endurance and subjectively reported fatigue, walking capacity, and participation in mildly affected adolescents with cerebral palsy (CP) and peers with typical development. In this case-control study, knee extensor muscle endurance was estimated from individual load-endurance curves as the load corresponding to a 15-repetition maximum in 17 adolescents with spastic CP (six males, 11 females; age 12-19y) and 18 adolescents with typical development (eight males, 10 females; age 13-19y). Questionnaires were used to assess subjectively reported fatigue (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale) and participation (Life-Habits questionnaire). Walking capacity was assessed using the 6-minute walk test. Relations were determined using multiple regression analyses. Muscle endurance related significantly to subjectively reported fatigue and walking capacity in adolescents with CP, while no relations were found for adolescents with typical development (subjectively reported fatigue: regression coefficient β [95% confidence intervals] for CP=23.72 [6.26 to 41.18], for controls=2.72 [-10.26 to 15.69]; walking capacity β for CP=125m [-87 to 337], for controls=2m [-86 to 89]). The 15-repetition maximum did not relate to participation in adolescents with CP. Subjectively reported fatigue and reduced walking capacity in adolescents with CP are partly caused by lower muscle endurance of knee extensors. Training of muscle endurance might contribute to reducing the experience of fatigue and improving walking capacity. Reduced muscle endurance seems to have no effect on participation. © 2016 Mac Keith Press.

Genetics Home Reference: hereditary neuropathy with liability to pressure palsies

MedlinePlus

... PubMed Central Yilmaz U, Bird TT, Carter GT, Wang LH, Weiss MD. Pain in hereditary neuropathy with liability to pressure palsy: an association with fibromyalgia syndrome? Muscle Nerve. 2015 Mar;51(3):385-90. doi: 10.1002/ ...

[Effects of surgery on muscles on clinical and radiographic findings in the hip joint region in cerebral palsy patients].

PubMed

Schejbalová, A; Havlas, V

2008-10-01

PURPOSE OF THE STUDY Isolated or combined surgical procedures on muscles around the hip joint are currently indicated by many authors. In cerebral palsy patients they are regarded as essential intervention. MATERIAL In the years 2005-2007, surgery in the hip joint region was essential for 150 children between 3 and 18 years of age. At the time of surgery, the patients' locomotion ranged from stage 1 to stage 7 of the Vojta system. METHODS The outcome was evaluated by clinical and radiographic examination at 2 and 6 months post-operatively and hip migration percentage and Wiberg's CE angle were measured. RESULTS The best clinical and radiographic outcomes were achieved in children younger than 6 years of age. On the other hand, isolated transfer of the distal rectus femoris muscle significantly affected pelvis anteflexion in adolescent patients. The most marked decrease in migration percentage was found after adductor tenotomy combined with surgery on the iliopsoas muscle (55.6 %) or when the two procedures were combined with distal rectus femoris transfer. DISCUSSION Combined surigical procedures, i.e., adductor tenotomy, surgery on the iliopsoas muscle or rectus femoris muscle and medial hamstrings, with fixation using an abduction modified Atlanta brace, are effective in patients with marked lateral hip migration who are younger that 6 years. Isolated adductor tenotomy and distal transfer of the rectus femoris muscle markedly improve standing position in walking patients. CONCLUSION An appropriate combination of surgical procedures on muscles in the hip region and on medial hamstrings can significantly improve the patient's locomotion and, if lateral migration is present, help to avoid surgery on bones.

Cerebral Palsy. NICHCY Disability Fact Sheet #2

ERIC Educational Resources Information Center

National Dissemination Center for Children with Disabilities, 2010

2010-01-01

Cerebral palsy--also known as CP--is a condition caused by injury to the parts of the brain that control the body's ability to use muscles effectively. Often the injury happens before birth, sometimes during delivery or soon after birth. The symptoms will differ from person to person and change as children and their nervous systems mature. This…

Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children.

PubMed

Simon, Anelise de Saldanha; do Pinho, Alexandre Severo; Grazziotin Dos Santos, Camila; Pagnussat, Aline de Souza

2014-10-01

This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP

Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma

PubMed Central

FENG, Yu-Ching; CHEN, Kuan-Sheng; CHANG, Shih-Chieh

2016-01-01

This animal was presented with a large-sized infiltrative lipoma in the abdominal wall that had been noted for 4 years. This lipoma was confirmed by histological examination from a previous biopsy, and the infiltrative features were identified by a computerized tomography scan. The surgical removal created a large-sized abdominal defect that was closed by a combination of latissimus dorsi and external abdominal oblique muscle flaps in a pedicle pattern. A small dehiscence at the most distal end of the muscle flap resulted in a small-sized abdominal hernia and was repaired with cranial sartorius muscle flap 14 days after surgery. The dog was in good general health with no signs of tumor recurrence after 18 months of follow-up. PMID:27476526

[Treatment of Bell's palsy with combination of traditional Chinese medicine and western medicine].

PubMed

Wang, Xiao-hong; Zhang, Li-ming; Han, Mei; Zhang, Ke-qing; Jiang, Jiao-jiao

2004-06-01

To evaluation the clinical effect of combination of traditional Chinese medicine and western medicine on Bell's palsy. 83 patients with Bell's palsy were randomly divided into two groups (trail group 54 cases and control group 29 cases). Patients in two groups were treated with medicine, acupuncture, physiotherapy, while patients in the trail group were treated with massage and functional exercise as the same time. The results of both groups were evaluated according to Portmann's Simple Scale. The score before treatment of trail group was 2.907 +/- 1.794, while control group was 2.931 +/- 2.034. And the score after treatment of trail group was 18.593 +/- 1.743, while control group was 9.862 +/- 3.091. Score of the function of facial muscles obtained from trail group was distinctly higher than that was from the control group (P < 0.01), as well as the improvement index (P < 0.01, trail group: 0.844 +/- 0.095, control group: 0.712 +/- 0.129). There is significant curative effect and suitability in the treatment of Bell's palsy with combination of traditional Chinese medicine and western medicine. The improvement of facial muscles' motive function pre- and post-treatment and quantitative evaluation of curative effect can be objectively obtained by evaluation of facial muscles' function.

Cerebral Palsy: A Lifelong Challenge Asks for Early Intervention

PubMed Central

Panteliadis, Christos P; Hagel, Christian; Karch, Dieter; Heinemann, Karl

2015-01-01

One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196–1190 B.C., and a letter from Hippocrates (460–390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention. PMID:26191093

Influence of inward pressure of the transducer on lateral abdominal muscle thickness during ultrasound imaging.

PubMed

Ishida, Hiroshi; Watanabe, Sususmu

2012-09-01

Controlled laboratory study, technical note. The purpose of this study was to quantify changes in the thickness of the transversus abdominis, internal oblique, and external oblique muscles induced by different inward pressures of the transducer during ultrasound imaging (USI). USI of the lateral abdominal muscles is increasingly used in managing musculoskeletal dysfunction. However, to the best of our knowledge, no study has evaluated the influence of different inward pressures of the transducer on the lateral abdominal muscle thickness during USI. Thirty healthy male volunteers participated in this study. The thickness of the transversus abdominis, internal oblique, and external oblique muscles was measured with USI by the same rater in 4 conditions of inward pressures of 0.5, 1.0, 2.0, and 4.0 N. Intraclass correlation coefficients (ICC1,1), with 95% confidence intervals, were calculated, and a repeated-measures analysis of variance was used to assess the influence of inward pressure on the thickness of the lateral abdominal muscles. The thickness of the transversus abdominis, internal oblique, and external oblique muscles was significantly different among the 4 conditions (P<.038). The mean difference between the 0.5-N and 4.0-N conditions was greater than the minimal detectable change of the 0.5-N condition in the lateral abdominal muscles. The difference in magnitude produced by the forces under different conditions was meaningful. When using a technique that involves a handheld transducer, the examiner should attempt to maintain consistent inward pressure of the transducer during USI to quantify the thickness of lateral abdominal muscles. J Orthop Sports Phys Ther 2012;42(9):815-818, Epub 19 April 2012. doi:10.2519/jospt.2012.4064.

Peripheral facial weakness (Bell's palsy).

PubMed

Basić-Kes, Vanja; Dobrota, Vesna Dermanović; Cesarik, Marijan; Matovina, Lucija Zadro; Madzar, Zrinko; Zavoreo, Iris; Demarin, Vida

2013-06-01

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.

Gait Trainer for Children with Spastic Cerebral Palsy

DTIC Science & Technology

2001-10-25

same person. Spastic CP is the most common type of Cerebral Palsy. It can be subdivided into 5 types : Quadriplegia : A type of CP when occurs in...all four of their limbs-both arms and both legs it is called quadriplegia . Due to the problems of controlling the muscles in their face and upper

The use of artificial neural networks to predict the muscle behavior

NASA Astrophysics Data System (ADS)

Kutilek, Patrik; Viteckova, Slavka; Svoboda, Zdenĕk; Smrcka, Pavel

2013-09-01

The aim of this article is to introduce methods of prediction of muscle behavior of the lower extremities based on artificial neural networks, which can be used for medical purposes. Our work focuses on predicting muscletendon forces and moments during human gait with the use of angle-time diagram. A group of healthy children and children with cerebral palsy were measured using a Vicon MoCap system. The kinematic data was recorded and the OpenSim software system was used to identify the joint angles, muscle-tendon forces and joint muscle moment, which are presented graphically with time diagrams. The musculus gastrocnemius medialis that is often studied in the context of cerebral palsy have been chosen to study the method of prediction. The diagrams of mean muscle-tendon force and mean moment are plotted and the data about the force-time and moment-time dependencies are used for training neural networks. The new way of prediction of muscle-tendon forces and moments based on neural networks was tested. Neural networks predicted the muscle forces and moments of healthy children and children with cerebral palsy. The designed method of prediction by neural networks could help to identify the difference between muscle behavior of healthy subjects and diseased subjects.

Internal Oblique and Transversus Abdominis Muscle Fatigue Induced by Slumped Sitting Posture after 1 Hour of Sitting in Office Workers

PubMed Central

Waongenngarm, Pooriput; Rajaratnam, Bala S.; Janwantanakul, Prawit

2015-01-01

Background Prolonged sitting leads to low back discomfort and lumbopelvic muscle fatigue. This study examined the characteristics of body perceived discomfort and trunk muscle fatigue during 1 hour of sitting in three postures in office workers. Methods Thirty workers sat for 1 hour in one of three sitting postures (i.e., upright, slumped, and forward leaning postures). Body discomfort was assessed using the Body Perceived Discomfort scale at the beginning and after 1 hour of sitting. Electromyographic (EMG) signals were recorded from superficial lumbar multifidus, iliocostalis lumborum pars thoracis, internal oblique (IO)/transversus abdominis (TrA), and rectus abdominis muscles during 1 hour of sitting. The median frequency (MDF) of the EMG power spectrum was calculated. Results Regardless of the sitting posture, the Body Perceived Discomfort scores in the neck, shoulder, upper back, low back, and buttock significantly increased after 1 hour of sitting compared with baseline values (t(9) = −11.97 to −2.69, p < 0.05). The MDF value of the EMG signal of rectus abdominis, iliocostalis lumborum pars thoracis, and multifidus muscles was unchanged over time in all three sitting postures. Only the right and left IO/TrA in the slumped sitting posture was significantly associated with decreased MDF over time (p = 0.019 to 0.041). Conclusion Prolonged sitting led to increased body discomfort in the neck, shoulder, upper back, low back, and buttock. No sign of trunk muscle fatigue was detected over 1 hour of sitting in the upright and forward leaning postures. Prolonged slumped sitting may relate to IO/TrA muscle fatigue, which may compromise the stability of the spine, making it susceptible to injury. PMID:27014491

Trunk muscle activity during bridging exercises on and off a Swissball

PubMed Central

Lehman, Gregory J; Hoda, Wajid; Oliver, Steven

2005-01-01

Background A Swiss ball is often incorporated into trunk strengthening programs for injury rehabilitation and performance conditioning. It is often assumed that the use of a Swiss ball increases trunk muscle activity. The aim of this study was to determine whether the addition of a Swiss ball to trunk bridging exercises influences trunk muscle activity. Methods Surface electrodes recorded the myoelectric activity of trunk muscles during bridging exercises. Bridging exercises were performed on the floor as well as on a labile surface (Swiss ball). Results and Discussion During the prone bridge the addition of an exercise ball resulted in increased myoelectric activity in the rectus abdominis and external oblique. The internal oblique and erector spinae were not influenced. The addition of a swiss ball during supine bridging did not influence trunk muscle activity for any muscles studied. Conclusion The addition of a Swiss ball is capable of influencing trunk muscle activity in the rectus abdominis and external oblique musculature during prone bridge exercises. Modifying common bridging exercises can influence the amount of trunk muscle activity, suggesting that exercise routines can be designed to maximize or minimize trunk muscle exertion depending on the needs of the exercise population. PMID:16053529

Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy.

PubMed

Grazziotin Dos Santos, C; Pagnussat, Aline S; Simon, A S; Py, Rodrigo; Pinho, Alexandre Severo do; Wagner, Mário B

2014-10-20

This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluating the Relationship Between Muscle Activation and Spine Kinematics Through Wavelet Coherence.

PubMed

Hay, Dean C; Wachowiak, Mark P; Graham, Ryan B

2016-10-01

Advances in time-frequency analysis can provide new insights into the important, yet complex relationship between muscle activation (ie, electromyography [EMG]) and motion during dynamic tasks. We use wavelet coherence to compare a fundamental cyclical movement (lumbar spine flexion and extension) to the surface EMG linear envelope of 2 trunk muscles (lumbar erector spinae and internal oblique). Both muscles cohere to the spine kinematics at the main cyclic frequency, but lumbar erector spinae exhibits significantly greater coherence than internal oblique to kinematics at 0.25, 0.5, and 1.0 Hz. Coherence phase plots of the 2 muscles exhibit different characteristics. The lumbar erector spinae precedes trunk extension at 0.25 Hz, whereas internal oblique is in phase with spine kinematics. These differences may be due to their proposed contrasting functions as a primary spine mover (lumbar erector spinae) versus a spine stabilizer (internal oblique). We believe that this method will be useful in evaluating how a variety of factors (eg, pain, dysfunction, pathology, fatigue) affect the relationship between muscles' motor inputs (ie, activation measured using EMG) and outputs (ie, the resulting joint motion patterns).

A Stepwise Approach: Decreasing Infection in Deep Brain Stimulation for Childhood Dystonic Cerebral Palsy.

PubMed

Johans, Stephen J; Swong, Kevin N; Hofler, Ryan C; Anderson, Douglas E

2017-09-01

Dystonia is a movement disorder characterized by involuntary muscle contractions, which cause twisting movements or abnormal postures. Deep brain stimulation has been used to improve the quality of life for secondary dystonia caused by cerebral palsy. Despite being a viable treatment option for childhood dystonic cerebral palsy, deep brain stimulation is associated with a high rate of infection in children. The authors present a small series of patients with dystonic cerebral palsy who underwent a stepwise approach for bilateral globus pallidus interna deep brain stimulation placement in order to decrease the rate of infection. Four children with dystonic cerebral palsy who underwent a total of 13 surgical procedures (electrode and battery placement) were identified via a retrospective review. There were zero postoperative infections. Using a multistaged surgical plan for pediatric patients with dystonic cerebral palsy undergoing deep brain stimulation may help to reduce the risk of infection.

Comparison of abdominal muscle activity and peak expiratory flow between forced vital capacity and fast expiration exercise.

PubMed

Ishida, Hiroshi; Suehiro, Tadanobu; Watanabe, Susumu

2017-04-01

[Purpose] The purpose of this investigation was to compare the activities of the abdominal muscles and peak expiratory flow between forced vital capacity and fast expiration exercise. [Subjects and Methods] Fifteen healthy male participated in this study. Peak expiratory flow and electromyographic activities of the rectus abdominis, external oblique, and internal oblique/transversus abdominis muscles were measured during forced vital capacity and fast expiration exercise and then peak amplitude and its appearance time were obtained. [Results] Peak expiratory flow values were significantly higher during fast expiration exercise than during forced vital capacity. The internal oblique/transversus abdominis muscles showed significantly higher peak amplitude during fast expiration exercise than during forced vital capacity. However, there were no significant differences between forced vital capacity and fast expiration exercise in the rectus abdominis and external oblique muscles. There was no difference in the appearance time of the peak amplitude between forced vital capacity and fast expiration exercise in any muscle. [Conclusion] Fast expiration exercise might be beneficial for increasing expiratory speed and neuromuscular activation of the internal oblique/transversus abdominis muscles compared to forced vital capacity. These findings could be considered when recommending a variation of expiratory muscle strength training as part of pulmonary rehabilitation programs.

Comparative anatomy of the extraocular muscles in four Myliobatoidei rays (Batoidea, Myliobatiformes).

PubMed

Cunha, Carlo M; Oliveira, Luciano E; Kfoury, José R

2016-05-01

Extraocular muscles are classically grouped as four rectus and two oblique muscles. However, their description and potential associations with species behavior are limited. The objective was to characterize extraocular muscles in four Myliobatoidei rays from diverse habitats with divergent behaviors. Heads (10 per species) of Dasyatis hypostigma, Gymnura altavela, Mobula thurstoni and Pteroplatytrygon violacea were decalcified and dissected to characterize and describe extraocular muscles. Principal component analysis (PCA) was used to evaluate relationships between muscle length and species; for P. violacea, D. hypostigma and G. altavela, these were qualitatively and quantitatively consistent with the general pattern of extraocular muscles in vertebrates. In contrast, for M. thurstoni, the two oblique muscles were completely fused and there was a seventh extraocular muscle, named m. lateral rectus β (both were apparently novel findings in this species). There were also significant differences in eye disposition in the chondrocranium. The PCA axis 1 (rectus muscles) and PCA axis 2 (oblique muscles) accounted for 98.47% of data variability. Extraocular muscles had significant differences in length and important anatomical differences among sampled species that facilitated grouping species according to their life history. In conclusion, extraocular muscles are not uniform in all vertebrate species, thereby providing another basis for comparative studies. © 2016 Anatomical Society.

Active behavior of abdominal wall muscles: Experimental results and numerical model formulation.

PubMed

Grasa, J; Sierra, M; Lauzeral, N; Muñoz, M J; Miana-Mena, F J; Calvo, B

2016-08-01

In the present study a computational finite element technique is proposed to simulate the mechanical response of muscles in the abdominal wall. This technique considers the active behavior of the tissue taking into account both collagen and muscle fiber directions. In an attempt to obtain the computational response as close as possible to real muscles, the parameters needed to adjust the mathematical formulation were determined from in vitro experimental tests. Experiments were conducted on male New Zealand White rabbits (2047±34g) and the active properties of three different muscles: Rectus Abdominis, External Oblique and multi-layered samples formed by three muscles (External Oblique, Internal Oblique, and Transversus Abdominis) were characterized. The parameters obtained for each muscle were incorporated into a finite strain formulation to simulate active behavior of muscles incorporating the anisotropy of the tissue. The results show the potential of the model to predict the anisotropic behavior of the tissue associated to fibers and how this influences on the strain, stress and generated force during an isometric contraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cerebral Palsy Symptoms in Children Decreased Following Massage Therapy

ERIC Educational Resources Information Center

Hernandez-Reif, Maria; Field, Tiffany; Largie, Shay; Diego, Miguel; Manigat, Natasha; Seoanes, Jacqueline; Bornstein, Joan

2005-01-01

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…

Use of Hybrid Assistive Limb (HAL®) for a postoperative patient with cerebral palsy: a case report.

PubMed

Mataki, Yuki; Kamada, Hiroshi; Mutsuzaki, Hirotaka; Shimizu, Yukiyo; Takeuchi, Ryoko; Mizukami, Masafumi; Yoshikawa, Kenichi; Takahashi, Kazushi; Matsuda, Mayumi; Iwasaki, Nobuaki; Kawamoto, Hiroaki; Wadano, Yasuyoshi; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-03-27

The Hybrid Assistive Limb (HAL ® ) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery. We report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased. Hybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting.

Muscle-skeletal model of the thigh: a tool for understanding the biomechanics of gait in patients with cerebral palsy

NASA Astrophysics Data System (ADS)

Ravera, Emiliano Pablo; Catalfamo Formento, Paola Andrea; José Crespo, Marcos; Andrés Braidot, Ariel

2011-12-01

Cerebral Palsy represents the most common cause of physical disability in modern world and within the pediatrics orthopedics units. The gait analysis provides great contributions to the understanding of gait disorders in CP. Giving a more comprehensive treatment plan, including or excluding surgical procedures that can potentially decrease the number of surgical interventions in the life of these patients. Recommendations for orthopedic surgery may be based on a quantitative description of how to alter the properties probably muscle force generation, and how this affects the action of the muscle to determine how these muscles, impaired by disease or surgery, contributing to the movement of the segments of the limb during crouch gait. So the causes and appropriate treatment of gait abnormalities are difficult to determine because the movements generated by the muscular forces of these patients are not clearly understood. A correct determination of the etiology of abnormal patterns of the knee is the key to select the appropriate therapy, presenting a major challenge at present since there is no theoretical basis to determine the biomechanical causes of abnormal gait of these patients. The potential and necessity of using correct biomechanical models that consistently study the abnormalities becomes clear. Reinforcing and correcting a simple gait analysis and eliminating the unknowns when selecting the appropriate treatment is crucial in clinical settings. In this paper a computer muscle-skeletal model is proposed. The model represents a person's thigh simulating the six most representative muscles and joints of the hip and knee. In this way you can have a better understanding of gait abnormalities present in these patients. So the quality of these estimates of individual muscle dynamics facilitate better understanding of the biomechanics of gait pathologies helping to reach better diagnosis prior to surgery and rehabilitation treatments.

Bell's Palsy.

PubMed

Reich, Stephen G

2017-04-01

Bell's palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. Recognition and management of Bell's palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bell's palsy, suggesting an alternative cause of peripheral facial palsy. The first American Academy of Neurology (AAN) evidence-based review on the treatment of Bell's palsy in 2001 concluded that corticosteroids were probably effective and that the antiviral acyclovir was possibly effective in increasing the likelihood of a complete recovery from Bell's palsy. Subsequent studies led to a revision of these recommendations in the 2012 evidence-based review, concluding that corticosteroids, when used shortly after the onset of Bell's palsy, were "highly likely" to increase the probability of recovery of facial weakness and should be offered; the addition of an antiviral to steroids may increase the likelihood of recovery but, if so, only by a very modest effect. Bell's palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bell's palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.

Muscle mass and composition of the hip, thigh and abdominal muscles in women with and without hip osteoarthritis.

PubMed

Fukumoto, Yoshihiro; Ikezoe, Tome; Tateuchi, Hiroshige; Tsukagoshi, Rui; Akiyama, Haruhiko; So, Kazutaka; Kuroda, Yutaka; Yoneyama, Tomohide; Ichihashi, Noriaki

2012-09-01

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA. Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Botulinum toxin (Dysport) treatment of the spastic gastrocnemius muscle in children with cerebral palsy: a randomized trial comparing two injection volumes.

PubMed

Hu, Gwo-Chi; Chuang, Yao-Chia; Liu, Jen-Pei; Chien, Kuo-Liong; Chen, Yi-Min; Chen, Ying-Fang

2009-01-01

To compare the effect of equivalent doses in two different volumes of botulinum toxin type A (Dysport) on gastrocnemius spasticity. Single-blind, randomized, controlled trial. Hospital rehabilitation department. Twenty-two children with spastic diplegic or quadriplegic cerebral palsy. High (500 U/5 mL) and low (500 U/1 mL)-volume preparations of Dysport were injected into the gastrocnemius muscles, each child randomly receiving one preparation in the right and the other in the left leg. Dynamic ankle joint range of motion (ROM), passive ROM of the ankle joint, modified Ashworth Scale scores, and the areas of the compound muscle action potential assessed before treatment and at four and eight weeks post treatment. Both legs improved significantly. The mean (SD) improvements between baseline and the end of follow-up were 19.7 (10.83) degrees for dynamic ROM, 8.4 (9.19) degrees for passive ROM, -1.3 (0.6) for modified Ashworth Scale scores, and -9.4 (11.41) mV-ms for compound muscle action potential in the high-volume group; and 13.5 (10.45) degrees for dynamic ROM, 7.4 (7.88) for passive ROM, -0.9 (0.5) for modified Ashworth Scale scores, and -5.9 (7.50) mV-ms for areas of compound muscle action potential in the low-volume group. The high-volume preparation yielded significantly greater improvement in dynamic ROM (P<0.001), muscle tone (P < 0.001), and lower compound muscle action potential area (P = 0.006). A high-volume preparation of Dysport is more effective than a low volume in reducing spasticity in the gastrocnemius muscle.

Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

PubMed

Cederwall, Elisabet; Olsén, Monika Fagevik; Hanner, Per; Fogdestam, Ingemar

2006-01-01

The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

Bell's palsy: data from a study of 70 cases.

PubMed

Cirpaciu, D; Goanta, C M

2014-01-01

Bell's palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded.

Managing the patient with oculomotor nerve palsy.

PubMed

Sadagopan, Karthikeyan A; Wasserman, Barry N

2013-09-01

To provide clinically relevant information regarding the evaluation and current treatment options for oculomotor nerve palsies. We survey recent literature and provide some insights into these studies. Recent case reports highlight emerging new causes of oculomotor cranial nerve palsies, including sellar chordoma, odontogenic abscess, nonaneurysmal subarachnoid hemorrhage, polycythemia, sphenoiditis, neurobrucellosis, interpeduncular fossa lipoma, metastatic pancreatic cancer, leukemia, and lymphoma. Surgical studies have focused on modifications and innovations regarding strabismus surgery for this condition. New globe fixation procedures may include fixation to the medial orbital wall by precaruncular and retrocaruncular approaches, apically based orbital bone periosteal flap fixation and the suture/T-plate anchoring platform system. Management of oculomotor nerve palsy depends in part upon the underlying cause and anatomical location of the lesion. Careful clinical evaluation and appropriate imaging can identify a definitive cause in most cases. Surgical options depend on the number, extent, and severity of the muscles involved as well as the presence or absence of signs of aberrant regeneration. The clinician should also address issues that arise due to involvement of the pupil and accommodation. Strabismus surgery can be challenging but also rewarding with appropriate selection and staging of procedures.

Differences in pedal forces during recumbent cycling in adolescents with and without cerebral palsy

PubMed Central

Johnston, Therese E.; Prosser, Laura A.; Lee, Samuel C.K.

2011-01-01

Background We showed that subjects with cerebral palsy had greater transverse and frontal plane hip and knee motion, increased duration of muscle activity, increased cocontraction, and decreased efficiency during recumbent cycling than subjects with typical development. However, it is also important to understand the forces exerted on the pedals. The purpose of this report was to compare pedal forces during cycling between adolescents with and without cerebral palsy. Methods Ten subjects (3 male, 7 female) with spastic diplegic or quadriplegic cerebral palsy (15.6 years, SD 1.8) and 10 subjects (3 male, 7 female) with typical development (14.9 years, SD 1.4) cycled on a stationary recumbent cycle at 30 and 60 revolutions per minute if able. Three-dimensional piezoelectric force transducers measured pedal forces. Data were analyzed using two-way ANOVAs. Findings Subjects with cerebral palsy spent a smaller percentage (P < .001, r2 = .09, power = 1.0) of the revolution applying positive force (pushing into the pedal during the extension phase) and a greater percentage (P < .001, r2 = .09, power = 1.0) of the revolution applying negative force (pulling away from the pedal during the flexion phase). There was no effect of cadence and no interaction effect. Interpretation These findings compliment our earlier findings of altered joint kinematics and muscle activity indicating that subjects with cerebral palsy and typical development have different cycling strategies. Methods to increase the duration of the positive force may allow subjects with CP to cycle more successfully and cycle vigorously enough to reach a heart rate necessary for improving fitness. PMID:17950505

Functional Electrical Stimulation in Children and Adolescents with Cerebral Palsy

ERIC Educational Resources Information Center

van der Linden, Marietta

2012-01-01

In this article, the author talks about functional electrical stimulation in children and adolescents with cerebral palsy. Functional electrical stimulation (FES) is defined as the electrical stimulation of muscles that have impaired motor control, in order to produce a contraction to obtain functionally useful movement. It was first proposed in…

Effects of antagonistic and synergistic muscles' co-activation on mechanics of activated spastic semitendinosus in children with cerebral palsy.

PubMed

Ateş, Filiz; Temelli, Yener; Yucesoy, Can A

2018-02-01

Most activities involve co-activation of several muscles and epimuscular myofascial force transmission (EMFT) can affect their mechanics. This can be relevant for spastic muscles of cerebral palsy (CP) patients. Isometric spastic semitendinosus (ST) forces vs. knee angle (KA-F ST ) data were collected intra-operatively to test the following hypotheses: (i) Inter-antagonistic EMFT elevates F ST , (ii) changes the shape of KA-F ST characteristics, (iii) reduces the muscle's joint range of force exertion (Range-F ST ) and (iv) combined inter-antagonistic and synergistic EMFT further changes those effects. 11 limbs of 6 patients with CP (mean (SD) = 7.7 (4.7) years; GMFCS levels = II-IV) were tested in 3 conditions from 120° to full extension: ST activated (I) exclusively, (II) simultaneously with an antagonist, and (III) with added activation of synergists. Condition II increased F ST (e.g., peak force = 87.6 N (30.5 N)) significantly (by 33.6%), but condition III caused no further change. No condition changed the muscle's wide Range-F ST (100.7° (15.9°)) significantly. Therefore, only the first hypothesis was confirmed. Co-activating its antagonist elevates forces of activated spastic ST substantially, but does not change its joint range of force exertion. Added activation of its synergists causes no further effects. Therefore, EMFT effects in CP can be relevant and need to be tested in other knee flexors. Copyright © 2017 Elsevier B.V. All rights reserved.

Retroperitoneal oblique corridor to the L2-S1 intervertebral discs: an MRI study.

PubMed

Molinares, Diana M; Davis, Timothy T; Fung, Daniel A

2015-10-09

OBJECT The purpose of this study was to analyze MR images of the lumbar spine and document: 1) the oblique corridor at each lumbar disc level between the psoas muscle and the great vessels, and 2) oblique access to the L5-S1 disc space. Access to the lumbar spine without disruption of the psoas muscle could translate into decreased frequency of postoperative neurological complications observed after a transpsoas approach. The authors investigated the retroperitoneal oblique corridor of L2-S1 as a means of surgical access to the intervertebral discs. This oblique approach avoids the psoas muscle and is a safe and potentially superior alternative to the lateral transpsoas approach used by many surgeons. METHODS One hundred thirty-three MRI studies performed between May 4, 2012, and February 27, 2013, were randomly selected from the authors' database. Thirty-three MR images were excluded due to technical issues or altered lumbar anatomy due to previous spine surgery. The oblique corridor was defined as the distance between the left lateral border of the aorta (or iliac artery) and the anterior medial border of the psoas. The L5-S1 oblique corridor was defined transversely from the midsagittal line of the inferior endplate of L-5 to the medial border of the left common iliac vessel (axial view) and vertically to the first vascular structure that crossed midline (sagittal view). RESULTS The oblique corridor measurements to the L2-5 discs have the following mean distances: L2-3 = 16.04 mm, L3-4 = 14.21 mm, and L4-5 = 10.28 mm. The L5-S1 corridor mean distance was 10 mm between midline and left common iliac vessel, and 10.13 mm from the first midline vessel to the inferior endplate of L-5. The bifurcation of the aorta and confluence of the vena cava were also analyzed in this study. The aortic bifurcation was found at the L-3 vertebral body in 2% of the MR images, at the L3-4 disc in 5%, at the L-4 vertebral body in 43%, at the L4-5 disc in 11%, and at the L-5 vertebral

Innovative strength training-induced neuroplasticity and increased muscle size and strength in children with spastic cerebral palsy: an experimenter-blind case study--three-month follow-up.

PubMed

Lee, Dong Ryul; Kim, Yun Hee; Kim, Dong A; Lee, Jung Ah; Hwang, Pil Woo; Lee, Min Jin; You, Sung Hyun

2014-01-01

In children with cerebral palsy (CP), the never-learned-to-use (NLTU) effect and underutilization suppress the normal development of cortical plasticity in the paretic limb, which further inhibits its functional use and increases associated muscle weakness. To highlight the effects of a novel comprehensive hand repetitive intensive strengthening training system on neuroplastic changes associated with upper extremity (UE) muscle strength and motor performance in children with spastic hemiplegic CP. Two children with spastic hemiplegic CP were recruited. Intervention with the comprehensive hand repetitive intensive strengthening training system was provided for 60 min a day, three times a week, for 10 weeks. Neuroplastic changes, muscle size, strength, and associated motor function were measured using functional magnetic resonance imaging (MRI), ultrasound imaging, and standardized motor tests, respectively. The functional MRI data showed that the comprehensive hand repetitive intensive strengthening training intervention produced measurable neuroplastic changes in the neural substrates associated with motor control and learning. These neuroplastic changes were associated with increased muscle size, strength and motor function. These results provide compelling evidence of neuroplastic changes and associated improvements in muscle size and motor function following innovative upper extremity strengthening exercise.

Factitious buccal lesion secondary to bruxism in a child with cerebral palsy

PubMed Central

Harris, D

2006-01-01

Children with cerebral palsy are at greater risk of a whole range of oral conditions than their peers. These include bruxism (tooth grinding), oral skill dysfunction, gross malocclusion due to effects of the abnormal orofacial muscle tone on tooth eruption, drooling of saliva, and poor oral hygiene.1 A challenging case of a painful buccal lesion in a 2 year old girl with cerebral palsy (CP) that did not respond to antifungal, antiviral or antibiotic treatment is presented as a factitious lesion. The recognition and significance of self‐injurious behaviour and factitious lesions in children are discussed. PMID:16373789

Factitious buccal lesion secondary to bruxism in a child with cerebral palsy.

PubMed

Harris, D

2006-01-01

Children with cerebral palsy are at greater risk of a whole range of oral conditions than their peers. These include bruxism (tooth grinding), oral skill dysfunction, gross malocclusion due to effects of the abnormal orofacial muscle tone on tooth eruption, drooling of saliva, and poor oral hygiene. A challenging case of a painful buccal lesion in a 2 year old girl with cerebral palsy (CP) that did not respond to antifungal, antiviral or antibiotic treatment is presented as a factitious lesion. The recognition and significance of self-injurious behaviour and factitious lesions in children are discussed.

Use of the Teager-Kaiser Energy Operator for Muscle Activity Detection in Children

PubMed Central

Lauer, Richard T.; Prosser, Laura A.

2009-01-01

The purpose of this study was to demonstrate the usefulness of the Teager-Kaiser Energy (TKE) operator to assess surface electromyographic (sEMG) activity from the hip and trunk muscles during pediatric gait in children with and without cerebral palsy (CP). Muscle activity was recorded from the trapezius, erector spinae, rectus abdominus, external oblique, gluteus maximus and medius, rectus femoris, and semitendinosus bilaterally in ten children with typical development (TD) and five children with CP ages 44.4 ± 18.6 months. Duration of muscle activity was calculated as a percentage of the gait cycle, and compared to two common onset detection methods, a standard deviation (SD) amplitude threshold method, and the visual inspection from two raters (R1, R2). Relative and absolute agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Of the two automated methods, the TKE method demonstrated better agreement with visual inspection (0.45–0.89) than the SD (0.11–0.76) method. The Bland-Altman plots indicated a smaller bias and 95% confidence interval for the TKE method in comparison to the raters (TKE to R1: −5, 113%; TKE to R2: 4, 95%; SD to R1: −24, 170%; SD to R2: −15, 151%). The use of the TKE operator may better detect sEMG activity in children than the standard amplitude method. PMID:19484385

The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis.

PubMed

Quant, Eudocia C; Jeste, Shafali S; Muni, Rajeev H; Cape, Alison V; Bhussar, Manveen K; Peleg, Anton Y

2009-09-07

To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell's palsy than steroids alone. Meta-analysis. PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references. Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell's palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required. Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model. Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids. Antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with

Acupuncture and Kinesio Taping for the acute management of Bell's palsy: A case report.

PubMed

Alptekin, Derya Özmen

2017-12-01

Bell's palsy is an idiopathic, acute peripheral palsy of the facial nerve that supplies the muscles of facial expression. Despite an expected 70% full recovery rate, up to 30% of patients are left with potentially disfiguring facial weakness, involuntary movements, or persistent lacrimation. The most frequently used treatment options are corticosteroids and antiviral drugs. However, accompanying clinical conditions, such as uncontrolled diabetes, hypertension, gastrointestinal disturbances, polypharmacy of geriatric patients, and significant sequelae ratios, indicate the need for safe and effective complementary therapies that would enhance the success of the conventional interventions. A 26-year-old female presented with numbness and earache on the left side of the face; these symptoms had been ongoing for 8-10h. Physical examination revealed peripheral facial paralysis of House-Brackmann grade III and corticosteroid-valacyclovir treatment was initiated. On the same day, Kinesio Taping was applied to the affected nerve and muscle area with the aim of primarily neurofacilitation and edema-pain relief. On the fifth day, acupuncture treatment was started and was continued for 3 consecutive days. A physical therapy program was administered for the subsequent 10days. At the 3-week follow-up examination, Bell's palsy was determined as grade I, and the treatment was stopped. Acupuncture and Kinesio Taping, in conjunction with physical therapy modalities, are safe and promising complementary therapies for the acute management of Bell's palsy. However, further large scale and randomized controlled studies are necessary to assess whether these complementary interventions have significant additive or synergistic effect for complete recovery of patients with Bell's palsy. Copyright © 2017 Elsevier Ltd. All rights reserved.

The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice.

PubMed

Linek, P

2018-01-01

Some studies have not considered body mass as a confounder in analysis of oblique abdominis muscles (OAM) (including the oblique externus [OE] and oblique internus [OI]), which may have led to improper interpretation of results. To assess the differences in the effect of age, gender, and physical activity between normalised for body mass and actual values of the OAM as well as to establish the effect of age, gender, and physical activity on normalised for body mass OAM thicknesses in adolescents. A real-time ultrasound was used to obtain images of the OAM. Body mass normalisation for OAM thicknesses was performed with allometric scaling and the following equations: Allometric-scaled OE = OE thickness/body mass0.88; Allometric-scaled OI = OI thickness/body mass0.72. Analysis showed that boys have significantly thicker OAM than girls, and those who practise sports have thicker OAM than non-active individuals. For allometric-scaled OAM, there was only a significant gender effect, where boys have thicker allometric-scaled OAM than girls. There was a significant correlation between participants' age and the actual value of the OAM. The correlations between age and allometric-scaled OAM were insignificant. An analysis of OAM without body mass normalisation can lead to improper interpretation of study results. Thus, future studies should analyse OE and OI thickness measurements after normalisation rather than actual values. In the adolescent population, there is no effect of age and physical activity on allometric-scaled OAM; males have thicker allometric-scaled OAM than females. (Folia Morphol 2018; 77, 1: 123-130).

Facial palsy in Melkersson-Rosenthal syndrome and Bell's palsy: familial history and recurrence tendency.

PubMed

Sun, Baochun; Zhou, Chengyong; Han, Zeli

2015-02-01

The aim of this study was to compare genetic predilection and recurrence tendency between facial palsy in Melkersson-Rosenthal syndrome (MRS) and Bell's palsy We carried out an investigation on patients with facial palsy in MRS and those with Bell's palsy who visited the outpatient department in our hospital between February 2009 and February 2013. They were asked about familial history and whether it was the first episode, with the results recorded and compared. There were 16 patients with facial palsy in MRS and 860 patients with Bell's palsy involved in the study. Familial history was positive in 5 of 16 patients (31.3%) with facial palsy in MRS and 56 of 860 patients (6.5%) with Bell's palsy (P < .01). Twelve of 16 cases (75%) with facial palsy in MRS and 88 of 860 cases (10.2%) with Bell's palsy had a history of facial palsy in the past (P < .01). Compared to Bell's palsy, facial palsy in MRS has an obvious genetic predilection and recurrence tendency. © The Author(s) 2014.

Comparison of Transcranial Magnetic Stimulation and Electroneuronography Between Bell's Palsy and Ramsay Hunt Syndrome in Their Acute Stages

PubMed Central

Hur, Dong Min; Lee, Young Hee; Kim, Sung Hoon; Park, Jung Mi; Kim, Ji Hyun; Yong, Sang Yeol; Shinn, Jong Mock; Oh, Kyung Joon

2013-01-01

Objective To examine the neurophysiologic status in patients with idiopathic facial nerve palsy (Bell's palsy) and Ramsay Hunt syndrome (herpes zoster oticus) within 7 days from onset of symptoms, by comparing the amplitude of compound muscle action potentials (CMAP) of facial muscles in electroneuronography (ENoG) and transcranial magnetic stimulation (TMS). Methods The facial nerve conduction study using ENoG and TMS was performed in 42 patients with Bell's palsy and 14 patients with Ramsay Hunt syndrome within 7 days from onset of symptoms. Denervation ratio was calculated as CMAP amplitude evoked by ENoG or TMS on the affected side as percentage of the amplitudes on the healthy side. The severity of the facial palsy was graded according to House-Brackmann facial grading scale (H-B FGS). Results In all subjects, the denervation ratio in TMS (71.53±18.38%) was significantly greater than the denervation ratio in ENoG (41.95±21.59%). The difference of denervation ratio between ENoG and TMS was significantly smaller in patients with Ramsay Hunt syndrome than in patients with Bell's palsy. The denervation ratio of ENoG or TMS did not correlated significantly with the H-B FGS. Conclusion In the electrophysiologic study for evaluation in patients with facial palsy within 7 days from onset of symptoms, ENoG and TMS are useful in gaining additional information about the neurophysiologic status of the facial nerve and may help to evaluate prognosis and set management plan. PMID:23525840

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy.

PubMed

Martín-Ruiz, María-Luisa; Máximo-Bocanegra, Nuria; Luna-Oliva, Laura

2016-03-26

The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children's oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.

Therapeutic effects of anti-gravity treadmill (AlterG) training on reflex hyper-excitability, corticospinal tract activities, and muscle stiffness in children with cerebral palsy.

PubMed

Parvin, Sh; Taghiloo, A; Irani, A; Mirbagheri, M Mehdi

2017-07-01

We aimed to study therapeutic effects of antigravity treadmill (AlterG) training on reflex hyper-excitability, muscle stiffness, and corticospinal tract (CST) function in children with spastic hemiplegic cerebral palsy (CP). Three children received AlterG training 3 days per week for 8 weeks as experimental group. Each session lasted 45 minutes. One child as control group received typical occupational therapy for the same amount of time. We evaluated hyper-excitability of lower limb muscles by H-reflex response. We quantified muscle stiffness by sonoelastography images of the affected muscles. We quantified CST activity by transcranial magnetic stimulation (TMS). We performed the evaluations before and after training for both groups. H response latency and maximum M-wave amplitude were improved in experimental group after training compared to control group. Two children of experimental group had TMS response. Major parameters of TMS (i.e. peak-to-peak amplitude of motor evoked potential (MEP), latency of MEP, cortical silent period, and intensity of pulse) improved for both of them. Three parameters of texture analysis of sonoelastography images were improved for experimental group (i.e. contrast, entropy, and shear wave velocity). These findings indicate that AlterG training can improve reflexes, muscle stiffness, and CST activity in children with spastic hemiplegic CP and can be considered as a therapeutic tool to improve neuromuscular abnormalities occurring secondary to CP.

Phrenic nerve palsy associated with birth trauma--case reports and a literature review.

PubMed

Shiohama, Tadashi; Fujii, Katsunori; Hayashi, Masaharu; Hishiki, Tomoro; Suyama, Maiko; Mizuochi, Hiromi; Uchikawa, Hideki; Yoshida, Shigetoshi; Yoshida, Hideo; Kohno, Yoichi

2013-04-01

Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma or cardiac surgery. We describe two new patients with phrenic nerve palsy associated with birth trauma. Both patients exhibited profound dyspnea and general hypotonia immediately after birth. A chest roentgenogram and fluoroscopy revealed elevation of the diaphragm, leading to a diagnosis of phrenic nerve palsy associated with birth trauma. Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively. Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once. However, this recovery was transient and subsequently led to an increased ventilation volume demand, finally resulting in surgical treatment at 15 months. Histological examination of the diaphragm at this time showed grouped muscle atrophy caused by phrenic nerve degeneration. To our knowledge, this is the first pathologically proven report of grouped muscle atrophy of the diaphragm due to phrenic nerve degeneration, suggesting that partial impairment of phrenic nerves resulted in respiratory dysfunction with incomplete recovery. We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Bilateral Abducent Nerve Palsy After Neck Trauma: A Case Report

PubMed Central

Aminiahidashti, Hamed; Shafiee, Sajad; Sazegar, Mohammad; Nosrati, Nazanin

2016-01-01

Introduction The abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare. Case Presentation A 65-year-old woman presented to the emergency department following a motor vehicle accident. A neurological assessment showed the patient’s Glascow coma scale (GCS) to be 15. She complained of double vision, and we found lateral gaze palsy in both eyes. A hangman fracture type IIA (C2 fracture with posterior ligamentous C1 - C2 distraction) was found on the cervical CT scan. A three-month follow-up of the patient showed complete recovery of the abducent nerve. Conclusions Conservative treatment is usually recommended for traumatic bilateral abducent nerve palsy. Our patient recovered from this condition after three months without any remaining neurological deficit, a very rare outcome in a rare case. PMID:27218062

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis

PubMed Central

Quant, Eudocia C; Jeste, Shafali S; Muni, Rajeev H; Cape, Alison V; Bhussar, Manveen K

2009-01-01

Objective To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell’s palsy than steroids alone. Design Meta-analysis. Data sources PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references. Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell’s palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required. Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model. Results Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids. Conclusions Antivirals did not provide an added benefit in achieving at least partial facial muscle

Relative Activity of Abdominal Muscles during Commonly Prescribed Strengthening Exercises.

ERIC Educational Resources Information Center

Willett, Gilbert M.; Hyde, Jennifer E.; Uhrlaub, Michael B.; Wendel, Cara L.; Karst, Gregory M.

2001-01-01

Examined the relative electromyographic (EMG) activity of upper and lower rectus abdominis (LRA) and external oblique (EOA) muscles during five abdominal strengthening exercises. Isometric and dynamic EMG data indicated that abdominal strengthening exercises activated various abdominal muscle groups. For the LRA and EOA muscle groups, there were…

Cerebral Palsy (For Teens)

MedlinePlus

... Staying Safe Videos for Educators Search English Español Cerebral Palsy KidsHealth / For Teens / Cerebral Palsy What's in this ... do just what everyone else does. What Is Cerebral Palsy? Cerebral palsy (CP) is a disorder of the ...

Interface Stability Influences Torso Muscle Recruitment and Spinal Load During Pushing Tasks

PubMed Central

LEE, P. J.; GRANATA, K. P.

2006-01-01

Handle or interface design can influence torso muscle recruitment and spinal load during pushing tasks. The objective of the study was to provide insight into the role of interface stability with regard to torso muscle recruitment and biomechanical loads on the spine. Fourteen subjects generated voluntary isometric trunk flexion force against a rigid interface and similar flexion exertions against an unstable interface, which simulated handle design in a cart pushing task. Normalized electromyographic (EMG) activity in the rectus abdominus, external oblique and internal oblique muscles increased with exertion effort. When using the unstable interface, EMG activity in the internal and external oblique muscle groups was greater than when using the rigid interface. Results agreed with trends from a biomechanical model implemented to predict the muscle activation necessary to generate isometric pushing forces and maintain spinal stability when using the two different interface designs. The co-contraction contributed to increased spinal load when using the unstable interface. It was concluded that handle or interface design and stability may influence spinal load and associated risk of musculoskeletal injury during manual materials tasks that involve pushing exertions. PMID:16540437

[F-waves in brachial plexus palsy correlated to the prognosis of intrinsic paralysis].

PubMed

Nobuta, S

1995-04-01

F-waves were examined in 80 nerves of 40 brachial plexus palsies in 37 cases. The electrical responses were evoked by 30 consecutive supramaximal electric stimuli to the median and ulnar nerves at the wrist and elbow, and recorded from the abductor pollicis brevis and abductor digiti minimi muscles. Three parameters in the F-waves were analyzed--conduction velocity, the difference between the maximal and minimal latencies, and the amplitude. In all cases, examinations were done repeatedly to detect changes in these parameters, and the results were compared with the clinical course of the intrinsic muscle function. Twenty-seven cases were investigated before and after explorative surgery. The findings were divided into four groups. The 1st group consisted of 12 nerves in which F-waves were not recorded. The intrinsic muscle power in this group was zero, and did not show any restoration. The 2nd group consisted of 10 nerves in which the conduction velocity was delayed. The muscle power in this group was fair, poor or trace, and there was no change in conduction velocity and muscle function. The 3rd group consisted of 18 nerves in which parameters other than the conduction velocity were abnormal, and the intrinsic muscle power in this group was fair, good or normal. In 7 of these nerves, the large latency difference decreased to normal at the 2nd, 3rd or 4th test with functional recovery in the intrinsic muscle. The high amplitude also changed to normal at the 2nd test with functional recovery. The 4th group consisted of 40 nerves in which all the parameters were normal and had full intrinsic muscle power. In conclusion, an examination of the F-waves was valuable to indicate the prognosis of the intrinsic muscle in the hand in brachial plexus palsy.

Bell’s palsy: data from a study of 70 cases

PubMed Central

Cirpaciu, D; Goanta, CM

2014-01-01

Bell’s palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded. PMID:25870668

Cerebral Palsy (For Parents)

MedlinePlus

... Staying Safe Videos for Educators Search English Español Cerebral Palsy KidsHealth / For Parents / Cerebral Palsy What's in this ... Ahead Print en español Parálisis cerebral What Is Cerebral Palsy? Cerebral palsy (CP) is a disorder that affects ...

Tendon transfer to reconstruct wrist extension in children with obstetric brachial plexus palsy.

PubMed

Al-Qattan, M M

2003-04-01

This study reports on 20 children with obstetric brachial plexus palsy who underwent a tendon transfer to reconstruct wrist extension. The mean age at the time of tendon transfer was 8 years. There were seven patients with Erb's palsy and the remaining 13 had total palsy. The flexor carpi ulnaris was utilized 15 times and the flexor carpi radialis five times. The transferred tendon was sutured to the tendon of the extensor carpi radialis brevis. The result of the transfer was assessed according to a modified Medical Research Council (MRC) muscle grading system. A good result was obtained in 18 patients (modified MRC grade of 4) and a fair result (modified MRC grade of 3) in two. The choice of tendon transfer to reconstruct the wrist drop deformity in various conditions including adult traumatic brachial plexus injuries is discussed.

Effects of age and inactivity due to prolonged bed rest on atrophy of trunk muscles.

PubMed

Ikezoe, Tome; Mori, Natsuko; Nakamura, Masatoshi; Ichihashi, Noriaki

2012-01-01

This study investigated the effects of age and inactivity due to being chronically bedridden on atrophy of trunk muscles. The subjects comprised 33 young women (young group) and 41 elderly women who resided in nursing homes or chronic care institutions. The elderly subjects were divided into two groups: independent elderly group who were able to perform activities of daily living involving walking independently (n = 28) and dependent elderly group who were chronically bedridden (n = 13). The thickness of the following six trunk muscles was measured by B-mode ultrasound: the rectus abdominis, external oblique, internal oblique, transversus abdominis, thoracic erector spinae (longissimus) and lumbar multifidus muscles. All muscles except for the transversus abdominis and lumbar multifidus muscles were significantly thinner in the independent elderly group compared with those in the young group. The thicknesses of all muscles in the dependent elderly group was significantly smaller than that in the young group, whereas there were no differences between the dependent elderly and independent elderly groups in the muscle thicknesses of the rectus abdominis and internal oblique muscles. In conclusion, our results suggest that: (1) age-related atrophy compared with young women was less in the deep antigravity trunk muscles than the superficial muscles in the independent elderly women; (2) atrophy associated with chronic bed rest was more marked in the antigravity muscles, such as the back and transversus abdominis.

Oblique Wing Flights

NASA Image and Video Library

2018-05-09

Flown in the mid 70's, this Oblique Wing was a large-scale R/C experimental aircraft to demonstrate the ability to pivot its wing to an oblique angle, allowing for a reduced drag penalty at transonic speeds.

Mechanical Properties of the Plantarflexor Musculotendinous Unit during Passive Dorsiflexion in Children with Cerebral Palsy Compared with Typically Developing Children

ERIC Educational Resources Information Center

Alhusaini, Adel A. A.; Crosbie, Jack; Shepherd, Roberta B.; Dean, Catherine M.; Scheinberg, Adam

2010-01-01

Aim: To examine the passive length-tension relations in the myotendinous components of the plantarflexor muscles of children with and without cerebral palsy (CP) under conditions excluding reflex muscle contraction. Method: A cross-sectional, non-interventional study was conducted in a hospital outpatient clinic. Passive torque-angle…

The prognostic value of concurrent phrenic nerve palsy in newborn babies with neonatal brachial plexus palsy.

PubMed

Yoshida, Kiyoshi; Kawabata, Hidehiko

2015-06-01

To investigate the prognostic value of concurrent phrenic nerve palsy for predicting spontaneous motor recovery in neonatal brachial plexus palsy. We reviewed the records of 366 neonates with brachial plexus palsy. The clinical and follow-up data of patients with and without phrenic nerve palsy were compared. Of 366 newborn babies with neonatal brachial plexus palsy, 21 (6%) had concurrent phrenic nerve palsy. Sixteen of these neonates had upper-type palsy and 5 had total-type palsy. Poor spontaneous motor recovery was observed in 13 neonates with concurrent phrenic nerve palsy (62%) and in 129 without concurrent phrenic nerve palsy (39%). Among neonates born via vertex delivery, poor motor recovery was observed in 7 of 9 (78%) neonates with concurrent phrenic nerve palsy and 115 of 296 (39%) without concurrent phrenic nerve palsy. Concurrent phrenic nerve palsy in neonates with brachial plexus palsy has prognostic value in predicting poor spontaneous motor recovery of the brachial plexus, particularly after vertex delivery. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Sit-to-Stand Movement in Children with Cerebral Palsy: A Critical Review

ERIC Educational Resources Information Center

dos Santos, Adriana Neves; Pavao, Silvia Leticia; Rocha, Nelci Adriana Cicuto Ferreira

2011-01-01

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…

Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy.

PubMed

Cho, Chunhee; Hwang, Wonjeong; Hwang, Sujin; Chung, Yijung

2016-03-01

Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy (CP). Virtual reality-based rehabilitation therapy is effective in motivating children with CP. This study investigated the effects of treadmill training with virtual reality on gait, balance, muscular strength, and gross motor function in children with CP. Eighteen children with spastic CP were randomly divided into the virtual reality treadmill training (VRTT) group (9 subjects, mean age, 10.2 years) and treadmill training (TT) group (9 subjects, mean age, 9.4 years). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. Muscle strength was assessed using a digitalized manual muscle tester. Gross motor function was assessed using the Gross Motor Functional Measure (GMFM). Balance was assessed using the Pediatric Balance Scale (PBS). Gait speed was assessed using the 10-meter walk test (10MWT), and gait endurance was assessed using the 2-minute walk test (2MWT). After training, gait and balance was improved in the VRTT compared to the TT group (P < 0.05). Muscular strength was significantly greater in the VRTT group than the TT group, except for right hamstring strength. The improvements in GMFM (standing) and PBS scores were greater in the VRTT group than the TT group (P < 0.05). Furthermore, the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group (P < 0.05). In conclusion, VRTT programs are effective for improving gait, balance, muscular strength, and gross motor function in children with CP.

Mechanical and histological characterization of the abdominal muscle. A previous step to modelling hernia surgery.

PubMed

Hernández, B; Peña, E; Pascual, G; Rodríguez, M; Calvo, B; Doblaré, M; Bellón, J M

2011-04-01

The aims of this study are to experimentally characterize the passive elastic behaviour of the rabbit abdominal wall and to develop a mechanical constitutive law which accurately reproduces the obtained experimental results. For this purpose, tissue samples from New Zealand White rabbits 2150±50 (g) were mechanically tested in vitro. Mechanical tests, consisting of uniaxial loading on tissue samples oriented along the craneo-caudal and the perpendicular directions, respectively, revealed the anisotropic non-linear mechanical behaviour of the abdominal tissues. Experiments were performed considering the composite muscle (including external oblique-EO, internal oblique-IO and transverse abdominis-TA muscle layers), as well as separated muscle layers (i.e., external oblique, and the bilayer formed by internal oblique and transverse abdominis). Both the EO muscle layer and the IO-TA bilayer demonstrated a stiffer behaviour along the transversal direction to muscle fibres than along the longitudinal one. The fibre arrangement was measured by means of a histological study which confirmed that collagen fibres are mainly responsible for the passive mechanical strength and stiffness. Furthermore, the degree of anisotropy of the abdominal composite muscle turned out to be less pronounced than those obtained while studying the EO and IO-TA separately. Moreover, a phenomenological constitutive law was used to capture the measured experimental curves. A Levenberg-Marquardt optimization algorithm was used to fit the model constants to reproduce the experimental curves. Copyright © 2010 Elsevier Ltd. All rights reserved.

Joint Angular Velocity in Spastic Gait and the Influence of Muscle-Tendon Lengthening*

PubMed Central

GRANATA, KEVIN P.; ABEL, MARK F.; DAMIANO, DIANE L.

2006-01-01

Background Joint angular velocity (the rate of flexion and extension of a joint) is related to the dynamics of muscle activation and force generation during walking. Therefore, the goal of this research was to examine the joint angular velocity in normal and spastic gait and changes resulting from muscle-tendon lengthening (recession and tenotomy) in patients who have spastic cerebral palsy. Methods The gait patterns of forty patients who had been diagnosed with spastic cerebral palsy (mean age, 8.3 years; range, 3.7 to 14.8 years) and of seventy-three age-matched, normally developing subjects were evaluated with three-dimensional motion analysis and electromyography. The patients who had cerebral palsy were evaluated before muscle-tendon lengthening and nine months after treatment. Results The gait patterns of the patients who had cerebral palsy were characterized by increased flexion of the knee in the stance phase, premature plantar flexion of the ankle, and reduced joint angular velocities compared with the patterns of the normally developing subjects. Even though muscle-tendon lengthening altered sagittal joint angles in gait, the joint angular velocities were generally unchanged at the hip and knee. Only the ankle demonstrated modified angular velocities, including reduced dorsiflexion velocity at foot-strike and improved dorsiflexion velocity through midstance, after treatment. Electromyographic changes included reduced amplitude of the gastrocnemius-soleus during the loading phase and decreased knee coactivity (the ratio of quadriceps and hamstring activation) at toe-off. Principal component analyses showed that, compared with joint-angle data, joint angular velocity was better able to discriminate between the gait patterns of the normal and cerebral palsy groups. Conclusions This study showed that muscle-tendon lengthening corrects biomechanical alignment as reflected by changes in sagittal joint angles. However, joint angular velocity and

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy

PubMed Central

Martín-Ruiz, María-Luisa; Máximo-Bocanegra, Nuria; Luna-Oliva, Laura

2016-01-01

The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children’s oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy. PMID:27023561

A study on muscle activity and ratio of the knee extensor depending on the types of squat exercise

PubMed Central

Kang, Jeong-Il; Park, Joon-Su; Choi, Hyun; Jeong, Dae-Keun; Kwon, Hye-Min; Moon, Young-Jun

2017-01-01

[Purpose] For preventing the patellofemoral pain syndrome, this study aims to suggest a proper squat method, which presents selective muscle activity of Vastus Medialis Oblique and muscle activity ratios of Vastus Medialis Oblique/Vastus Lateralis by applying squat that is a representative weight bearing exercise method in various ways depending on the surface conditions and knee bending angles. [Subjects and Methods] An isometric squat that was accompanied by hip adduction, depending on the surface condition and the knee joint flexion angle, was performed by 24 healthy students. The muscle activity and the ratio of muscle activity were measured. [Results] In a comparison of muscle activity depending on the knee joint flexion angle on a weight-bearing surface, the vastus medialis oblique showed a significant difference at 15° and 60°. Meanwhile, in a comparison of the muscle activity ratio between the vastus medialis oblique and the vastus lateralis depending on the knee joint flexion angle on a weight-bearing surface, significant differences were observed at 15° and 60°. [Conclusion] An efficient squat exercise posture for preventing the patellofemoral pain syndrome is to increase the knee joint bending angle on a stable surface. But it would be efficient for patients with difficulties in bending the knee joint to keep a knee joint bending angle of 15 degrees or less on an unstable surface. It is considered that in future, diverse studies on selective Vastus Medialis Oblique strengthening exercise methods would be needed after applying them to patients with the patellofemoral pain syndrome. PMID:28210036

Comparison of the thickness of lateral abdominal muscles between pregnant women with and without low back pain.

PubMed

Rostami, Mohsen; Noormohammadpour, Pardis; Mansournia, Mohammad Ali; Hantoushzadeh, Sedigheh; Farahbakhsh, Farzin; Nourian, Ruhollah; Kordi, Ramin

2015-05-01

To compare the thickness of the external oblique, internal oblique, and transversus abdominis muscles in pregnant subjects with and without low back pain (LBP) by the use of ultrasound to measure thickness. A case-control study. An academic and tertiary care referral spine and sports medicine center. Fifty pregnant women with LBP during pregnancy and 54 pregnant control subjects. Case and control subjects were matched for body mass index, gestational age, and number of previous pregnancies. A multiple linear regression model with adjustment for the gestational age of the subjects, as the potential confounder of the primary outcomes, was used to evaluate the association between LBP appearance and abdominal muscles thickness of the subjects. The thickness of lateral abdominal muscles was measured by ultrasound with the subject in a hook-lying position on the examination table. We found that there was no significant difference between pregnant subjects with and without LBP in terms of the thickness of external oblique, internal oblique, and transversus abdominis muscles. These findings suggest that other factors rather than the thickness of core stabilizing muscles are influential in the etiology of LBP during pregnancy. We hypothesize that enlargement of uterus during pregnancy might influence the thickness of the lateral abdominal muscles. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery.

PubMed

Akulov, Mihail A; Orlova, Ol'ga R; Orlova, Aleksandra S; Usachev, Dmitrij J; Shimansky, Vadim N; Tanjashin, Sergey V; Khatkova, Svetlana E; Yunosha-Shanyavskaya, Anna V

2017-10-15

This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy.

PubMed

Shin, Yoon Kyum; Lee, Dong Ryul; Kim, Do Hyun; Lee, Jae Jin; You, Sung Joshua Hyun; Yi, Chung Hwi; Jeon, Hye Seon

2014-01-01

Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP.

[Etiology of cerebral palsy].

PubMed

Jaisle, F

1996-01-01

The "perinatal asphyxia" is regarded to be one of the causes of cerebral palsy, though in the very most of the children with cerebral palsy there is found no hypoxia during labour. It should be mentioned, that the definition of "perinatal" and "asphyxia" neither are unic nor concret. And also there is no correlation between nonreassuring fetal heart rate patterns and acidosis in fetal blood with the incidence of cerebral palsy. Numerous studies in pregnant animals failed in proving an acute intrapartal hypoxia to be the origin of the cerebral palsy. Myers (1975) describes four patterns of anatomic brain damage after different injuries. Only his so called oligo-acidotic hypoxia, which is protracted and lasts over a longer time is leading to brain injury, which can be regarded in analogy to the injury of children with cerebral palsy. Summarising the update publications about the causes of cerebral palsy and the studies in pregnant animals there is no evidence that hypoxia during labour may be the cause of cerebral palsy. There is a great probability of a pre(and post-)natal origin of brain injury (for instance a periventricular leucomalacia found after birth) which leads to cerebral palsy. Short after labour signs of a so called "asphyxia" may occur in addition to this preexisting injury and misrepresent the cause of cerebral palsy. Finally the prepartal injury may cause both: Cerebral palsy and hypoxia.

Altered trunk muscle recruitment patterns during lifting in individuals in remission from recurrent low back pain.

PubMed

Suehiro, Tadanobu; Ishida, Hiroshi; Kobara, Kenichi; Osaka, Hiroshi; Watanabe, Susumu

2018-04-01

Changes in the recruitment pattern of trunk muscles may contribute to the development of recurrent or chronic symptoms in people with low back pain (LBP). However, the recruitment pattern of trunk muscles during lifting tasks associated with a high risk of LBP has not been clearly determined in recurrent LBP. The present study aimed to investigate potential differences in trunk muscles recruitment patterns between individuals with recurrent LBP and asymptomatic individuals during lifting. The subjects were 25 individuals with recurrent LBP and 20 asymptomatic individuals. Electromyography (EMG) was used to measure onset time, EMG amplitude, overall activity of abdominal muscles, and overall activity of back muscles during a lifting task. The onsets of the transversus abdominis/internal abdominal oblique and multifidus were delayed in the recurrent LBP group despite remission from symptoms. Additionally, the EMG amplitudes of the erector spinae, as well as the overall activity of abdominal muscles or back muscles, were greater in the recurrent LBP group. No differences in EMG amplitude of the external oblique, transversus abdominis/internal abdominal oblique, and multifidus were found between the groups. Our findings indicate the presence of an altered trunk muscle recruitment pattern in individuals with recurrent LBP during lifting. Copyright © 2018 Elsevier Ltd. All rights reserved.

Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water.

PubMed

Takenaka, S; Hosono, N; Mukai, Y; Tateishi, K; Fuji, T

2016-01-01

The aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling. Irrigation saline for drilling was used at room temperature (RT, 25.6°C) in open-door laminoplasty in 400 patients (RT group) and chilled to a mean temperature of 12.1°C during operations for 400 patients (low-temperature (LT) group). We assessed deltoid, biceps, and triceps brachii muscle strength by MMT. ULP occurring within two days post-operatively was categorised as early-onset palsy. The incidence of ULP (4.0% vs 9.5%, p = 0.003), especially early-onset palsy (1.0% vs 5.5%, p < 0.001), was significantly lower for the LT group than for the RT group. Multivariate analysis indicated that RT irrigation saline use, concomitant foraminotomy, and opened side were significant predictors for ULP. Using chilled irrigation saline during bone drilling significantly decreased the ULP incidence, particularly the early-onset type, and shortened the recovery period for ULP. Chilled irrigation saline can thus be recommended as a simple method for preventing ULP. Chilled irrigation during laminoplasty reduces C5 palsy. ©2016 The British Editorial Society of Bone & Joint Surgery.

Cerebral Palsy

MedlinePlus

Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...

Risk factors associated with upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy.

PubMed

Wu, Feng L; Sun, Yu; Pan, Sheng F; Zhang, Li; Liu, Zhong J

2014-06-01

Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. There have been several reports about upper extremity palsy after cervical laminoplasty for patients with cervical myelopathy. However, the possible risk factors remain unclear. To investigate the factors associated with the development of upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. A retrospective review of medical records. A total of 102 patients (76 men and 26 women) were eligible for analysis in this study. The mean age of the patients was 58.7 years (range 35-81 years). Sixteen patients (13 men and 3 women, average age 62.8 years) with palsy were categorized as Group P, and eighty-six patients (63 men and 23 women, average age 57.8 years) without palsy as Group C. The demographic data collected from both groups were age, sex, duration of symptoms, disease, and type of surgical procedure. Cervical curvature index, width of the intervertebral foramen (WIF) at C5, anterior protrusion of the superior articular process (APSAP), number of compressed segments, high-signal intensity zone at the level corresponding to C3-C5 (HIZ:C3-C5), and posterior shift of the spinal cord (PSSC) were also evaluated. Upper extremity palsy was defined as weakness of Grade 4 or less of the key muscles in the upper extremity by manual muscle test without any deterioration of myelopathic symptoms after surgery. Comparisons were made with screen for the parameters with significant differences, and then we further analyzed these parameters by logistic regression analysis (the forward method) to verify the risk factors of the upper extremity palsy. Significant differences in diagnosis, the type of procedure, WIF, APSAP, and HIZ:C3-C5 were observed between the two groups. No statistical difference in PSSC between the groups was noted (2.06 vs. 2.53 mm, p=.247). In logistic regression analysis, ossification of the posterior longitudinal

Distance between intramuscular nerve and artery in the extraocular muscles: a preliminary immunohistochemical study using elderly human cadavers.

PubMed

Kitamura, Kei; Cho, Kwang Ho; Jang, Hyung Suk; Murakami, Gen; Yamamoto, Masahito; Abe, Shin-Ichi

2017-01-01

Extraocular muscles are quite different from skeletal muscles in muscle fiber type and nerve supply; the small motor unit may be the most well known. As the first step to understanding the nerve-artery relationship, in this study we measured the distance from the arteriole (25-50 μm in thickness) to the nerve terminal twigs in extraocular muscles. With the aid of immunohistochemistry for nerves and arteries, we examined the arteriole-nerve distance at 10-15 sites in each of 68 extraocular muscles obtained from ten elderly cadavers. The oblique sections were nearly tangential to the muscle plate and included both global and orbital aspects of the muscle. In all muscles, the nerve twigs usually took a course parallel to muscle fibers, in contrast to most arterioles that crossed muscles. Possibly due to polyinnervation, an intramuscular nerve plexus was evident in four rectus and two oblique muscles. The arteriole-nerve distance usually ranged from 300 to 400 μm. However, individual differences were more than two times greater in each of seven muscles. Moreover, in each muscle the difference between sites sometimes reached 1 mm or more. The distance was generally shorter in the rectus and oblique muscles than in the levator palpebrae muscle, which reached statistical significance (p < 0.05). The differences in arteriole-nerve distances between sites within each muscle, between muscles, and between individuals might lead to an individual biological rhythm of fatigue in oculomotor performance.

Effect of surface stability on core muscle activity for dynamic resistance exercises.

PubMed

Willardson, Jeffrey M; Fontana, Fabio E; Bressel, Eadric

2009-03-01

To compare core muscle activity during resistance exercises performed on stable ground vs. the BOSU Balance Trainer. Twelve trained men performed the back squat, dead lift, overhead press, and curl lifts. The activity of the rectus abdominis, external oblique abdominis, transversus abdominis/internal oblique abdominis, and erector spinae muscles was assessed. Subjects performed each lift under three separate conditions including standing on stable ground with 50% of a 1-RM, standing on a BOSU Balance Trainer with 50% of a 1-RM, and standing on stable ground with 75% of a 1-RM. Significant differences were noted between the stable 75% of 1-RM and BOSU 50% of 1-RM conditions for the rectus abdominis during the overhead press and transversus abdominis/internal oblique abdominis during the overhead press and curl (P < .05). Conversely, there were no significant differences between the stable 75% of 1-RM and BOSU 50% of 1-RM conditions for the external obliques and erector spinae across all lifts examined. Furthermore, there were no significant differences between the BOSU 50% of 1-RM and stable 50% of 1-RM conditions across all muscles and lifts examined. The current study did not demonstrate any advantage in utilizing the BOSU Balance Trainer. Therefore, fitness trainers should be advised that each of the aforementioned lifts can be performed while standing on stable ground without losing the potential core muscle training benefits.

Effects of visibility and types of the ground surface on the muscle activities of the vastus medialis oblique and vastus lateralis

PubMed Central

Park, Jeong-ki; Lee, Dong-yeop; Kim, Jin-Seop; Hong, Ji-Heon; You, Jae-Ho; Park, In-mo

2015-01-01

[Purpose] The purpose of this study was to compare the effects of visibility and types of ground surface (stable and unstable) during the performance of squats on the muscle activities of the vastus medialis oblique (VMO) and vastus lateralis (VL). [Subjects and Methods] The subjects were 25 healthy adults in their 20s. They performed squats under four conditions: stable ground surface (SGS) with vision-allowed; unstable ground surface (UGS) with vision-allowed; SGS with vision-blocked; and UGS with vision-blocked. The different conditions were performed on different days. Surface electromyogram (EMG) values were recorded. [Results] The most significant difference in the activity of the VMO and VL was observed when the subjects performed squats on the UGS, with their vision blocked. [Conclusion] For the selective activation of the VMO, performing squats on an UGS was effective, and it was more effective when subjects’ vision was blocked. PMID:26356407

Effects of electrical stimulation on House-Brackmann scores in early Bell's palsy.

PubMed

Alakram, Prisha; Puckree, Threethambal

2010-04-22

ABSTRACT Limited evidence may support the application of electrical stimulation in the subacute and chronic stages of facial palsy, yet some physiotherapists in South Africa have been applying this modality in the acute stage in the absence of published evidence of clinical efficacy. This preliminary study's aim was to determine the safety and potential efficacy of applying electrical stimulation to the facial muscles during the early phase of Bells palsy. A pretest posttest control vs. experimental groups design composed of 16 patients with Bell's palsy of less than 30 days' duration. Adult patients with clinical diagnosis of Bell's palsy were systematically (every second patient) allocated to the control and experimental groups. Each group (n = 8) was pretested and posttested using the House-Brackmann index. Both groups were treated with heat, massage, exercises, and a home program. The experimental group also received electrical stimulation. The House-Brackmann Scale of the control group improved between 17% and 50% with a mean of 30%. The scores of the experimental group ranged between 17% and 75% with a mean of 37%. The difference between the groups was not statistically significant (two-tailed p = 0.36). Electrical stimulation as used in this study during the acute phase of Bell's palsy is safe but may not have added value over spontaneous recovery and multimodal physiotherapy. A larger sample size or longer stimulation time or both should be investigated.

Medial gastrocnemius and soleus muscle-tendon unit, fascicle, and tendon interaction during walking in children with cerebral palsy.

PubMed

Barber, Lee; Carty, Chris; Modenese, Luca; Walsh, John; Boyd, Roslyn; Lichtwark, Glen

2017-08-01

This study investigates the in vivo function of the medial gastrocnemius and soleus muscle-tendon units (MTU), fascicles, and tendons during walking in children with cerebral palsy (CP) and an equinus gait pattern. Fourteen children with CP (9 males, 5 females; mean age 10y 6mo, standard deviation [SD] 2y 11mo; GMFCS level I=8, II=6), and 10 typically developing (6 males, 4 females; mean age 10y, SD 2y 1mo) undertook full body 3D gait analysis and simultaneous B-mode ultrasound images of the medial gastrocnemius and soleus fascicles during level walking. Fascicle lengths were analysed using a semi-automated tracking algorithm and MTUs using OpenSim. Statistical parametric mapping (two-sample t-test) was used to compare differences between groups (p<0.05). In the CP group medial gastrocnemius fascicles lengthened during mid-stance gait and remained longer into late-stance compared to the typically developing group (p<0.001). CP medial gastrocnemius fascicles shortened less during stance (1.16mm [SD 1.47mm]) compared to the typically developing group (4.48mm [SD 1.94mm], p<0.001). In the CP group the medial gastrocnemius and soleus MTU and tendon were longer during early- and mid-stance (p<0.001). Ankle power during push-off (p=0.015) and positive work (p<0.002) and net work (p<0.001) were significantly lower in the CP group. Eccentric action of the CP medial gastrocnemius muscle fascicles during mid-stance walking is consistent with reduced volume and neuromuscular control of impaired muscle. Reduced ankle push-off power and positive work in the children with CP may be attributed to reduced active medial gastrocnemius fascicle shortening. These findings suggest a reliance on passive force generation for forward propulsion during equinus gait. © 2017 Mac Keith Press.

Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee.

PubMed

Sánchez, M; Yoshioka, T; Ortega, M; Delgado, D; Anitua, E

2014-05-01

Peroneal nerve palsy in traumatic knee dislocations associated with multiple ligament injuries is common. Several surgical approaches are described for this lesion with less-than-optimal outcomes. The present case represents the application of plasma rich in growth factors (PRGF) technology for the treatment of peroneal nerve palsy with drop foot. This technology has already been proven its therapeutic potential for various musculoskeletal disorders. Based on these results, we hypothesized that PRGF could stimulate the healing process of traumatic peroneal nerve palsy with drop foot. The patient was a healthy 28-year-old man. He suffered peroneal nerve palsy with drop foot after multiple ligament injuries of the knee. PRGF was prepared according to the manufactured instruction. Eleven months after the trauma with severe axonotmesis, serial intraneural infiltrations of PRGF were started using ultrasound guidance. The therapeutic effect was assessed by electromyography (EMG), echogenicity of the peroneal nerve under ultrasound (US) and manual muscle testing. Twenty-one months after the first injection, not complete but partial useful recovery is obtained. He is satisfied with walking and running without orthosis. Sensitivity demonstrates almost full recovery in the peroneal nerve distribution area. EMG controls show complete reinnervation for the peroneus longus and a better reinnervation for the tibialis anterior muscle, compared with previous examinations. Plasma rich in growth factors (PRGF) infiltrations could enhance healing process of peroneal nerve palsy with drop foot. This case report demonstrates the therapeutic potential of this technology for traumatic peripheral nerve palsy and the usefulness of US-guided PRGF. V.

Bell's palsy.

PubMed

Holland, N Julian; Bernstein, Jonathan M

2014-04-09

Bell's palsy is characterised by an acute, unilateral, partial, or complete paralysis of the face. Bell's palsy occurs in a lower motor neurone pattern. The weakness may be partial or complete, and may be associated with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy is idiopathic, but a proportion of cases may be caused by re-activation of herpes virus at the geniculate ganglion of the facial nerve. Bell's palsy is most common in people aged 15 to 40 years, with a 1 in 60 lifetime risk. Most people make a spontaneous recovery within 1 month, but up to 30% show delayed or incomplete recovery. We conducted a systematic review to answer the following clinical questions: What are the effects of drug treatments for Bell's palsy in adults and children? What are the effects of physical treatments for Bell's palsy in adults and children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 13 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or with antiviral treatment), hyperbaric oxygen therapy, and facial re-training.

ON THE TIDAL DISSIPATION OF OBLIQUITY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rogers, T. M.; Lin, D. N. C., E-mail: tami@lpl.arizona.edu, E-mail: lin@ucolick.org

2013-05-20

We investigate tidal dissipation of obliquity in hot Jupiters. Assuming an initial random orientation of obliquity and parameters relevant to the observed population, the obliquity of hot Jupiters does not evolve to purely aligned systems. In fact, the obliquity evolves to either prograde, retrograde, or 90 Degree-Sign orbits where the torque due to tidal perturbations vanishes. This distribution is incompatible with observations which show that hot Jupiters around cool stars are generally aligned. This calls into question the viability of tidal dissipation as the mechanism for obliquity alignment of hot Jupiters around cool stars.

Bell's Palsy.

PubMed

Vakharia, Kavita; Vakharia, Kalpesh

2016-02-01

Bell's palsy is unilateral, acute onset facial paralysis that is a common condition. One in every 65 people experiences Bell's palsy in the course of their lifetime. The majority of patients afflicted with this idiopathic disorder recover facial function. Initial treatment involves oral corticosteroids, possible antiviral drugs, and protection of the eye from desiccation. A small subset of patients may be left with incomplete recovery, synkinesis, facial contracture, or hemifacial spasm. A combination of medical and surgical treatment options exist to treat the long-term sequelae of Bell's palsy. Copyright © 2016 Elsevier Inc. All rights reserved.

Recurrences of Bell's palsy.

PubMed

Cirpaciu, D; Goanta, C M; Cirpaciu, M D

2014-01-01

Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron 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 the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients

Bell's palsy and autoimmunity.

PubMed

Greco, A; Gallo, A; Fusconi, M; Marinelli, C; Macri, G F; de Vincentiis, M

2012-12-01

To review our current knowledge of the etiopathogenesis of Bell's palsy, including viral infection or autoimmunity, and to discuss disease pathogenesis with respect to pharmacotherapy. Relevant publications on the etiopathogenesis, clinical presentation, diagnosis and histopathology of Bell's palsy from 1975 to 2012 were analysed. Bell's palsy is an idiopathic peripheral nerve palsy involving the facial nerve. It accounts for 60 to 75% of all cases of unilateral facial paralysis. The annual incidence of Bell's palsy is 15 to 30 per 100,000 people. The peak incidence occurs between the second and fourth decades (15 to 45 years). The aetiology of Bell's palsy is unknown but viral infection or autoimmune disease has been postulated as possible pathomechanisms. Bell's palsy may be caused when latent herpes viruses (herpes simplex, herpes zoster) are reactivated from cranial nerve ganglia. A cell-mediated autoimmune mechanism against a myelin basic protein has been suggested for the pathogenesis of Bell's palsy. Bell's palsy may be an autoimmune demyelinating cranial neuritis, and in most cases, it is a mononeuritic variant of Guillain-Barré syndrome, a neurologic disorder with recognised cell-mediated immunity against peripheral nerve myelin antigens. In Bell's palsy and GBS, a viral infection or the reactivation of a latent virus may provoke an autoimmune reaction against peripheral nerve myelin components, leading to the demyelination of cranial nerves, especially the facial nerve. Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms should be offered combination therapy. However it seems logical that in fact, steroids exert their beneficial effect via immunosuppressive action, as is the case in some other autoimmune disorders. It is to be hoped that (monoclonal) antibodies and/or T-cell immunotherapy might provide more specific treatment guidelines in the

People With Cerebral Palsy: Effects of and Perspectives for Therapy

PubMed Central

Mayston, Margaret J.

2001-01-01

The movement disorder of cerebral palsy (CP) is expressed in a variety of ways and to varying degrees in each individual. The condition has become more complex over the last 20 years with the increasing survival of children born at less than 28 to 30 weeks gestationai age. Impairments present in children with CP as a direct result of the brain injury or occurring indirectly to compensate for underlying problems include abnormal muscle tone; weakness and lack of fitness; limited variety of muscle synergies; contracture and altered biomechanics, the net result being limited functional ability. Other contributors to the motor disorder include sensory, cognitive and perceptual impairments. In recent years understanding of the motor problem has increased, but less is known about effects of therapy. Evidence suggests that therapy can improve functional possibilities for children with cerebral palsy but is inconclusive as to which approach might be most beneficial. The therapist requires an understanding of the interaction of all systems, cognitive/perceptual, motor, musculoskeletal, sensory and behavioral, in the context of the development and plasticity of the CNS. It is necessary to understand the limitations of the damaged immature nervous system, but important to optimize the child's functional possibilities. PMID:11530888

Cutaneous Sensibility Changes in Bell's Palsy Patients.

PubMed

Cárdenas Palacio, Carlos Andrés; Múnera Galarza, Francisco Alejandro

2017-05-01

Objective Bell's palsy is a cranial nerve VII dysfunction that renders the patient unable to control facial muscles from the affected side. Nevertheless, some patients have reported cutaneous changes in the paretic area. Therefore, cutaneous sensibility changes might be possible additional symptoms within the clinical presentation of this disorder. Accordingly, the aim of this research was to investigate the relationship between cutaneous sensibility and facial paralysis severity in these patients. Study Design Prospective longitudinal cohort study. Settings Tertiary care medical center. Subjects and Methods Twelve acute-onset Bell's palsy patients were enrolled from March to September 2009. In addition, 12 sex- and age-matched healthy volunteers were tested. Cutaneous sensibility was evaluated with pressure threshold and 2-point discrimination at 6 areas of the face. Facial paralysis severity was evaluated with the House-Brackmann scale. Results Statistically significant correlations based on the Spearman's test were found between facial paralysis severity and cutaneous sensitivity on forehead, eyelid, cheek, nose, and lip ( P < .05). Additionally, significant differences based on the Student's t test were observed between both sides of the face in 2-point discrimination on eyelid, cheek, and lip ( P < .05) in Bell's palsy patients but not in healthy subjects. Conclusion Such results suggest a possible relationship between the loss of motor control of the face and changes in facial sensory information processing. Such findings are worth further research about the neurophysiologic changes associated with the cutaneous sensibility disturbances of these patients.

Skeletal muscle mechanics, energetics and plasticity.

PubMed

Lieber, Richard L; Roberts, Thomas J; Blemker, Silvia S; Lee, Sabrina S M; Herzog, Walter

2017-10-23

The following papers by Richard Lieber (Skeletal Muscle as an Actuator), Thomas Roberts (Elastic Mechanisms and Muscle Function), Silvia Blemker (Skeletal Muscle has a Mind of its Own: a Computational Framework to Model the Complex Process of Muscle Adaptation) and Sabrina Lee (Muscle Properties of Spastic Muscle (Stroke and CP) are summaries of their representative contributions for the session on skeletal muscle mechanics, energetics and plasticity at the 2016 Biomechanics and Neural Control of Movement Conference (BANCOM 2016). Dr. Lieber revisits the topic of sarcomere length as a fundamental property of skeletal muscle contraction. Specifically, problems associated with sarcomere length non-uniformity and the role of sarcomerogenesis in diseases such as cerebral palsy are critically discussed. Dr. Roberts then makes us aware of the (often neglected) role of the passive tissues in muscles and discusses the properties of parallel elasticity and series elasticity, and their role in muscle function. Specifically, he identifies the merits of analyzing muscle deformations in three dimensions (rather than just two), because of the potential decoupling of the parallel elastic element length from the contractile element length, and reviews the associated implications for the architectural gear ratio of skeletal muscle contraction. Dr. Blemker then tackles muscle adaptation using a novel way of looking at adaptive processes and what might drive adaptation. She argues that cells do not have pre-programmed behaviors that are controlled by the nervous system. Rather, the adaptive responses of muscle fibers are determined by sub-cellular signaling pathways that are affected by mechanical and biochemical stimuli; an exciting framework with lots of potential. Finally, Dr. Lee takes on the challenging task of determining human muscle properties in vivo. She identifies the dilemma of how we can demonstrate the effectiveness of a treatment, specifically in cases of muscle

The putative involvement of the transabdominal muscles in dysphonia: a preliminary study and thoughts.

PubMed

Rubin, J S; Macdonald, I; Blake, E

2011-03-01

Real-time ultrasound was used as an adjunct to assess patterns of periabdominal musculature in 14 individual with dysphonia and muscle tension dysphonia. Fourteen individuals with muscle tension dysphonia were evaluated with real-time ultrasound as a part of their initial evaluation and management. In 13 of 14 individuals, there was an imbalance found during phonation between the transversus abdominis muscles (TAs) and internal oblique muscles (IOs), whereby the IOs were found to be overactive and the TAs underactive. After physiotherapy, this pattern was reversed. The abdominal muscle pattern of overactivity of the internal oblique and underactivity of the TA during phonation was found to be present in the large majority of patients in this pilot sample who had presented with muscle tension dysphonia. The significance of this is unclear but deserves further review. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Bell's Palsy

MedlinePlus

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 ... from mild to severe and ... inflamed. You are most likely to get Bell's palsy if you are pregnant, diabetic or sick ...

The Effect of Muscle Direction on the Predictions of Finite Element Model of Human Lumbar Spine

PubMed Central

Wang, Zhi-peng; Pei, Xiao-long

2018-01-01

The normal physiological loads from muscles experienced by the spine are largely unknown due to a lack of data. The aim of this study is to investigate the effects of varying muscle directions on the outcomes predicted from finite element models of human lumbar spine. A nonlinear finite element model of L3–L5 was employed. The force of the erector spinae muscle, the force of the rectus abdominis muscle, follower loads, and upper body weight were applied. The model was fixed in a neural standing position and the direction of the force of the erector spinae muscle and rectus abdominis muscle was varied in three directions. The intradiscal pressure, reaction moments, and intervertebral rotations were calculated. The intradiscal pressure of L4-L5 was 0.56–0.57 MPa, which agrees with the in vivo pressure of 0.5 MPa from the literatures. The models with the erector spinae muscle loaded in anterior-oblique direction showed the smallest reaction moments (less than 0.6 Nm) and intervertebral rotations of L3-L4 and L4-L5 (less than 0.2 degrees). In comparison with loading in the vertical direction and posterior-oblique direction, the erector spinae muscle loaded in the anterior-oblique direction required lower external force or moment to keep the lumbar spine in the neutral position. PMID:29511680

The Effect of Muscle Direction on the Predictions of Finite Element Model of Human Lumbar Spine.

PubMed

Zhu, Rui; Niu, Wen-Xin; Wang, Zhi-Peng; Pei, Xiao-Long; He, Bin; Zeng, Zhi-Li; Cheng, Li-Ming

2018-01-01

The normal physiological loads from muscles experienced by the spine are largely unknown due to a lack of data. The aim of this study is to investigate the effects of varying muscle directions on the outcomes predicted from finite element models of human lumbar spine. A nonlinear finite element model of L3-L5 was employed. The force of the erector spinae muscle, the force of the rectus abdominis muscle, follower loads, and upper body weight were applied. The model was fixed in a neural standing position and the direction of the force of the erector spinae muscle and rectus abdominis muscle was varied in three directions. The intradiscal pressure, reaction moments, and intervertebral rotations were calculated. The intradiscal pressure of L4-L5 was 0.56-0.57 MPa, which agrees with the in vivo pressure of 0.5 MPa from the literatures. The models with the erector spinae muscle loaded in anterior-oblique direction showed the smallest reaction moments (less than 0.6 Nm) and intervertebral rotations of L3-L4 and L4-L5 (less than 0.2 degrees). In comparison with loading in the vertical direction and posterior-oblique direction, the erector spinae muscle loaded in the anterior-oblique direction required lower external force or moment to keep the lumbar spine in the neutral position.

Pelvic floor muscle contraction and abdominal hollowing during walking can selectively activate local trunk stabilizing muscles.

PubMed

Lee, Ah Young; Baek, Seung Ok; Cho, Yun Woo; Lim, Tae Hong; Jones, Rodney; Ahn, Sang Ho

2016-11-21

Trunk muscle exercises are widely performed, and many studies have been performed to examine their effects on low back pains. However, the effect of trunk muscles activations during walking with pelvic floor muscle contraction (PFMC) and abdominal hollowing (AH) has not been clarified. To investigate whether walking with PFMC and AH is more effective for promoting local trunk muscle activation than walking without PFMC and AH. Twenty healthy men (28.9 ± 3.14 years, 177.2 ± 4.25 cm, 72.1 ± 6.39 kg, body mass index 22.78 ± 2.38 kg/m2) were participated in this study. Surface electrodes were attached over the multifidus (MF), lumbar erector spinae (LES), thoracic erector spinae (TES), transverse abdominus-internal oblique abdominals (TrA-IO), external oblique abdominals (EO), and rectus abdominus (RA). The amplitudes of electromyographic signals were measured during a normal walking with and without PFMC and AH. PFMC and AH while walking was found to result in significant bilateral increases in the normalized maximum voluntary contraction (MVC) of MFs and TrA-IOs (p< 0.05). Ratios of local muscle activity to global muscle activities were increased while performing PFMC and AH during normal walking. Bilateral TrA-IO/EO activity ratios were significantly increased by PFMC and AH (p< 0.05). Performance of the PFMC and AH during walking resulted in significantly more recruitment of local trunk muscles. This study suggests that PFMC and AH during normal daily walking improves activation of muscles responsible for spinal dynamic stabilization and might be useful if integrated into low back disability and pain physical rehabilitation efforts.

Effects of Vojta method on trunk stability in healthy individuals

PubMed Central

Ha, Sun-Young; Sung, Yun-Hee

2016-01-01

Vojta reflex locomotion is important to main upright posture through stimulation of breast zone to patient with cerebral palsy. However, application in other diseases is no investigated. So, we determined the effects of stimulation of the breast zone on trunk stability in healthy individuals. Fourteen young healthy adults (7 males and 7 females) voluntarily participated in this study. The subjects were randomly divided into an experimental group (breast zone) and control group (arbitrary point). All groups were stimulated for 5 min on the left and right sides, respectively, for a total 10 times. We used the thickness of the external oblique abdominal muscle (EO), the internal oblique abdominal muscle, the transversus abdominis muscle (TrA), and the rectus abdominis muscles, as well as the area of the diaphragm by using ultrasonography. In the experimental group, the thickness of the TrA significantly increased during stimulation (P<0.05) while the thickness of the EO significantly decreased (P<0.05). Also, the area of diaphragm in inspiration was significantly different (P<0.05). Therefore, stimulation of the breast zone may be effective to improve trunk stability through activation of the TrA muscle and the diaphragm. PMID:28119875

Effects of Vojta method on trunk stability in healthy individuals.

PubMed

Ha, Sun-Young; Sung, Yun-Hee

2016-12-01

Vojta reflex locomotion is important to main upright posture through stimulation of breast zone to patient with cerebral palsy. However, application in other diseases is no investigated. So, we determined the effects of stimulation of the breast zone on trunk stability in healthy individuals. Fourteen young healthy adults (7 males and 7 females) voluntarily participated in this study. The subjects were randomly divided into an experimental group (breast zone) and control group (arbitrary point). All groups were stimulated for 5 min on the left and right sides, respectively, for a total 10 times. We used the thickness of the external oblique abdominal muscle (EO), the internal oblique abdominal muscle, the transversus abdominis muscle (TrA), and the rectus abdominis muscles, as well as the area of the diaphragm by using ultrasonography. In the experimental group, the thickness of the TrA significantly increased during stimulation ( P <0.05) while the thickness of the EO significantly decreased ( P <0.05). Also, the area of diaphragm in inspiration was significantly different ( P <0.05). Therefore, stimulation of the breast zone may be effective to improve trunk stability through activation of the TrA muscle and the diaphragm.

Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises.

PubMed

Drysdale, Cheri L.; Earl, Jennifer E.; Hertel, Jay

2004-03-01

OBJECTIVE: To investigate surface electromyographic (EMG) activity of the rectus abdominus and external oblique abdominus muscles during pelvic-tilt and abdominal-hollowing exercises performed in different positions. DESIGN AND SETTING: 2 x 3 (exercise by position) within-subjects design with repeated measures on both factors. All testing was performed in a university laboratory. SUBJECTS: Twenty-six healthy, active young adult females. MEASUREMENTS: Surface EMG activity was recorded from the left and right rectus abdominus and external oblique muscles while the 2 exercises (pelvic tilt and abdominal hollowing) were performed in different positions (standard, legs supported, and legs unsupported). The standard position was supine in the crook-lying position, the supported position was with hips and knees flexed to 90 degrees and legs supported on a platform, and the unsupported position was with hips and knees flexed to 90 degrees without external support. Peak EMG activity was normalized to a maximum voluntary isometric contraction for each muscle. RESULTS: For the rectus abdominus, there was an interaction between position and activity. Abdominal hollowing produced significantly less activity than the pelvic tilt in all positions. The difference between the 2 exercises with the legs unsupported was of a greater magnitude than the other 2 positions. For the external obliques, there was significantly lower activity during the abdominal hollowing compared with the pelvic tilting. The greatest muscle activity occurred with the legs-unsupported position during both exercises. CONCLUSIONS: Abdominal-hollowing exercises produced less rectus abdominus and external oblique activity than pelvic-tilting exercises. Abdominal hollowing may be performed with minimal activation of the large global abdominal muscles.

Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study.

PubMed

Yoon, Jeong-Oh; Kang, Min-Hyeok; Kim, Jun-Seok; Oh, Jae-Seop

This is a cross-sectional study. University research laboratory. Fifteen healthy adults (mean age: 27.47 years) volunteered for this study. The individuals performed standard bridge exercise and modified bridge exercises with right leg-lift (single-leg-lift bridge exercise, single-leg-lift bridge exercise on an unstable surface, and single-leg-lift hip abduction bridge exercise). During the bridge exercises, electromyography of the rectus abdominis, internal oblique, erector spinae, and multifidus muscles was recorded using a wireless surface electromyography system. Two-way repeated-measures analysis of variance (exercise by side) with post hoc pairwise comparisons using Bonferroni correction was used to compare the electromyography data collected from each muscle. Bilateral internal oblique muscle activities showed significantly greater during single-leg-lift bridge exercise (95% confidence interval: right internal oblique=-8.99 to -1.08, left internal oblique=-6.84 to -0.10), single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right internal oblique=-7.32 to -1.78, left internal oblique=-5.34 to -0.99), and single-leg-lift hip abduction bridge exercise (95% confidence interval: right internal oblique=-17.13 to -0.89, left internal oblique=-8.56 to -0.60) compared with standard bridge exercise. Bilateral rectus abdominis showed greater electromyography activity during single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right rectus abdominis=-9.33 to -1.13, left rectus abdominis=-4.80 to -0.64) and single-leg-lift hip abduction bridge exercise (95% confidence interval: right rectus abdominis=-14.12 to -1.84, left rectus abdominis=-6.68 to -0.16) compared with standard bridge exercise. In addition, the right rectus abdominis muscle activity was greater during single-leg-lift hip abduction bridge exercise compared with single-leg-lift bridge exercise on an unstable surface (95% confidence interval=-7.51 to

Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in muscle size and associated motor improvement in a child with cerebral palsy: an experimenter-blind study.

PubMed

Lee, Dong Ryul; You, Joshua H; Lee, Nam Gi; Oh, Jin Hwan; Cha, You Jin

2009-01-01

This case study was conducted to determine Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in the commonly affected extensor carpi radialis (ECR) and triceps brachii (TRI) muscle and associated muscle strength and motor performance in a child with hemiparetic cerebral palsy (CP) using standardized clinical tests and ultrasound imaging. A single case study with pre-/post-test. A 4.9-year-old female, diagnosed with hemiparetic CP. The child received a 5-week course of CHRIST course, comprising of 60-minute periods a day, five times a week. A real-time ultrasound imaging was performed to determine the CHRIST-induced changes in cross-sectional area (CSA) of the ECR and TRI. Clinical tests including the modified Wolf Motor function test (WMFT), the modified Jebsen-taylor hand function test (Jebsen hand) and the modified Pediatric Motor Activity Log (PMAL) questionnaire were used to compare the intervention-related changes in motor performance in upper extremity. Ultrasound imaging data showed that the CSAs of both ECR and TRI muscles of the affected upper limb at relaxation and contraction states were enhanced and these therapy-induced morphological changes were associated with enhanced muscle strength and gross motor performance in reaching and grasping skills. Our results suggest that the CHRIST is effective in treating muscle weakness and motor function in a child with hemiparetic CP. This is the first evidence in literature that might shed light on the therapeutic efficacy of our novel intervention on muscle size, associated muscle strength and motor improvement.

Effects of Botulinum Toxin on Reducing the Co-contraction of Antagonists in Birth Brachial Plexus Palsy

PubMed Central

Shin, Yong Beom; Chang, Jae Hyeok; Cha, Young Sun; Ko, Hyun-Yoon

2014-01-01

Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles. PMID:24639937

Bell's palsy

PubMed Central

2014-01-01

Introduction Bell's palsy is characterised by an acute, unilateral, partial, or complete paralysis of the face. Bell's palsy occurs in a lower motor neurone pattern. The weakness may be partial or complete, and may be associated with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy is idiopathic, but a proportion of cases may be caused by re-activation of herpes virus at the geniculate ganglion of the facial nerve. Bell's palsy is most common in people aged 15 to 40 years, with a 1 in 60 lifetime risk. Most people make a spontaneous recovery within 1 month, but up to 30% show delayed or incomplete recovery. Methods and outcomes We conducted a systematic review to answer the following clinical questions: What are the effects of drug treatments for Bell's palsy in adults and children? What are the effects of physical treatments for Bell's palsy in adults and children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or with antiviral treatment), hyperbaric oxygen therapy, and facial re-training. PMID:24717284

Effect of whole body vibration training on mobility in children with cerebral palsy: a randomized controlled experimenter-blinded study.

PubMed

Lee, Byoung-Kwon; Chon, Seung-Chul

2013-07-01

To evaluate ambulatory function and leg muscle thickness after whole body vibration training in children with cerebral palsy. A block randomized controlled trial with two groups. Physical therapy department laboratory. A total of 30 (15 experimental, mean (SD) age 10.0 (2.26) years and 15 control, 9.6 (2.58)) children with cerebral palsy, 15 males and 15 females. The experimental group underwent whole body vibration training combined with conventional physical therapy training; the control group underwent conventional physical therapy training three days a week for eight weeks respectively. Three-dimensional gait analyses and ultrasonographic imaging of the leg muscles were measured at pre- and post-test of intervention for eight weeks. Whole body vibration training resulted in significantly better gait speed (P = 0.001, from 0.37 (0.04) m/s to 0.48 (0.06)), stride length (P = 0.001, from 0.38 (0.18) m to 0.48 (0.18)) and cycle time (P = 0.001, from 0.85 (0.48) s to 0.58 (0.38)) in the experimental group compared with that in the control group. The ankle angle (P = 0.019, from 7.30 (4.02) degree to 13.58 (8.79)) also showed a remarkable increase in the experimental group, but not the hip (P = 0.321) and knee angle (P = 0.102). The thicknesses of the tibialis anterior (P = 0.001, 0.48 (0.08) mm to 0.63 (0.10)) and soleus (P = 0.001, 0.45 (0.04) mm to 0.63 (0.12)) muscles were significantly higher in the experimental group than in the control group. However, no significant effect was observed in the thickness of the gastrocnemius muscle (P = 0.645). These findings suggest that whole body vibration may improve mobility in children with cerebral palsy, probably through a positive effect on the leg muscles.

Peripheral facial palsy in children.

PubMed

Yılmaz, Unsal; Cubukçu, Duygu; Yılmaz, Tuba Sevim; Akıncı, Gülçin; Ozcan, Muazzez; Güzel, Orkide

2014-11-01

The aim of this study is to evaluate the types and clinical characteristics of peripheral facial palsy in children. The hospital charts of children diagnosed with peripheral facial palsy were reviewed retrospectively. A total of 81 children (42 female and 39 male) with a mean age of 9.2 ± 4.3 years were included in the study. Causes of facial palsy were 65 (80.2%) idiopathic (Bell palsy) facial palsy, 9 (11.1%) otitis media/mastoiditis, and tumor, trauma, congenital facial palsy, chickenpox, Melkersson-Rosenthal syndrome, enlarged lymph nodes, and familial Mediterranean fever (each 1; 1.2%). Five (6.1%) patients had recurrent attacks. In patients with Bell palsy, female/male and right/left ratios were 36/29 and 35/30, respectively. Of them, 31 (47.7%) had a history of preceding infection. The overall rate of complete recovery was 98.4%. A wide variety of disorders can present with peripheral facial palsy in children. Therefore, careful investigation and differential diagnosis is essential. © The Author(s) 2013.

Cerebral palsy - resources

MedlinePlus

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/Patient-Caregiver-Education/Hope- ...

Recurrences of Bell's palsy

PubMed Central

Cirpaciu, D; Goanta, CM; Cirpaciu, MD

2014-01-01

Introduction. Bell’s palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron 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 the untreated cases. Clinical trials performed for Bell’s palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. Purpose. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. Methods & Materials. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. Results. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell’s palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients’ age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Conclusions. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which

Aging and Cerebral Palsy.

ERIC Educational Resources Information Center

Networker, 1993

1993-01-01

This special edition of "The Networker" contains several articles focusing on aging and cerebral palsy (CP). "Aging and Cerebral Palsy: Pathways to Successful Aging" (Jenny C. Overeynder) reports on the National Invitational Colloquium on Aging and Cerebral Palsy held in April 1993. "Observations from an Observer" (Kathleen K. Barrett) describes…

Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach

PubMed Central

Giannasi, Lilian Chrystiane; Matsui, Miriam Yumi; Freitas, Sandra Regina Batista; Caldas, Bruna F.; Grossmann, Eduardo; Amorim, José Benedito O.; dos Santos, Israel dos Reis; Oliveira, Luis Vicente Franco; Oliveira, Claudia Santos; Gomes, Monica Fernandes

2015-01-01

Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP. Trial Registration ReBEC RBR994XFS http://www.ensaiosclinicos.gov.br PMID:26247208

A 6-year-old girl with restricted upward gaze of her right eye.

PubMed

Tuli, Sanjeev; Tuli, Sonal

2012-08-01

Brown syndrome is an incomitant strabismus syndrome characterized by inability of the eye to elevate during adduction. • Primary Brown syndrome is thought to occur due to the inability of the superior oblique tendon to stretch.However, there are many secondary causes of this condition that must be ruled out. • Despite significant misalignment of the eyes during upgaze, patients with Brown syndrome usually do not have decreased vision or diplopia with primary gaze. • Unlike paralytic strabismus, forced duction tests demonstrate restriction and a Parks’ three-step test does not demonstrate a paralytic muscle. Spontaneous resolution is frequent, and surgical management typically is not indicated because of the high incidence of postoperative symptomatic superior oblique palsy.

Muscle strength and kinetic gait pattern in children with bilateral spastic CP.

PubMed

Eek, Meta Nyström; Tranberg, Roy; Beckung, Eva

2011-03-01

Cerebral palsy is often associated with an abnormal gait pattern. This study put focus on relation between muscle strength and kinetic gait pattern in children with bilateral spastic cerebral palsy and compares them with a reference group. In total 20 children with CP and 20 typically developing children participated. They were all assessed with measurement of muscle strength in eight muscle groups in the legs and a 3-dimensional gait analysis including force data. It was found that children with CP were not only significantly weaker in all muscle groups but also walked with slower velocity and shorter stride length when compared with the reference group. Gait moments differed at the ankle level with significantly lower moments in children with CP. Gait moments were closer to the maximal muscle strength in the group of children with CP. Furthermore a correlation between plantarflexing gait moment and muscle strength was observed in six of the eight muscle groups in children with CP, a relation not found in the reference group. A similar pattern was seen between muscle strength and generating ankle power with a rho=0.582-0.766. The results of this study state the importance of the relationship of the overall muscle strength pattern in the lower extremity, not only the plantarflexors. Copyright © 2010 Elsevier B.V. All rights reserved.

Phasic-to-tonic shift in trunk muscle activity relative to walking during low-impact weight bearing exercise

NASA Astrophysics Data System (ADS)

Caplan, Nick; Gibbon, Karl; Hibbs, Angela; Evetts, Simon; Debuse, Dorothée

2014-11-01

The aim of this study was to investigate the influence of an exercise device, designed to improve the function of lumbopelvic muscles via low-impact weight-bearing exercise, on electromyographic (EMG) activity of lumbopelvic, including abdominal muscles. Surface EMG activity was collected from lumbar multifidus (LM), erector spinae (ES), internal oblique (IO), external oblique (EO) and rectus abdominis (RA) during overground walking (OW) and exercise device (EX) conditions. During walking, most muscles showed peaks in activity which were not seen during EX. Spinal extensors (LM, ES) were more active in EX. Internal oblique and RA were less active in EX. In EX, LM and ES were active for longer than during OW. Conversely, EO and RA were active for a shorter duration in EX than OW. The exercise device showed a phasic-to-tonic shift in activation of both local and global lumbopelvic muscles and promoted increased activation of spinal extensors in relation to walking. These features could make the exercise device a useful rehabilitative tool for populations with lumbopelvic muscle atrophy and dysfunction, including those recovering from deconditioning due to long-term bed rest and microgravity in astronauts.

Umbilical cord mesenchymal stem cell (UC-MSC) transplantations for cerebral palsy

PubMed Central

Dong, Huajiang; Li, Gang; Shang, Chongzhi; Yin, Huijuan; Luo, Yuechen; Meng, Huipeng; Li, Xiaohong; Wang, Yali; Lin, Ling; Zhao, Mingliang

2018-01-01

This study reports a case of a 4-year-old boy patient with abnormalities of muscle tone, movement and motor skills, as well as unstable gait leading to frequent falls. The results of the electroencephalogram (EEG) indicate moderately abnormal EEG, accompanied by irregular seizures. Based on these clinical characteristics, the patient was diagnosed with cerebral palsy (CP) in our hospital. In this study, the patient was treated with umbilical cord mesenchymal stem cell (UC-MSC) transplantation therapy. This patient received UC-MSC transplantation 3 times (5.3*107) in total. After three successive cell transplantations, the patient recovered well and showed obvious improvements in EEG and limb strength, motor function, and language expression. However, the improvement in intelligence quotient (IQ) was less obvious. These results indicate that UC-MSC transplantation is a promising treatment for cerebral palsy. PMID:29636880

Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises

PubMed Central

Drysdale, Cheri L.; Earl, Jennifer E.

2004-01-01

Objective: To investigate surface electromyographic (EMG) activity of the rectus abdominus and external oblique abdominus muscles during pelvic-tilt and abdominal-hollowing exercises performed in different positions. Design and Setting: 2 × 3 (exercise by position) within-subjects design with repeated measures on both factors. All testing was performed in a university laboratory. Subjects: Twenty-six healthy, active young adult females. Measurements: Surface EMG activity was recorded from the left and right rectus abdominus and external oblique muscles while the 2 exercises (pelvic tilt and abdominal hollowing) were performed in different positions (standard, legs supported, and legs unsupported). The standard position was supine in the crook-lying position, the supported position was with hips and knees flexed to 90° and legs supported on a platform, and the unsupported position was with hips and knees flexed to 90° without external support. Peak EMG activity was normalized to a maximum voluntary isometric contraction for each muscle. Results: For the rectus abdominus, there was an interaction between position and activity. Abdominal hollowing produced significantly less activity than the pelvic tilt in all positions. The difference between the 2 exercises with the legs unsupported was of a greater magnitude than the other 2 positions. For the external obliques, there was significantly lower activity during the abdominal hollowing compared with the pelvic tilting. The greatest muscle activity occurred with the legs-unsupported position during both exercises. Conclusions: Abdominal-hollowing exercises produced less rectus abdominus and external oblique activity than pelvic-tilting exercises. Abdominal hollowing may be performed with minimal activation of the large global abdominal muscles. PMID:15085209

The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw.

PubMed

Guimarães, João Antonio Matheus; Martin, Murphy P; da Silva, Flávio Ribeiro; Duarte, Maria Eugenia Leite; Cavalcanti, Amanda Dos Santos; Machado, Jamila Alessandra Perini; Mauffrey, Cyril; Rojas, David

2018-06-08

Percutaneous fixation of the acetabulum is a treatment option for select acetabular fractures. Intra-operative fluoroscopy is required, and despite various described imaging strategies, it is debatable as to which combination of fluoroscopic views provides the most accurate and reliable assessment of screw position. Using five synthetic pelvic models, an experimental setup was created in which the anterior acetabular columns were instrumented with screws in five distinct trajectories. Five fluoroscopic images were obtained of each model (Pelvic Inlet, Obturator Oblique, Iliac Oblique, Obturator Oblique/Outlet, and Iliac Oblique/Outlet). The images were presented to 32 pelvic and acetabular orthopaedic surgeons, who were asked to draw two conclusions regarding screw position: (1) whether the screw was intra-articular and (2) whether the screw was intraosseous in its distal course through the bony corridor. In the assessment of screw position relative to the hip joint, accuracy of surgeon's response ranged from 52% (iliac oblique/outlet) to 88% (obturator oblique), with surgeon confidence in the interpretation ranging from 60% (pelvic inlet) to 93% (obturator oblique) (P < 0.0001). In the assessment of intraosseous position of the screw, accuracy of surgeon's response ranged from 40% (obturator oblique/outlet) to 79% (iliac oblique/outlet), with surgeon confidence in the interpretation ranging from 66% (iliac oblique) to 88% (pelvic inlet) (P < 0.0001). The obturator oblique and obturator oblique/outlet views afforded the most accurate and reliable assessment of penetration into the hip joint, and intraosseous position of the screw was most accurately assessed with pelvic inlet and iliac oblique/outlet views. Clinical Question.

Rehabilitation of Bell's palsy patient with complete dentures.

PubMed

Muthuvignesh, J; Kumar, N Suman; Reddy, D Narayana; Rathinavelu, Pradeep; Egammai, S; Adarsh, A

2015-08-01

Facial nerve disorders may be of sudden onset and more often of unknown etiology. Edema of the facial nerve within the fallopian canal results in Bell's palsy. This causes compression of the nerve and affects the microcirculation. Many authors have suggested treatment for facial nerve paralysis ranging from simple physiotherapy to complicated microvascular decompression. It more often results in symptoms like synkinesis and muscle spasm after the decompression surgery of the nerve because of the inability to arrange the nerve fibers within the canal. The treatment choice also depends on patient's age, extent of the nerve damage, and patient's needs and desires. Many patients who cannot be rehabilitated functionally can be treated for esthetics of the involved muscles. This case report elaborates about a patient who was rehabilitated for esthetics and to some extent for function.

Isolated Medial Rectus Nuclear Palsy as a Rare Presentation of Midbrain Infarction.

PubMed

Al-Sofiani, Mohammed; Lee Kwen, Peterkin

2015-10-08

Diplopia is a common subjective complaint that can be the first manifestation of a serious pathology. Here, we report a rare case of midbrain infarction involving the lateral subnucleus of the oculomotor nuclear complex presenting as diplopia, with no other stroke manifestations. An 83-year-old right-handed white man with past medical history of diabetes mellitus, hypertension, dyslipidemia, and coronary artery disease presented to the emergency department (ED) with diplopia and unsteadiness. Two days prior to admission, the patient woke up with constant horizontal diplopia and unsteadiness, which limited his daily activities and led to a fall at home. He denied any weakness, clumsiness, nausea, vomiting, photophobia, fever, or chills. Ocular exam showed a disconjugate gaze at rest, weakness of the left medial rectus muscle, impaired convergence test, and bilateral 3-mm reactive pupils. The diplopia resolved by closing either eye. The remaining extraocular muscles and other cranial nerves were normal. There was no nystagmus, ptosis, or visual field deficit. Sensation, muscle tone, and strength were normal in all extremities. Magnetic resonance imaging (MRI) of the brain revealed a tiny focus of restricted diffusion in the left posterior lateral midbrain. A thorough history and physical examination is essential to diagnose and manage diplopia. Isolated extraocular palsy is usually thought to be caused by orbital lesions or muscular diseases. Here, we report a case of midbrain infarction manifested as isolated medial rectus palsy.

A PILOT STUDY OF DIAGNOSTIC NEUROMUSCULAR ULTRASOUND IN BELL'S PALSY

PubMed Central

TAWFIK, EMAN A.; WALKER, FRANCIS O.; CARTWRIGHT, MICHAEL S.

2015-01-01

Background and purpose Neuromuscular ultrasound of the cranial nerves is an emerging field which may help in the assessment of cranial neuropathies. The aim of this study was to evaluate the role of neuromuscular ultrasound in Bell's palsy. A second objective was to assess the possibility of any associated vagus nerve abnormality. Methods Twenty healthy controls and 12 Bell's palsy patients were recruited. The bilateral facial nerves, vagus nerves, and frontalis muscles were scanned using an 18 MHz linear array transducer. Facial nerve diameter, vagus nerve cross-sectional area, and frontalis thickness were measured. Results Mean facial nerve diameter was 0.8 ± 0.2 mm in controls and 1.1 ± 0.3 mm in patients group. The facial nerve diameter was significantly larger in patients than controls (p = 0.006, 95% CI for the difference between groups of 0.12-0.48), with a significant side-to-side difference in patients as well (p = 0.004, 95% CI for side-to-side difference of 0.08-0.52). ROC curve analysis of the absolute facial nerve diameter revealed a sensitivity of 75 % and a specificity of 70 %. No significant differences in vagus nerve cross-sectional area or frontalis thickness were detected between patients and controls. Conclusions Ultrasound can detect facial nerve enlargement in Bell's palsy and may have a role in assessment, or follow-up, of Bell's palsy and other facial nerve disorders. The low sensitivity of the current technique precludes its routine use for diagnosis, however, this study demonstrates its validity and potential for future research. PMID:26076910

Systematic review of the effects of mirror therapy in children with cerebral palsy.

PubMed

Park, Eom-Ji; Baek, Soon-Hyung; Park, Soohee

2016-11-01

[Purpose] To provide data for systematic intervention plans in occupational therapy practice by objectivity showing the value of mirror therapy interventions in children with cerebral palsy. [Subjects and Methods] Medline and EMBASE databases were searched for the key words "cerebral palsy," "mirror movement," "mirror therapy," and "mirror visual feedback." Nine studies that met the inclusion and exclusion criteria were identified. The qualitatively determined level of evidence, period of research, comparisons and interventions, tools used to measure the intervention, and the effects were analyzed. [Results] According to the results analyzed, one (1/9, 11.1%) study showed the same result as the control group, one (1/9, 11.1%) showed a negative effect, and seven (7/9, 77.8%) showed positive effects of mirror-mediated therapy, with meaningful improvement in function, such as hand strength, movement speed, muscle activity, and accuracy of hand matching. [Conclusion] Through this study, the value of mirror-mediated therapeutic interventions in occupational therapy practice targeting cerebral palsy was confirmed. It is expected that this result will be useful in establishing mirror therapy as an interventional program.

Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage lengthening temporalis myoplasty for facial and lip reanimation.

PubMed

Har-Shai, Yaron; Gil, Tamir; Metanes, Issa; Labbé, Daniel

2010-07-01

Facial paralysis is a significant functional and aesthetic handicap. Facial reanimation is performed either by two-stage microsurgical methods or by regional one-stage muscle pedicle flaps. Labbé has modified and improved the regional muscle pedicle transfer flaps for facial reanimation (i.e., the lengthening temporalis myoplasty procedure). This true myoplasty technique is capable of producing a coordinated, spontaneous, and symmetrical smile. An intraoperative electrical stimulation of the temporal muscle is proposed to simulate the smile of the paralyzed side on the surgical table. The intraoperative electrical stimulation of the temporalis muscle, employing direct percutaneous electrode needles or transcutaneous electrical stimulation electrodes, was utilized in 11 primary and four secondary cases with complete facial palsy. The duration of the facial paralysis was up to 12 years. Postoperative follow-up ranged from 3 to 12 months. The insertion points of the temporalis muscle tendon to the nasolabial fold, upper lip, and oral commissure had been changed according to the intraoperative muscle stimulation in six patients of the 11 primary cases (55 percent) and in all four secondary (revisional) cases. A coordinated, spontaneous, and symmetrical smile was achieved in all patients by 3 months after surgery by employing speech therapy and biofeedback. This adjunct intraoperative refinement provides crucial feedback for the surgeon in both primary and secondary facial palsy cases regarding the vector of action of the temporalis muscle and the accuracy of the anchoring points of its tendon, thus enhancing a more coordinated and symmetrical smile.

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity.

PubMed

Eek, Meta N; Olsson, Kristina; Lindh, Karin; Askljung, Berit; Påhlman, Magnus; Corneliusson, Olle; Himmelmann, Kate

2018-01-01

To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP). A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured. Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB. After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved. Intrathecal baclofen can affect specific aspects of functioning in dyskinetic cerebral palsy. Sitting, communication, and fine motor function improved. Dystonia and spasticity were reduced. Pain was reduced and sleep improved. © 2017 Mac Keith Press.

Climates of Oblique Exoplanets

NASA Astrophysics Data System (ADS)

Dobrovolskis, A. R.

2008-12-01

A previous paper (Dobrovolskis 2007; Icarus 192, 1-23) showed that eccentricity can have profound effects on the climate, habitability, and detectability of extrasolar planets. This complementary study shows that obliquity can have comparable effects. The known exoplanets exhibit a wide range of orbital eccentricities, but those within several million km of their suns are generally in near-circular orbits. This fact is widely attributed to the dissipation of tides in the planets, which is particularly effective for solid/liquid bodies like "Super-Earths". Along with friction between a solid mantle and a liquid core, tides also are expected to despin a planet until it is captured in the synchronous resonance, so that its rotation period is identical to its orbital period. The canonical example of synchronous spin is the way that our Moon always keeps nearly the same hemisphere facing the Earth. Tides also tend to reduce the planet's obliquity (the angle between its spin and orbital angular velocities). However, orbit precession can cause the rotation to become locked in a "Cassini state", where it retains a nearly constant non-zero obliquity. For example, our Moon maintains an obliquity of about 6.7° with respect to its orbit about the Earth. For comparison, stable Cassini states can exist for practically any obliquity up to 180° for planets of binary stars, or in multi-planet systems with high mutual inclinations, such as are produced by scattering or by the Kozai mechanism. This work considers planets in synchronous rotation with circular orbits. For obliquities greater than 90°, the ground track of the sub-solar point wraps around all longitudes on the surface of such a planet. For smaller obliquities, the sub-solar track takes the figure-8 shape of an analemma. This can be visualized as the intersection of the planet's spherical surface with a right circular cylinder, parallel to the spin axis and tangent to the equator from the inside. The excursion of the

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients

PubMed Central

Park, Jung Min; Kim, Myung Gu; Jung, Junyang; Kim, Sung Su; Jung, A Ra; Kim, Sang Hoon

2017-01-01

Background and Objectives To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. Subjects and Methods This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. Results EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p<0.05). In contrast, chemical taste tests showed no significant differences in taste thresholds between the two groups (p>0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p<0.05). In older individuals, however, no significant differences in taste thresholds were observed between Bell's palsy patients and healthy subjects (p>0.05). Conclusions Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals. PMID:28417103

Habitable planets with high obliquities

NASA Technical Reports Server (NTRS)

Williams, D. M.; Kasting, J. F.

1997-01-01

Earth's obliquity would vary chaotically from 0 degrees to 85 degrees were it not for the presence of the Moon (J. Laskar, F. Joutel, and P. Robutel, 1993, Nature 361, 615-617). The Moon itself is thought to be an accident of accretion, formed by a glancing blow from a Mars-sized planetesimal. Hence, planets with similar moons and stable obliquities may be extremely rare. This has lead Laskar and colleagues to suggest that the number of Earth-like planets with high obliquities and temperate, life-supporting climates may be small. To test this proposition, we have used an energy-balance climate model to simulate Earth's climate at obliquities up to 90 degrees. We show that Earth's climate would become regionally severe in such circumstances, with large seasonal cycles and accompanying temperature extremes on middle- and high-latitude continents which might be damaging to many forms of life. The response of other, hypothetical, Earth-like planets to large obliquity fluctuations depends on their land-sea distribution and on their position within the habitable zone (HZ) around their star. Planets with several modest-sized continents or equatorial supercontinents are more climatically stable than those with polar supercontinents. Planets farther out in the HZ are less affected by high obliquities because their atmospheres should accumulate CO2 in response to the carbonate-silicate cycle. Dense, CO2-rich atmospheres transport heat very effectively and therefore limit the magnitude of both seasonal cycles and latitudinal temperature gradients. We conclude that a significant fraction of extrasolar Earth-like planets may still be habitable, even if they are subject to large obliquity fluctuations.

Electromyographic and kinetic analysis of two abdominal muscle performance tests.

PubMed

Haladay, Douglas E; Denegar, Craig R; Miller, Sayers J; Challis, John

2015-01-01

In order to accurately assess the abdominal muscles, clinicians need valid clinical measures. The double leg lowering test (DLLT) and lower abdominal muscle progression (LAMP) are two common tests of abdominal muscle performance. The purposes of this study were to determine the relation between surface electromyographic (EMG) activity during the DLLT and LAMP levels; hip joint resultant moments and DLLT and LAMP levels; and the two measures of DLLT and LAMP. Ten healthy participants were tested under both conditions. Surface EMG activity of the abdominal muscles was obtained, while pelvic movement was detected simultaneously. A moderate to strong association was found between rectus abdominus muscle activity and a moderate association with the external obliques with both test levels. For the internal oblique/transversus abdominus, a moderate and weak association was found with the DLLT and LAMP, respectively. A very strong association existed between the hip resultant joint moments (RJM) and the DLLT, while there was a weak correlation between hip RJM and the LAMP. No significant correlation was found between the DLLT and LAMP grades. This finding suggests that these tests may measure different qualities of muscle performance and provides preliminary support for their use. Further evaluation of these assessments with clinical populations is necessary.

Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy).

PubMed

Bremell, Daniel; Hagberg, Lars

2011-08-10

Bell's palsy and Lyme neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell's palsy is treated with corticosteroids, while Lyme neuroborreliosis is treated with antibiotics. The diagnosis of Lyme neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme neuroborreliosis or Bell's palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage. Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell's palsy, definite Lyme neuroborreliosis, or possible Lyme neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans. One hundred and two patients were analysed; 51 were classified as Bell's palsy, 34 as definite Lyme neuroborreliosis and 17 as possible Lyme neuroborreliosis. Patients with definite Lyme neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell's palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups. We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme neuroborreliosis as a cause of peripheral facial palsy in an area endemic for Borrelia. For

Epidural Baclofen for the Management of Postoperative Pain in Children With Cerebral Palsy.

PubMed

Nemeth, Blaise A; Montero, Robert J; Halanski, Matthew A; Noonan, Kenneth J

2015-09-01

Children with cerebral palsy undergoing soft tissue and bony procedures often experience pain and spasticity postoperatively. Differentiation of pain from spasticity complicates management, so controlling spasticity with a continuous infusion of baclofen, an antispasmodic, through an already present indwelling epidural catheter holds interest. A retrospective chart review was performed of patients with cerebral palsy undergoing single event, multilevel lower extremity surgery at a single institution who received epidural analgesia with or without continuous baclofen infusion. Primary outcomes included need for supplemental narcotic analgesics and benzodiazepines postoperatively. Duration of hospitalization, pain scores, and complications were also evaluated. Forty-four patients were identified, ranging in age from 3 to 17 years, 19 of whom received epidural baclofen. No differences were found in use of supplemental narcotic analgesia, benzodiazepines, or duration of hospitalization. Differences in pain scores were not statistically significant (0.82±0.95 for baclofen vs. 1.48±0.99 for controls) (P=0.391). Mean arterial pressure was lower in patients receiving baclofen (P=0.004). No potential side effects attributable to baclofen were noted. Continuous epidural baclofen infusion seems unlikely to alter the pain-spasm cycle experienced by patients with cerebral palsy following orthopaedic surgery to a clinically significant degree. More effective, and cost-effective, measures at assessing and controlling pain and muscle spasm should be explored to benefit cerebral palsy patients postoperatively. Level III-therapeutic study.

Lunar Obliquity History Revisited

NASA Astrophysics Data System (ADS)

Siegler, M.; Bills, B.; Paige, D.

2007-12-01

In preparation for a LRO (Lunar Reconnaissance Orbiter) related study of possible lunar polar volatiles, we re- examined the lunar orbital and rotational history, with primary focus on the obliquity history of the Moon. Though broad models have been made of lunar obliquity, a cohesive obliquity history was not found. We report on a new model of lunar obliquity including secular changes in inclination of the lunar orbit, tidal dissipation, lunar moments of inertia, and details for periods outside of the stable configurations known as Cassini states. For planets, the obliquity, or angle between the spin and orbit poles, is the dominant control on incident solar radiation. For planetary satellites, the radiation pattern can be more complex, as it depends on the mutual inclinations of three poles; the satellite spin and orbit poles, and the planetary heliocentric orbit pole. Presently, the lunar spin pole and orbit pole co-precess about the ecliptic pole, in a stable situation known as a Cassini state. As a result, permanently shadowed regions near the poles are expected to exist and act as cold traps, retaining water or other volatiles delivered to the surface by comets, solar wind, or via outgassing of the lunar interior. However, tidally driven secular changes in the lunar semimajor axis cause changes in precession rates of the spin and orbit poles, and thereby alter or destabilize the Cassini states. Only one prograde Cassini state exists at present (state 2). In the standard Cassini state model of Ward [1975], two other such states would have existed in the past (states 1 and 4) with the Moon starting in the low obliquity state 1, and remaining there until states 1 and 4 merged and disappear, at roughly half the present Earth-Moon distance. At that point, the Moon transitioned into the currently occupied state 2, and briefly attained very high obliquity values during the transition, and then stayed in state 2 until the present. If correct, this model implies that

Effect of core muscle thickness and static or dynamic balance on prone bridge exercise with sling by shoulder joint angle in healthy adults.

PubMed

Park, Mi Hwa; Yu, Jae Ho; Hong, Ji Heon; Kim, Jin Seop; Jung, Sang Woo; Lee, Dong Yeop

2016-03-01

[Purpose] To date, core muscle activity detected using ultrasonography during prone bridge exercises has not been reported. Here we investigated the effects of core muscle thickness and balance on sling exercise efficacy by shoulder joint angle in healthy individuals. [Subjects and Methods] Forty-three healthy university students were enrolled in this study. Ultrasonography thickness of external oblique, internal oblique, and transversus abdominis during sling workouts was investigated. Muscle thickness was measured on ultrasonography imaging before and after the experiment. Dynamic balance was tested using a functional reaching test. Static balance was tested using a Tetrax Interactive Balance System. [Results] Different muscle thicknesses were observed during the prone bridge exercise with the shoulder flexed at 60°, 90° or 120°. Shoulder flexion at 60° and 90° in the prone bridge exercise with a sling generated the greatest thickness of most transversus abdominis muscles. Shoulder flexion at 120° in the prone bridge exercise with a sling generated the greatest thickness of most external oblique muscles. [Conclusion] The results suggest that the prone bridge exercise with shoulder joint angle is an effective method of increasing global and local muscle strength.

An unusual case of isolated sixth cranial nerve palsy in leprosy.

PubMed

Vaishampayan, Sanjeev; Borde, Priyanka

2012-08-15

Cranial nerve involvement is not common in leprosy. The fifth and seventh cranial nerves are the most commonly affected in leprosy. Herein we present a patient with Hansen disease (BL) with type I reaction who developed isolated involvement of the sixth cranial nerve leading to lateral rectus muscle palsy. He responded to timely anti-reactional therapy and it produced a good response. Careful observation of patients with lepra reaction is needed to avoid damage to important organs.

Muscle-Bone Interactions in Pediatric Bone Diseases.

PubMed

Veilleux, Louis-Nicolas; Rauch, Frank

2017-10-01

Here, we review the skeletal effects of pediatric muscle disorders as well as muscle impairment in pediatric bone disorders. When starting in utero, muscle disorders can lead to congenital multiple contractures. Pediatric-onset muscle weakness such as cerebral palsy, Duchenne muscular dystrophy, spinal muscular atrophy, or spina bifida typically are associated with small diameter of long-bone shafts, low density of metaphyseal bone, and increased fracture incidence in the lower extremities, in particular, the distal femur. Primary bone diseases can affect muscles through generic mechanisms, such as decreased physical activity or in disease-specific ways. For example, the collagen defect underlying the bone fragility of osteogenesis imperfecta may also affect muscle force generation or transmission. Transforming growth factor beta released from bone in Camurati Engelman disease may decrease muscle function. Considering muscle-bone interactions does not only contribute to the understanding of musculoskeletal disorders but also can identify new targets for therapeutic interventions.

Development of Bell's Palsy After Treatment With Ipilimumab and Nivolumab for Metastatic Melanoma: A Case Report.

PubMed

Zecchini, Julia M; Kim, Sara; Yum, Kendra; Friedlander, Philip

2018-01-01

Ipilimumab is a human monoclonal antibody that targets cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and it is FDA approved for the treatment of unresectable or metastatic melanoma. Immune-related adverse events (irAEs) of gastrointestinal, dermatologic, and endocrine origin are commonly seen, ranging between 18% and 44%, with immune checkpoint inhibitors (anti-CTLA-4 and anti-PD-1/PD-L1). Rare irAEs include neurological, renal, and hematologic toxicities. Bell's palsy is a form of neurological toxicity that presents as an idiopathic paralysis of the muscles on one side of the face. We report a case of Bell's palsy in a 45-year-old male patient who received 1 dose of both ipilimumab and nivolumab for the treatment of metastatic melanoma. After the resolution of symptoms, ipilimumab was permanently discontinued and single-agent nivolumab administered. The patient has remained free of neurological symptoms. This case suggests that Bell's palsy is an irAE induced by ipilimumab.

Ultrasound Assessment of Abdominal Muscle Thickness in Postpartum vs Nulliparous Women.

PubMed

Weis, Carol Ann; Triano, John J; Barrett, Jon; Campbell, Michelle D; Croy, Martine; Roeder, Jessica

2015-06-01

The purpose of this study was to determine the effect size in measurable change of abdominal musculature morphology using ultrasonography in postpartum women within 1 month of a healthy, vaginal delivery. One hundred fifty-six participants were recruited for this study. B-mode ultrasound imaging was used to measure abdominal muscle thickness on 80 nulliparous women and 76 mothers who had delivered within the past 4 weeks. Measures were taken for the upper and lower rectus abdominus, external and internal obliques, and transversus abdominus at rest. Statistically significant differences were found in the thickness of the rectus abdominus muscle at both sites; upper (P < .0001) and lower (P < .0001) as well as the internal oblique (P < .0001). All 3 muscles were thinner in postpartum participants (8.29 ± 1.83 mm, 8.89 ± 2.29 mm, and 7.06 ± 1.82 mm, respectively) within the first month of delivery than in controls (10.82 ± 1.93 mm, 11.13 ± 2.38 mm, and 8.36 ± 1.87 mm, respectively). Large effect sizes were found for the influence of pregnancy on the rectus muscle segments (1.35 for the upper rectus abdominus and 1.00 for the lower rectus abdominus) and a medium effect size for the internal oblique (0.71). No significant differences were observed in the remaining 2 muscles. This study showed that there are differences in morphology of the abdominal muscles in pregnant women vs nonpregnant controls. The large effect sizes reported may provide the basis for future studies examining relationships between morphology, functional change, and back pain during pregnancy. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Therapeutic interventions in cerebral palsy.

PubMed

Patel, Dilip R

2005-11-01

Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy.

Facial nerve palsy due to birth trauma

MedlinePlus

Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... An infant's facial nerve is also called the seventh cranial nerve. It can be damaged just before or at the time of delivery. ...

Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy.

PubMed

Pavone, Vito; Testa, Gianluca; Restivo, Domenico A; Cannavò, Luca; Condorelli, Giuseppe; Portinaro, Nicola M; Sessa, Giuseppe

2016-01-01

CP is the most common cause of chronic disability in childhood occurring in 2-2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles.

Ramus marginalis mandibulae nervus facialis palsy in hemifacial microsomia.

PubMed

Silvestri, A; Mariani, G; Vernucci, R A

2008-12-01

The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency. Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit. Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement. Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal. The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.

Climate at high obliquity

NASA Astrophysics Data System (ADS)

Marshall, J.; Ferreira, D.; O'Gorman, P. A.; Seager, S.

2011-12-01

One method of studying earth-like exoplanets is to view earth as an exoplanet and consider how its climate might change if, for example, its obliquity were ranged from 0 to 90 degrees. High values of obliquity challenge our understanding of climate dynamics because if obliquity exceeds 54 degrees, then polar latitudes receive more energy per unit area than do equatorial latitudes. Thus the pole will become warmer than the equator and we are led to consider a world in which the meridional temperature gradients, and associated prevailing zonal wind, have the opposite sign to the present earth. The problem becomes even richer when one considers the dynamics of an ocean, should one exist below. A central question for the ocean circulation is: what is the pattern of surface winds at high obliquities?, for it is the winds that drive the ocean currents and thermohaline circulation. How do atmospheric weather systems growing in the easterly sheared middle latitude jets determine the surface wind pattern? Should one expect middle latitude easterly winds? Finally, a key aspect with regard to habitability is to understand how the atmosphere and ocean of this high obliquity planet work cooperatively together to transport energy meridionally, mediating the warmth of the poles and the coldness of the equator. How extreme are seasonal temperature fluctuations? Should one expect to find ice around the equator? Possible answers to some of these questions have been sought by experimentation with a coupled atmosphere, ocean and sea-ice General Circulation Model of an earth-like aquaplanet: i.e. a planet like our own but on which there is only an ocean but no land. The coupled climate is studied across a range of obliquities (23.5, 54 and 90). We present some of the descriptive climatology of our solutions and how they shed light on the deeper questions of coupled climate dynamics that motivate them. We also review what they tell us about habitability on such planets.

A robotic exoskeleton to treat crouch gait from cerebral palsy: Initial kinematic and neuromuscular evaluation.

PubMed

Lerner, Zachary F; Damiano, Diane L; Bulea, Thomas C

2016-08-01

A robotic exoskeleton was designed for individuals with crouch gait caused by cerebral palsy with the intent to supplement existing muscle function during walking. The aim of this study was to evaluate how powered knee extension assistance provided during stance and swing phases of the gait cycle affect knee kinematics, and knee flexor and extensor muscle activity. Muscle activity and kinematic data were collected from four individuals with crouch gait from cerebral palsy during their normal walking condition and while walking with the exoskeleton under stance, swing, and stance & swing assistance. The exoskeleton was effective in reducing crouch by an average of 13.8° in three of the four participants when assistance was provided during the stance phase; assistance during the swing phase alone was ineffective. Peak knee extensor activity was maintained for all of the conditions during the stance and swing phases. Integrated (i.e. area under the curve) knee extensor activity decreased in two of the subjects indicating a more well-modulated activation pattern. Modest increases in peak and integrated antagonist knee flexor activity were exhibited in all participants; the subject without kinematic improvement had the greatest increase. While the exoskeleton was well tolerated, additional training with a focus on reducing knee flexor activity may lead to further improvements in crouch gait reduction.

Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy)

PubMed Central

2011-01-01

Background Bell's palsy and Lyme neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell's palsy is treated with corticosteroids, while Lyme neuroborreliosis is treated with antibiotics. The diagnosis of Lyme neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme neuroborreliosis or Bell's palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage. Methods Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell's palsy, definite Lyme neuroborreliosis, or possible Lyme neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans. Results One hundred and two patients were analysed; 51 were classified as Bell's palsy, 34 as definite Lyme neuroborreliosis and 17 as possible Lyme neuroborreliosis. Patients with definite Lyme neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell's palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups. Conclusions We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme neuroborreliosis as a cause of peripheral facial palsy

[The new S2k AWMF guideline for the treatment of Bell's palsy in commented short form].

PubMed

Heckmann, J G; Lang, C; Glocker, F X; Urban, P; Bischoff, C; Weder, B; Reiter, G; Meier, U; Guntinas-Lichius, O

2012-11-01

A new S2k AWMF guideline for the treatment of idiopathic facial palsy has been published. An accurate differential diagnosis is indispensable as 25-40% of all facial palsy cases are of non-idiopathic origin. It is explicitly recommended to treat patients with idiopathic facial palsy with steroids. Steroids favour a complete recovery, decrease the risk of synkinesis, autonomic sequelae and contractures. Adjuvant antiviral therapy cannot be recommended. On current data there is not sufficient evidence that the combination of steroids with antiviral drugs has a benefit for the patients. Even when not supported by randomized trials, adjuvant symptomatic therapy to protect the cornea and to avoid complications is recommended. There is no scientific evidence that physical therapy has any benefit but it should be taken into account because of psychological reasons. A benefit of acupuncture has not been proven. If eye closure remains incomplete as result of defective healing, one therapeutic option is lid loading of the upper eye lid. Moreover, in case of severe persistent palsy, several well-established microsurgical nerve and muscle plasty procedures are available. © Georg Thieme Verlag KG Stuttgart · New York.

Systematic review of the effects of mirror therapy in children with cerebral palsy

PubMed Central

Park, Eom-ji; Baek, Soon-hyung; Park, Soohee

2016-01-01

[Purpose] To provide data for systematic intervention plans in occupational therapy practice by objectivity showing the value of mirror therapy interventions in children with cerebral palsy. [Subjects and Methods] Medline and EMBASE databases were searched for the key words “cerebral palsy,” “mirror movement,” “mirror therapy,” and “mirror visual feedback.” Nine studies that met the inclusion and exclusion criteria were identified. The qualitatively determined level of evidence, period of research, comparisons and interventions, tools used to measure the intervention, and the effects were analyzed. [Results] According to the results analyzed, one (1/9, 11.1%) study showed the same result as the control group, one (1/9, 11.1%) showed a negative effect, and seven (7/9, 77.8%) showed positive effects of mirror-mediated therapy, with meaningful improvement in function, such as hand strength, movement speed, muscle activity, and accuracy of hand matching. [Conclusion] Through this study, the value of mirror-mediated therapeutic interventions in occupational therapy practice targeting cerebral palsy was confirmed. It is expected that this result will be useful in establishing mirror therapy as an interventional program. PMID:27942154

Cerebral Palsy Litigation

PubMed Central

Sartwelle, Thomas P.

2015-01-01

The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy. Electronic fetal monitoring has, however, increased the cesarian section rate, with the expected increase in mortality and morbidity risks to mothers and babies alike. This article explains why electronic fetal monitoring remains endorsed as efficacious in the worlds’ labor rooms and courtrooms despite being such a feeble medical modality. It also reviews the reasons professional organizations have failed to condemn the use of electronic fetal monitoring in courtrooms. The failures of tort reform, special cerebral palsy courts, and damage limits to stem the escalating litigation are discussed. Finally, the authors propose using a currently available evidence rule—the Daubert doctrine that excludes “junk science” from the courtroom—as the beginning of the end to cerebral palsy litigation and electronic fetal monitoring’s 40-year masquerade as science. PMID:25183322

Effect of feedback techniques for lower back pain on gluteus maximus and oblique abdominal muscle activity and angle of pelvic rotation during the clam exercise.

PubMed

Koh, Eun-Kyung; Park, Kyue-Nam; Jung, Do-Young

2016-11-01

This study was conducted in order to determine the effect of feedback tools on activities of the gluteus maximus (Gmax) and oblique abdominal muscles and the angle of pelvic rotation during clam exercise (CE). Comparative study using repeated measures. University laboratory. Sixteen subjects with lower back pain. Each subject performed the CE without feedback, the CE using a pressure biofeedback unit (CE-PBU), and the CE with palpation and visual feedback (CE-PVF). Electromyographic (EMG) activity and the angles of pelvic rotation were measured using surface EMG and a three-dimensional motion-analysis system, respectively. One-way repeated-measures ANOVA followed by the Bonferroni post hoc test were used to compare the EMG activity in each muscle as well as the angle of pelvic rotation during the CE, CE-PBU, and CE-PVF. The results of post-hoc testing showed a significantly reduced angle of pelvic rotation and significantly more Gmax EMG activity during the CE-PVF compared with during the CE and CE-PBU. These findings suggest that palpation and visual feedback is effective for activating the Gmax and controlling pelvic rotation during the CE in subjects with lower back pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does Surgical Management of the Hand in Children with Spastic Unilateral Cerebral Palsy Affect Functional Outcome?

ERIC Educational Resources Information Center

van Munster, Judith C.; Maathuis, Karel G. B.; Haga, Nienke; Verheij, Nienke P.; Nicolai, Jean-Philippe A.; Hadders-Algra, Mijna

2007-01-01

The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of…

Changes in the activity of trunk and hip extensor muscles during bridge exercises with variations in unilateral knee joint angle.

PubMed

Kim, Juseung; Park, Minchul

2016-09-01

[Purpose] This study compared abdominal and hip extensor muscle activity during a bridge exercise with various knee joint angles. [Subjects and Methods] Twenty-two healthy male subjects performed a bridge exercise in which the knee joint angle was altered. While subjects performed the bridge exercise, external oblique, internal oblique, gluteus maximus, and semitendinosus muscle activity was measured using electromyography. [Results] The bilateral external and internal oblique muscle activity was significantly higher at 0° knee flexion compared to 120°, 90°, and 60°. The bilateral gluteus maximus muscle activity was significantly different at 0° of knee flexion compared to 120°, 90°, and 60°. The ipsilateral semitendinosus muscle activity was significantly increased at 90° and 60° of knee flexion compared to 120°, and significantly decreased at 0° knee flexion compared with 120°, 90°, and 60°. The contralateral semitendinosus muscle activity was significantly higher at 60° of knee flexion than at 120°, and significantly higher at 0° of knee flexion than at 120°, 90°, and 60°. [Conclusion] Bridge exercises performed with knee flexion less than 90° may be used to train the ipsilateral semitendinosus. Furthermore, bridge exercise performed with one leg may be used to train abdominal and hip extensor muscles.

Low-latitude glaciation and rapid changes in the Earth's obliquity explained by obliquity-oblateness feedback

NASA Astrophysics Data System (ADS)

Williams, Darren M.; Kasting, James F.; Frakes, Lawrence A.

1998-12-01

Palaeomagnetic data suggest that the Earth was glaciated at low latitudes during the Palaeoproterozoic, (about 2.4-2.2Gyr ago) and Neoproterozoic (about 820-550Myr ago) eras, although some of the Neoproterozoic data are disputed,. If the Earth's magnetic field was aligned more or less with its spin axis, as it is today, then either the polar ice caps must have extended well down into the tropics - the `snowball Earth' hypothesis - or the present zonation of climate with respect to latitude must have been reversed. Williams has suggested that the Earth's obliquity may have been greater than 54° during most of its history, which would have made the Equator the coldest part of the planet. But this would require a mechanism to bring the obliquity down to its present value of 23.5°. Here we propose that obliquity-oblateness feedback could have reduced the Earth's obliquity by tens of degrees in less than 100Myr if the continents were situated so as to promote the formation of large polar ice sheets. A high obliquity for the early Earth may also provide a natural explanation for the present inclination of the lunar orbit with respect to the ecliptic (5°), which is otherwise difficult to explain.

Low-latitude glaciation and rapid changes in the Earth's obliquity explained by obliquity-oblateness feedback.

PubMed

Williams, D M; Kasting, J F; Frakes, L A

1998-12-03

Palaeomagnetic data suggest that the Earth was glaciated at low latitudes during the Palaeoproterozoic (about 2.4-2.2 Gyr ago) and Neoproterozoic (about 820-550 Myr ago) eras, although some of the Neoproterozoic data are disputed. If the Earth's magnetic field was aligned more or less with its spin axis, as it is today, then either the polar ice caps must have extended well down into the tropics-the 'snowball Earth' hypothesis-or the present zonation of climate with respect to latitude must have been reversed. Williams has suggested that the Earth's obliquity may have been greater than 54 degrees during most of its history, which would have made the Equator the coldest part of the planet. But this would require a mechanism to bring the obliquity down to its present value of 23.5 degrees. Here we propose that obliquity-oblateness feedback could have reduced the Earth's obliquity by tens of degrees in less than 100 Myr if the continents were situated so as to promote the formation of large polar ice sheets. A high obliquity for the early Earth may also provide a natural explanation for the present inclination of the lunar orbit with respect to the ecliptic (5 degrees), which is otherwise difficult to explain.

The efficacy of diazepam in enhancing motor function in children with spastic cerebral palsy.

PubMed

Mathew, Anna; Mathew, M C; Thomas, Molly; Antonisamy, B

2005-04-01

Muscle spasm and hypertonia limit mobility in children with spastic cerebral palsy. This double-blind, placebo-controlled, randomized controlled clinical trial studies the clinical efficacy of a low dose of diazepam in enhancing movement in children with spastic cerebral palsy. One hundred and eighty children fulfilled the criteria and were randomly allocated to receive one of two doses of diazepam or placebo at bedtime; 173 completed the study. There was a significant reduction of hypertonia, improvement in the range of passive movement, and an increase in spontaneous movement in the children who received diazepam. There was no report of daytime drowsiness. In developing countries, where cost factors often determine choice of drug, diazepam is a cheap and effective way of relieving spasm and stiffness, optimizing physical therapy and facilitating movement in children with spasticity.

Annual changes in radiographic indices of the spine in cerebral palsy patients.

PubMed

Lee, Seung Yeol; Chung, Chin Youb; Lee, Kyoung Min; Kwon, Soon-Sun; Cho, Kyu-Jung; Park, Moon Seok

2016-03-01

We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate. We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model. A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I-II and III groups. In the GMFCS level IV-V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV-V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV-V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis. The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV-V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.

Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

PubMed

Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

2016-09-01

Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cerebral Palsy (For Kids)

MedlinePlus

... Staying Safe Videos for Educators Search English Español Cerebral Palsy KidsHealth / For Kids / Cerebral Palsy What's in this ... the things that kids do every day. What's CP? Some kids with CP use wheelchairs and others ...

[Advances in genetic research of cerebral palsy].

PubMed

Wang, Fang-Fang; Luo, Rong; Qu, Yi; Mu, De-Zhi

2017-09-01

Cerebral palsy is a group of syndromes caused by non-progressive brain injury in the fetus or infant and can cause disabilities in childhood. Etiology of cerebral palsy has always been a hot topic for clinical scientists. More and more studies have shown that genetic factors are closely associated with the development of cerebral palsy. With the development and application of various molecular and biological techniques such as chromosome microarray analysis, genome-wide association study, and whole exome sequencing, new achievements have been made in the genetic research of cerebral palsy. Chromosome abnormalities, copy number variations, susceptibility genes, and single gene mutation associated with the development of cerebral palsy have been identified, which provides new opportunities for the research on the pathogenesis of cerebral palsy. This article reviews the advances in the genetic research on cerebral palsy in recent years.

Digital Oblique Remote Ionospheric Sensing (DORIS) Program Development

DTIC Science & Technology

1992-04-01

waveforms. A new with the ARTIST software (Reinisch and Iluang. autoscaling technique for oblique ionograms 1983, Gamache et al., 1985) which is...development and performance of a complete oblique ionogram autoscaling and inversion algorithm is presented. The inver.i-,n algorithm uses a three...OTIH radar. 14. SUBJECT TERMS 15. NUMBER OF PAGES Oblique Propagation; Oblique lonogram Autoscaling ; i Electron Density Profile Inversion; Simulated 16

Large capacity oblique all-wing transport aircraft

NASA Technical Reports Server (NTRS)

Galloway, Thomas L.; Phillips, James A.; Kennelly, Robert A., Jr.; Waters, Mark H.

1996-01-01

Dr. R. T. Jones first developed the theory for oblique wing aircraft in 1952, and in subsequent years numerous analytical and experimental projects conducted at NASA Ames and elsewhere have established that the Jones' oblique wing theory is correct. Until the late 1980's all proposed oblique wing configurations were wing/body aircraft with the wing mounted on a pivot. With the emerging requirement for commercial transports with very large payloads, 450-800 passengers, Jones proposed a supersonic oblique flying wing in 1988. For such an aircraft all payload, fuel, and systems are carried within the wing, and the wing is designed with a variable sweep to maintain a fixed subsonic normal Mach number. Engines and vertical tails are mounted on pivots supported from the primary structure of the wing. The oblique flying wing transport has come to be known as the Oblique All-Wing (OAW) transport. This presentation gives the highlights of the OAW project that was to study the total concept of the OAW as a commercial transport.

What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR).

PubMed

Jahan, Israt; Muhit, Mohammad; Karim, Tasneem; Smithers-Sheedy, Hayley; Novak, Iona; Jones, Cheryl; Badawi, Nadia; Khandaker, Gulam

2018-04-16

To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0-18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were -2.8 (standard deviation 1.8), -3.1 (standard deviation 2.2) and -1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Implications for Rehabilitation Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these

Bell's palsy before Bell: Cornelis Stalpart van der Wiel's observation of Bell's palsy in 1683.

PubMed

van de Graaf, Robert C; Nicolai, Jean-Philippe A

2005-11-01

Bell's palsy is named after Sir Charles Bell (1774-1842), who has long been considered to be the first to describe idiopathic facial paralysis in the early 19th century. However, it was discovered that Nicolaus Anton Friedreich (1761-1836) and James Douglas (1675-1742) preceded him in the 18th century. Recently, an even earlier account of Bell's palsy was found, as observed by Cornelis Stalpart van der Wiel (1620-1702) from The Hague, The Netherlands in 1683. Because our current knowledge of the history of Bell's palsy before Bell is limited to a few documents, it is interesting to discuss Stalpart van der Wiel's description and determine its additional value for the history of Bell's palsy. It is concluded that Cornelis Stalpart van der Wiel was the first to record Bell's palsy in 1683. His manuscript provides clues for future historical research.

Obliquity dependence of the tangential YORP

NASA Astrophysics Data System (ADS)

Ševeček, P.; Golubov, O.; Scheeres, D. J.; Krugly, Yu. N.

2016-08-01

Context. The tangential Yarkovsky-O'Keefe-Radzievskii-Paddack (YORP) effect is a thermophysical effect that can alter the rotation rate of asteroids and is distinct from the so-called normal YORP effect, but to date has only been studied for asteroids with zero obliquity. Aims: We aim to study the tangential YORP force produced by spherical boulders on the surface of an asteroid with an arbitrary obliquity. Methods: A finite element method is used to simulate heat conductivity inside a boulder, to find the recoil force experienced by it. Then an ellipsoidal asteroid uniformly covered by these types of boulders is considered and the torque is numerically integrated over its surface. Results: Tangential YORP is found to operate on non-zero obliquities and decreases by a factor of two for increasing obliquity.

Subjective Global Nutritional Assessment: A Reliable Screening Tool for Nutritional Assessment in Cerebral Palsy Children.

PubMed

Minocha, Priyanka; Sitaraman, Sadasivan; Choudhary, Anita; Yadav, Rajiv

2018-01-01

To determine the prevalence of undernutrition in children with cerebral palsy and to compare subjective and objective methods of nutritional assessment. This was a hospital based analytical observational study in which 180 children of cerebral palsy, aged 1-12 y, attending tertiary level hospital, Jaipur from March, 2012 through March, 2013 were included. Subjective assessment was done by questionnaire (Subjective Global Nutritional Assessment; SGNA) in which questions related to nutrition history and physical examination, signs of fat, muscle wasting and edema was done while objective assessment was done by weight, height and triceps skinfold thickness (TSFT) measurements. In this study prevalence of undernutrition by subjective method (SGNA) was 76.67% while by objective measurement (weight, height, TSFT) was 48.89%, 77.78% 35.18% respectively. There was fair to moderate agreement between the SGNA and objective assessments including weight and height (k = 0.341, p = 0.000; k = 0.337, p = 0.000 respectively) while for TSFT agreement between both methods was poor (k = 0.092, p = 0.190). In the index study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SGNA was for weight was 95%, 37%, 56%, 90%; for height 84%, 50%, 85%, 47%; for TSFT 81%, 30%, 38%, 75% respectively. The prevalence of undernutrition is high in cerebral palsy children. SGNA can be a reliable tool for assessing nutritional status in children with cerebral palsy and is a simple, comprehensive, noninvasive, and cost-effective tool for screening undernutrition in children of cerebral palsy.

Steroid-antivirals treatment versus steroids alone for the treatment of Bell's palsy: a meta-analysis.

PubMed

Dong, Yabing; Zhu, Yong; Ma, Chuan; Zhao, Huaqiang

2015-01-01

To illustrate whether the steroid-antivirals treatment could acquire a better recovery in patients with Bell's palsy than the steroids alone treatment. We conducted an exhaustive search over Pub med/Medline, Ovid, Elsevier search engines and the Cochrane library thereby collecting the randomized controlled trials in the treatment of patients with Bell's palsy with steroid-antivirals and steroids. The qualities of relevant articles were assessed by GRADE, which was used to present the overall quality of evidence as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Two investigators evaluated these papers independently, and resolved the disagreements by discussion. At last 8 eligible papers (1816 patients included: 896 treated with steroid-antivirals and 920 treated with steroids alone) match the criteria. Owing to the result (chi(2) = 12.57, P = 0.08, I(2) = 44%) presented by the formal test for heterogeneity, the fixed effect meta-analysis model was chosen. The facial muscle recovery between the steroids-antivirals group and the steroids alone group show significant differences (OR = 1.52, 95% CI: 1.20-1.94), while the statistical outcome of adverse effect shows no statistical significance (OR = 1.28, 95% CI: 0.71-2.31). The present meta-analysis indicates that the steroid-antivirals treatment could improve the recovery rate in patients with Bell's palsy when comparing with the steroid alone treatment. This meta-analysis showed that the steroid-antivirals treatment achieved the better outcomes in patients with Bell's palsy. Clinicians should consider that steroid-antivirals therapy is an alternative choice for the patients with Bell's palsy.

Functional aspects of cross-legged sitting with special attention to piriformis muscles and sacroiliac joints.

PubMed

Snijders, Chris J; Hermans, Paul F G; Kleinrensink, Gerrit Jan

2006-02-01

Transversely oriented pelvic muscles such as the internal abdominal oblique, transversus abdominis, piriformis and pelvic floor muscles may contribute to sacroiliac joint stability by pressing the sacrum between the hipbones. Surface electromyographic measurements showed that leg crossing lowers the activity of the internal oblique abdominal muscle significantly. This suggests that leg crossing is a substitute for abdominal muscle activity. No previous studies addressed piriformis muscle and related pelvic structures in cross-legged sitting. Angles of pelvis and femur were measured in healthy subjects in standing, normal sitting and cross-legged sitting, and were used to simulate these postures on embalmed pelvises and measure piriformis muscle elongation. Deformations of pelvic ring and iliolumbar ligament caused by piriformis muscle force were measured on embalmed pelvises. Cross-legged sitting resulted in a relative elongation of the piriformis muscle of 11.7% compared to normal sitting and even 21.4% compared to standing. Application of piriformis muscle force resulted in inward deformation of the pelvic ring and compression of the sacroiliac joints and the dorsal side of the pubic symphysis. Cross-legged sitting is common. We believe that it contributes to sacroiliac joint stability. This study demonstrates the influence of the piriformis muscle on sacroiliac joint compression. The elongation of the piriformis muscle bilaterally by crossing the legs may be functional in the build-up of active or passive tension between sacrum and femur.

Muscle activation in young men during a lower limb aquatic resistance exercise with different devices.

PubMed

Borreani, Sebastien; Colado, Juan Carlos; Furio, Josep; Martin, Fernando; Tella, Víctor

2014-05-01

Little research has been reported on the effects of using different devices with resistance exercises in a water environment. This study compared muscular activation of lower extremity and core muscles during leg adduction performed at maximum velocity with drag and floating devices of different sizes. A total of 24 young men (mean age 23.20 ± 1.18 years) performed 3 repetitions of leg adduction at maximum velocity using 4 different devices (ie, large/small and drag/floating). The maximum amplitude of the electromyographic root mean square of the adductor longus, rectus abdominis, external oblique on the dominant side, external oblique on the nondominant side, and erector lumbar spinae were recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). Unexpectedly, no significant (P > 0.05) differences were found in the neuromuscular responses among the different devices used; the average activation of agonist muscle adequate for neuromuscular conditioning was 40.95% of MVIC. In addition, external oblique activation is greater on the contralateral side to stabilize the body (average, 151.74%; P < 0.05). Therefore, if maximum muscle activation is required, the kind of device is not relevant. Thus, the choice should be based on economic factors.

Secular obliquity variations for Ceres

NASA Astrophysics Data System (ADS)

Bills, Bruce; Scott, Bryan R.; Nimmo, Francis

2016-10-01

We have constructed secular variation models for the orbit and spin poles of the asteroid (1) Ceres, and used them to examine how the obliquity, or angular separation between spin and orbit poles, varies over a time span of several million years. The current obliquity is 4.3 degrees, which means that there are some regions near the poles which do not receive any direct Sunlight. The Dawn mission has provided an improved estimate of the spin pole orientation, and of the low degree gravity field. That allows us to estimate the rate at which the spin pole precesses about the instantaneous orbit pole.The orbit of Ceres is secularly perturbed by the planets, with Jupiter's influence dominating. The current inclination of the orbit plane, relative to the ecliptic, is 10.6 degrees. However, it varies between 7.27 and 11.78 degrees, with dominant periods of 22.1 and 39.6 kyr. The spin pole precession rate parameter has a period of 205 kyr, with current uncertainty of 3%, dominated by uncertainty in the mean moment of inertia of Ceres.The obliquity varies, with a dominant period of 24.5 kyr, with maximum values near 26 degrees, and minimum values somewhat less than the present value. Ceres is currently near to a minimum of its secular obliquity variations.The near-surface thermal environment thus has at least 3 important time scales: diurnal (9.07 hours), annual (4.60 years), and obliquity cycle (24.5 kyr). The annual thermal wave likely only penetrates a few meters, but the much long thermal wave associated with the obliquity cycle has a skin depth larger by a factor of 70 or so, depending upon thermal properties in the subsurface.

Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy

PubMed Central

Pavone, Vito; Testa, Gianluca; Restivo, Domenico A.; Cannavò, Luca; Condorelli, Giuseppe; Portinaro, Nicola M.; Sessa, Giuseppe

2016-01-01

CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles. PMID:26924985

Idiopathic Non-traumatic Facial Nerve Palsy (Bell's Palsy) in Neonates; An Atypical Age and Management Dilemma.

PubMed

Khair, Abdulhafeez M; Ibrahim, Khalid

2018-01-01

Idiopathic (Bell's) palsy is the commonest cause of unilateral facial paralysis in children. Although being idiopathic by definition, possible infectious, inflammatory, and ischemic triggers have been suggested. Bell's palsy is thought to be responsible for up to three-fourths of cases of acute unilateral facial paralysis worldwide. The diagnosis has to be reached after other causes of acute peripheral palsy have been excluded. However, it is rarely described in neonates and young infants. Steroids may have some role in treatment, but antiviral therapies have doubtful evidence of benefit. Prognosis is good, though residual dysfunction is occasionally encountered. We report the case of a two-week-old neonate with no prior illnesses who presented with acute left facial palsy. Clinical findings and normal brain imaging were consistent with the diagnosis of Bell's palsy. The patient had a good response to oral steroids.

The effect of polar caps on obliquity

NASA Technical Reports Server (NTRS)

Lindner, B. L.

1993-01-01

Rubincam has shown that the Martian obliquity is dependent on the seasonal polar caps. In particular, Rubincam analytically derived this dependence and showed that the change in obliquity is directly proportional to the seasonal polar cap mass. Rubincam concludes that seasonal friction does not appear to have changed Mars' climate significantly. Using a computer model for the evolution of the Martian atmosphere, Haberle et al. have made a convincing case for the possibility of huge polar caps, about 10 times the mass of the current polar caps, that exist for a significant fraction of the planet's history. Since Rubincam showed that the effect of seasonal friction on obliquity is directly proportional to polar cap mass, a scenario with a ten-fold increase in polar cap mass over a significant fraction of the planet's history would result in a secular increase in Mars' obliquity of perhaps 10 degrees. Hence, the Rubincam conclusion of an insignificant contribution to Mars' climate by seasonal friction may be incorrect. Furthermore, if seasonal friction is an important consideration in the obliquity of Mars, this would significantly alter the predictions of past obliquity.

Ceres' obliquity history: implications for permanently shadowed regions

NASA Astrophysics Data System (ADS)

Ermakov, A.; Mazarico, E.; Schroeder, S.; Carsenty, U.; Schorghofer, N.; Raymond, C. A.; Zuber, M. T.; Smith, D. E.; Russell, C. T.

2016-12-01

The Dawn spacecraft's Framing Camera (FC) images and radio-tracking data have allowed precise determination of Ceres' rotational pole and obliquity. Presently, the obliquity (ɛ) of Ceres is ≈4°. Because of the low obliquity, permanently shadowed regions (PSRs) can exist on Ceres, and have been identified using both images and shape models (Schorghofer et al., 2016). These observations make Ceres only the third body in the solar system with recognized PSRs after the Moon (Zuber et al., 1997) and Mercury (Chabot et al., 2012). Some craters in Ceres' polar regions possess bright crater floor deposits (BCFD). These crater floors are typically in shadow. However, they receive light scattered from the surrounding sunlit crater walls and therefore can be seen by FC. These bright deposits are hypothesized to be water ice accumulated in PSR cold traps, analogous to the Moon (Watson et al., 1961). The existence of the PSRs critically depends on the body's obliquity. The goal of this work is to study the history of Ceres' obliquity. Knowing past obliquity variations can shed light on the history of PSRs, and can help constrain the water-ice deposition time scales. We integrate the obliquity of Ceres over the last 3 My for the range of C/MR2vol constrained by the Dawn gravity measurements (Park et al., 2016, Ermakov et al., 2016) using methods described in Wisdom & Holman (1991) and Touma & Wisdom (1994). The obliquity history for C/MR2vol=0.392 is shown in Fig. 1. The integrations show that the obliquity of Ceres undergoes large oscillations with the main period of T=25 ky and a maximum of 19.7°. The obliquity oscillations are driven by the periodic change of Ceres' orbit inclination (T=22 ky) and the pole precession (T=210 ky). Ceres passed a local obliquity minimum 1327 years ago when (ɛmin=2.4°). The most recent maximum was 13895 years ago (ɛmax=18.5°). At such high obliquity, most of the present-day PSRs receive direct sunlight. We find a correlation between

Oblique Wing Research Aircraft on ramp

NASA Technical Reports Server (NTRS)

1976-01-01

This 1976 photograph of the Oblique Wing Research Aircraft was taken in front of the NASA Flight Research Center hangar, located at Edwards Air Force Base, California. In the photograph the noseboom, pitot-static probe, and angles-of-attack and sideslip flow vanes(covered-up) are attached to the front of the vehicle. The clear nose dome for the television camera, and the shrouded propellor for the 90 horsepower engine are clearly seen. The Oblique Wing Research Aircraft was a small, remotely piloted, research craft designed and flight tested to look at the aerodynamic characteristics of an oblique wing and the control laws necessary to achieve acceptable handling qualities. NASA Dryden Flight Research Center and the NASA Ames Research Center conducted research with this aircraft in the mid-1970s to investigate the feasibility of flying an oblique wing aircraft.

Influence of exercise training on the oxidative capacity of rat abdominal muscles

NASA Technical Reports Server (NTRS)

Uribe, J. M.; Stump, C. S.; Tipton, C. M.; Fregosi, R. F.

1992-01-01

Our purpose was to determine if endurance exercise training would increase the oxidative capacity of the abdominal expiratory muscles of the rat. Accordingly, 9 male rats were subjected to an endurance training protocol (1 h/day, 6 days/week, 9 weeks) and 9 litter-mates served as controls. Citrate synthase (CS) activity was used as an index of oxidative capacity, and was determined in the following muscles: soleus, plantaris, costal diaphragm, crural diaphragm, and in all four abdominal muscles: rectus abdominis, transversus abdominis, external oblique, and internal oblique. Compared to their non-trained litter-mates, the trained rats had higher peak whole body oxygen consumption rates (+ 16%) and CS activities in plantaris (+34%) and soleus (+36%) muscles. Thus, the training program caused substantial systemic and locomotor muscle adaptations. The CS activity of costal diaphragm was 20% greater in the trained animals, but no difference was observed in crural diaphragm. The CS activity in the abdominal muscles was less than one-half of that in locomotor and diaphragm muscles, and there were no significant changes with training except in the rectus abdominis where a 26% increase was observed. The increase in rectus abdominis CS activity may reflect its role in postural support and/or locomotion, as none of the primary expiratory pumping muscles adapted to the training protocol. The relatively low levels of CS activity in the abdominal muscles suggests that they are not recruited frequently at rest, and the lack of an increase with training indicates that these muscles do not contribute significantly to the increased ventilatory activity accompanying exercise in the rat.

Osteopathic manipulative treatment of a 26-year-old woman with Bell's palsy.

PubMed

Lancaster, David G; Crow, William Thomas

2006-05-01

Bell's palsy is caused by a lesion of the facial nerve and results in unilateral paralysis or paresis of the face. The condition affects approximately 23 in 100,000 persons, with onset typically occurring between the ages of 10 and 40 years. The authors report the case of a 26-year-old woman with Bell's palsy, whom they treated with osteopathic manipulative treatment that was focused on the enhancement of lymphatic circulation. The osteopathic manipulative procedures used involved reducing restrictions around four key diaphragms (thoracic outlet, respiratory diaphragm, suboccipital diaphragm, cerebellar tentorium), as well as applying the thoracic pump, muscle energy, primary respiratory mechanism, and osteopathy in the cranial field. The authors, who were guided by the four principles of osteopathic philosophy, report that the patient's symptoms resolved within 2 weeks, during which two sessions of osteopathic manipulative treatment, each lasting approximately 20 minutes, were held. Patient recovery occurred without the use of pharmaceuticals.

Effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients.

PubMed

Lee, Dong-Kyu; Kang, Min-Hyeok; Kim, Ji-Won; Kim, Yang-Gon; Park, Ji-Hyuk; Oh, Jae-Seop

2013-01-01

Abdominal strengthening exercises are important for stroke patients; however, there is a lack of research on therapeutic exercises for increasing abdominal muscle activity in stroke patients. We investigated the effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients. In total, 18 hemiplegic subjects (13 males, 5 females) were recruited. All subjects performed non-paretic arm exercises involving three different shoulder movements (extension, flexion, and horizontal abduction) using an elastic tubing band. Surface electromyography (EMG) signals were recorded from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles bilaterally during non-paretic arm exercises. EMG activities of abdominal muscles during non-paretic arm extension and horizontal abduction were increased significantly versus shoulder flexion when subjects performed the arm exercise in a seated position. Muscle activity of the EO was significantly greater in the paretic than the non-paretic side during non-paretic arm extension and horizontal abduction. We suggest that non-paretic arm extension and horizontal abduction exercises using an elastic tubing band may be effective in increasing abdominal muscle activity.

The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia

PubMed Central

Vleeming, A; Schuenke, M D; Danneels, L; Willard, F H

2014-01-01

The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior

The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia.

PubMed

Vleeming, A; Schuenke, M D; Danneels, L; Willard, F H

2014-10-01

The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior

Use of botulinum toxin type A in the management of neonatal brachial plexus palsy.

PubMed

Michaud, Linda J; Louden, Emily J; Lippert, William C; Allgier, Allison J; Foad, Susan L; Mehlman, Charles T

2014-12-01

To evaluate functional outcomes and the impact on surgical interventions after the use of botulinum neurotoxin type A (BoNT-A) for muscle imbalance, cocontractions, or contractures with neonatal brachial plexus palsy. A retrospective cohort study. A brachial plexus center in a tertiary children's hospital. Fifty-nine patients with neonatal brachial plexus palsy (75 injection procedures, 91 muscles and/or muscle groups) received BoNT-A injections (mean age at injection, 36.2 months; range, 6-123 months; 31 boys; 30 right-sided injuries, 28 left-sided injuries, 1 bilateral injury). Data collected retrospectively from medical records, from procedure notes and clinic visits before BoNT-A use, at ≤6 months follow-up (BoNT-A active [BA]) and at ≥7 months follow-up (BoNT-A not active [BNA]) included demographics, injection indication, side, and site(s), previous surgical history, occupational therapy and/or physical therapy plan, and outcome measurements. Outcomes assessed before and after injections included active and passive range of motion, Mallet and Toronto scores, parent comments about arm function, preinjection surgical considerations, and postinjection surgical history. Injection procedures included 51 to shoulder internal rotators, 15 triceps, 15 pronator teres, 9 biceps, and 1 flexor carpi ulnaris. Active and passive shoulder external rotation (SER) range of motion improved after shoulder internal rotator injections (P = .0003 and P = .002, respectively), as did Mallet scores with BA; the latter were sustained with BNA. Surgical intervention was averted, modified, or deferred after BoNT-A in 45% (n = 20) under surgical consideration before BoNT-A. Active elbow flexion improved in 67% (P = .005), sustained BNA (P = .004) after triceps injections; 2 of 7 patients averted surgery. Active supination improved with BA (P = .002), with gains sustained BNA (P = .016). Passive elbow extension improved after biceps injections by an average 17° (P�

The effect of abdominal resistance training and energy restricted diet on lateral abdominal muscles thickness of overweight and obese women.

PubMed

Noormohammadpour, Pardis; Kordi, Ramin; Dehghani, Saeed; Rostami, Mohsen

2012-07-01

The role of transabdominal muscles (external oblique, internal oblique and transversus abdominis) on core stability has been shown previously. Energy restricted diet and abdominal resistance training are commonly used by overweight and obese people to reduce their weight. In this study we investigated the impact of 12 weeks concurrent energy restricted diet and abdominal resistance training on the thickness of the lateral abdominal muscles of 19 obese and overweight women employing ultrasonography in resting and drawing-in maneuvers. The results showed significant increase of the muscle thicknesses during drawing-in maneuver after 12 weeks intervention. Based on our findings, it can be concluded that 12 weeks concurrent abdominal resistance training and energy restricted diet in addition to weight loss lead to improvement of transabdominal muscles thickness in obese and overweight people. Considering the role of these muscles in core stability, using this therapeutic protocol in obese people, particularly in those who have weakness of these muscles might be helpful. Copyright © 2011 Elsevier Ltd. All rights reserved.

[A Bell"s palsy of long standing, and its rehabilitation. An electromyographic documentation. (author's transl)].

PubMed

Kilimov, N

1977-09-01

We examined a 31 year-old female patient who, since her first year of life and following a parotis operation, had suffered from left-sided Bell's palsy. The electromyographical examinations disclosed a complete loss of voluntary muscle control and of the trigemino-facial reflexes, although the direct responses of the facial nerve could be demonstrated with delayed latences. The findings indicated peripheral regeneration of the facial nerve with absence of central programming and reflex pathways. By means of rhythmic muscle stimulation, voluntary control and reflex excitability was re-established, to a limited extent, on the formerly inactive side within a short space of time.

Acupuncture for Bell's palsy.

PubMed

Chen, Ning; Zhou, Muke; He, Li; Zhou, Dong; Li, N

2010-08-04

Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. We updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register (24 May 2010), The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010), MEDLINE (January 1966 to May 2010), EMBASE (January 1980 to May 2010), AMED (January 1985 to May 2010), LILACS (from January 1982 to May 2010) and the Chinese Biomedical Retrieval System (January 1978 to May 2010) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. We included all randomised controlled trials involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions. Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently. All disagreements were resolved by discussion between the review authors. The literature search and handsearching identified 49 potentially relevant articles. Of these, six RCTs were included involving 537 participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs. Of the six included trials, five used acupuncture while the other one used

Unusual cause of brachial palsy with diaphragmatic palsy.

PubMed

Gupta, Vishal; Pandita, Aakash; Panghal, Astha; Hassan, Neha

2018-05-12

We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. On examination, there was bilateral congenital talipes equinovarus and a scar was present on the forearm. The mother had a history of chickenpox during the 16 weeks of pregnancy for which no treatment was sought. On investigation, PCR for varicella was found to be positive in the neonate. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Shock Waves in the Treatment of Muscle Hypertonia and Dystonia

PubMed Central

Mori, Laura; Currà, Antonio; Molfetta, Luigi; Abbruzzese, Giovanni

2014-01-01

Since 1997, focused shock waves therapy (FSWT) has been reported to be useful in the treatment of muscle hypertonia and dystonia. More recently, also radial shock wave therapy (RSWT) has been successfully used to treat muscle hypertonia. The studies where FSWT and RSWT have been used to treat muscle hypertonia and dystonia are reviewed in this paper. The more consistent and long lasting results were obtained in the lower limb muscles of patients affected by cerebral palsy with both FSWT and RSWT and in the distal upper limb muscles of adult stroke patients using FSWT. The most probable mechanism of action is a direct effect of shock waves on muscle fibrosis and other nonreflex components of muscle hypertonia. However, we believe that up to now the biological effects of shock waves on muscle hypertonia and dystonia cannot be clearly separated from a placebo effect. PMID:25309915

Hypoglossal nerve palsy in infectious mononucleosis.

PubMed

DeSimone, P A; Snyder, D

1978-08-01

Involvement of the central nervous system is a rare complication of infectious mononucleosis. Isolated cranial nerve palsy is the least reported neurologic complication. We report a second case of hypoglossal nerve palsy associated with infectious mononucleosis, and review 20 other reported cases of cranial nerve palsies. Any cranial nerve may be involved. The onset of the palsy usually follows the diagnosis and clinical presentation of infectious mononucleosis. The prognosis for a complete recovery is excellent, although recovery may be protracted. The use of steroids does not appear to be etiologic, nor beneficial or deleterious in treatment.

Clinical practice guideline: Bell's Palsy executive summary.

PubMed

Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

2013-11-01

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

Gait analysis in children with cerebral palsy.

PubMed

Armand, Stéphane; Decoulon, Geraldo; Bonnefoy-Mazure, Alice

2016-12-01

Cerebral palsy (CP) children present complex and heterogeneous motor disorders that cause gait deviations.Clinical gait analysis (CGA) is needed to identify, understand and support the management of gait deviations in CP. CGA assesses a large amount of quantitative data concerning patients' gait characteristics, such as video, kinematics, kinetics, electromyography and plantar pressure data.Common gait deviations in CP can be grouped into the gait patterns of spastic hemiplegia (drop foot, equinus with different knee positions) and spastic diplegia (true equinus, jump, apparent equinus and crouch) to facilitate communication. However, gait deviations in CP tend to be a continuum of deviations rather than well delineated groups. To interpret CGA, it is necessary to link gait deviations to clinical impairments and to distinguish primary gait deviations from compensatory strategies.CGA does not tell us how to treat a CP patient, but can provide objective identification of gait deviations and further the understanding of gait deviations. Numerous treatment options are available to manage gait deviations in CP. Generally, treatments strive to limit secondary deformations, re-establish the lever arm function and preserve muscle strength.Additional roles of CGA are to better understand the effects of treatments on gait deviations. Cite this article: Armand S, Decoulon G, Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy. EFORT Open Rev 2016;1:448-460. DOI: 10.1302/2058-5241.1.000052.

A new teaching model for demonstrating the movement of the extraocular muscles.

PubMed

Iwanaga, Joe; Refsland, Jason; Iovino, Lee; Holley, Gary; Laws, Tyler; Oskouian, Rod J; Tubbs, R Shane

2017-09-01

The extraocular muscles consist of the superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles. This study aimed to create a new teaching model for demonstrating the function of the extraocular muscles. A coronal section of the head was prepared and sutures attached to the levator palpebral superioris muscle and six extraocular muscles. Tension was placed on each muscle from a posterior approach and movement of the eye documented from an anterior view. All movements were clearly seen less than that of the inferior rectus muscle. To our knowledge, this is the first cadaveric teaching model for demonstrating the movements of the extraocular muscles. Clin. Anat. 30:733-735, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Dorsal scapular neuropathy causing rhomboids palsy and scapular winging.

PubMed

Argyriou, Andreas A; Karanasios, Panagiotis; Makridou, Alexandra; Makris, Nicolaos

2015-01-01

Most cases of scapular winging (SW) are attributed to either long thoracic or spinal accessory nerve lesions. Dorsal scapular nerve lesions are quite rare and the literature contains very few case reports of SW secondary to rhomboid paralysis. We are reporting the unusual case of a young patient who developed right-side scapular winging due to dorsal scapular neuropathy and rhomboids palsy, and we highlight the role of conservative treatment and rehabilitation for cases of mild/medium injury to the dorsal scapular nerve or to the rhomboid muscles. For those cases, physiotherapy is recommended, and this is mainly aimed at strengthening the trapezius in order to compensate for rhomboids weakness.

Oblique nonlinear whistler wave

NASA Astrophysics Data System (ADS)

Yoon, Peter H.; Pandey, Vinay S.; Lee, Dong-Hun

2014-03-01

Motivated by satellite observation of large-amplitude whistler waves propagating in oblique directions with respect to the ambient magnetic field, a recent letter discusses the physics of large-amplitude whistler waves and relativistic electron acceleration. One of the conclusions of that letter is that oblique whistler waves will eventually undergo nonlinear steepening regardless of the amplitude. The present paper reexamines this claim and finds that the steepening associated with the density perturbation almost never occurs, unless whistler waves have sufficiently high amplitude and propagate sufficiently close to the resonance cone angle.

Early results of one-stage correction for hip instability in cerebral palsy.

PubMed

Kim, Hui Taek; Jang, Jae Hoon; Ahn, Jae Min; Lee, Jong Seo; Kang, Dong Joon

2012-06-01

We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients. We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months. Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery. A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.

[Application of grading evaluation on facial nerve function of Bell's palsy treated with electroacupuncture].

PubMed

Zhou, Zhang-Ling; Zuo, Cong; Cheng, Shu-Luo; Shao, Wei-Wei; Liu, Li-Ping

2013-08-01

To explore the correlation of facial nerve injury degree with facial contraction degree induced by electric stimulation in the treatment of Bell's palsy with electroacupuncture, and the significance in elec tric reaction grading evaluation. Sixty-eight cases of Bell's palsy were enrolled. The positive and negative electrodes of the acupuncture treatment apparatus were attached to the needle handles at the 3 groups of points, named Taiyang (EX-HN 5)-Yangbai(GB 14), Xiaguan (ST 7)-Quanliao (SI 18) and Heliao (LI 19)-Jiachengjiang (Extra). The disperse-dense wave was applied. According to the severity of local muscle contraction after needling, the electric reaction was divided into 4 grades, named superior, moderate, poor and no reaction. After acupuncture and electroacupuncture, the efficacy was evaluated in accordance with the different electric reaction grades. The curative rate was 100.0% (44/44) in patients with superior electric reaction, was 100.0% (7/7) in patients with moderate electric reaction, was 18.2% (2/11) in patients with poor electric reaction and was 0 (0/6) in patients with noelectric reaction. The difference was significant statistically in comparison of 4 groups (P<0.01). The superiority correlation presented between the efficacy and electric reaction grade (P< 0.001). The higher the superiority of electric reaction grade was, the better the efficacy was. The difference in the efficacy among different electric reaction grades was significant statistically (P<0.001). And the course of treatment was the shortest for those with the high superiority of electric reaction. The reaction grade of electric stimulation is conform to the facial nerve injury grading in Bell's palsy. The contraction degree of facial mimetic muscle induced by electroacupuncture stimulation is closely correlated with severity of disease. Based on the electric reaction, the facial nerve injury severity can be understood generally and the prognosis be judged.

Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy.

PubMed

García-Contreras, Andrea A; Vásquez-Garibay, Edgar M; Romero-Velarde, Enrique; Ibarra-Gutiérrez, Ana Isabel; Troyo-Sanromán, Rogelio; Sandoval-Montes, Imelda E

2014-04-01

To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia. Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used. During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01). The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%). Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy.

PubMed

Arad, Ehud; Stephens, Derek; Curtis, Christine G; Clarke, Howard M

2013-06-01

Residual muscle imbalance is a common problem affecting obstetrical brachial plexus palsy patients. The goal of this study was to examine the efficacy of botulinum toxin type A (Botox) in improving this muscle imbalance. The authors retrospectively reviewed obstetrical brachial plexus palsy patients treated with Botox for muscle imbalance as an isolated procedure. Outcomes were the change in Active Movement Scale scores from pre-Botox scores to scores at 1 month after Botox and 1 year after Botox. Twenty-seven patients were included, 19 treated for shoulder imbalance and eight treated for elbow imbalance. Active Movement Scale scores (mean±SD) for shoulder external rotation improved from 0.6±1.0 before Botox to 2.6±2.14 (p<0.01) at 1 month after Botox, and declined to 1.3±1.2 (p<0.01) at 1 year after Botox. Scores for elbow flexion were 3.3±2.1 before Botox, unchanged at 4.4±1.8 (p=0.07) 1 month after Botox, and improved to 5.8±0.5 (p<0.01) at 1 year after Botox. Scores for elbow supination were 2.9±1.7 before Botox and 3.4±1.5 (p=0.2) at 1 month after Botox, and improved to 3.9±2.0 (p<0.01) at 1 year after Botox. Botox for shoulder movement imbalance produces improvement in external rotation that is not sufficiently sustained over time to be of clinical benefit. However, Botox for elbow movement imbalance produces a sustained and clinically useful improvement. Therapeutic, IV.

Management of peripheral facial nerve palsy

PubMed Central

2008-01-01

Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell’s palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell’s palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell’s palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell’s palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell’s palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae. PMID:18368417

Quantifying muscle patterns and spine load during various forms of the push-up.

PubMed

Freeman, Stephanie; Karpowicz, Amy; Gray, John; McGill, Stuart

2006-03-01

This study was conducted to quantify the normalized amplitudes of the abdominal wall and back extensor musculature during a variety of push-up styles. We also sought to quantify their impact on spinal loading by calculating spinal compression and torque generation in the L4-5 area. Ten university-age participants, nine males and one female, in good to excellent condition, volunteered to participate in this study. All participants were requested to perform a maximum of 12 different push-up exercises, three trials per exercise. Surface electromyographic data (EMG) were collected bilaterally on rectus abdominis, external oblique, internal oblique, latissimus dorsi, and erector spinae muscles, and unilaterally (right side) on pectoralis major, triceps brachii, biceps brachii, and anterior deltoid muscles. Spine kinetics were obtained using an anatomically detailed model of the torso/spine. This study revealed that more dynamic push-ups (i.e., ballistic, with hand movement) required more muscle activation and higher spine load, whereas placing labile balls under the hands only resulted in modest increases in spine load. Right rectus abdominis (RA) activation was significantly higher than left RA activation during the left hand forward push-up and vice versa for the right hand forward push-up (P < 0.001). External oblique (EO) demonstrated the same switch in dominance during staggered hand push-ups (P < 0.01). The one-arm push-up resulted in the highest spine compression. Skilled participants showed greater synchronicity with peak muscle activation (plyometric type of contractions) during ballistic push-ups. These data will help guide exercise selection for individuals with differing training objectives and injury history.

Centrifuge models simulating magma emplacement during oblique rifting

NASA Astrophysics Data System (ADS)

Corti, Giacomo; Bonini, Marco; Innocenti, Fabrizio; Manetti, Piero; Mulugeta, Genene

2001-07-01

A series of centrifuge analogue experiments have been performed to model the mechanics of continental oblique extension (in the range of 0° to 60°) in the presence of underplated magma at the base of the continental crust. The experiments reproduced the main characteristics of oblique rifting, such as (1) en-echelon arrangement of structures, (2) mean fault trends oblique to the extension vector, (3) strain partitioning between different sets of faults and (4) fault dips higher than in purely normal faults (e.g. Tron, V., Brun, J.-P., 1991. Experiments on oblique rifting in brittle-ductile systems. Tectonophysics 188, 71-84). The model results show that the pattern of deformation is strongly controlled by the angle of obliquity ( α), which determines the ratio between the shearing and stretching components of movement. For α⩽35°, the deformation is partitioned between oblique-slip and normal faults, whereas for α⩾45° a strain partitioning arises between oblique-slip and strike-slip faults. The experimental results show that for α⩽35°, there is a strong coupling between deformation and the underplated magma: the presence of magma determines a strain localisation and a reduced strain partitioning; deformation, in turn, focuses magma emplacement. Magmatic chambers form in the core of lower crust domes with an oblique trend to the initial magma reservoir and, in some cases, an en-echelon arrangement. Typically, intrusions show an elongated shape with a high length/width ratio. In nature, this pattern is expected to result in magmatic and volcanic belts oblique to the rift axis and arranged en-echelon, in agreement with some selected natural examples of continental rifts (i.e. Main Ethiopian Rift) and oceanic ridges (i.e. Mohns and Reykjanes Ridges).

Idiopathic Non-traumatic Facial Nerve Palsy (Bell’s Palsy) in Neonates; An Atypical Age and Management Dilemma

PubMed Central

Khair, Abdulhafeez M.; Ibrahim, Khalid

2018-01-01

Idiopathic (Bell’s) palsy is the commonest cause of unilateral facial paralysis in children. Although being idiopathic by definition, possible infectious, inflammatory, and ischemic triggers have been suggested. Bell’s palsy is thought to be responsible for up to three-fourths of cases of acute unilateral facial paralysis worldwide. The diagnosis has to be reached after other causes of acute peripheral palsy have been excluded. However, it is rarely described in neonates and young infants. Steroids may have some role in treatment, but antiviral therapies have doubtful evidence of benefit. Prognosis is good, though residual dysfunction is occasionally encountered. We report the case of a two-week-old neonate with no prior illnesses who presented with acute left facial palsy. Clinical findings and normal brain imaging were consistent with the diagnosis of Bell’s palsy. The patient had a good response to oral steroids. PMID:29468002

Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results.

PubMed

Bonnechère, Bruno; Omelina, Lubos; Jansen, Bart; Van Sint Jan, Serge

2017-02-01

Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30 min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p = 0.04]. SG could therefore be an interesting option to integrate in the conventional treatment of CP children. Implication for Rehabilitation Cerebral palsy (CP) leads to balance issues. Rehabilitation exercises are not performed (enough) at home. Serious games (SG) could increase patients' motivation. SG increase balance control of CP children.

Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring.

PubMed

Schneider, R; Sekulla, C; Machens, A; Lorenz, K; Nguyen Thanh, P; Dralle, H

2015-10-01

Continuous monitoring of electromyographic (EMG) amplitudes of the vocal muscles detects impending injury of the recurrent laryngeal nerve (RLN) during thyroid operations earlier than intermittent EMG monitoring. This may alert the surgeon to stop a manoeuvre causing stretching or pressure on the RLN, with better recovery of nerve function. Patients with intact preoperative RLN function who underwent thyroid surgery for benign disease between January 2011 and September 2014 under continuous intraoperative nerve monitoring (CIONM) or intermittent intraoperative nerve monitoring (IIONM) were included in this observational study conducted at a tertiary surgical centre. For CIONM, combined EMG events indicative of imminent nerve injury were defined as an EMG amplitude decrease of 50 per cent or more and a latency increase of 10 per cent relative to baseline values. The rates of early and permanent palsy for the two groups of patients were compared. There were 1526 patients, 788 of whom (1314 nerves at risk) underwent thyroid surgery using CIONM and 738 (965 nerves at risk) had IIONM. With the use of CIONM, 63 (82 per cent) of 77 combined events were reversible during the operation. No permanent vocal fold palsy occurred with CIONM, whereas four unilateral permanent vocal fold palsies (0·4 per cent) were diagnosed after IIONM (P = 0·019). Operation with CIONM resulted in fewer permanent vocal fold palsies compared with IIONM after thyroid surgery in patients with benign disease. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Tendon Transfers Part II: Transfers for Ulnar Nerve Palsy and Median Nerve Palsy

PubMed Central

Sammer, Douglas M.; Chung, Kevin C.

2009-01-01

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. PMID:19730287

Magnetic resonance imaging in dissociated strabismus complex demonstrates generalized hypertrophy of rectus extraocular muscles.

PubMed

Rajab, Ghada Z; Suh, Soh Youn; Demer, Joseph L

2017-06-01

Dissociated strabismus complex (DSC) is an enigmatic form of strabismus that includes dissociated vertical deviation (DVD) and dissociated horizontal deviation (DHD). We employed magnetic resonance imaging (MRI) to evaluate the extraocular muscles in DSC. We studied 5 patients with DSC and mean age of 25 years (range, 12-42 years), and 15 age-matched, orthotropic control subjects. All patients had DVD; 4 also had DHD. We employed high-resolution, surface coil MRI with thin, 2 mm slices and central target fixation. Volumes of the rectus and superior oblique muscles in the region 12 mm posterior to 4 mm anterior to the globe-optic nerve junction were measured in quasi-coronal planes in central gaze. Patients with DSC had no structural abnormalities of rectus muscles or rectus pulleys or the superior oblique muscle but exhibited modest, statistically significant increased volume of all rectus muscles ranging from 20% for medial rectus to 9% for lateral rectus (P < 0.05). DSC includes various combinations of sursumduction, excycloduction, and abduction not conforming to Hering's law. We have found modest generalized enlargement of all rectus muscles. DSC is associated with generalized rectus extraocular muscle hypertrophy in the absence of other orbital abnormalities. Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Results of the superior oblique tendon elongation procedure for severe Brown's syndrome.

PubMed Central

Wright, K W

2000-01-01

patient was corrected with a second surgery providing an overall success rate of 93%. Ten of the 15 patients had at least 11 months' follow-up, and 6 of the 10 patients showed a delayed improvement over a 4- to 6-month period. Five patients had more than 5 years of follow-up, and 4 (80%) had an excellent long-term outcome (final result, 9 to 10) with a single operations; all 5 had a good final outcome (final result, 7 to 10, mean 9.2) with 1 patient requiring a second surgery. There were no long-term complications, including no extrusions, no restriction of ocular rotations, and no infections. The patient who underwent the procedure elsewhere demonstrated limited movement of the eye to adduction elevation, and there was underaction of the ipsilateral superior oblique muscle. A reoperation performed by the author revealed positive forced ductions up and nasal ward. There were scars and adhesions in the area of the silicone implant, including scar to superior nasal sclera and superior rectus muscle. The silicone implant was removed and scar excised until forced ductions improved. This resulted in improved motility. Thirty-nine AAPOS members reported on 140 patients who had undergone the silicone tendon elongation procedure for Brown's syndrome. Judged by the surgeon on a scale of 1 to 10 (10 being best), 26 surgeons rated 91 patients (65%) as good with a score of 8 to 10, and 14 surgeons rated 18 patients (13%) poor with scores of 1 to 3. Complications were recorded for 9 patients and included scarring and restriction with removal of silicone implant in 4 and spontaneous extrusion in 5. Three of the 5 spontaneous extrusions came from the same surgeon, and in another case a surgeon used a 10 mm length of silicone. CONCLUSIONS: A novel procedure, the silicone tendon expander, is an effective option for correcting Brown's syndrome caused by a stiff or inelastic superior oblique tendon; long-term outcomes are excellent. Proper technique with maintenance of the tendon capsule is

Bow and Oblique Shock Formation in Soap Film

NASA Astrophysics Data System (ADS)

Kim, Ildoo; Mandre, Shreyas; Sane, Aakash

2015-11-01

In recent years, soap films have been exploited primarily to approximate two-dimensional flows while their three-dimensional character is relatively unattended. An example of the three-dimensional character of the flow in a soap film is the observed Marangoni shock wave when the flow speed exceeds the wave speed. In this study, we investigated the formation of bow and oblique shocks in soap films generated by wedges with different deflection angles. When the wedge deflection angle is small and the film flows fast, oblique shocks are observed. When the oblique shock cannot exists, bow shock is formed upstream the wedge. We characterized the oblique shock angle as a function of the wedge deflection angle and the flow speed, and we also present the criteria for transition between bow and oblique Marangoni shocks in soap films.

Change in trunk muscle activities with prone bridge exercise in patients with chronic low back pain.

PubMed

Kong, Yong-Soo; Park, Seol; Kweon, Mi-Gyong; Park, Ji-Won

2016-01-01

[Purpose] The aim of this study was to determine the effect of three different bridge exercises on internal oblique, external oblique, transverse abdominis, and erector spinae activities. [Subjects and Methods] Forty-five subjects with chronic low back pain participated in this study. The training outcome was evaluated with three different testing methods: supine bridge exercise, supine bridge on Swiss ball exercise, and prone bridge exercise. The activities of the transverse abdominis, internal oblique, external oblique, and erector spinae were measured using surface electromyography. [Results] There were significant differences in the internal oblique, external oblique, and erector spinae according to the three kinds of bridging exercises. The internal oblique, external oblique and transverse abdominis activities were highest in the prone bridge exercise, followed by those in the supine bridge on Swiss ball exercise, and supine bridge exercises. The activity of erector spine was highest in the supine bridge on Swiss ball exercise followed by the supine bridge exercise and prone bridge exercise. [Conclusion] These results suggest that prone bridge exercise is more effective than conventional supine bridge exercise and supine bridge on Swiss ball in increasing trunk muscle activity of chronic low back pain patients.

Effects of flexi-bar and non-flexi-bar exercises on trunk muscles activity in different postures in healthy adults.

PubMed

Chung, Jun Sub; Park, Seol; Kim, JiYoung; Park, Ji Won

2015-07-01

[Purpose] The purpose of this study was to assess the effects of flexi-bar exercises and non-flexi-bar exercises on trunk muscle activity in different postures in healthy adults. [Subjects] Twenty healthy right-hand dominant adults (10 males and 10 females) were selected for this study. None of the participants had experienced any orthopedic problems in the spine or in the upper and lower extremities in the previous six months. [Methods] The subjects were instructed to adopt three exercise postures: posture 1, quadruped; posture 2, side-bridge; and posture 3, standing. Surface electromyography of selected trunk muscles was normalized to maximum voluntary isometric contraction. [Results] The external oblique, internal oblique, and erector spinae muscle activity showed significant differences between flexi-bar exercises and non-flexi-bar exercises. [Conclusion] The results of this study suggest that flexi-bar exercises are useful in the activation of trunk muscles.

Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy.

PubMed

Ryan, Jennifer M; Theis, Nicola; Kilbride, Cherry; Baltzopoulos, Vasilios; Waugh, Charlie; Shortland, Adam; Lavelle, Grace; Noorkoiv, Marika; Levin, Wendy; Korff, Thomas

2016-10-04

Gait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy. 60 adolescents (Gross Motor Function Classification System level I-III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle-tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme. This trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London-Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and

Exercise and Transversus Abdominis Muscle Atrophy after 60-d Bed Rest.

PubMed

Belavý, Daniel Ludovic; Gast, Ulf; Felsenberg, Dieter

2017-02-01

This study aimed to investigate atrophy in the deep abdominal muscles, spinal extensors, and the effect of high-load resistive exercise with and without whole-body vibration after 60 d of strict bed rest. Twenty-four subjects underwent 60 d of head-down tilt bed rest and performed either resistive vibration exercise (RVE), resistive exercise only (RE), or no exercise control (2nd Berlin BedRest Study). The thickness of the transversus abdominis, internal oblique, and erector spinae muscles and the area of the multifidus muscle were measured bilaterally via real-time ultrasound. Intention-to-treat analysis was implemented, and P values were adjusted by the false discovery rate method. At the end of the bed rest, transversus abdominis thickness was reduced by 18.3% in the inactive group (P = 0.00011) with no significant change in the RVE (-4.0%; P = 0.014 vs control) or RE (-5.0%; P = 0.10 vs control) groups. In the inactive subjects, internal oblique thickness reduced by 10.6% (P = 0.0025) and by 7% (P > 0.05) in each of the training groups. The lengthening of the lumbar spine was greatest on day 1 (+7.4%, P = 0.004) and day 2 (+6.3%, P = 0.004; day 54: +4.1%, P = 0.023). A 4.7% reduction of multifidus area was observed on day 1 of bed rest (P = 0.0049) and a 4.2% reduction of erector spinae thickness was observed on day 2 (P = 0.0011). Extensor atrophy and spinal lengthening was not affected by exercise. No significant difference was seen between RVE and RE. Bed rest leads to atrophy of the transversus abdominis and internal oblique muscles. The exercise program, which implemented lower-limb and back extension exercises against shoulder restraints, was able to reduce atrophy seen in transversus abdominis in bed rest.

Steroid-antivirals treatment versus steroids alone for the treatment of Bell’s palsy: a meta-analysis

PubMed Central

Dong, Yabing; Zhu, Yong; Ma, Chuan; Zhao, Huaqiang

2015-01-01

Background: To illustrate whether the steroid-antivirals treatment could acquire a better recovery in patients with Bell’s palsy than the steroids alone treatment. Materials and methods: We conducted an exhaustive search over Pub med/Medline, Ovid, Elsevier search engines and the Cochrane library thereby collecting the randomized controlled trials in the treatment of patients with Bell’s palsy with steroid-antivirals and steroids. The qualities of relevant articles were assessed by GRADE, which was used to present the overall quality of evidence as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Two investigators evaluated these papers independently, and resolved the disagreements by discussion. At last 8 eligible papers (1816 patients included: 896 treated with steroid-antivirals and 920 treated with steroids alone) match the criteria. Owing to the result (chi2 = 12.57, P = 0.08, I2 = 44%) presented by the formal test for heterogeneity, the fixed effect meta-analysis model was chosen. The facial muscle recovery between the steroids-antivirals group and the steroids alone group show significant differences (OR = 1.52, 95% CI: 1.20-1.94), while the statistical outcome of adverse effect shows no statistical significance (OR = 1.28, 95% CI: 0.71-2.31). Conclusions: The present meta-analysis indicates that the steroid-antivirals treatment could improve the recovery rate in patients with Bell’s palsy when comparing with the steroid alone treatment. Clinical significance: This meta-analysis showed that the steroid-antivirals treatment achieved the better outcomes in patients with Bell’s palsy. Clinicians should consider that steroid-antivirals therapy is an alternative choice for the patients with Bell’s palsy. PMID:25785012

The Effect of Botulinum Toxin A Injections in the Spine Muscles for Cerebral Palsy Scoliosis, Examined in a Prospective, Randomized Triple-blinded Study.

PubMed

Wong, Christian; Pedersen, Søren Anker; Kristensen, Billy B; Gosvig, Kasper; Sonne-Holm, Stig

2015-12-01

A prospective, randomized triple-blinded cross-over design treating with either botulinum toxin A (BXT) or saline (NaCl). To examine the efficacy of BTX treatment in cerebral palsy scoliosis (CPS). Intramuscular injections with BTX have been used off label in treating CPS. 1 prospective study has been conducted, demonstrating in both radiological and clinical improvement, whereas showing no side effects or complications. Subjects (brace-treated CPS between 2 and 18 yr) were injected using ultrasonic-guidance with either NaCl or BTX in selected spine muscles with 6 mo intervals (block randomization, sealed envelope). Radiographs of the spine and clinical follow-up were captured before and 6 weeks after each injection. Primary outcome parameter was radiological change in Cobb angle, where a 7° change was regarded as an effect (1 SD). Radiological parameters were measured before and 6 weeks after treatment by 3 experienced doctors separately. Moreover, clinical results were evaluated by the pediatric quality of life score and systematic open questioning of the parents about the child's wellbeing. Subjects, researchers, and monitors were blinded during the trial. Appropriate permissions (2008-004584-19) and no funding were obtained. 16 cerebral palsy patients (GFMCS III-V) with CPS were consecutively included, whereas 6 patients were excluded. There were no drop-outs to follow-up, but 1 possible serious adverse event of pneumonia resulting in death was recorded and the study was terminated. No significant radiological or clinical changes were detected when compared with NaCl injections using Wilcoxon matched pair signed-rank test. No positive radiological or clinical effects were demonstrated by this treatment, except for the parent's initial subjective but positive appraisal of the effect. However, the study was terminated due to 1 possible severe adverse event and scheduled numbers needed to treat (hence power) were not reached. 1.

Neuroevolutional Approach to Cerebral Palsy and Speech.

ERIC Educational Resources Information Center

Mysak, Edward D.

Intended for cerebral palsy specialists, the book emphasizes the contribution that a neuroevolutional approach to therapy can make to habilitation goals of the child with cerebral palsy and applies the basic principles of the Bobath approach to therapy. The first section discusses cerebral palsy as a reflection of disturbed neuro-ontogenisis and…

C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications.

PubMed

Miller, Jacob A; Lubelski, Daniel; Alvin, Matthew D; Benzel, Edward C; Mroz, Thomas E

2014-12-01

C5 palsy is a debilitating postoperative complication of cervical decompression surgery. Although the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality-of-life and financial implications. The aim of the study was to determine the impact on quality-of-life and costs of C5 palsy after posterior cervical decompression and fusion (PCDF). A 2:1 matched retrospective cohort study was conducted at a single tertiary-care institution between 2007 and 2012. Individuals who had undergone PCDF were included. Self-reported: Euroqol-5 Dimensions quality-of-life survey. Physiologic: postoperative change in deltoid and biceps strength via manual muscle testing. Functional: cost of interventions and missed workdays postoperatively. Individuals with postoperative C5 palsy were matched to controls based on age, gender, body mass index, and diagnosis. Demographic, operative, postoperative, quality-of-life, and cost data were collected for both the C5 palsy and control groups, with 1-year follow-up. We reviewed 245 patients who underwent PCDF and 17 were identified (6.9%) with C5 palsy and matched to 34 controls. No significant differences in demographic or operative characteristics were observed between groups. The C5 palsy group had a significantly reduced capacity for self-care in the immediate postoperative (2.0±0.71 vs. 1.2±0.4, p<.001) and long-term (1.6±0.6 vs. 1.2±0.4, p=.004) periods and a significantly reduced capacity for completion of usual activities (2.4±0.7 vs. 1.9±0.6, p=.014) compared with controls. Furthermore, the C5 group had a significantly greater cost of physical/occupational therapy, an increase of $2,078 ($4,386±$2,801 vs. $2,307±$1,907, p=.013). There were no significant differences between groups in the cost of hospital stay, surgery, or other direct or indirect costs. Overall, there was a significantly greater cost ($1

The scaling of oblique plasma double layers

NASA Technical Reports Server (NTRS)

Borovsky, J. E.

1983-01-01

Strong oblique plasma double layers are investigated using three methods, i.e., electrostatic particle-in-cell simulations, numerical solutions to the Poisson-Vlasov equations, and analytical approximations to the Poisson-Vlasov equations. The solutions to the Poisson-Vlasov equations and numerical simulations show that strong oblique double layers scale in terms of Debye lengths. For very large potential jumps, theory and numerical solutions indicate that all effects of the magnetic field vanish and the oblique double layers follow the same scaling relation as the field-aligned double layers.

The Efficacy of Two Treatment Techniques for Children with Spastic Cerebral Palsy as Measured by Electromyography and Thermal Information. [Final Report.

ERIC Educational Resources Information Center

Finn, David Michael

Two techniques to normalize muscle tone were evaluated with nine infants and young children with cerebral palsy who were enrolled in the Rural Infant Stimulation Environment (RISE) Program, near Tuscaloosa, Alabama. Electromyography (EMG) and skin temperature data were used to assess the effects of trunk rotation and slow rolling on a ball. EMG…

[Hereditary neuropathy with liability to pressure palsies in childhood: Report of three cases].

PubMed

Bar, C; Villéga, F; Espil, C; Husson, M; Pedespan, J-M; Rouanet, M-F

2017-03-01

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant neuropathy. It is characterized by recurrent sensory and motor nerve palsies, usually precipitated by minor trauma or compression. Even though rare in childhood, this disorder is probably underdiagnosed given its wide spectrum of clinical symptoms. We review three separate cases of HNPP diagnosed in children with various phenotypes: fluctuating and distal paresthesias disrupting learning at school, cramps related to intensive piano practice, and discrete muscle weakness with no functional complaint. Family history should be carefully reviewed to identify potential undiagnosed HNPP cases, as in our three reports. Electrophysiological study is essential for the diagnosis, with a double advantage: to confirm the presence of focal abnormalities in clinically symptomatic areas and to guide molecular biology by revealing an underlying demyelinating polyneuropathy. The diagnosis of HNPP is confirmed by genetic testing, which in 90% of cases shows a 1.5-Mb deletion of chromosome 17p11.2 including the PMP22 gene. Patients are expected to make a full recovery after each relapse. However, it is very important for both the patient and his or her family to establish a diagnosis in order to prevent recurrent palsy brought on by situations involving prolonged immobilizations leading to nerve compression. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Management of synkinesis and asymmetry in facial nerve palsy: a review article.

PubMed

Pourmomeny, Abbas Ali; Asadi, Sahar

2014-10-01

The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

Long-Term Obliquity Variations of a Moonless Earth

NASA Astrophysics Data System (ADS)

Barnes, Jason W.; Lissauer, J. J.; Chambers, J. E.

2012-05-01

Earth's present-day obliquity varies by +/-1.2 degrees over 100,000-year timescales. Without the Moon's gravity increasing the rotation axis precession rate, prior theory predicted that a moonless Earth's obliquity would be allowed to vary between 0 and 85 degrees -- moreso even than present-day Mars (0 - 60 degrees). We use a modified version of the symplectic orbital integrator `mercury' to numerically investigate the obliquity evolution of hypothetical moonless Earths. Contrary to the large theoretically allowed range, we find that moonless Earths more typically experience obliquity variations of just +/- 10 degrees over Gyr timescales. Some initial conditions for the moonless Earth's rotation rate and obliquity yield slightly greater variations, but the majority have smaller variations. In particular, retrograde rotators are quite stable and should constitute 50% of the population if initial terrestrial planet rotation is isotropic. Our results have important implications for the prospects of long-term habitability of moonless planets in extrasolar systems.

Influence of Body Position on Shoulder and Trunk Muscle Activation During Resisted Isometric Shoulder External Rotation.

PubMed

Krause, David A; Dueffert, Lucas G; Postma, Jaclyn L; Vogler, Eric T; Walsh, Amy J; Hollman, John H

External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank). Significantly greater force and shoulder muscle activation would be generated while side lying given the inherent stability of the position, and greater trunk muscle activation would be generated in the less stable plank position. Quasi-experimental repeated-measures study. Level 5. A convenience sample of 25 healthy overhead recreational athletes (9 men, 16 women) participated in this study. EMG electrodes were placed on the infraspinatus, posterior deltoid, middle trapezius, multifidi, internal obliques, and external obliques. EMG signals were normalized to a maximal isometric contraction. Participants performed resisted isometric ER in standing, side-lying, and side plank positions. Results were analyzed using a repeated-measures analysis of variance with post hoc Bonferroni corrections (α = 0.05). There was no significant difference in ER torque between positions (α = 0.05). A significant difference in EMG activity of shoulder and trunk musculature between positions was found in 7 of the 8 muscles monitored. Significantly greater EMG activity in the infraspinatus, middle trapezius, and the nondominant external and internal obliques was found in the side plank position as compared with standing and side lying. While there was no difference in ER torque between the 3 exercise positions, EMG activity of the shoulder and trunk muscles was dependent on body position. If a clinician is seeking to integrate trunk muscle activation while performing shoulder ER strengthening, the side

Effect of instruction, surface stability, and load intensity on trunk muscle activity.

PubMed

Bressel, Eadric; Willardson, Jeffrey M; Thompson, Brennan; Fontana, Fabio E

2009-12-01

The aim of this study was to assess the effect of verbal instruction, surface stability, and load intensity on trunk muscle activity levels during the free weight squat exercise. Twelve trained males performed a free weight squat under four conditions: (1) standing on stable ground lifting 50% of their 1-repetition maximum (RM), (2) standing on a BOSU balance trainer lifting 50% of their 1-RM, (3) standing on stable ground lifting 75% of their 1-RM, and (4) receiving verbal instructions to activate the trunk muscles followed by lifting 50% of their 1-RM. Surface EMG activity from muscles rectus abdominis (RA), external oblique (EO), transversus abdominis/internal oblique (TA/IO), and erector spinae (ES) were recorded for each condition and normalized for comparisons. Muscles RA, EO, and TA/IO displayed greater peak activity (39-167%) during squats with instructions compared to the other squat conditions (P=0.04-0.007). Peak EMG activity of muscle ES was greater for the 75% 1-RM condition than squats with instructions or lifting 50% of 1-RM (P=0.04-0.02). The results indicate that if the goal is to enhance EMG activity of the abdominal muscles during a multi-joint squat exercise then verbal instructions may be more effective than increasing load intensity or lifting on an unstable surface. However, in light of other research, conscious co-activation of the trunk muscles during the squat exercise may lead to spinal instability and hazardous compression forces in the lumbar spine.

Evaluation of the oblique detonation wave ramjet

NASA Technical Reports Server (NTRS)

Morrison, R. B.

1978-01-01

The potential performance of oblique detonation wave ramjets is analyzed in terms of multishock diffusion, oblique detonation waves, and heat release. Results are presented in terms of thrust coefficients and specific impulses for a range of flight Mach numbers of 6 to 16.

Body Mass Normalization for Lateral Abdominal Muscle Thickness Measurements in Adolescent Athletes.

PubMed

Linek, Pawel

2017-09-01

To determine the value of allometric parameters for ultrasound measurements of the oblique external (OE), oblique internal (OI), and transversus abdominis (TrA) muscles in adolescent athletes. The allometric parameter is the slope of the linear regression line between the log-transformed body mass and log-transformed muscle size measurement. The study included 114 male adolescent football players between the ages of 10 and 19 years. All individuals with no surgical procedures performed on the trunk area and who had played a sport for at least 2 years were included. A real-time B-mode ultrasound scanner with a linear array transducer was used to obtain images of the lateral abdominal muscles from both sides of the body. A stabilometric platform was used to assess the body mass value. The correlations between body mass and the OE, OI, and TrA muscle thicknesses were r = 0.73, r = 0.79, and r = 0.64, respectively (in all cases, P < .0001). The allometric parameters were 0.77 for the OE, 0.67 for the OI, and 0.61 for the TrA. Using these parameters, no significant correlations were found between body mass and the allometric-scaled thickness of the lateral abdominal muscles. Significant positive correlations exist between body mass and lateral abdominal muscle thickness in adolescent athletes. Therefore, it is reasonable to advise that the values of the allometric parameters for the OE, OI, and TrA muscles obtained in this study should be used, and the allometric-scaled thicknesses of those muscles should be analyzed in future research on adolescent athletes. © 2017 by the American Institute of Ultrasound in Medicine.

The effects of aquatic trunk exercise on gait and muscle activity in stroke patients: a randomized controlled pilot study.

PubMed

Park, Byoung-Sun; Noh, Ji-Woong; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Shin, Yong-Sub; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Park, Jaehong; Kim, Junghwan

2015-11-01

[Purpose] The purpose of this study was to investigate the relationship between muscle activity and gait function following aquatic trunk exercise in hemiplegic stroke patients. [Subjects and Methods] This study's participants included thirteen hemiplegic patients (ten males and three females). The aquatic therapy consisted of administering concentrative aquatic therapy for four weeks in a therapeutic pool. Gait parameters were measured using a gait analysis system adjusted to each subject's comfortable walking speed. Electromyographic signals were measured for the rectus abdominis, external abdominal oblique, transversus abdominis/internal-abdominal oblique, and erector spine of each patients. [Results] The pre- and post-training performances of the transversus abdominis/internal-abdominal oblique were compared statistically. There was no statistical difference between the patients' pre- and post-training values of maximal voluntary isometric contraction of the rectus abdominis, but the external abdominal oblique values tended to improve. Furthermore, gait factors improved significantly in terms of walking speeds, walking cycles, affected-side stance phases, affected-stride lengths, and stance-phase symmetry indices, respectively. [Conclusion] These results suggest that the trunk exercise during aquatic therapy may in part contribute to clinically relevant improvements in muscle activities and gait parameters.

The effects of aquatic trunk exercise on gait and muscle activity in stroke patients: a randomized controlled pilot study

PubMed Central

Park, Byoung-Sun; Noh, Ji-Woong; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Shin, Yong-Sub; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Park, Jaehong; Kim, Junghwan

2015-01-01

[Purpose] The purpose of this study was to investigate the relationship between muscle activity and gait function following aquatic trunk exercise in hemiplegic stroke patients. [Subjects and Methods] This study’s participants included thirteen hemiplegic patients (ten males and three females). The aquatic therapy consisted of administering concentrative aquatic therapy for four weeks in a therapeutic pool. Gait parameters were measured using a gait analysis system adjusted to each subject’s comfortable walking speed. Electromyographic signals were measured for the rectus abdominis, external abdominal oblique, transversus abdominis/internal-abdominal oblique, and erector spine of each patients. [Results] The pre- and post-training performances of the transversus abdominis/internal-abdominal oblique were compared statistically. There was no statistical difference between the patients’ pre- and post-training values of maximal voluntary isometric contraction of the rectus abdominis, but the external abdominal oblique values tended to improve. Furthermore, gait factors improved significantly in terms of walking speeds, walking cycles, affected-side stance phases, affected-stride lengths, and stance-phase symmetry indices, respectively. [Conclusion] These results suggest that the trunk exercise during aquatic therapy may in part contribute to clinically relevant improvements in muscle activities and gait parameters. PMID:26696736

Passive mechanical properties of rat abdominal wall muscles suggest an important role of the extracellular connective tissue matrix.

PubMed

Brown, Stephen H M; Carr, John Austin; Ward, Samuel R; Lieber, Richard L

2012-08-01

Abdominal wall muscles have a unique morphology suggesting a complex role in generating and transferring force to the spinal column. Studying passive mechanical properties of these muscles may provide insights into their ability to transfer force among structures. Biopsies from rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were harvested from male Sprague-Dawley rats, and single muscle fibers and fiber bundles (4-8 fibers ensheathed in their connective tissue matrix) were isolated and mechanically stretched in a passive state. Slack sarcomere lengths were measured and elastic moduli were calculated from stress-strain data. Titin molecular mass was also measured from single muscle fibers. No significant differences were found among the four abdominal wall muscles in terms of slack sarcomere length or elastic modulus. Interestingly, across all four muscles, slack sarcomere lengths were quite long in individual muscle fibers (>2.4 µm), and demonstrated a significantly longer slack length in comparison to fiber bundles (p < 0.0001). Also, the extracellular connective tissue matrix provided a stiffening effect and enhanced the resistance to lengthening at long muscle lengths. Titin molecular mass was significantly less in TrA compared to each of the other three muscles (p < 0.0009), but this difference did not correspond to hypothesized differences in stiffness. Copyright © 2012 Orthopaedic Research Society.

Tumors Presenting as Multiple Cranial Nerve Palsies

PubMed Central

Kumar, Kishore; Ahmed, Rafeeq; Bajantri, Bharat; Singh, Amandeep; Abbas, Hafsa; Dejesus, Eddy; Khan, Rana Raheel; Niazi, Masooma; Chilimuri, Sridhar

2017-01-01

Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor. PMID:28553221

Delayed facial nerve decompression for Bell's palsy.

PubMed

Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

2016-07-01

Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

Divergence Palsy due to Divalproex and Oxcarbazepine.

PubMed

Bouffard, Marc Albert; Caplan, Louis R; Torun, Nurhan

This case series is the first to describe divergence palsy as an adverse effect of antiepileptic drug use. Diplopia is a common adverse effect of antiepileptic drugs, but no explanatory motility deficit has ever been reported. We present 2 patients, 1 on oxcarbazepine and 1 on divalproex, each with a normal examination result between spells and divergency palsy when symptomatic. Discontinuation of the antiepileptic medication led to resolution of the episodes in both cases. Rechallenge with the offending agent after washout in one patient resulted in recurrence of diplopia and divergence palsy, both resolving after subsequent withdrawal of the antiepileptic. Antiepileptic drugs may cause divergence palsy.

Oblique effect in visual area 2 of macaque monkeys

PubMed Central

Shen, Guofu; Tao, Xiaofeng; Zhang, Bin; Smith, Earl L.; Chino, Yuzo M.

2014-01-01

The neural basis of an oblique effect, a reduced visual sensitivity for obliquely oriented stimuli, has been a matter of considerable debate. We have analyzed the orientation tuning of a relatively large number of neurons in the primary visual cortex (V1) and visual area 2 (V2) of anesthetized and paralyzed macaque monkeys. Neurons in V2 but not V1 of macaque monkeys showed clear oblique effects. This orientation anisotropy in V2 was more robust for those neurons that preferred higher spatial frequencies. We also determined whether V1 and V2 neurons exhibit a similar orientation anisotropy soon after birth. The oblique effect was absent in V1 of 4- and 8-week-old infant monkeys, but their V2 neurons showed a significant oblique effect. This orientation anisotropy in infant V2 was milder than that in adults. The results suggest that the oblique effect emerges in V2 based on the pattern of the connections that are established before birth and enhanced by the prolonged experience-dependent modifications of the neural circuitry in V2. PMID:24511142

The Obliquities of the Giant Planets

NASA Astrophysics Data System (ADS)

Hamilton, D. P.; Ward, Wm. R.

2002-09-01

Jupiter has by far the smallest obliquity ( ~ 3o) of the planets (not counting tidally de-spun Mercury and Venus) which may be reflective of its formation by hydrodynamic gas flow rather than stochastic impacts. Saturn's obliquity ( ~ 26o), however, seems to belie this simple formation picture. But since the spin angular momentum of any planet is much smaller than its orbital angular momentum, post-formation obliquity can be strongly modified by passing through secular spin-orbit resonances, i.e., when the spin axis precession rate of the planet matches one of the frequencies describing the precession of the orbit plane. Spin axis precession is due to the solar torque on both the oblate figure of the planet and any orbiting satellites. In the case of Jupiter, the torque on the Galilean satellites is the principal cause of its 4.5*105 year precession; Saturn's precession of 1.8*106 years is dominated by Titan. In the past, the planetary spin axis precession rates should have been much faster due to the massive circumplanetary disks from which the current satellites condensed. The regression of the orbital node of a planet is due to the gravitational perturbations of the other planets. Nodal regression is not uniform, but is instead a composite of the planetary system's normal modes. For Jupiter and Saturn, the principal frequency is the nu16, with a period of ~ 49,000 years; the amplitude of this term is I ~ 0o.36 for Jupiter and I ~ 0o.90 for Saturn. In spite of the small amplitudes, slow adiabatic passages through this resonance (due to circumplanetary disk dispersal) could increase planetary obliquities from near zero to ~ [tan1/3 I] ~ 10o. We will discuss scenarios in which giant planet obliquities are affected by this and other resonances, and will use Jupiter's low obliquity to constrain the mass and duration of a satellite precursor disk. DPH acknowledges support from NSF Career Grant AST 9733789 and WRW is grateful to the NASA OSS and PGG programs.

Trunk muscle activation during moderate- and high-intensity running.

PubMed

Behm, David G; Cappa, Dario; Power, Geoffrey A

2009-12-01

Time constraints are cited as a barrier to regular exercise. If particular exercises can achieve multiple training functions, the number of exercises and the time needed to achieve a training goal may be decreased. It was the objective of this study to compare the extent of trunk muscle electromyographic (EMG) activity during running and callisthenic activities. EMG activity of the external obliques, lower abdominals (LA), upper lumbar erector spinae (ULES), and lumbosacral erector spinae (LSES) was monitored while triathletes and active nonrunners ran on a treadmill for 30 min at 60% and 80% of their maximum heart rate (HR) reserve, as well as during 30 repetitions of a partial curl-up and 3 min of a modified Biering-Sørensen back extension exercise. The mean root mean square (RMS) amplitude of the EMG signal was monitored over 10-s periods with measures normalized to a maximum voluntary contraction rotating curl-up (external obliques), hollowing exercise (LA), or back extension (ULES and LSES). A main effect for group was that triathletes had greater overall activation of the external obliques (p < 0.05), LA (p = 0.01), and LSES (p < 0.05) than did nonrunners. Main effects for exercise type showed that the external obliques had less EMG activity during 60% and 80% runs, respectively, than with the curl-ups (p = 0.001). The back extension exercise provided less ULES (p = 0.009) and LSES (p = 0.0001) EMG activity than the 60% and 80% runs, respectively. In conclusion, triathletes had greater trunk activation than nonrunners did while running, which could have contributed to their better performance. Back-stabilizing muscles can be activated more effectively with running than with a prolonged back extension activity. Running can be considered as an efficient, multifunctional exercise combining cardiovascular and trunk endurance benefits.

Toward modeling locomotion using electromyography-informed 3D models: application to cerebral palsy.

PubMed

Sartori, M; Fernandez, J W; Modenese, L; Carty, C P; Barber, L A; Oberhofer, K; Zhang, J; Handsfield, G G; Stott, N S; Besier, T F; Farina, D; Lloyd, D G

2017-03-01

This position paper proposes a modeling pipeline to develop clinically relevant neuromusculoskeletal models to understand and treat complex neurological disorders. Although applicable to a variety of neurological conditions, we provide direct pipeline applicative examples in the context of cerebral palsy (CP). This paper highlights technologies in: (1) patient-specific segmental rigid body models developed from magnetic resonance imaging for use in inverse kinematics and inverse dynamics pipelines; (2) efficient population-based approaches to derive skeletal models and muscle origins/insertions that are useful for population statistics and consistent creation of continuum models; (3) continuum muscle descriptions to account for complex muscle architecture including spatially varying material properties with muscle wrapping; (4) muscle and tendon properties specific to CP; and (5) neural-based electromyography-informed methods for muscle force prediction. This represents a novel modeling pipeline that couples for the first time electromyography extracted features of disrupted neuromuscular behavior with advanced numerical methods for modeling CP-specific musculoskeletal morphology and function. The translation of such pipeline to the clinical level will provide a new class of biomarkers that objectively describe the neuromusculoskeletal determinants of pathological locomotion and complement current clinical assessment techniques, which often rely on subjective judgment. WIREs Syst Biol Med 2017, 9:e1368. doi: 10.1002/wsbm.1368 For further resources related to this article, please visit the WIREs website. © 2016 Wiley Periodicals, Inc.

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy.

PubMed

Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy.

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy

PubMed Central

Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy. PMID:27065561

Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy.

PubMed

Hawamdeh, Z M; Ibrahim, A I; Al-Qudah, A A

2007-09-01

The aim of this study was to determine possible long-term effects of multi-injections of botulinum toxin A (BT-A) on muscle tone and functional abilities in children with cerebral palsy. A randomized, single blind study was carried out. Sixty patients with spastic diplegia were enrolled; 40 received 3 successive doses of BT-A to the calf muscle bilaterally at intervals of 3 to 4 months; 20 received no injections and were considered the control group. Evaluation included measurement of muscle tone, passive ankle dorsiflexion range of motion, and gross motor function. The children in the study group were assessed at entry into the study, at 3 months, and at 18 months after the last injection. An identical assessment protocol was applied to the control group, with measurements taken at entry into the study, at 12 to 15 months, and then at 27 to 30 months, roughly corresponding to the time periods set for the study group. Muscle tone and passive ankle dorsiflexion range showed clinically and statistically significant improvement following BT-A injection at 3 months (P=0.000, P=0.04, respectively) and at 18 months (P=0.005, P=0.007, respectively) compared to the control group, but gross motor function showed significant improvement only at 18 months (P=0.02). Comparison between the first and second evaluations after the last injection in the study group showed a significant improvement in gross motor function and ankle dorsiflexion range (P=0.000 for both parameters); however, muscle tone was significantly increased (P=0.002). This study gives support to a possible prolonged effect of intramuscular BT-A as an adjunct to conventional physiotherapy to reduce spasticity and improve functional mobility in children with spastic diplegic cerebral palsy.

Cerebral palsy

MedlinePlus

... Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Cerebral palsy URL of this page: //medlineplus.gov/ency/article/ ...

Zolpidem in progressive supranuclear palsy.

PubMed

Dash, Sandip K

2013-01-01

Progressive supranuclear palsy (PSP) is a progressive neurodegenerative disorder, characterized by motor symptoms, postural instability, personality changes, and cognitive impairment. There is no effective treatment for this disorder. Reduced neurotransmission of GABA in the striatum and globus pallidus may contribute to the symptoms of motor and cognitive symptoms seen in PSP. Zolpidem is a GABA agonist of the benzodiazepine subreceptor BZ1. Here a nondiabetic, normotensive case of PSP is (Progressive Supranuclear Palsy) described, which showed improvement in swallowing, speech, and gaze paresis after zolpidem therapy and possible mechanism of actions are discussed. However, more trials are needed with large number of patients to confirm the effectiveness of zolpidem in progressive supranuclear palsy.

Pattern of facial palsy in a typical Nigerian specialist hospital.

PubMed

Lamina, S; Hanif, S

2012-12-01

Data on incidence of facial palsy is generally lacking in Nigeria. To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.

Obliquity variation in a Mars climate evolution model

NASA Technical Reports Server (NTRS)

Tyler, D.; Haberle, Robert M.

1993-01-01

The existence of layered terrain in both polar regions of Mars is strong evidence supporting a cyclic variation in climate. It has been suggested that periods of net deposition have alternated with periods of net erosion in creating the layered structure that is seen today. The cause for this cyclic climatic behavior is variation in the annually averaged latitudinal distribution of solar insolation in response to obliquity cycles. For Mars, obliquity variation leads to major climatological excursion due to the condensation and sublimation of the major atmospheric constituent, CO2. The atmosphere will collapse into the polar caps, or existing caps will rapidly sublimate into the atmosphere, dependent upon the polar surface heat balance and the direction of the change in obliquity. It has been argued that variations in the obliquity of Mars cause substantial departures from the current climatological values of the surface pressure and the amount of CO2 stored in both the planetary regolith and polar caps. In this new work we have modified the Haberle et al. model to incorporate variable obliquity by allowing the polar and equatorial insolation to become functions of obliquity, which we assume to vary sinusoidally in time. As obliquity varies in the model, there can be discontinuities in the time evolution of the model equilibrium values for surface pressure, regolith, and polar cap storage. The time constant, tau r, for the regolith to find equilibrium with the climate is estimated--depending on the depth, thermal conductivity, and porosity of the regolith--between 10(exp 4) and 10(exp 6) yr. Thus, using 2000-yr timesteps to move smoothly through the 0.1250 m.y. obliquity cycles, we have an atmosphere/regolith system that cannot be assumed in equilibrium. We have dealt with this problem by limiting the rate at which CO2, can move between the atmosphere and regolith, mimicking the diffusive nature and effects of the temperature and pressure waves, by setting the time

Classification of upper limb disability levels of children with spastic unilateral cerebral palsy using K-means algorithm.

PubMed

Raouafi, Sana; Achiche, Sofiane; Begon, Mickael; Sarcher, Aurélie; Raison, Maxime

2018-01-01

Treatment for cerebral palsy depends upon the severity of the child's condition and requires knowledge about upper limb disability. The aim of this study was to develop a systematic quantitative classification method of the upper limb disability levels for children with spastic unilateral cerebral palsy based on upper limb movements and muscle activation. Thirteen children with spastic unilateral cerebral palsy and six typically developing children participated in this study. Patients were matched on age and manual ability classification system levels I to III. Twenty-three kinematic and electromyographic variables were collected from two tasks. Discriminative analysis and K-means clustering algorithm were applied using 23 kinematic and EMG variables of each participant. Among the 23 kinematic and electromyographic variables, only two variables containing the most relevant information for the prediction of the four levels of severity of spastic unilateral cerebral palsy, which are fixed by manual ability classification system, were identified by discriminant analysis: (1) the Falconer index (CAI E ) which represents the ratio of biceps to triceps brachii activity during extension and (2) the maximal angle extension (θ Extension,max ). A good correlation (Kendall Rank correlation coefficient = -0.53, p = 0.01) was found between levels fixed by manual ability classification system and the obtained classes. These findings suggest that the cost and effort needed to assess and characterize the disability level of a child can be further reduced.

CAN-flip: A Pilot Gymnastics Program for Children With Cerebral Palsy.

PubMed

Cook, Olivia; Frost, Gail; Twose, Donna; Wallman, Linda; Falk, Bareket; Galea, Victoria; Adkin, Allan; Klentrou, Panagiota

2015-10-01

This pilot study examined whether an adapted gymnastics program, CAN-flip, could be a feasible activity for children with cerebral palsy (CP) leading to improvements in muscle fitness, motor performance, and physical self-perception. Four girls and 1 boy (9.8 ± 1.3 yr) with CP participated in this multiple-baseline across-subjects design and were randomly assigned to start either the 6-wk gymnastics or the 6-wk control period. Muscle strength, neuromuscular activation, range of motion, gross motor performance, balance, and physical self-perception were assessed at baseline, after the first 6-wk period, and at the conclusion of the study. The gymnastics program comprised two 1-hr individualized classes per week. All participants were able to complete the gymnastics classes without injury and showed improvement in specific gymnastics skills. In addition, 3 of the 5 participants registered for regular gymnastics classes after the study, demonstrating the program's usability as a link to inclusive gymnastic classes.

Strike-Slip Fault Patterns on Europa: Obliquity or Polar Wander?

NASA Technical Reports Server (NTRS)

Rhoden, Alyssa Rose; Hurford, Terry A.; Manga, Michael

2011-01-01

Variations in diurnal tidal stress due to Europa's eccentric orbit have been considered as the driver of strike-slip motion along pre-existing faults, but obliquity and physical libration have not been taken into account. The first objective of this work is to examine the effects of obliquity on the predicted global pattern of fault slip directions based on a tidal-tectonic formation model. Our second objective is to test the hypothesis that incorporating obliquity can reconcile theory and observations without requiring polar wander, which was previously invoked to explain the mismatch found between the slip directions of 192 faults on Europa and the global pattern predicted using the eccentricity-only model. We compute predictions for individual, observed faults at their current latitude, longitude, and azimuth with four different tidal models: eccentricity only, eccentricity plus obliquity, eccentricity plus physical libration, and a combination of all three effects. We then determine whether longitude migration, presumably due to non-synchronous rotation, is indicated in observed faults by repeating the comparisons with and without obliquity, this time also allowing longitude translation. We find that a tidal model including an obliquity of 1.2?, along with longitude migration, can predict the slip directions of all observed features in the survey. However, all but four faults can be fit with only 1? of obliquity so the value we find may represent the maximum departure from a lower time-averaged obliquity value. Adding physical libration to the obliquity model improves the accuracy of predictions at the current locations of the faults, but fails to predict the slip directions of six faults and requires additional degrees of freedom. The obliquity model with longitude migration is therefore our preferred model. Although the polar wander interpretation cannot be ruled out from these results alone, the obliquity model accounts for all observations with a value

The Role of Superior Oblique Posterior Tenectomy Along With Inferior Rectus Recessions for the Treatment of Chin-up Head Positioning in Patients With Nystagmus.

PubMed

Escuder, Anna G; Ranka, Milan P; Lee, Kathy; Nam, Julie N; Steele, Mark A

2018-05-29

To evaluate the clinical outcomes of bilateral superior oblique posterior 7/8th tenectomy with inferior rectus recession on improving chin-up head positioning in patients with horizontal nystagmus. Medical records were reviewed from 2007 to 2017 for patients with nystagmus and chin-up positioning of 15° or more who underwent combined bilateral superior oblique posterior 7/8th tenectomy with an inferior rectus recession of at least 5 mm. Thirteen patients (9 males and 4 females) were included, with an average age of 7.3 years (range: 1.8 to 15 years). Chin-up positioning ranged from 15° to 45° degrees (average: 30°). Three patients had prior horizontal muscle surgeries, 1 for esotropia and 2 for horizontal null zones causing anomalous face turns. Ten patients underwent other concomitant eye muscle surgery: 3 had esotropia, 1 had exotropia, and 2 had biplanar nystagmus null point requiring a horizontal Anderson procedure. Four patients underwent simultaneous bilateral medial rectus tenotomy and reattachment. All patients had improved chin-up positioning. Eight patients had complete resolution, whereas 5 had minimal residual chin-up positioning. Three patients developed an eccentric horizontal gaze null point with compensatory anomalous face turn with onset 2 weeks, 2 years, and 3 years postoperatively. Average follow-up was 42.7 months. No postoperative pattern deviations, cyclodeviations, or inferior oblique overaction were seen. No surgical complications were noted. Bilateral superior oblique posterior 7/8th tenectomy in conjunction with bilateral inferior rectus recession is a safe and effective procedure for improving chin-up head positioning in patients with horizontal nystagmus with a down gaze null point. [J Pediatr Ophthalmol Strabismus. 201X;XX(X):XX-XX.]. Copyright 2018, SLACK Incorporated.

Hereditary Neuropathy With Liability to Pressure Palsies: Diverse Phenotypes in Childhood.

PubMed

Harada, Yohei; Puwanant, Araya; Herrmann, David N

2016-12-01

Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal-dominant disorder that most commonly produces recurrent painless focal sensory and motor neuropathies often preceded by minor, mechanical stress, or minor trauma. Herein, we report 2 pediatric cases of HNPP with atypical presentations; isolated muscle cramping and toe walking. Electrophysiologic testing disclosed multifocal sensorimotor polyneuropathy with slowing of sensory conduction velocities in both cases, which prompted PMP 22 gene deletion testing. Multifocal sensorimotor electrophysiologic abnormalities, with slowing of sensory conduction velocities should raise consideration of HNPP in childhood. These case reports emphasize that the diagnosis of HNPP in children requires a high index of suspicion.

Serial neurophysiological and neurophysiological examinations for delayed facial nerve palsy in a patient with Fisher syndrome.

PubMed

Umekawa, Motoyuki; Hatano, Keiko; Matsumoto, Hideyuki; Shimizu, Takahiro; Hashida, Hideji

2017-05-27

The patient was a 47-year-old man who presented with diplopia and gait instability with a gradual onset over the course of three days. Neurological examinations showed ophthalmoplegia, diminished tendon reflexes, and truncal ataxia. Tests for anti-GQ1b antibodies and several other antibodies to ganglioside complex were positive. We made a diagnosis of Fisher syndrome. After administration of intravenous immunoglobulin, the patient's symptoms gradually improved. However, bilateral facial palsy appeared during the recovery phase. Brain MRI showed intensive contrast enhancement of bilateral facial nerves. During the onset phase of facial palsy, the amplitude of the compound muscle action potential (CMAP) in the facial nerves was preserved. During the peak phase, the facial CMAP amplitude was within the lower limit of normal values, or mildly decreased. During the recovery phase, the CMAP amplitude was normalized, and the R1 and R2 responses of the blink reflex were prolonged. The delayed facial nerve palsy improved spontaneously, and the enhancement on brain MRI disappeared. Serial neurophysiological and neuroradiological examinations suggested that the main lesions existed in the proximal part of the facial nerves and the mild lesions existed in the facial nerve terminals, probably due to reversible conduction failure.

Childhood Sarcoidosis Presenting as Recurrent Facial Palsy.

PubMed

Passi, Gouri Rao; Arora, Kriti; Gokhale, Narendra

2018-04-15

Recurrent facial palsy in a patient merits investigation for underlying etiology. 8-year-old boy with erythematous itchy skin lesion and recurrent facial palsy. He had a past history of aseptic meningitis and nephrocalcinosis. Raised angiotensin converting enzyme levels, interstitial lung disease on CT chest, and non caseating granulomas on skin biopsy clinched the diagnosis of sarcoidosis. Multisystem involvement and recurrent lower motor facial nerve palsy is a clinical clue for sarcoidosis.

Ventral Dural Injury After Oblique Lumbar Interbody Fusion.

PubMed

Chang, JaeChil; Kim, Jin-Sung; Jo, Hyunjin

2017-02-01

Oblique lumbar interbody fusion (OLIF) through the oblique corridor between the aorta and anterior border of psoas muscle is favored among spinal surgeons who employ minimally invasive techniques. We report a case of ventral dural tear after OLIF that was associated with the inaccurate trajectory direction of endplate preparation. This is the first report to our knowledge of ventral dural tear associated with OLIF. A 72-year-old woman presented with right leg pain and numbness. X-rays showed degenerative spondylolisthesis and loss of disc height at L4-L5 and L5-S1 levels. Magnetic resonance imaging revealed right-sided paracentral disc herniation at the L3-L4 level and foraminal disc herniation at L4-L5. The initial surgical plan was OLIF of L3-L4 and L4-L5 after percutaneous screw fixation without laminectomy. With the patient in the lateral position, discectomy and endplate preparation were done successfully at the L3-L4 level, and the same procedure was done at the L4-L5 level for OLIF. A sharp Cobbs elevator for endplate preparation triggered a ventral dural defect at the L4-L5 level. We changed the patient's position to attempt dural repair. The ventral dural defect could not be repaired because it was too large. After the herniated rootlets were repositioned, TachoComb was patched over the defect site. Postoperatively, the patient has no definite neurologic deficits. When a surgeon performs OLIF, ventral dural injury should be avoided during the procedure of endplate preparation and contralateral annular release. Copyright © 2016 Elsevier Inc. All rights reserved.

Reaching to virtual targets: The oblique effect reloaded in 3-D.

PubMed

Kaspiris-Rousellis, Christos; Siettos, Constantinos I; Evdokimidis, Ioannis; Smyrnis, Nikolaos

2017-02-20

Perceiving and reproducing direction of visual stimuli in 2-D space produces the visual oblique effect, which manifests as increased precision in the reproduction of cardinal compared to oblique directions. A second cognitive oblique effect emerges when stimulus information is degraded (such as when reproducing stimuli from memory) and manifests as a systematic distortion where reproduced directions close to the cardinal axes deviate toward the oblique, leading to space expansion at cardinal and contraction at oblique axes. We studied the oblique effect in 3-D using a virtual reality system to present a large number of stimuli, covering the surface of an imaginary half sphere, to which subjects had to reach. We used two conditions, one with no delay (no-memory condition) and one where a three-second delay intervened between stimulus presentation and movement initiation (memory condition). A visual oblique effect was observed for the reproduction of cardinal directions compared to oblique, which did not differ with memory condition. A cognitive oblique effect also emerged, which was significantly larger in the memory compared to the no-memory condition, leading to distortion of directional space with expansion near the cardinal axes and compression near the oblique axes on the hemispherical surface. This effect provides evidence that existing models of 2-D directional space categorization could be extended in the natural 3-D space. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN AND ADOLESCENTS WITH SPASTIC QUADRIPLEGIC CEREBRAL PALSY.

PubMed

Caselli, Thaisa Barboza; Lomazi, Elizete Aparecida; Montenegro, Maria Augusta Santos; Bellomo-Brandão, Maria Angela

2017-01-01

Due to several factors, such as gastrointestinal's diseases and difficulty in feeding, children with Spastic Quadriplegic Cerebral Palsy tend to present nutritional deficits. To assess the nutritional status of pediatric patients with Spastic Quadriplegic Cerebral Palsy according to reference curves for this population and with the measures of folds and circumferences, obtained by the upper arm circumference and triceps skin fold. The data were obtained from: knee-height, estimated height, weight, upper arm circumference, and triceps skin fold. Values of folds and circumferences were compared with Frisancho, and specific curves for these patients were used as reference. The relationship between the values in the growth curve for healthy children, Z-Score, and comparison with the reference curve were verified by Fisher's exact test. We adopted the significance level of 5%. We evaluated 54 patients. The mean age was 10.2 years, and 34 were male, 25 fed by gastrostomy and 29, orally. The frequency of low weight by the reference curve was 22.22%. More than half of the patients presented the parameters indicating lean mass below the 5th percentile. The height of all patients was classified as adequate for the age by the reference curve. Low weight was found in 22% of patients, and there is a greater tendency to present reduced muscle mass and increased fat mass, showing the need for evaluation and appropriate interventions for patients with Spastic Quadriplegic Cerebral Palsy.

Comparison of EMG activity on abdominal muscles during plank exercise with unilateral and bilateral additional isometric hip adduction.

PubMed

Kim, Soo-Yong; Kang, Min-Hyeok; Kim, Eui-Ryong; Jung, In-Gui; Seo, Eun-Young; Oh, Jae-Seop

2016-10-01

The aim of this study was to investigate the effects of additional isometric hip adduction during the plank exercise on the abdominal muscles. Twenty healthy young men participated in this study. Surface electromyography (EMG) was used to monitor the activity of the bilateral rectus abdominis (RA), the internal oblique (IO), and the external oblique (EO) muscles. The participants performed three types of plank exercise; the standard plank exercise, the plank exercise with bilateral isometric hip adduction, and the plank exercise with unilateral isometric hip adduction. All abdominal muscle activity was significantly increased during the plank exercise combined with the bilateral and unilateral isometric hip adduction compared with the standard plank exercise (p<0.05). Bilateral IO, EO, and left RA muscle activity was significantly increased during the unilateral isometric hip adduction compared with the bilateral isometric hip adduction (p<0.05). These findings suggest that additional isometric hip adduction during the plank exercise could be a useful method to enhance abdominal muscle activity. In particular, the unilateral isometric hip adduction is a more beneficial exercise than the bilateral isometric hip adduction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bell's Palsy

MedlinePlus

... or paralysis. Bell's palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who described ... confirm diagnosis of the disorder. Generally, a physician will examine the individual for upper and lower facial ...

Steroid plus antiviral treatment for Bell's palsy.

PubMed

Kang, H M; Jung, S Y; Byun, J Y; Park, M S; Yeo, S G

2015-05-01

The effectiveness of antiviral agents for the treatment of Bell's palsy is uncertain. We evaluated whether a steroid with an antiviral agent (S + A group) provided better recovery outcomes than a steroid alone (S group) in patients with Bell's palsy. A total of 1342 patients diagnosed with Bell's palsy who visited the Kyung Hee Medical Center in Seoul, Korea, from 2002 to 2012 were included in this study. Patients in the S + A group were treated with prednisolone and antiviral agents (n = 569) and those in the S group with prednisolone alone (n = 773). Outcomes were measured using the House-Brackmann (HB) scale according to age, initial disease severity, electroneurography (ENoG) findings and underlying comorbidities. The rate of recovery (HB grades I and II) with initially severe Bell's palsy (HB grades V and VI) was higher in the S + A than in the S group (P = 0.001). However, the rates of recovery were similar with initially moderate palsy (HB grades II-IV) (P = 0.502). In patients classified according to age and ENoG-determined severity of palsy, the overall recovery rate was higher in the S + A than in the S group, but the differences were not statistically significant (P > 0.05 for both). The recovery rate without diabetes mellitus (DM) and hypertension (HTN) was higher in the S + A group than in the S group (P = 0.031). But in the patients with HTN and DM, the difference in recovery rates between the S + A and S groups was not statistically significant (P = 0.805). Treatment with a steroid plus antiviral agent resulted in significantly higher recovery rates than steroid therapy alone in patients with initially severe Bell's palsy and without either HTN or DM, and a nonsignificant trend towards higher recovery rates in all patients with Bell's palsy in this study. Antiviral agents may therefore help in the treatment of Bell's palsy. © 2014 The Association for the Publication of the Journal of Internal Medicine.

Comparison of the sonographic features of the abdominal wall muscles and connective tissues in individuals with and without lumbopelvic pain.

PubMed

Whittaker, Jackie L; Warner, Martin B; Stokes, Maria

2013-01-01

Cross-sectional, case-control study. To measure and compare the resting thickness of the 4 abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and interrecti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging. The muscles and PMCT of the abdominal wall assist in controlling the spine. Functional deficits of the abdominal wall muscles have been detected in populations with LPP. Investigations of the abdominal wall in those with LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (IO). Because the abdominal wall functions as a unit, all 4 abdominal muscles and their associated connective tissues should be considered concurrently. B-mode ultrasound imaging was used to measure the resting thickness of the rectus abdominis (RA), external oblique, IO, and TrA muscles; the PMCT planes; and IRD in 50 male and female subjects, 25 with and 25 without LPP (mean ± SD age, 36.3 ± 9.4 and 46.6 ± 8.0 years, respectively). Univariate correlation analysis was used to identify covariates. Analyses of covariance (ANCOVAs) and the Kruskal-Wallis test (IRD) were used to compare cohorts (α = .05). The LPP cohort had less total abdominal muscle thickness (LPP mean ± SD, 18.9 ± 3.0 mm; control, 20.3 ± 3.0 mm; ANCOVA adjusted for body mass index, P = .03), thicker PMCT (LPP, 5.5 ± 0.2 mm; control, 4.3 ± 0.2 mm; ANCOVA adjusted for body mass index, P = .007), and wider IRD (LPP, 11.5 ± 2.0 mm; control, 8.4 ± 1.8 mm; Kruskal-Wallis, P = .005). Analysis of individual muscle thickness revealed no difference in the external oblique, IO, and TrA, but a thinner RA in the LPP cohort (LPP mean ± SD, 7.8 ± 1.5 mm; control, 9.1 ± 1.2 mm; ANCOVA adjusted for body mass index, P<.001). To our knowledge, this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest that there

Cerebral Palsy

MedlinePlus

... her strength. Recommend on Facebook Tweet Share Compartir Cerebral palsy (CP) is a group of disorders that affect a ... ability to move and maintain balance and posture. CP is the most common motor disability in childhood. ...

Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain.

PubMed

Hides, Julie A; Belavý, Daniel L; Cassar, Lana; Williams, Michelle; Wilson, Stephen J; Richardson, Carolyn A

2009-03-01

An important aspect of neuromuscular control at the lumbo-pelvic region is stabilization. Subjects with low back pain (LBP) have been shown to exhibit impairments in motor control of key muscles which contribute to stabilization of the lumbo-pelvic region. However, a test of automatic recruitment that relates to function has been lacking. A previous study used ultrasound imaging to show that healthy subjects automatically recruited the transversus abdominis (TrA) and internal oblique (IO) muscles in response to a simulated weight-bearing task. This task has not been investigated in subjects with LBP. The aim of this study was to compare the automatic recruitment of the abdominal muscles among subjects with and without LBP in response to the simulated weight-bearing task. Twenty subjects with and without LBP were tested. Real-time ultrasound imaging was used to assess changes in thickness of the TrA and internal oblique IO muscles as well as lateral movement ("slide") of the anterior fascial insertion of the TrA muscle. Results showed that subjects with LBP showed significantly less shortening of the TrA muscle (P < 0.0001) and greater increases in thickness of the IO muscle (P = 0.002) with the simulated weight-bearing task. There was no significant difference between groups for changes in TrA muscle thickness (P = 0.055). This study provides evidence of changes in motor control of the abdominal muscles in subjects with LBP. This test may provide a functionally relevant and non-invasive method to investigate the automatic recruitment of the abdominal muscles in people with and without LBP.

Bell's palsy syndrome: mimics and chameleons.

PubMed

Fuller, Geraint; Morgan, Cathy

2016-12-01

In this article we will explore the mimics and chameleons of Bell's palsy and in addition argue that we should use the term 'Bell's palsy syndrome' to help guide clinical reasoning when thinking about patients with facial weakness. The diagnosis of Bell's palsy can usually be made on clinical grounds without the need for further investigations. This is because the diagnosis is not one of exclusion (despite this being commonly how it is described), a lower motor neurone facial weakness where all alternative causes have been eliminated, but rather a positive recognition of a clinical syndrome, with a number of exclusions, which are described below. This perhaps would be more accurately referred to a 'Bell's palsy syndrome'. Treatment with corticosteroids improves outcome; adding an antiviral probably reduces the rates of long-term complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reduced Oblique Effect in Children with Autism Spectrum Disorders (ASD)

PubMed Central

Sysoeva, Olga V.; Davletshina, Maria A.; Orekhova, Elena V.; Galuta, Ilia A.; Stroganova, Tatiana A.

2016-01-01

People are very precise in the discrimination of a line orientation relative to the cardinal (vertical and horizontal) axes, while their orientation discrimination sensitivity along the oblique axes is less refined. This difference in discrimination sensitivity along cardinal and oblique axes is called the “oblique effect.” Given that the oblique effect is a basic feature of visual processing with an early developmental origin, its investigation in children with Autism Spectrum Disorder (ASD) may shed light on the nature of visual sensory abnormalities frequently reported in this population. We examined line orientation sensitivity along oblique and vertical axes in a sample of 26 boys with ASD (IQ > 68) and 38 typically developing (TD) boys aged 7–15 years, as well as in a subsample of carefully IQ-matched ASD and TD participants. Children were asked to detect the direction of tilt of a high-contrast black-and-white grating relative to vertical (90°) or oblique (45°) templates. The oblique effect was reduced in children with ASD as compared to TD participants, irrespective of their IQ. This reduction was due to poor orientation sensitivity along the vertical axis in ASD children, while their ability to discriminate line orientation along the oblique axis was unaffected. We speculate that this deficit in sensitivity to vertical orientation may reflect disrupted mechanisms of early experience-dependent learning that takes place during the critical period for orientation selectivity. PMID:26834540

Trunk Muscle Activation and Estimating Spinal Compressive Force in Rope and Harness Vertical Dance.

PubMed

Wilson, Margaret; Dai, Boyi; Zhu, Qin; Humphrey, Neil

2015-12-01

Rope and harness vertical dance takes place off the floor with the dancer suspended from his or her center of mass in a harness attached to a rope from a point overhead. Vertical dance represents a novel environment for training and performing in which expected stresses on the dancer's body are different from those that take place during dance on the floor. Two male and eleven female dancers with training in vertical dance performed six typical vertical dance movements with electromyography (EMG) electrodes placed bilaterally on rectus abdominus, external oblique, erector spinae, and latissimus dorsi. EMG data were expressed as a percentage of maximum voluntary isometric contraction (MVIC). A simplified musculoskeletal model based on muscle activation for these four muscle groups was used to estimate the compressive force on the spine. The greatest muscle activation for erector spinae and latissimus dorsi and the greatest trunk compressive forces were seen in vertical axis positions where the dancer was moving the trunk into a hyper-extended position. The greatest muscle activation for rectus abdominus and external oblique and the second highest compressive force were seen in a supine position with the arms and legs extended away from the center of mass (COM). The least muscle activation occurred in positions where the limbs were hanging below the torso. These movements also showed relatively low muscle activation compression forces. Post-test survey results revealed that dancers felt comfortable in these positions; however, observation of some positions indicated insufficient muscular control. Computing the relative contribution of muscles, expressed as muscle activation and estimated spinal compression, provided a measure of how much the muscle groups were working to support the spine and the rest of the dancer's body in the different movements tested. Additionally, identifying typical muscle recruitment patterns in each movement will help identify key exercises

Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking.

PubMed

Hu, Hai; Meijer, Onno G; van Dieën, Jaap H; Hodges, Paul W; Bruijn, Sjoerd M; Strijers, Rob L; Nanayakkara, Prabath W; van Royen, Barend J; Wu, Wenhua; Xia, Chun

2010-02-10

Women with pregnancy-related pelvic girdle pain (PPP), or athletes with groin pain, may have trouble with the active straight leg raise (ASLR), for which a pelvic belt can be beneficial. How the problems emerge, or how the belt works, remains insufficiently understood. We assessed muscle activity during ASLR, and how it changes with a pelvic belt. Healthy nulligravidae (N=17) performed the ASLR, and walked on a treadmill at increasing speeds, without and with a belt. Fine-wire electromyography (EMG) was used to record activity of the mm. psoas, iliacus and transversus abdominis, while other hip and trunk muscles were recorded with surface EMG. In ASLR, all muscles were active. In both tasks, transverse and oblique abdominal muscles were less active with the belt. In ASLR, there was more activity of the contralateral m. biceps femoris, and in treadmill walking of the m. gluteus maximus in conditions with a belt. For our interpretation, we take our starting point in the fact that hip flexors exert a forward rotating torque on the ilium. Apparently, the abdominal wall was active to prevent such forward rotation. If transverse and oblique abdominal muscles press the ilia against the sacrum (Snijders' "force closure"), the pelvis may move as one unit in the sagittal plane, and also contralateral hip extensor activity will stabilize the ipsilateral ilium. The fact that transverse and oblique abdominal muscles were less active in conditions with a pelvic belt suggests that the belt provides such "force closure", thus confirming Snijders' theory. Copyright 2009 Elsevier Ltd. All rights reserved.

Comparison of differences in respiratory function and pressure as a predominant abnormal movement of children with cerebral palsy

PubMed Central

Kwon, Hae-Yeon

2017-01-01

[Purpose] The purpose of this study was to determine differences in respiratory function and pressure among three groups of children with cerebral palsy as a predominant abnormal movement which included spastic type, dyskinetic type, and ataxic type. [Subjects and Methods] Forty-three children with cerebral palsy of 5–13 years of age in I–III levels according to the Gross Motor Function Classification System, the study subjects were divided by stratified random sampling into three groups of spastic type, dyskinetic type, and ataxic type. For reliability of the measurement results, respiratory function and pressure of the children with cerebral palsy were measured by the same inspector using Spirometer Pony FX (Cosmed Ltd., Italy) equipment, and the subject’s guardians (legal representative) was always made to observe. [Results] In the respiratory function, there were significant differences among three groups in all of forced vital capacity, forced expiratory volume at one second, and peak expiratory flow. For respiratory pressure, the maximal inspiratory pressure had significant differences among three groups, although the maximal expiratory pressure had no significant difference. [Conclusion] Therefore, pediatric physical therapists could be provided with important clinical information in understanding the differences in respiratory function and pressure for the children with cerebral palsy showing predominantly abnormal movement as a diverse qualitative characteristics of the muscle tone and movement patterns, and in planning intervention programs for improvement of respiratory capacity. PMID:28265153

Are mechanically sensitive regulators involved in the function and (patho)physiology of cerebral palsy-related contractures?

PubMed

Pingel, Jessica; Suhr, Frank

2017-08-01

Skeletal muscle tissue is mechanosensitive, as it is able to sense mechanical impacts and to translate these into biochemical signals making the tissue adapt. Among its mechanosensitive nature, skeletal muscle tissue is the largest metabolic organ of the human body. Disturbances in skeletal muscle mechanosensing and metabolism cause and contribute to many diseases, i.e. muscular dystrophies/myopathies, cardiovascular diseases, COPD or diabetes mellitus type 2. A less commonly focused muscle-related disorder is clinically known as muscle contractures that derive from cerebral palsy (CP) conditions in young and adults. Muscle contractures are characterized by gradually increasing passive muscle stiffness resulting in complete fixation of joints. Different mechanisms have been identified in CP-related contractures, i.e. altered calcium handling, altered metabolism or altered titin regulation. The muscle-related extracellular matrix (ECM), specifically collagens, plays a role in CP-related contractures. Herein, we focus on mechanically sensitive complexes, known as costameres (Cstms), and discuss their potential role in CP-related contractures. We extend our discussion to the ECM due to the limited knowledge of its role in CP-related contractures. The aims of this review are (1) to summarize CP-related contracture mechanisms, (2) to raise novel hypotheses on the genesis of contractures with a focus on Cstms, and (3) to stimulate novel approaches to study CP-related contractures.

Three-dimensional frictional plastic strain partitioning during oblique rifting

NASA Astrophysics Data System (ADS)

Duclaux, Guillaume; Huismans, Ritske S.; May, Dave

2017-04-01

Throughout the Wilson cycle the obliquity between lithospheric plate motion direction and nascent or existing plate boundaries prompts the development of intricate three-dimensional tectonic systems. Where oblique divergence dominates, as in the vast majority of continental rift and incipient oceanic domains, deformation is typically transtensional and large stretching in the brittle upper crust is primarily achieved by the accumulation of displacement on fault networks of various complexity. In continental rift depressions such faults are initially distributed over tens to hundreds of kilometer-wide regions, which can ultimately stretch and evolve into passive margins. Here, we use high-resolution 3D thermo-mechanical finite element models to investigate the relative timing and distribution of localised frictional plastic deformation in the upper crust during oblique rift development in a simplified layered lithosphere. We vary the orientation of a wide oblique heterogeneous weak zone (representing a pre-existing geologic feature like a past orogenic domain), and test the sensitivity of the shear zones orientation to a range of noise distribution. These models allow us to assess the importance of material heterogeneities for controlling the spatio-temporal shear zones distribution in the upper crust during oblique rifting, and to discuss the underlying controls governing oblique continental breakup.

[Acetabuloplasty in cerebral palsy patients].

PubMed

Schejbalová, A; Chládek, P

2007-12-01

Acetabuloplasty as an isolated surgical procedure is one of the options allowing for hip joint realignment in cerebral palsy patients. Also, it is often involved in combined techniques used for hip joint reconstruction. In the years 2004-2005, 20 cerebral palsy patients, aged from 4 to 13 years, were indicated for acetabuloplasty. The group included children with varying degrees of locomotor disability, ranging from inability even to crawl to ability to move without support (stages 2 to 7 on the Vojta scale). Clinical and X-ray findings were evaluated at 2 and 6 months after surgical treatment and then every 6 months of follow- up. The X-ray finding was described by means of CE angle (Wiberg) values and hip migration percentage. Of 21 hips (in 20 patients) treated by acetabuloplasty in our modification during the two years, one developed recurrent dorsal dislocation which was possible to deal with by conservative treatment. All hips pre-operatively categorized as group B or group C were post-operatively assessed as group A hips. Subsequent migration of the acetabulum occurred within a year in two patients with distinct original asymmetry. Surgery on bones comprising the hip joint in cerebral palsy patients is indicated according to the degree of lateral migration and changes in hip joint geometry involving the proximal femur or pelvis, or in combination with open reduction. Acetabuloplasty is indicated as an isolated procedure or as part of combined techniques leading to a better coverage of the hip joint. It is recommended for children up to 10 years of age, but also older ones, in whom the flexibility of child bones enables us to do without internal osteosynthesis. Acetabuloplasty is indicated as an isolated surgical procedure for hip joint subluxation in cerebral palsy children. It has no adverse effects on hip abductors that, in cerebral palsy patients, are 85 % insufficient. It improves hip joint symmetry and helps to avoid more demanding reconstructive or

Obliquity evolution of the minor satellites of Pluto and Charon

NASA Astrophysics Data System (ADS)

Quillen, Alice C.; Nichols-Fleming, Fiona; Chen, Yuan-Yuan; Noyelles, Benoît

2017-09-01

New Horizons mission observations show that the small satellites Styx, Nix, Kerberos and Hydra, of the Pluto-Charon system, have not tidally spun-down to near synchronous spin states and have high obliquities with respect to their orbit about the Pluto-Charon binary (Weaver, 2016). We use a damped mass-spring model within an N-body simulation to study spin and obliquity evolution for single spinning non-round bodies in circumbinary orbit. Simulations with tidal dissipation alone do not show strong obliquity variations from tidally induced spin-orbit resonance crossing and this we attribute to the high satellite spin rates and low orbital eccentricities. However, a tidally evolving Styx exhibits intermittent obliquity variations and episodes of tumbling. During a previous epoch where Charon migrated away from Pluto, the minor satellites could have been trapped in orbital mean motion inclination resonances. An outward migrating Charon induces large variations in Nix and Styx's obliquities. The cause is a commensurability between the mean motion resonance frequency and the spin precession rate of the spinning body. As the minor satellites are near mean motion resonances, this mechanism could have lifted the obliquities of all four minor satellites. The high obliquities need not be primordial if the minor satellites were at one time captured into mean motion resonances.

Bell's palsy

PubMed Central

2008-01-01

Introduction Bell's palsy is characterised by an acute, unilateral, partial or complete paralysis of the face, which may occur with mild pain, numbness, increased sensitivity to sound, and altered taste. Bell's palsy remains idiopathic, but a proportion may be caused by reactivation of herpes viruses from cranial nerve ganglia. Bell's palsy is most common in people aged 15-40 years, affecting 1 in 60 in their lifetime. Most make a spontaneous recovery within 1 month, but up to 30% have delayed or incomplete recovery. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in adults and children? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found eight systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiviral treatment, corticosteroids (alone or plus antiviral treatment), facial nerve decompression surgery, and mime therapy. PMID:19450338

Pediatric Cerebral Palsy in Botswana: Etiology, Outcomes, and Comorbidities

PubMed Central

Bearden, David R.; Monokwane, Baphaleng; Khurana, Esha; Baier, James; Baranov, Esther; Westmoreland, Kate; Mazhani, Loeto; Steenhoff, Andrew P.

2016-01-01

BACKGROUND Cerebral palsy is the most common cause of motor dysfunction in children worldwide and is often accompanied by multiple comorbidities. Although cerebral palsy has been studied extensively in high-resource settings, there are few published studies on cerebral palsy etiology, outcomes and comorbidities in low-resource settings. METHODS Children with cerebral palsy were prospectively enrolled from inpatient and outpatient settings at a referral center in Gaborone, Botswana, in a cross-sectional study conducted from 2013 to 2014. Cerebral palsy etiology, outcomes, and comorbidities were determined through caregiver interviews, review of medical records, and direct physical examination. RESULTS Sixty-eight children with cerebral palsy were enrolled. Subjects were 41% male, with a median age of 4 years (interquartile range = 2 to 7). The most common etiologies for cerebral palsy in our cohort were intrapartum hypoxic events (18%), postnatal infections (15%), prematurity (15%), focal ischemic strokes (10%), and prenatal infections (10%). Severe motor impairment was common, with the most severe category present in 41%. The predominant comorbidities were cognitive impairment (84%), epilepsy (77%), and visual impairment (46%). CONCLUSIONS Cerebral palsy in Botswana has different etiologies and is associated with poorer outcomes and higher prevalence of comorbidities than what has been reported in high-resource settings. Further studies are necessary to determine optimal preventative and treatment strategies in this population. PMID:27114082

Constraints on the Obliquities of Kepler Planet-hosting Stars

NASA Astrophysics Data System (ADS)

Winn, Joshua N.; Petigura, Erik A.; Morton, Timothy D.; Weiss, Lauren M.; Dai, Fei; Schlaufman, Kevin C.; Howard, Andrew W.; Isaacson, Howard; Marcy, Geoffrey W.; Justesen, Anders Bo; Albrecht, Simon

2017-12-01

Stars with hot Jupiters have obliquities ranging from 0° to 180°, but relatively little is known about the obliquities of stars with smaller planets. Using data from the California-Kepler Survey, we investigate the obliquities of stars with planets spanning a wide range of sizes, most of which are smaller than Neptune. First, we identify 156 planet hosts for which measurements of the projected rotation velocity (v\\sin i) and rotation period are both available. By combining estimates of v and v\\sin i, we find nearly all the stars to be compatible with high inclination, and hence, low obliquity (≲20°). Second, we focus on a sample of 159 hot stars ({T}{eff}> 6000 K) for which v\\sin i is available but not necessarily the rotation period. We find six stars for which v\\sin i is anomalously low, an indicator of high obliquity. Half of these have hot Jupiters, even though only 3% of the stars that were searched have hot Jupiters. We also compare the v\\sin i distribution of the hot stars with planets to that of 83 control stars selected without prior knowledge of planets. The mean v\\sin i of the control stars is lower than that of the planet hosts by a factor of approximately π /4, as one would expect if the planet hosts have low obliquities. All these findings suggest that the Kepler planet-hosting stars generally have low obliquities, with the exception of hot stars with hot Jupiters.

Inferring planetary obliquity using rotational and orbital photometry

NASA Astrophysics Data System (ADS)

Schwartz, J. C.; Sekowski, C.; Haggard, H. M.; Pallé, E.; Cowan, N. B.

2016-03-01

The obliquity of a terrestrial planet is an important clue about its formation and critical to its climate. Previous studies using simulated photometry of Earth show that continuous observations over most of a planet's orbit can be inverted to infer obliquity. However, few studies of more general planets with arbitrary albedo markings have been made and, in particular, a simple theoretical understanding of why it is possible to extract obliquity from light curves is missing. Reflected light seen by a distant observer is the product of a planet's albedo map, its host star's illumination, and the visibility of different regions. It is useful to treat the product of illumination and visibility as the kernel of a convolution. Time-resolved photometry constrains both the albedo map and the kernel, the latter of which sweeps over the planet due to rotational and orbital motion. The kernel's movement distinguishes prograde from retrograde rotation for planets with non-zero obliquity on inclined orbits. We demonstrate that the kernel's longitudinal width and mean latitude are distinct functions of obliquity and axial orientation. Notably, we find that a planet's spin axis affects the kernel - and hence time-resolved photometry - even if this planet is east-west uniform or spinning rapidly, or if it is north-south uniform. We find that perfect knowledge of the kernel at 2-4 orbital phases is usually sufficient to uniquely determine a planet's spin axis. Surprisingly, we predict that east-west albedo contrast is more useful for constraining obliquity than north-south contrast.

Extraocular muscle architecture in hawks and owls.

PubMed

Plochocki, Jeffrey H; Segev, Tamar; Grow, Wade; Hall, Margaret I

2018-02-06

A complete and accurate understanding of extraocular muscle function is important to the veterinary care of the avian eye. This is especially true for birds of prey, which rely heavily on vision for survival and yet are prone to ocular injury and disease. To better understand the function of extraocular muscles in birds of prey, we studied extraocular muscle architecture grossly and histologically. This sample was composed of two each of the following species: red-tailed hawk (Buteo jamaicensis), Harris's hawk (Parabuteo unicinctus), great horned owl (Bubo virginianus), and barn owl (Tyto alba). All extraocular muscles were dissected and weighed. To analyze muscle fiber architecture, the superior oblique and quadratus muscles were dissected, weighed, and sectioned at 5 μm thickness in the transverse plane. We calculated the physiologic cross-sectional area and the ratio of muscle mass to predicted effective maximum tetanic tension. Hawk and owl extraocular muscles exhibit significant physiological differences that play roles in ocular movements and closure of the nictitating membrane. Owls, which do not exhibit extraocular movement, have muscle architecture suited to stabilize the position of a massive, tubular eye that protrudes significantly from the orbit. Hawks, which have a more globose eye that is largely contained within the orbit, do not require as much muscular stability and instead have muscle architecture that facilitates rapid eye movement. © 2018 American College of Veterinary Ophthalmologists.

Biomechanics of Submaximal Recumbent Cycling in Adolescents With and Without Cerebral Palsy

PubMed Central

Johnston, Therese E; Barr, Ann E; Lee, Samuel CK

2011-01-01

Background and Purpose The purpose of this study was to compare the biomechanics of recumbent cycling between adolescents with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels III and IV and adolescents with typical development (TD). Subjects Twenty subjects, ages (X̄±SD) 15.2±1.6 years (10 with TD, 10 with CP), participated. Methods Lower-extremity kinematics and muscle activity were measured at 30 and 60 rpm while subjects pedaled on a recumbent cycle. Energy expenditure and perceived exertion were measured during a 5-minute test, and efficiency was calculated. Noncircular data were analyzed with analyses of variance. Circular data were analyzed using circular t tests. Results Differences were found between groups for joint kinematics for all motions. Subjects with CP displayed earlier onsets and later offsets of muscle activity, increased co-contraction of agonist and antagonist muscles, and decreased efficiency compared with subjects with TD. There were no differences in perceived exertion. Discussion and Conclusion Differences in cycling biomechanics between children with CP and children with TD may be due to decreased strength and motor control in the children with CP. PMID:17405804

Effects of Extreme Obliquity Variations on the Habitability of Exoplanets

NASA Technical Reports Server (NTRS)

Armstrong, J. C.; Barnes, R.; Domagal-Goldman, S.; Breiner, J.; Quinn, T. R.; Meadows, V. S.

2014-01-01

We explore the impact of obliquity variations on planetary habitability in hypothetical systems with high mutual inclination. We show that large-amplitude, high-frequency obliquity oscillations on Earth-like exoplanets can suppress the ice-albedo feedback, increasing the outer edge of the habitable zone. We restricted our exploration to hypothetical systems consisting of a solar-mass star, an Earth-mass planet at 1 AU, and 1 or 2 larger planets. We verified that these systems are stable for 108 years with N-body simulations and calculated the obliquity variations induced by the orbital evolution of the Earth-mass planet and a torque from the host star. We ran a simplified energy balance model on the terrestrial planet to assess surface temperature and ice coverage on the planet's surface, and we calculated differences in the outer edge of the habitable zone for planets with rapid obliquity variations. For each hypothetical system, we calculated the outer edge of habitability for two conditions: (1) the full evolution of the planetary spin and orbit and (2) the eccentricity and obliquity fixed at their average values. We recovered previous results that higher values of fixed obliquity and eccentricity expand the habitable zone, but we also found that obliquity oscillations further expand habitable orbits in all cases. Terrestrial planets near the outer edge of the habitable zone may be more likely to support life in systems that induce rapid obliquity oscillations as opposed to fixed-spin planets. Such planets may be the easiest to directly characterize with space-borne telescopes.

Effects of extreme obliquity variations on the habitability of exoplanets.

PubMed

Armstrong, J C; Barnes, R; Domagal-Goldman, S; Breiner, J; Quinn, T R; Meadows, V S

2014-04-01

We explore the impact of obliquity variations on planetary habitability in hypothetical systems with high mutual inclination. We show that large-amplitude, high-frequency obliquity oscillations on Earth-like exoplanets can suppress the ice-albedo feedback, increasing the outer edge of the habitable zone. We restricted our exploration to hypothetical systems consisting of a solar-mass star, an Earth-mass planet at 1 AU, and 1 or 2 larger planets. We verified that these systems are stable for 10(8) years with N-body simulations and calculated the obliquity variations induced by the orbital evolution of the Earth-mass planet and a torque from the host star. We ran a simplified energy balance model on the terrestrial planet to assess surface temperature and ice coverage on the planet's surface, and we calculated differences in the outer edge of the habitable zone for planets with rapid obliquity variations. For each hypothetical system, we calculated the outer edge of habitability for two conditions: (1) the full evolution of the planetary spin and orbit and (2) the eccentricity and obliquity fixed at their average values. We recovered previous results that higher values of fixed obliquity and eccentricity expand the habitable zone, but we also found that obliquity oscillations further expand habitable orbits in all cases. Terrestrial planets near the outer edge of the habitable zone may be more likely to support life in systems that induce rapid obliquity oscillations as opposed to fixed-spin planets. Such planets may be the easiest to directly characterize with space-borne telescopes.

Bell palsy in lyme disease-endemic regions of canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease.

PubMed

Ho, Karen; Melanson, Michel; Desai, Jamsheed A

2012-09-01

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.

Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial.

PubMed

Babl, Franz E; Mackay, Mark T; Borland, Meredith L; Herd, David W; Kochar, Amit; Hort, Jason; Rao, Arjun; Cheek, John A; Furyk, Jeremy; Barrow, Lisa; George, Shane; Zhang, Michael; Gardiner, Kaya; Lee, Katherine J; Davidson, Andrew; Berkowitz, Robert; Sullivan, Frank; Porrello, Emily; Dalziel, Kim Marie; Anderson, Vicki; Oakley, Ed; Hopper, Sandy; Williams, Fiona; Wilson, Catherine; Williams, Amanda; Dalziel, Stuart R

2017-02-13

Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with

Obliquity Modulation of the Incoming Solar Radiation

NASA Technical Reports Server (NTRS)

Liu, Han-Shou; Smith, David E. (Technical Monitor)

2001-01-01

Based on a basic principle of orbital resonance, we have identified a huge deficit of solar radiation induced by the combined amplitude and frequency modulation of the Earth's obliquity as possibly the causal mechanism for ice age glaciation. Including this modulation effect on solar radiation, we have performed model simulations of climate change for the past 2 million years. Simulation results show that: (1) For the past 1 million years, temperature fluctuation cycles were dominated by a 100-Kyr period due to amplitude-frequency resonance effect of the obliquity; (2) From 2 to 1 million years ago, the amplitude-frequency interactions. of the obliquity were so weak that they were not able to stimulate a resonance effect on solar radiation; (3) Amplitude and frequency modulation analysis on solar radiation provides a series of resonance in the incoming solar radiation which may shift the glaciation cycles from 41-Kyr to 100-Kyr about 0.9 million years ago. These results are in good agreement with the marine and continental paleoclimate records. Thus, the proposed climate response to the combined amplitude and frequency modulation of the Earth's obliquity may be the key to understanding the glaciation puzzles in paleoclimatology.

Exploratory Bi-factor Analysis: The Oblique Case.

PubMed

Jennrich, Robert I; Bentler, Peter M

2012-07-01

Bi-factor analysis is a form of confirmatory factor analysis originally introduced by Holzinger and Swineford (Psychometrika 47:41-54, 1937). The bi-factor model has a general factor, a number of group factors, and an explicit bi-factor structure. Jennrich and Bentler (Psychometrika 76:537-549, 2011) introduced an exploratory form of bi-factor analysis that does not require one to provide an explicit bi-factor structure a priori. They use exploratory factor analysis and a bifactor rotation criterion designed to produce a rotated loading matrix that has an approximate bi-factor structure. Among other things this can be used as an aid in finding an explicit bi-factor structure for use in a confirmatory bi-factor analysis. They considered only orthogonal rotation. The purpose of this paper is to consider oblique rotation and to compare it to orthogonal rotation. Because there are many more oblique rotations of an initial loading matrix than orthogonal rotations, one expects the oblique results to approximate a bi-factor structure better than orthogonal rotations and this is indeed the case. A surprising result arises when oblique bi-factor rotation methods are applied to ideal data.

Associations of Abdominal Muscle Area with 4-Year Change in Coronary Artery Calcium Differ by Ethnicity Among Post-Menopausal Women.

PubMed

Wassel, Christina L; Laughlin, Gail A; Saad, Sarah D; Araneta, Maria Rosario G; Wooten, Wilma; Barrett-Connor, Elizabeth; Allison, Matthew A

2015-11-05

To examine the association of abdominal muscle area with coronary artery calcium (CAC) presence, extent, and progression in a multi-ethnic cohort of older, community-dwelling post-menopausal women. Cross-sectional and longitudinal population-based cohort. The sample comprised 179 non-Hispanic White women, 116 Filipina women and 144 African American women, all without known CVD, who underwent chest and abdominal computed tomography (CT) scans twice about four years apart for abdominal muscle and fat, as well as CAC. CAC presence, extent and progression. There was a significant interaction of ethnicity with baseline oblique muscle area (p-for-interaction .01), and marginally significant interactions with baseline total and paraspinal muscle for change in CAC (p-for-interactions both .09). Among Filipina women, each standard deviation (SD) greater total muscle area was associated with a 26% (95% CI (-43%, -4%), P=.02) reduced rate of change in CAC; higher paraspinal and oblique muscle area were associated with a 24% (-38%, -6%, P=.01) and a 37% (-53%, -16%, P=.0002) reduced rate of change in CAC, respectively. These associations were not significant in African American or non-Hispanic White women. There were no significant associations of abdominal muscle with CAC presence or extent, nor were there significant ethnicity by muscle interactions in these models. Among Filipina women, greater abdominal muscle mass is associated with a decreased rate of CAC progression. Higher muscle mass may be important for this group in reducing CVD outcomes.

33 CFR 118.90 - Bridges crossing channel obliquely.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Bridges crossing channel obliquely. 118.90 Section 118.90 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LIGHTING AND OTHER SIGNALS § 118.90 Bridges crossing channel obliquely. Bridges...

33 CFR 118.90 - Bridges crossing channel obliquely.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Bridges crossing channel obliquely. 118.90 Section 118.90 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES BRIDGE LIGHTING AND OTHER SIGNALS § 118.90 Bridges crossing channel obliquely. Bridges...

Core Muscle Activity, Exercise Preference, and Perceived Exertion during Core Exercise with Elastic Resistance versus Machine.

PubMed

Vinstrup, Jonas; Sundstrup, Emil; Brandt, Mikkel; Jakobsen, Markus D; Calatayud, Joaquin; Andersen, Lars L

2015-01-01

Objectives. To investigate core muscle activity, exercise preferences, and perceived exertion during two selected core exercises performed with elastic resistance versus a conventional training machine. Methods. 17 untrained men aged 26-67 years participated in surface electromyography (EMG) measurements of five core muscles during torso-twists performed from left to right with elastic resistance and in the machine, respectively. The order of the exercises was randomized and each exercise consisted of 3 repetitions performed at a 10 RM load. EMG amplitude was normalized (nEMG) to maximum voluntary isometric contraction (MVC). Results. A higher right erector spinae activity in the elastic exercise compared with the machine exercise (50% [95% CI 36-64] versus 32% [95% CI 18-46] nEMG) was found. By contrast, the machine exercise, compared with the elastic exercise, showed higher left external oblique activity (77% [95% CI 64-90] versus 54% [95% CI 40-67] nEMG). For the rectus abdominis, right external oblique, and left erector spinae muscles there were no significant differences. Furthermore, 76% preferred the torso-twist with elastic resistance over the machine exercise. Perceived exertion (Borg CR10) was not significantly different between machine (5.8 [95% CI 4.88-6.72]) and elastic exercise (5.7 [95% CI 4.81-6.59]). Conclusion. Torso-twists using elastic resistance showed higher activity of the erector spinae, whereas torso-twist in the machine resulted in higher activity of the external oblique. For the remaining core muscles the two training modalities induced similar muscular activation. In spite of similar perceived exertion the majority of the participants preferred the exercise using elastic resistance.

Role of Anesthesiologist in the Management of a Child with Cerebral Palsy

PubMed Central

Shaikh, Safiya Imtiaz; Hegade, Ganapati

2017-01-01

Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Postoperative analgesia is important, particularly in orthopedic surgeries one for pain relief. This review highlights the clinical manifestations in CP and anesthetic considerations in such child presenting for various surgeries. PMID:28928544

Association of Lead Levels and Cerebral Palsy

PubMed Central

Bansal, Neha; Aggarwal, Anju; Faridi, M. M. A.; Sharma, Tusha; Baneerjee, B. D.

2017-01-01

Background: Cerebral palsy is a common motor disability in childhood. Raised lead levels affect cognition. Children with cerebral palsy may have raised lead levels, further impairing their residual cognitive motor and behavioral abilities. Environmental exposure and abnormal eating habits may lead to increased lead levels. Aims and Objectives: To measure blood lead levels in children with cerebral palsy and compare them with healthy neurologically normal children. To correlate blood lead levels with environmental factors. Material and Methods: Design: Prospective case-control study. Setting: Tertiary care hospital. Participants: Cases comprised 34 children with cerebral palsy, and controls comprised 34 neurologically normal, age- and sex-matched children. Methods: Clinical and demographic details were recorded as per proforma. Detailed environmental history was recorded to know the source of exposure to lead. These children were investigated and treated as per protocol. Venous blood was collected in ethylenediaminetetraacetic acid vials for analysis of blood lead levels. Lead levels were estimated by Schimadzu Flame AA-6800 (atomic absorption spectrophotometer). Data were analyzed using SPSS version 17. P < .05 was taken as significant. Results: Mean blood lead levels were 9.20 ± 8.31 µg/dL in cerebral palsy cases and 2.89 ± 3.04 µg/dL in their controls (P < .001). Among children with cerebral palsy, 19 (55.88%) children had blood lead levels ≥5 µg/dL. Lead levels in children with pica were 12.33 ± 10.02 µg/dL in comparison to children with no history of pica, 6.70 ± 4.60 µg/dL (P = .029). No correlation was found between hemoglobin and blood lead levels in cases and controls. Conclusion: In our study, blood lead levels are raised in children with cerebral palsy. However, further studies are required to show effects of raised levels in these children. PMID:28491920

Progressive supranuclear palsy

MedlinePlus

... dystonia; Richardson-Steele-Olszewski syndrome; Palsy - progressive supranuclear Images Central nervous system and peripheral nervous system References Jankovic J. Parkinson disease and other movement disorders. In: Daroff ...

Functional Outcomes Following Anterior Transfer of the Tibialis Posterior Tendon for Foot Drop Secondary to Peroneal Nerve Palsy.

PubMed

Cho, Byung-Ki; Park, Kyoung-Jin; Choi, Seung-Myung; Im, Se-Hyuk; SooHoo, Nelson F

2017-06-01

This retrospective comparative study reports the practical function in daily and sports activities after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Seventeen patients were followed for a minimum of 3 years after tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Matched controls were used to evaluate the level of functional restoration. Functional evaluations included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) scores, and isokinetic muscle strength test. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, hindfoot alignment angle, and navicular height. Mean AOFAS, FAOS, and FAAM scores significantly improved from 65.1 to 86.2, 55.6 to 87.8, and 45.7 to 84.4 points at final follow-up, respectively. However, all functional evaluation scores were significantly lower as compared to the control group ( P < .001). Mean peak torque (60 degrees/sec) of ankle dorsiflexors, plantarflexors, invertors, and evertors at final follow-up were 7.1 (deficit ratio of 65.4%), 39.2, 9.8, and 7.3 Nm, respectively. These muscle strengths were significantly lower compared to the control group ( P < .001). No significant differences in radiographic measurements were found, and no patients presented with a postoperative flat foot deformity. One patient (5.9%) needed an ankle-foot orthosis for occupational activity. Anterior transfer of the tibialis posterior tendon appears to be an effective surgical option for paralytic foot drop secondary to peroneal nerve palsy. Although restoration of dorsiflexion strength postoperatively was about 33% of the normal ankle, function in daily activities and gait ability were satisfactorily improved. In addition, tibialis posterior tendon transfer demonstrated no definitive radiographic or clinical progression to postoperative flat

Plasma Fibrinogen in Patients With Bell Palsy.

PubMed

Zhao, Hua; Zhang, Xin; Tang, Yinda; Li, Shiting

2016-10-01

To determine the plasma fibrinogen level in patients with Bell palsy and explore the significances of it in Bell palsy. One hundred five consecutive patients with facial paralysis were divided into 3 groups: group I (Bell palsy), group II (temporal bone fractures), and group III (facial nerve schwannoma). In addition, 22 volunteers were defined as control group. Two milliliters fasting venous blood from elbow was collected, and was evaluated by CA-7000 Full-Automatic Coagulation Analyzer. The plasma fibrinogen concentration was significantly higher in the group of patients with Bell palsy (HB IV-VI) than that in the control group (P <0.05). There was no significant difference between group II and control group (P >0.05); similarly, there was also no marked difference between group III and control group (P >0.05). In group I, the plasma fibrinogen levels became higher with the HB grading increase. The plasma fibrinogen level of HB-VI was highest. Plasma fibrinogen has an important clinical meaning in Bell palsy, which should be used as routine examination items. Defibrinogen in treatment for patients with high plasma fibrinogen content also should be suggested.

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy

PubMed Central

Whitney, Daniel G.; Singh, Harshvardhan; Miller, Freeman; Barbe, Mary F.; Slade, Jill M.; Pohlig, Ryan T.; Modlesky, Christopher M.

2016-01-01

Introduction Nonambulatory children with severe cerebral palsy (CP) have an underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Materials and methods Ambulatory children with mild spastic CP and typically developing children (4 to 11 years; 12/group) were tested. Magnetic resonance imaging was used to estimate cortical, medullary and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Physical activity monitors worn on the ankle were used to assess physical activity. Results There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44 %) than controls (both p < 0.05). Children with CP also had lower cortical volume (30 %), cortical width in the posterior (16 %) and medial (32 %) portion of the shaft, total bone width in the medial-lateral direction (15 %), Z in the medial-lateral direction (34 %), J (39 %) and muscle volume (39 %), and higher bone marrow fat concentration (82.1 ± 1.8 % vs. 80.5 ± 1.9 %), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0 ± 8.0 % vs. 16.1 ± 3.3 %) than controls (all p < 0.05). When tibia length was statistically controlled, all group differences in bone architecture, bone strength, muscle volume and fat infiltration estimates, except posterior cortical width, were still present (all p < 0.05). Furthermore, a higher intermuscular AT volume in children with CP compared to

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy.

PubMed

Whitney, Daniel G; Singh, Harshvardhan; Miller, Freeman; Barbe, Mary F; Slade, Jill M; Pohlig, Ryan T; Modlesky, Christopher M

2017-01-01

Nonambulatory children with severe cerebral palsy (CP) have underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Ambulatory children with mild spastic CP and typically developing children (4 to 11years; 12/group) were compared. Magnetic resonance imaging was used to estimate cortical bone, bone marrow and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Accelerometer-based activity monitors worn on the ankle were used to assess physical activity. There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44%) than controls (both p<0.05). Children with CP also had lower cortical bone volume (30%), cortical bone width in the posterior (16%) and medial (32%) portions of the shaft, total bone width in the medial-lateral direction (15%), Z in the medial-lateral direction (34%), J (39%) and muscle volume (39%), and higher bone marrow fat concentration (82.1±1.8% vs. 80.5±1.9%), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0±8.0% vs. 16.1±3.3%) than controls (all p<0.05). When tibia length was statistically controlled, all group differences in bone architecture, bone strength, muscle volume and fat infiltration estimates, except posterior cortical bone width, were still present (all p<0.05). Furthermore, a higher intermuscular AT volume in children with CP compared to controls emerged (p<0.05). Ambulatory