La danse créative,une approche holistique aux bienfaits rééducatifs

The practice of dance, in the context of rehabilitation, is of growing interest as a global, motivating and beneficial approach. Scientific literature shows that dance leads to favorable motor, cognitive and psychosocial effects for people with neurological disorders, notably, for people with Parkinson's disease. Recent studies have also suggested that dance, as a rehabilitation therapy, is an effective approach, which leads to motor and potential cognitive and psychosocial benefits for those with cerebral palsy. Among the numerous existing dance approaches, the creative dance approach is particularly interesting for its specific pedagogical process that not only includes the dancer's physical and psychological experience of dance, but is also guided by the dancer's own capacities of movement. Creative dance uses a participative, inclusive and playful method that facilitates social link and permits the improvement of self-confidence and empowerment. This approach, based on each individual's ability, enables rehabilitation de be adaptable and specific to the needs of each dancer and each group. Oral testimonies of adolescents with neurological disorders who have participated to creative dance classes in a rehabilitation context have shown that this activity is pleasant and leads to observed benefits both during classes and in daily life. Thus, creative dance appears as a promising therapeutic approach, and easy to implement in a rehabilitation context for young people with neurological disorders.     

针刺配合康复训练治疗脑卒中上肢功能障碍的队列研究

目的:探讨针刺配合康复训练对脑卒中上肢功能障碍患者神经功能特异性烯醇化酶(NSE)、硫化氢(H_2S)、神经营养因子(NGF)与脑血管动力学的影响。方法:选取2016年5月至2017年10月空军军医大学唐都医院收治的脑卒中上肢功能障碍患者198例进行回顾性分析。将患者分为针刺配合康复训练治疗观察组100例,单纯依靠康复训练治疗对照组98例。比较与分析2组治疗前后的NSE、H_2S、NGF与脑血管动力学等。结果:观察组治疗后NSE(12. 36±6. 35)μg/L,H_2S(52. 19±3. 77)μmol/L,NGF(152. 94±32. 67) pg/m L。对照组治疗后NSE (16. 28±7. 45)μg/L,H_2S (36. 67±6. 95)μmol/L,NGF(129. 81±33. 02) pg/m L。观察组治疗后颈动脉血流速度平均值(V_(mean))(26. 45±3. 79) cm/s,血流量(Q_(mean))(18. 52±3. 32) cm~3/s,外周阻力(RV)(82. 37±22. 39) k Pa·s/m,舒张压与临界压差值(DP)(0. 45±0. 08) k Pa. s/m,动态阻力(DR)(32. 36±10. 08) k Pa。对照组治疗后V_(mean)(19. 86±3. 73) cm/s,Q_(mean)(14. 79±2. 72) cm3/s,RV(95. 31±30. 45)k Pa·s/m,DP(0. 63±0. 14) k Pa·s/m,DR(42. 37±9. 67) k Pa。观察组治疗前FMA评分为(38. 41±7. 52)分,治疗后FMA评分为(54. 61±5. 34)分,改善值(16. 22±6. 46)分。MBI指数治疗前为(36. 75±6. 87),治疗后为(60. 33±12. 73),改善值为(23. 58±9. 34)。观察组中医证候积分治疗前(16. 52±0. 68)和治疗后(4. 60±0. 22)。对照组中医证候积分治疗前(16. 95±0. 83)分和治疗后(8. 72±0. 27)分。结论:针刺配合康复训练能够有效的帮助脑卒中上肢功能障碍患者的恢复神经功能,加速脑血管血流速度,减少压强阻力,从而达到治疗患者上肢及手功能,恢复日常生活活动能力的效果。     

La douleur chez l’enfant en situation de handicap neurologique : mise au point de la Commission « déficience intellectuelle et handicap » de la Société française de neurologie pédiatrique

Management of pain is one of the major expectations of children with neurological impairment and their families. The medical literature is poor on this topic accounting for approximately 0.15 % of the publications on pain in general. The objective of the French Pediatric Neurology Society was to review the current knowledge on this topic. Bibliographic research was conducted with PubMed and RefDoc for publications between 1994 and 2014 in French or English. A total of 925 articles were retrieved and 92 were selected for review. Pain is common in this population: a 2-week survey indicated that pain occurs in 50–75 % of children. Pain negatively impacts the quality of life of children and their parents. Children with neurological impairment express their pain with pain expression patterns and specific patterns common to children (change of tone, abnormal movements, spasticity, paradoxical reactions, such as laughter, self-injury or vasomotor dysfunction). Some children with neurological impairment are able to use self-report pain scales. If not, observational measures should be used. Behavioral rating scales specifically designed for this population are more sensitive than others. Scales must be selected according to children's communication skills, type of pain, and the context. Sometimes behavioral changes are the only expression of pain: any change in sleep, tone, feeding, or mood must suggest pain in this population. Management of pain remains difficult. There are no specific guidelines. Procedural pain management guidelines and the usual analgesic drugs can be used in children with neurological impairment with specific concerns regarding tolerance and side effects. These children are particularly at risk for neuropathic pain. A multidisciplinary approach is helpful, involving physicians, nurses, physiotherapists, psychologists and parents.     

Follow-Up Study in a Family with Dominant Progressive Hereditary Sensorineural Hearing Impairment II. Clinical Aspects

An autosomal-dominant progressive sensorineural hearing loss in six generations of a large family with 105 affected members was studied. The pattern of inheritance is autosomal dominant with an almost complete penetrance. The age of onset is between 5 and 15 years. Individuals with a normal audiogram at the age of 15 and over will not develop the disorder. Different generations show an identical pattern of progression. Because the age of onset is the same, anticipation is excluded. The hearing loss is symmetrical. Over 40 years, low-frequency losses are greater in females than in males. Epistasis possibly plays a role since affected individuals in branch II of this family have a more severe expression than those in the other two affected branches. No abnormal excretion of organic acids in the urine could be established.

Une atteinte auditive de perception héréditaire dominante a été étudiée dans une famille de six générations, 105 personnes atteintes. La transmission est autosomale dominante avec une pénétrance de presque 100%. L'anomalie débute entre 5 et 15 ans. Un individu de 15 ans ou plus avec un audiogramme normal ne sera jamais atteint de cette surdité. La progression dans les gënérations est identique et l'aˇge auquel se manifeste la maladie est le měme. La perte d'audition est symétrique pour l'oreille droite et gauche. La perte auditive sur les graves est plus importante chez les femmes que chez les hommes. Dans la branche généalogique II la perte d'audition se développe plus rapidement que dans les autres branches. L'excrétion urinaire d'acides organiques est normale.     

How many forms of perseveration? Evidence from cancellation tasks in right hemisphere patients

Neglect patients' performance during cancellation tasks is characterized by left sided omissions and, in many cases, by the production of inappropriate material of various kinds in the ipsilesional space, e.g. additional marks over already cancelled targets, marks drawn away from targets, scribbles, irrelevant drawings. It is unclear whether these behaviours, which have collectively been called perseverative, are functionally and anatomically connected and whether they correlate with the severity of neglect. Here we report a retrospective study on 33 right brain damaged patients with neglect after right hemisphere lesions in whom we measured the intensity of perseveration of the three following kinds: (1) ‘additional marks' (AM) perseveration where patients cancelled a target with two or more well separated marks; (2) ‘scribble’ perseveration, where patients, instead of cancelling the target with a single pen stroke as required by the task, performed multiple pen strokes without breaking the pen-to-paper contact, with the final product being a scribble; (3) ‘flying marks’ (FM) perseveration where patients produced cancellation marks well away from the targets. We found that AM and FM perseveration correlated with neglect severity, while ‘scribble’ perseveration did not. The lesion-symptom mapping showed three separate anatomical areas in the right hemisphere: ‘scribble’ perseveration was associated with lesions of the orbitofrontal cortex and caudate nucleus; AM perseveration was associated with damage to the rolandic operculum, superior temporal gyrus and inferior frontal gyrus; FM perseveration was associated with damage to the dorsal premotor cortex and the temporal pole. Neglect severity followed damage to a region which grossly corresponds to the sum of the regions associated with AM and FM perseveration respectively. This complex behavioural and anatomical pattern is interpreted in terms of a three-factor model, in which AM perseveration is caused by a deficit of disengagement of attention from the right side (also causing omissions), FM perseveration is caused by directional hypokinesia (also causing left-side omissions), and ‘scribble’ perseveration is the consequence of a failure to inhibit an initiated motor act, which is completely separate (both anatomically and functionally) from the disorder inducing omissions.     

缓解-复发型EAE大鼠轴索损伤与神经功能障碍相关性研究

目的研究恢复期不同预后缓解-复发型EAE大鼠轴索损伤与神经功能障碍之间的关系。方法按照发病情况把缓解-复发型EAE大鼠分为缓解组和瘫痪组,分别进行HE染色和改良的Bielschowsky轴索染色,以免疫组化方法标记脊髓白质轴索中Tau蛋白的表达。结果缓解组和瘫痪组大鼠脊髓组织内均可见多个血管周围炎性细胞浸润呈袖套样分布,改良的Bielschowsky银染色轴索成空泡样缺失。神经纤维变性标志物Tau蛋白在变性的轴索内沉积,呈阳性表达的轴索数在缓解组和瘫痪组均高于正常组,差异显著(P<0.01),瘫痪组轴索内Tau蛋白呈阳性表达的数量高于恢复组,差异显著(P<0.01),具有统计学意义。结论缓解-复发型EAE大鼠的组织病理学改变为炎性细胞浸润和轴索损伤;恢复期大鼠缓解组与瘫痪组均发生轴索变性,当损伤达到一定程度会发生临床不可逆性神经功能障碍,导致肢体瘫痪。     

脑梗死患者早期应用氟西汀对卒中后康复影响的观察

目的评价氟西汀早期应用脑梗死患者对患者康复的影响。方法随机将符合诊断标准的40例脑梗死的患者分为治疗组和对照组各20例进行治疗观察。治疗组早期给予氟西汀,2组其他常规治疗药物相同。结果治疗4周后治疗组在神经功能缺损评分及日常生活活动能力Barthel指数均优于对照组,差异有统计学意义(P<0.05和P<0.01)。结论早期预防性应用氟西汀可使脑梗死患者卒中后抑郁发生及相关症状明显缓解,更利于调整患者的情绪,使患者积极参与康复训练以利康复。