Water Specific Therapy Halliwick (WSTH) : intérêt de la thérapie dans l’eau pour enfants paralysés cérébraux

The Halliwick method, created in England in 1949 by J. McMillan, engineer, who offered his services at the Halliwick swimming school for young girls cp, is based on the physical properties of water and consists of a program in ten points (TPP) for swimming initiation; WSTH is a learning engine in water which facilitates the management of the movements and activities of daily life on earth. It's in agreement with the normal motor development of the child, the levels of motor evolution (NEM), International Classification of Functioning, disability and health (ICF) proposed by the WHO in 2001 as well as with Huber's positive health (2011). Several scientific studies attest to the efficientness of the Halliwick method and of the WSTH on motor skills. Four field studies, published, compared WSTH to conventional aquatic therapy (CAT), randomized, in children with cp: (1) on spasticity (elbow/wrist/knee/ankle measurement), WSTH shows a decrease HS specifically on the wrist and ankle after WSTH; S results for CAT; (2) on the range of motion, the measurements show a S increase proximally, especially on the UE after WSTH; (3) on the active trunk recovery, the WSTH shows an action THS in th12, S in th8 and c7; NS in CAT; (4) on the head control, the results are, after WSTH, HS in flexion/extension/inclinations and S in rotations; they are NS for CAT.ConclusionThe Halliwick method and the WSTH have been proven to be efficient on motor skills; our 4 field studies show significantly better effects with WSTH – probably thanks to “its rotation points” – than with CAT.     

侧块螺钉固定术后不同颈椎曲度与脊髓后移的关系及其对手术疗效的影响

目的探讨全椎板减压侧块螺钉固定术后颈椎曲度大小与脊髓后移距离的关系及其对手术疗效的影响。方法回顾性分析2016年10月至2017年12月邯郸市中心医院行全椎板减压侧块螺钉固定术的85例脊髓型颈椎病患者的临床资料,其中有78例患者获得完整随访,术后根据Harrison方法测量颈椎曲度将患者分为A组(43例,0°≤颈椎角≤16.5°)和B组(35例,颈椎角>16.5°)。观察两组患者术后脊髓后移距离、神经恢复效果、轴性症状及C5神经麻痹发生情况。结果A组患者术后颈椎角为(8.5°±3.8°),B组为(19.6°±3.0°),两组比较差异有统计学意义(t=14.071,P<0.001);A组患者椎板切除宽度为(22.1±1.7)mm,B组为(21.8±1.5)mm,两组比较差异无统计学意义(P>0.05);A组患者脊髓后移距离为(1.7±0.4)mm,B组为(3.2±0.7)mm,两组比较差异有统计学意义(t=11.879,P<0.001)。术后两组患者神经功能均有显著恢复,至术后1年时,两组神经功能改善率分别为(63.3±13.1)%和(65.1±13.9)%,组间比较差异无统计学意义(t=0.587,P=0.559)。A组术后1周时VAS评分为(5.2±1.3)分,术后1个月时为(3.5±0.6)分;B组分别为(3.8±0.8)、(2.4±0.4)分,组间不同时间点比较差异均有统计学意义(t=5.567,P<0.001;t=9.289,P<0.001);A组患者C5神经麻痹发生率为7.0%(3/43),B组为11.4%(4/35),两组比较差异无统计学意义(P>0.05)。结论术后颈椎曲度越大脊髓后移越充分,术后颈椎曲度的丢失与轴性症状的发生有关,颈椎曲度与神经功能的恢复及C5神经麻痹的发生无关。     

Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland

Treatment for facial nerve-invading parotid malignancies usually results in complete facial palsy. The authors present a novel technique to treat facial palsy following radical parotid surgery and retrospectively evaluate results in terms of soft tissue symmetry at rest and during smiling and eyelid closure using the eFACE system.9 patients with facial palsy following parotid malignancies resection or undergoing parotidectomy with planned facial nerve resection for tumor invasion were treated with the association of mini-invasive temporalis flap rotation and upper lid lipofilling to restore symmetry of the middle facial third at rest and during smiling and eyelid closure. The technique was employed during the same surgical session as the tumor removal or for secondary facial reanimation.Systematic eFACE evaluation demonstrated significant improvement in static nasolabial fold depth orientation and oral commissure position, palpebral fissure narrowing during eye closure, and oral commissure movement and nasolabial fold depth and orientation with smile (p respectively .008, .011, 0.008, 0.035, 0.011, 0.008, and 0.011, Wilcoxon's test). Furthermore, all patients described subjective improvement of corneal discomfort.The presented technique appears promising in treating facial palsy in oncological patients, representing a potential alternative to other more complex reconstructive techniques.     

渐进式平衡训练方案在全髋关节置换术后患者中的应用

目的研究渐进式平衡训练方案在全髋关节置换术（THA）后患者干预过程中的应用。方法将2017年5月至2020年5月于深圳市宝安区石岩人民医院接受THA治疗的89例患者纳入研究，按照随机数字表法分作A组44例和B组45例。B组开展常规干预，A组则于常规干预基础上增用渐进式平衡训练。分析两组干预前后患者平衡能力、活动状态以及心理状态变化情况的差异。结果干预2周、4周、8周后，A组的Berg平衡量表评分均高于B组（均P＜0.05）；A组的站立行走测试结果短于B组（均P＜0.05）。在干预8周后，A组的SAS、SDS评分低于B组（均P＜0.05）。结论渐进式平衡训练方案的实施可显著改善THA患者的平衡能力，同时有助于减轻患者心理不良情绪，促进活动能力的提升。     

Reliability and validity of the gait classification system in children with cerebral palsy (GCS-CP)

BackgroundGait classification systems (GCS) may enable clinicians to differentiate gait patterns into clinically significant categories that assist in clinical decision-making and assessment of outcomes. Davids and Bagley in 2014 [1] described a GCS for children with cerebral palsy (GCS-CP). The purpose of our study was to use the GCS-CP for the first time on a sample of patients with CP and to evaluate the reliability and utility of the classification system.MethodsThe gait of 131 children with CP was retrospectively reviewed and classified according to Davids and Bagley’s classification using two-dimensional (2D) video and three-dimensional (3D) lower limb kinematics and kinetics. Gross Motor Function Classification System (GMFCS) levels were determined, and the Gait Profile Scores (GPS) calculated to characterize the sample concerning gait classification. The comparison between the groups was performed using the Kruskal-Wallis test with respect to the non-normal distribution of the data. The intrarater and interrater reliability was determined using the Kappa index (k) statistics with 95% CI.ResultsAll GCS-CP groups were represented within the evaluated sample. Of the 131 cases evaluated, 127 (96.95%) were able to be classified with respect to sagittal plane stance phase gait deviations. All patients in the sample were able to be classified with respect to sagittal plane swing phase and transverse plane gait deviations. The interrater reliability was 0.596 and 0.485 for the first and second levels of the classification, respectively, according to the Fleiss’s Kappa statistics. Intrarater reliability was 0.776 and 0.714 for the raters one and two, respectively, according to the Cohen’s Kappa statistics.SignificanceThe GCS-CP exhibited clinical utility, successfully classifying almost all subjects with CP in two planes, based upon kinematic and kinetic data. The classification is valid and has moderate interrater and moderate to substantial intrarater reliability.     

HLA-DRB typing among polyarticular juvenile idiopathic arthritis and progressive pseudorheumatoid dysplasia patients

Juvenile Idiopathic Arthritis (JIA) is a multi-factorial disease influenced both by environmental and genetic factors. Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal recessive genetic disorder affecting multiple joints, mimicking JIA. Aim of the work: to reveal the frequency of HLA-DR types among the studied patients and to correlate the different allele variations clinically. Patients and methods: Thirty JIA patients, in addition to 15 molecularly diagnosed PPD patients were subjected to full history taking and clinical examination. HLA-DRB1 typing was performed to 24/30 JIA and 12/15 PPD cases and thirty healthy age and sex matched children who were included as a control group. Results: The JIA patients were 22 females and 8 males with mean age of 15.8 ± 1.96 years and disease duration 5.3 ± 4.4 years. PPD patients were 8 males and 7 females with mean age of 8.7 ± 3.06 years and disease duration 3.95 ± 2.68 years. A significant frequency of HLA-DRB 04 (p = 0.049) among JIA patients was present in comparison to the controls (OR = 2.81, CI:1.02–7.75), other risky alleles were HLA-DRB 10, 13 and 15. However, HLA-DRB 01, 03, 07, 11 and 14 were found to be protective. HLA-DRB 01, 04, 10 and 13 were found to be risky alleles in PPD. However, HLA 03, 07, 11 and 15 were found to be protective alleles among PPD patients. Conclusion: HLA-DRB 04 was found in a higher frequency in JIA patients with a significant difference in comparison to the controls, denoting that it may play a role in the genetic pathogenesis of JIA.     

Oral health behaviors of preschool children with cerebral palsy: a case‐control community‐based study

To describe and compare the oral health behaviors of preschool children with and without cerebral palsy (CP), and to assess the oral health knowledge and attitudes of their primary caregivers (PCGs). Seventy‐two preschool children with CP were recruited from 23 Special Child Care Centers in Hong Kong. An age‐ (±3 months) and gender‐matched sample of children from mainstream preschools was recruited as a “control group.” Assessment of children's oral health behaviors and the PCGs' oral health knowledge and attitudes was conducted using questionnaires. Preschool children with CP were less likely to have ever attended a dentist (p < 0.05). Tooth brushing frequency was similar between the two groups (p > 0.05), but PCGs of children with CP more frequently reported provision of tooth brushing assistance to their children (p < 0.001). PCGs in both groups had similar oral health knowledge and attitudes (p > 0.05). Difference in oral health behaviors existed between preschool children with and without CP. PCGs of children with and without CP had similar oral health knowledge and attitudes.