Reliability and validity of the Turkish version of Fullerton Advanced Balance Scale in cerebral palsy

BackgroundThe Fullerton Advanced Balance Scale (FAB) is a multi-item balance assessment test designed to measure balance in relatively higher functioning individuals. The aim of this study was to examine the reliability and validity of the Turkish version of the FAB (FAB-T) in children with cerebral palsy (CP).Research questionIs the Turkish version of the Fullerton Advance Balance Scale valid and reliable in determining balance problems in children with cerebral palsy and determining the underlying cause of this condition?MethodsForty-six children with CP participated in this study. Rasch analysis was used to investigate item adherence. Internal consistency of the FAB-T was established using Cronbach's alpha coefficient. Test-retest reliability was also evaluated. In addition, to assess concurrent validity, FAB-T scores were compared with the Pediatric Balance Scale (PBS) using the Spearman correlation coefficient.ResultsThe FAB-T showed satisfactory internal consistency (Cronbach's alpha value=0.94) and excellent test-retest reliability (ICC=0.99). The FAB and the PBS exhibited concurrent positive validity (r = 0.913; p < 0.001). All items of the FAB-T were found to fit the Rasch Model (Chi-square 16.01(df=20), p = 0.716).SignificanceThe FAB-T is a reliable and valid tool that can be used to measure balance skills and to identify the source of the problem in children with CP.     

中药药浴治疗痉挛型脑性瘫痪患儿的临床效果

目的研究中药药浴治疗痉挛型脑性瘫痪患儿的临床效果。方法选取2021年1月至12月于粤北人民医院儿童康复科确诊的80例痉挛型脑性瘫痪患儿,按随机数字表法分为对照组和观察组,每组各40例。对照组实施常规康复疗法,涉及运动疗法、作业疗法、物理因子治疗等,观察组进行常规康复治疗并结合中药药浴疗法,分别评估两组的肌张力及大运动功能并进行比较。结果治疗后观察组的肌张力低于对照组,大运动功能评估得分高于对照组,差异均有统计学意义(P<0.05)。结论中药药浴治疗痉挛型脑性瘫痪患儿可获得显著的效果,可改善肌张力,促进大运动功能提升,具有临床推广价值。     

中医疗法结合3D打印技术治疗中重度肘管综合征

目的:观察应用3D打印技术指导下的尺神经沟扩大成形术结合尺神经原位松解,术后给予针刺促进神经康复来治疗中重度肘管综合征的临床疗效。方法:自2016年4月—2019年3月,对40例由于肘关节退行性病变引起的尺神经沟骨赘生成造成尺神经卡压的中重度肘管综合征患者,根据其术前肘关节CT平扫三维重建应用3D打印技术打印肘关节模型,根据我院骨科人员提出的"肘管指数"概念,经电脑辅助计算尺神经沟正常尺寸并制作个性化的磨骨"试模",术中原位松解尺神经沟后,将尺神经牵至后方保护,切开关节囊,根据磨骨"试模"大小应用磨钻打磨扩大加深尺神经沟,尺神经松解后重新还纳入扩大的肘管内,重建弓状韧带缝回,术后在常规预防感染,营养神经治疗的同时,应用针刺的方法进行治疗,取穴以尺神经走行手太阳小肠经穴位为主,10天为1个疗程,针刺3个疗程,每疗程结束后休息3天。结果:40例患者术后伤口均一期愈合,未见血肿形成,其中1例患者因恐惧针刺而中途放弃针灸治疗。所有患者术后得到随访,随访时间12～18个月,平均13.6个月。将术后12个月与术前的运动感觉传导速度、两点辨别觉、握力、侧方捏力(占对侧百分比)进行比较,均有明显提高,有统计学差异(P0.05)。根据中华医学会手外科分会上肢部分功能评定试用标准评价手部功能:优28例,良10例,可1例,差1例,优良率95%。结论:应用3D打印技术指导下的肘管扩大成形术+尺神经原位松解,术后结合中医针灸治疗中重度肘管综合征,有一定的临床疗效。     

Hip Displacement in Cerebral Palsy: The Role of Surveillance

IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.     

Importancia de algunos aspectos técnicos del procedimiento de estimulación percutánea del nervio tibial posterior en pacientes con incontinencia fecal

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Uncommon causes of nerve compression in the distal forearm

IntroductionNerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome.Clinical casesWe present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve, as demonstrated by ultrasound evaluation.DiscussionThe reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel, due to the maintenance of residual symptoms.ConclusionCareful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.