Impact of cerebral visual impairment on the everyday life of cerebral palsied children

Summary A group of 43 patients suffering from cerebral palsy and cerebral visual impairment was compared with a group of 24 cerebral palsy patients with normal visual acuity, with regard to a functional level in daily life. Four categories were considered: communication, emotional contact, self-care and intelligence. Cerebral visual impairment-cerebral palsy patients scored significantly lower in all categories than cerebral palsy patients with normal visual acuity. In the cerebral visual impairment-cerebral palsy group, there was a higher frequency of tetraplegia compared with the group with normal acuity, but even after this predominance had been excluded, a significant difference remained. When dealing with cerebral palsy patients, occurrence of cerebral visual impairment must be taken into account. By initiating intervention programmes, one can prevent extra handicaps due to the consequences of diminished visual acuity.     

活动义齿修复中磁性附着体的应用探究

目的：探讨活动义齿修复中磁性附着体的应用价值。方法：采用回顾性方法分析,选取2016年12月～2018年12月本院收治的45例活动义齿修复患者的临床资料,根据随机数字表法分组,观察组23例采用磁性附着体,对照组22例采用铸造支架活动义齿修复,对比总有效率、咀嚼效率、固位力、牙齿功能和修复后并发症。结果：观察组患者的修复总有效率高于对照组,治疗前对比于两组的咀嚼效率、固位力和牙齿功能无差异（P>0.05）,治疗后观察组的咀嚼效率、固位力和牙齿功能评分高于对照组（P<0.05）。观察组患者的修复并发症发生率低于对照组（P<0.05）。结论：活动义齿修复中应用磁性附着体,可改善咀嚼效率和固位力,且能恢复牙齿功能,减少并发症,具有临床意义。     

低频电刺激联合针刺治疗脑瘫儿童流涎的疗效观察

目的 观察在口腔康复训练的基础上使用低频电刺激联合针刺治疗脑瘫患儿流涎的临床效果。方法 将45例伴有流涎的脑瘫患儿按随机数字表法分为观察组23例和对照组22例,对照组仅接受口腔康复训练,观察组在对照组基础上加低频电刺激和针刺治疗。在治疗前及治疗后对患儿采用教师流涎分级法评定。结果 治疗后,观察组和对照组TDS均较治疗前改善(P<0.05),治疗后组间比较观察组优于对照组(U=2.97,P=0.03),总有效率分别为91.30%和63.64%,两组间差异有统计学意义(χ²=6.63,P=0.04)。结论 在口腔康复训练的基础上加用低频电刺激联合针刺疗法能明显改善脑瘫患儿流涎症状,进一步提高康复疗效。     

Success in life for older adolescents with cerebral palsy

In this article, the psychosocial themes emerging from an exploratory qualitative study are reported. Using a constant comparative method, the authors describe how older adolescents with cerebral palsy defined success in life and the factors they viewed as helping or hindering their success. Participants were 10 adolescents with cerebral palsy between 18 and 20 years of age who took part in a semistructured interview exploring their perceptions of success. For these adolescents, success meant being happy in life. Three key psychosocial factors were related to success in life: being believed in, believing in yourself, and being accepted by others (belonging). The findings are useful in guiding the design of services to meet the life needs of individuals with disabilities.     

Statistical analysis of gait patterns of persons with cerebral palsy

Patients at Boston's Children's Hospital diagnosed as having cerebral palsy were filmed walking. These films were digitized and translated into measurements associated with leg motion. In this paper we use the gait measurements of 128 such patients to illustrate that the kth nearest neighbour clustering procedure results in a gait typology for patients with cerebral palsy. The procedure identifies four subpopulations from the sample data; the membership of a patient within this typology is mostly determined by the patient's motor control. The developed typology differs from the present diagnostic system which classifies a cerebral palsy patient as either quadriplegic, diaplegic or hemiplegic.     

早产脑损伤患儿脑瘫101例的危险因素分析

目的 探讨1岁以内有神经学异常的早产脑损伤患儿发生脑瘫的危险因素,为降低其脑瘫的发生率和伤残程度、早产儿脑瘫的早期正确诊断提供临床依据。方法 对101例年龄<1岁有神经学异常的早产脑损伤患儿进行随访观察,应用Logistic单因素法和逐步回归法分析脑瘫的危险因素。结果 随访至2岁时101例患儿中51例(50.50%)确诊为脑瘫,出生胎龄<32周、出生体重<2 500 g、头围<x--s、双眼内斜视、肌张力≥I⁺级、踝阵挛阳性、颅脑磁共振(MRI)显示脑室周围白质软化(periventricular leukomalacia,PVL)或基底节损伤、就诊时Gesell大运动发育商(DQ)<55分及进步速度<0.75是1岁以内有神经学异常的早产脑损伤患儿脑瘫的危险因素(P<0.05)。 结论 出生胎龄小,出生体重低、头围小、双眼内斜视,且肌张力高、踝阵挛阳性、颅脑MRI显示存在PVL或基底节损伤、就诊时大运动DQ低、进步速度慢对早产脑损伤患儿发生脑瘫有预测价值。建议临床上对早产脑损伤患儿的上述相关指标进行常规检查,并极力改善。早产儿早期肌张力增高应结合其他因素综合考虑、谨慎判断。     

两种方法修复牙列缺损的临床研究

目的：比较两种方法用于修复后牙游离缺失伴残根残冠的修复效果。方法：选择38例后牙游离缺失伴残根残冠的患者,按随机数字表法将其分为两组,分别采用冠外栓道式精密附着体义齿（n=17）和卡环固位活动义齿修复（n=21）,5年后对修复效果进行评价。结果：冠外栓道式精密附着体义齿组出现1例崩瓷,无冠桩松动脱落、根折、桩折、牙周炎和根尖周炎,无活动部分破损,成功率为94．1％;卡环固位活动义齿组出现8例失败,成功率为61．9％,两组成功率比较差异有统计学意义（P〈0．05）。结论：对于后牙游离缺失伴残根残冠的牙列缺损病例,选用冠外栓道式精密附着体义齿修复的临床效果较好,值得临床推广使用。     

脑瘫儿童在CRT测验中反映的智力特征

目的分析脑瘫儿童在瑞文测试联合型测验(简称CRT)中所反映的智力特征。方法对78例脑瘫儿童和年龄性别与脑瘫儿童相匹配的无神经系统疾病的78例正常学龄儿童均采用CRT量表进行智力测试。结果 78例脑瘫儿童中有63例伴有智力发育迟缓。脑瘫儿童与正常儿童瑞文各单元及总分得分均有显著性差异(p<0.001)。不同类型的脑瘫儿童瑞文得分存在显著性差异(p<0.001)。结论脑瘫儿童的智力比正常儿童差;手足徐动型的脑瘫儿童一般智力因素好于痉挛型和共济失调型的脑瘫儿童。     

Prevalence of cerebral palsy in China

BACKGROUND: A population-based study on the prevalence of cerebral palsy has not been previously carried out in China. The purpose of the present paper was to determine the overall and birthweight-specific prevalence of cerebral palsy. METHODS: A cross-sectional study of cerebral palsy was carried out among 388192 children aged <7 years in seven cities of Jiangsu province in China from May to July 1997. Information about birthweight was obtained from routine health care records. Doctors from township and city hospitals examined all eligible children and doctors at city level finally diagnosed all cases. All the doctors involved had taken part in a training programme held by Beijing Medical University in April 1997. RESULTS: The total prevalence of cerebral palsy was 1.6 per 1000 children and the birthweight-adjusted prevalence 2.8 per 1000 children (using Australia's neonatal survivors 1994 as a standard population). The overall neonatal mortality rate was 6.8 per 1000 live births, being highest (581.1 per 1000) in the 1000-1499 g birthweight group. The birthweight-specific cerebral palsy prevalence ranged from 0.8 per 1000 children in children weighing 3750-3999 g to 67.3 in children weighing 1500-1749 g. Children weighing 3500-3999 g at birth were at the lowest risk of cerebral palsy. In a given low birthweight group the prevalence of cerebral palsy in China was higher than that in developed countries even though this study was unable to include those who died at risk of, or with cerebral palsy. However, the prevalence of cerebral palsy at normal birthweight was almost the same as that in developed countries. In all, about 2% of all children were of low birthweight (<2500 g), with those weighing <1500 g accounting for about 0.02%. Children weighing <2500 g at birth contributed 24% of all cerebral palsy cases with 99% in the group 1500-2499 g. CONCLUSIONS: The prevalence of cerebral palsy for children aged <7 years is 1.6 per 1000 children. It is estimated that there are 310000 children with cerebral palsy in China and as the survival of low birthweight infants improves the prevalence of cerebral palsy will rise. Survival of low birthweight infants is lower in China than in developed countries and our findings suggest the survival quality of these Chinese children needs to be improved and that intrapartum and neonatal antecedents might play an important role in the aetiology of cerebral palsy compared to developed countries.     

Cerebral palsy and multiple births in China

BACKGROUND: A population-based study on prevalence of cerebral palsy in multiple births has not been carried out in China. The purpose of this paper was to determine the prevalence of cerebral palsy in multiple births and to explore the influence of multiple pregnancy on cerebral palsy after controlling for birthweight. METHODS: A cross-sectional study of cerebral palsy was carried out among 388,192 children aged <7 years in seven cities of Jiangsu province in China. Information about birthweight and plurality was obtained from routine health care records. Pediatricians at city level diagnosed all cases. All the doctors involved had taken part in a training programme held by Beijing Medical University. Stratified analysis by birthweight and its standard normal deviate was employed to compare the prevalence of cerebral palsy in multiples and singletons. RESULTS: The prevalence of cerebral palsy for children aged <7 years in multiples was 9.7 per 1000 children (95% confidence interval [CI]: 6.5-14.0), which was 6.5 times that in singletons (95% CI: 4.4-9.3). The overall neonatal mortality rate was 60.9 per 1000 liveborn multiples, being highest (944.4 per 1000) in the 500-999 g birthweight groups. Most liveborn multiples weighing <1500 g at birth probably died from diseases related to very low birthweight prior to this study. The prevalence of cerebral palsy in multiple births was likely to be higher than that reported in developed countries for children weighing 1500-2499 g even though our data were from a cross-sectional study. When stratified by birthweight, the prevalence of cerebral palsy in multiples weighing <2500 g had tended to be lower than that of singletons in the same birthweight group. In contrast, in normal birthweight categories multiple births had a higher prevalence of cerebral palsy than singletons. When stratified by birthweight normal deviate, the prevalence of cerebral palsy in multiple births was uniformly higher than that in singletons in all birthweight strata and the prevalence of cerebral palsy among multiples appeared to be augmented as birthweight increased. CONCLUSION: The prevalence of cerebral palsy in multiples, 9.7 per 1000 children, is 6.5 times that in singletons. Survival of low birthweight infants is lower in China than in developed countries and survival quality of Chinese children weighing 1500-2499 g needs to be further improved. In terms of birthweight multiples and singletons may be heterogeneous. It might be difficult to directly use actual birthweight specific prevalence to compare the prevalence of cerebral palsy in multiples and singletons. Birthweight normal deviate specific prevalence of cerebral palsy suggests that multiple pregnancy is an independent risk factor for cerebral palsy in all birthweight groups. Multiples are in adverse circumstances very early in gestation and as the foetus matures the risk of cerebral palsy increases.     

早产儿网络化管理的临床研究

目的:探讨早产儿网络化管理的临床效果。方法:对2004年1月～2007年1月经我院网络转运1057例早产儿的临床资料进行统计分析。结果:1057例早产儿网络转运途中无1例死亡,转运成功率100%;治愈873例(82.6%),好转146例(13.8%),死亡15例(1.4%),自动出院12例(1.1%),转科治疗11例(1.0%);发生脑瘫8例,脑瘫发生率0.78%;1057例早产儿以窒息、吸入性肺炎、肺透明膜病、缺血缺氧性脑病(HIE)与颅内出血等疾病居多,共占81.6%(862/1057)。结论:通过早产儿院前急救→转运→救治→早期干预→康复的网络化管理,对降低早产儿病死率与改善早产儿的远期预后起到积极作用,同时也提高了网络转运基层医院的围产医疗保健水平。     

To what extent do children with cerebral palsy participate in everyday life situations?

The aims of the study are to describe participation of children with cerebral palsy in everyday life situations, to investigate the relationship between participation (primary outcome variable) with child and parent characteristics (independent variables) and to compare the frequency of participation (secondary outcome variable) of children with cerebral palsy with children without disabilities. A cross‐sectional survey of parents of children with cerebral palsy in Northern Ireland was undertaken in families’ homes using standard questionnaires. Children with cerebral palsy born between 31/8/1991 and 1/4/1997 were identified from a case register of people with the condition. A total of 102 parents opted in (51% response rate). Questionnaires included the Life Habits Questionnaire (Life‐H) to measure difficulties in participation and The Frequency of Participation Questionnaire (FPQ), to measure frequency of participation with comparative data for children without disability. Overall, children with cerebral palsy participated less often than their non‐disabled peers across a number of lifestyle and cultural pursuits. Among the 102 children with cerebral palsy, participation in ‘relationships’ was the least disrupted area of everyday life and aspects of ‘school’, ‘personal care’ and ‘mobility’ were the most disrupted. Children with cerebral palsy and severe co‐impairments were significantly less likely to experience higher levels of participation in most areas of everyday life when compared to children with cerebral palsy and no severe co‐impairments. Child physical and psychological well‐being did not influence participation although higher parenting stress was significantly related to lower child participation in ‘community activities’. Participation is an important health outcome for children with cerebral palsy and should be incorporated in routine clinical practice. Professionals have a role to play both at the level of addressing individual child and family needs as well as influencing legislation and policy to ensure improved access to services and local communities.     

The adult with cerebral palsy

Important aspects of eliciting a proper history, obtaining a review of systems, and performing a physical examination in adults with cerebral palsy are presented. Information regarding diagnosis, etiology, and epidemiology of cerebral palsy as well as suggestions for performing examinations and procedures on uncooperative and extremely dysmorphic patients are included. A MEDLINE search of all English-language publications related to cerebral palsy from 1985 to 1999 was conducted. Other older references also were obtained from articles published during this period. Our personal experiences in caring for a group of approximately 300 adults with cerebral palsy and other developmental disabilities in specialized centers for nearly a decade are used frequently throughout this review. Emphasis is given to studies of adults. Studies of children are included because there is a lack of data on adults. These studies are identified as such in the text, with extrapolation to adults only where there is a sound clinical or scientific basis. The number of adults with cerebral palsy is increasing. This growth is due to increased survival of low-birth-weight infants and increased longevity of the adult population. Depending on clinical status and the age at which survival is calculated, 65% to 90% of children survive until adulthood. Despite these observations, there is a lack of information in the literature and a lack of relevant post-graduate training programs for physicians in the adult health care system.     

Changes in mental health and quality of life with dental implants as evaluated by General Health Questionnaire (GHQ) and Health Utilities Index (HUI)

Objectives

The purpose of this study was to assess and compare the improvement in oral and systemic conditions and health-related quality of life in patients with missing teeth receiving dental implants and conventional treatment.

Methods

A total of 97 patients with missing teeth, of whom 59 received dental implants and 38 received conventional treatment, were included in this study. The patients were divided into two age groups for a more detailed analysis: a 30- to 59-year age group (young) and a >60-year age group. The changes in oral condition, mental health, and health utility level before and after (pre- and post-, respectively) the procedures were assessed using an original questionnaire, the General Health Questionnaire 12 (GHQ12), and Health Utilities Index Mark 3.

Results

Responses to the GHQ12 indicated that treatment with implants significantly improved the oral health of patients in all treatment groups, except for the young group receiving partial dentures (PD). The mental state improved with a lower GHQ score; in terms of pre- versus post-procedure, mental state improved after the procedure in the young group receiving full dentures (FD) (1.75 ± 2.12 vs. 0.88 ± 2.10, p < 0.05), in the old group receiving PD (2.61 ± 3.91 vs. 0.72 ± 1.71, p < 0.05), and in the old group receiving FD (2.63 ± 3.12 vs. 0.44 ± 0.27, p < 0.05). The sleep score also improved by implant in FD of the old group (2.00 vs. 1.00, p < 0.05); it also is better with a lower score.

Conclusions

Recovery of oral function and oral stability in middle-aged people who did not receive implants was possible with PD. However, the results suggest that implant treatment in edentulous denture cases and particularly in elderly people with dentures has a certain efficacy on the physical condition mediated through an improvement in aspects of the mental state.     

软组织松解术治疗脑瘫痉挛性四肢畸形

目的评价软组织松解术治疗脑瘫痉挛性四肢畸形的疗效。方法采用软组织松解术治疗脑瘫痉挛性四肢畸形60例,松解术后均采用石膏固定6周,6周后改为夜间支具固定,白天去除固定进行康复功能锻炼,一直坚持3~5年,年龄较小者则坚持到12岁以上。结果随诊平均3.8年(0.5~7.0年),优39例,良16例,差2例,优良率为91.67%。结论软组织松解术是一种治疗脑瘫痉挛性四肢畸形的有效方法之一。     

脑瘫儿童营养状况的影响因素研究进展

脑性瘫痪是继发于婴幼儿早期中枢神经系统损伤的一种姿势和运动发育障碍。近20年来,人们不仅只关注脑瘫儿童的肢体残疾问题,还会关注其营养健康问题。已有的研究发现脑瘫儿童存在多方面的营养问题。这些问题不仅会影响脑瘫儿童的预后,还会影响脑瘫儿童的生长发育甚至预期寿命。脑瘫儿童的营养问题已被康复临床所关注。本文综述近年来国内外文献并多维度分析影响脑瘫儿童营养状况的因素,希望为脑瘫儿童的临床营养干预提供切入点。     

A Parent Group for the Hispanic Parents of Children With Severe Cerebral Palsy

Children severely affected by cerebral palsy representa major challenge for their parents These parents have special educational and emotional support needs At Orthopaedic Hospital, this challenge has been met through the use of a prior parent group project A group of Hispanic parents of children with severe cerebral palsy was formed to educate about the childrens medical condition and to provide a forum for mutuai support among parents with similar challenges Language and cultural considerations were an integral part of the intervention A secondary gain that resuhed from this intervention was the improved use of the health care professional s time As a result of the group experience, parents became better health care managers for their children as measured by the childs weight, hospital usage, utilization of the educational system, and selfratings.     

Salivary parameters in Brazilian individuals with cerebral palsy who drool

Background Although drooling of saliva is considered abnormal in a child over 4 years of age, it has been estimated to occur in approximately in 10–37% of children with cerebral palsy. Aim The aim of this study was to evaluate the flow rate, pH and buffering capacity in saliva of Brazilian individuals with cerebral palsy who drool. Methods Cross‐sectional assessment of saliva from 139 individuals with cerebral palsy (3–16 years old) enrolled in a specialized rehabilitation centre in Sao Paulo, Brazil, divided into two groups, according to the presence (G1) or absence (G2) of drooling and controls (G3): G1 consisted of 63 individuals who drool; G2 consisted of 76 who do not drool; and G3 consisted of 47 individuals with no neurological damage of similar age and sex. Unstimulated whole saliva was collected and salivary flow rate (mL/min), initial pH and buffering capacity, by titration of saliva with a constant amount of 0.01 N HCl, were evaluated. The results from G1, G2 and G3 were compared by one‐way anova and the χ²‐test. Results A higher percentage of severe drooling (60.3%) was observed compared with moderate (27.0%) and mild (12.7%) in the cerebral palsy individuals who drool and the prevalence of drooling was highest among children and adolescents with spastic quadriplegia. Significant reductions in salivary flow rate, initial pH, buffering capacity of whole saliva in pH range 6.0–6.9 and total buffering capacity occurred in G1 and G2 compared with G3. Conclusion All individuals with cerebral palsy present lower flow rate, pH and buffering capacity of saliva, which increases the risk of oral diseases.     

Vojta姿势反射诊断早期脑瘫的临床价值

目的:探讨Vojta姿势反射检查在小儿脑瘫早期的诊断价值。方法:应用Vojta姿势反射检查法对有围产期高危因素的12个月以内婴儿及脑瘫患儿共160例进行神经发育检查及相关因素调查,并对结果进行统计学分析。结果:160例婴儿中Vojta姿势反射检查95例异常,疑诊为脑瘫95例,临床诊断脑瘫86例,Vojta姿势反射检查法与临床对脑瘫的诊断符合率为91.86%(79/86),两者相关性检验X2=81.352,P<0。001;配对X2检验,P>0.05。结论:Vojta姿势反射检查诊断早期脑瘫敏感性高,与临床诊断符合率为91.86％。Vojta姿势反射检查结合运动发育检查是目前诊断早期脑瘫较为准确而敏感的方法之一,在早期脑瘫筛查工作中具有重要的诊断价值,若能结合头颅CT或MRI等辅助检查,将极大提高早期诊断准确性,在儿童保健门诊开展神经发育筛查工作对早期发现、早期干预具有可行性及重要意义。