Constraint-induced therapy for a child with hemiplegic cerebral palsy: a case report

A 12-year-old boy with hemiplegic cerebral palsy (CP) presented with decreased function in his left upper extremity. He was treated with a 3-week protocol of constraint-induced therapy (CIT) consisting of six 2-hour sessions of physical and occupational therapy, plus home practice. Improvements in upper-extremity function were found in the mean and median time for completion of the Wolf Motor Function Test immediately posttreatment and at 8-month follow-up. Also, improvements in functional use of the arm were documented with the Assessment of Motor and Process Skills and by patient self-report of use of the upper extremity at home. The results suggest that CIT may be useful in the treatment of upper-extremity dysfunction in hemiplegic CP. Larger, experimentally controlled investigations of the efficacy of CIT and the mechanism of recovery in patients with CP are warranted. The effects of the duration and intensity of CIT protocols need additional study to increase its clinical application.     

Free-living energy expenditure reduced after deep brain stimulation surgery for Parkinson's disease

Background: The clinical picture in Parkinson’s disease (PD) is characterized by bradykinesia, rigidity, resting tremor and postural instability. In advanced stages of the disease, many patients will experience reduced efficacy of medication with fluctuations in symptoms and dyskinesias. Surgical treatment with deep brain stimulation in the subthalamic nucleus (STN‐DBS) is now considered the gold standard in fluctuating PD. Many patients experience a gain of weight following the surgery. The aim of this study was to identify possible mechanisms, which may contribute to body weight gain in patients with PD following bilateral STN‐DBS surgery. Methods: Ten patients with PD were studied before bilateral STN‐DBS surgery, and seven patients were studied again 3 and 12 months postoperatively. Clinical examination and resting metabolic rate with and without medical treatment was measured before and after STN‐DBS. Furthermore, free‐living energy expenditure, body composition, energy intake, peak oxygen consumption, maximal workload and leisure time physical activity were measured before and 3 and 12 months after surgery. Results: The STN‐DBS operated patients had a significant weight gain of 4·7 ± 1·6 kg (mean ± SE) 12 months postoperatively, and the weight gain was in the fat mass. The free‐living energy expenditure decreased postoperatively 13 ± 4% even though the reported dietary intake was reduced. A decreased energy expenditure took place in the non‐resting energy expenditure. The reported daily leisure time activity, peak oxygen consumption and maximal workload were unchanged. Conclusion: The STN‐DBS operated patients have a significant postoperative weight gain, as a result of a decrease in free‐living energy expenditure concomitant with an insufficient decrease in energy intake.     

Analysis of electrode deformations in deep brain stimulation surgery

Purpose

Deep brain stimulation (DBS) surgery is used to reduce motor symptoms when movement disorders are refractory to medical treatment. Post-operative brain morphology can induce electrode deformations as the brain recovers from an intervention. The inverse brain shift has a direct impact on accuracy of the targeting stage, so analysis of electrode deformations is needed to predict final positions.

Methods

DBS electrode curvature was evaluated in 76 adults with movement disorders who underwent bilateral stimulation, and the key variables that affect electrode deformations were identified. Non-linear modelling of the electrode axis was performed using post-operative computed tomography (CT) images. A mean curvature index was estimated for each patient electrode. Multivariate analysis was performed using a regression decision tree to create a hierarchy of predictive variables. The identification and classification of key variables that determine electrode curvature were validated with statistical analysis.

Results

The principal variables affecting electrode deformations were found to be the date of the post-operative CT scan and the stimulation target location. The main pathology, patient’s gender, and disease duration had a smaller although important impact on brain shift.

Conclusions

The principal determinants of electrode location accuracy during DBS procedures were identified and validated. These results may be useful for improved electrode targeting with the help of mathematical models.     

2例先天性脑性瘫痪患者剖宫产围手术期护理

目的 探讨先天性脑性瘫痪,简称脑瘫(cerebral palsy;CP)患者,在全麻下足月剖宫产的围手术期护理。方法 对2例脑瘫患者进行个性化的孕晚期支持、术前心理护理、手术配合、术后观察、母乳喂养、新生儿护理等。结果 2例患者均顺利度过围手术期,产后42d随访母婴预后良好。结论 多部门合作与配合,针对性的采取护理措施,是脑瘫患者顺利度过剖宫产围手术期的有效保障。     

早期丰富环境刺激对脑瘫大鼠脑发育的影响

目的：研究丰富环境刺激对脑瘫大鼠脑发育的影响。方法：给予LPS组28只孕16、17日龄大鼠连续两天腹腔注射脂多糖350μg／kg．制备脑瘫动物模型，对照组8只注射等量生理盐水。15日龄两组仔鼠利用神经行为学检测鉴定脑瘫动物模型．并检测脑源性神经生长因子（BDNF）表达。将脑瘫鼠随机分为干预组、非干预组。对干预组进行丰富环境刺激27天．非干预组和对照组常规饲养。结果：干预组与非干预组比较悬吊试验、斜坡试验、旷场试验、拒俘试验、学习能力、记忆能力有显著性差异fP〈0．05与P〈0．01）；干预组与正常对照组比较斜坡试验、姿势、肌张力、学习能力有显著性差异（P〈0．05与P〈0．01）。15日龄脑瘫组与对照组比较，BDNF表达无显著性差异（P〉0．05）；42日龄干预组与非干预组、对照组比较均有显著性差异（P〈0．01）。结论：丰富环境刺激可使脑瘫大鼠肌力、兴奋性、环境适应能力、记忆能力明显增强，达到正常化水平；平衡能力、协调能力、学习能力（或得分）明显增强，但未达到正常化水平；干预组BDNF表达较非干预组，正常对照组明显增加，但未能改善姿势、肌张力、不自主运动能力。     

Stochastic resonance stimulation improves balance in children with cerebral palsy: a case control study

Background

Stochastic Resonance (SR) Stimulation has been used to enhance balance in populations with sensory deficits by improving the detection and transmission of afferent information. Despite the potential promise of SR in improving postural control, its use in individuals with cerebral palsy (CP) is novel. The objective of this study was to investigate the immediate effects of electrical SR stimulation when applied in the ankle muscles and ligaments on postural stability in children with CP and their typically developing (TD) peers.

Methods

Ten children with spastic diplegia (GMFCS level I- III) and ten age-matched TD children participated in this study. For each participant the SR sensory threshold was determined. Then, five different SR intensity levels (no stimulation, 25, 50, 75, and 90% of sensory threshold) were used to identify the optimal SR intensity for each subject. The optimal SR and no stimulation condition were tested while children stood on top of 2 force plates with their eyes open and closed. To assess balance, the center of pressure velocity (COPV) in anteroposterior (A/P) and medial-lateral (M/L) direction, 95% COP confidence ellipse area (COPA), and A/P and M/L root mean square (RMS) measures were computed and compared.

Results

For the CP group, SR significantly decreased COPV in A/P direction, and COPA measures compared to the no stimulation condition for the eyes open condition. In the eyes closed condition, SR significantly decreased COPV only in M/L direction. Children with CP demonstrated greater reduction in all the COP measures but the RMS in M/L direction during the eyes open condition compared to their TD peers. The only significant difference between groups in the eyes closed condition was in the COPV in M/L direction.

Conclusions

SR electrical stimulation may be an effective stimulation approach for decreasing postural sway and has the potential to be used as a therapeutic tool to improve balance. Applying subject-specific SR stimulation intensities is recommended to maximize balance improvements. Overall, balance rehabilitation interventions in CP might be more effective if sensory facilitation methods, like SR, are utilized by the clinicians.

Trial registration

ClinicalTrials.gov identifier NCT02456376; 28 May 2015 (Retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT02456376.

     

Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery: A case report

BACKGROUNDThermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence. They require immediate and appropriate management before they progress to an irreversible condition. Although negative pressure wound therapy (NPWT) can prevent wound progression by increasing microcirculation, the inappropriate application of NPWT on complication-threatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARYA 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap. While applying a heating pad directly to the flap site, she sustained a deep second to third-degree contact burn over 30% of the transferred flap on postoperative 7 d. As the necrotic changes had progressed, we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d. After 4 d of NPWT application, the exposed fatty tissues of the flap changed to dry and brown-colored necrotic tissues. Upon further debridement, we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSIONAlthough NPWT has been shown to be successful for treating various wound types, the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.     

Postpartum care of a woman with cerebral palsy and deep vein thrombosis: a case study

Pregnancy can be challenging for women with cerebral palsy. Physical limitations and comorbidities can predispose them to complications during pregnancy, such as deep vein thrombosis and pulmonary embolism, making their care needs more complex. A multidisciplinary care plan, as well as clear and effective communication among different health care providers, will help ensure safe and optimal postpartum care of women with cerebral palsy and their newborns.     

重复经颅磁刺激治疗脑卒中后认知障碍病例报道1例

目的分析1例重复经颅磁刺激治疗脑卒中后认知障碍的病例,以期为卒中后认知障碍(PSCI)的临床治疗提供参考。方法给予该PSCI患者基础药物治疗,在此基础上应用重复经颅磁刺激(rTMS)治疗。比较治疗前、后的简易精神状态评价量表(MMSE)、日常生活能力(ADL)评定量表评分。结果16次规范治疗后,患者的MMSE评分由13分提升到26分;ADL评定量表评分从25分提升到60分。结论本病例研究发现,rTMS治疗PSCI患者的临床效果显著,但起效缓慢,早期疗效不明显,最佳治疗周期尚需进一步研究。     

康复训练对骨科术后深静脉血栓的预防作用

目的探讨康复训练对于骨科术后下肢深静脉血栓(DVT)的预防作用。方法选择68例骨科手术患者,术后进行下肢的被动及主动活动,包括踝关节的屈伸活动,膝关节的屈伸活动及股四头肌的等长收缩活动,应用彩色多普勒超声测定康复功能训练前与训练后下肢血流速度的变化。结果该研究中的病例均无DVT发生。踝关节、膝关节的主动、被动运动均可增加股动、静脉的血流速度,包括峰速度及平均速度,运动前后比较差异有统计学意义(P0.05),而且主动运动增加血流速度的幅度要明显高于被动运动(P0.05)。结论正规康复功能训练可促进患肢静脉回流,避免血流滞缓,达到预防下肢DVT的目的,具有简单、安全、有效、无创伤等优点,不需特殊设备,不会给患者增加经济负担,因此在临床及护理工作中有极大的应用价值。     

Gait training using a hybrid assistive limb after botulinum toxin treatment for cerebral palsy: a case report

[Purpose] Hybrid Assistive Limb^® (HAL; Cyberdyne, Tsukuba, Japan) is a wearable robot that assists patients based on their voluntary movements. We report gait training with HAL after botulinum toxin treatment for spasticity of the lower limb in cerebral palsy (CP). [Participant and Methods] The participant was a 36 year-old male with spastic diplegia due to periventricular leukomalacia, with Gross Motor Function Classification System (GMFCS) level II. HAL training was performed in 20-minute sessions (3 sessions/week for 4 weeks). The outcome measures were range of motion, spasticity, walking ability, muscle strength, gross motor function measure (GMFM), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory measured before, immediately after, and one, two, and three months after HAL training. [Results] No adverse events were observed during training. After the HAL intervention, gait speed, step length, cadence, 6-min walking distance (6MD), knee extension strength, GMFM, and COPM increased, and Physiological Cost Index declined. Three months post-intervention, gait speed, step length, cadence, 6MD, and GMFM remained higher than those observed within the first two months. [Conclusion] Gait training with HAL can be a safe and feasible method for patients with CP who undergo botulinum toxin treatment to improve walking ability and motor function.     

Femoral,saphenous nerve palsy after tourniquet use: a case report

Persistent motor and sensory abnormalities after surgery may affect the rehabilitation process. Patients with continued weakness may be perceived as lacking motivation by health care providers. However, there may be an underlying pathophysiologic abnormality preventing patients from progressing through their rehabilitation programs. We report a case of a 20-year-old man who underwent surgical repair of multiple knee structures with the use of a pneumatic tourniquet. Several weeks after surgery, electromyographic evaluation was done because he was having difficulty in his rehabilitation because of persistent weakness. An electromyography and nerve conduction study (NCS) revealed femoral and saphenous nerve palsies. Our report is the first on tourniquet-induced saphenous nerve injury as well as on abnormal femoral NCSs caused by tourniquet use. A review of the literature indicates that tourniquet-induced nerve palsies are not a rare event. Further evaluation should be considered if patients who are having persistent weakness or sensory findings after surgery have used a tourniquet.     

Effect of brain shift on the creation of functional atlases for deep brain stimulation surgery

Purpose  

In the recent past many groups have tried to build functional atlases of the deep brain using intra-operatively acquired information such as stimulation responses or micro-electrode recordings. An underlying assumption in building such atlases is that anatomical structures do not move between pre-operative imaging and intra-operative recording. In this study, we present evidences that this assumption is not valid. We quantify the effect of brain shift between pre-operative imaging and intra-operative recording on the creation of functional atlases using intra-operative somatotopy recordings and stimulation response data.     

预见性护理干预对骨科患者术后深静脉血栓形成的预防作用

目的：探讨预见性护理干预对骨科患者术后深静脉血栓形成的预防作用。方法选择本院收治的骨科手术患者共106例,按照随机数字表法将其随机分为干预组56例、对照组50例,对照组患者采取常规护理,干预组在常规护理基础上加用预见性护理,比较2组患者DVT发生率、住院时间、患者对护理满意度以及术前、术后7 d血浆D-二聚体水平。结果干预组DVT发生率显著低于对照组,差异具有统计学意义（P＜0．05）;干预组患者住院时间显著短于对照组,差异具有统计学意义（P＜0．05）;干预组患者对护理总满意率为94．64％,对照组患者对护理总满意率为82．00％,2组比较差异具有统计学意义（P＜0．05）;术前比较,2组患者血浆D-二聚体水平差异不具有统计学意义（P＞0．05）;术后7 d,2组患者血浆D-二聚体水平均较术前显著升高（P＜0．05）;术后7 d干预组血浆D-二聚体水平显著低于对照组（P＜0．05）。结论采用预见性护理,能够预防患者深静脉血栓的形成,缩短患者的住院时间,提高患者对护理的满意度,值得临床上推广运用。     

Robotic therapy and botulinum toxin type A: a novel intervention approach for cerebral palsy

The combined effects of robotic therapy and botulinum toxin type A (BTX-A) on upper-limb movement and function were studied in an 8(1/2)-yr-old child with hemiplegic cerebral palsy. Robotic therapy comprising repetitive, goal-directed reaching tasks was administered two times per week for 8 wks. Clinical measures included the Modified Ashworth Scale, the Quality of Upper Extremity Skills Test, and the Fugl-Meyer Assessment (upper-limb section). Improvements in upper-limb coordination and quality of motor performance were apparent throughout the robotic therapy trial. The observed gains are comparable with those attained from conventional occupational therapy combined with BTX-A. A parent questionnaire indicated that the amount of paretic arm use also improved during daily activities at home. This preliminary study indicates that robotic therapy may be a useful clinical tool when combined with BTX-A injections for improving upper-limb coordination and quality of motor performance in children with cerebral palsy.     

脑瘫患儿口运动障碍的治疗方法与疗效评价

目的探讨口腔感觉运动刺激治疗法对脑瘫患儿口运动障碍的疗效.方法对32例口运动障碍的脑瘫患儿行神经病学检查评价脑瘫类型,Gesell发育评分评价运动发育年龄.语言治疗师对患者进行口腔感觉运动刺激治疗,治疗前后分别测定口运动评分、构音能力、语言理解和表达商.结果治疗后脑瘫患儿口运动评分平均提高14.94分,明显高于治疗前(t=11.946,P<0.01);语言理解商与表达商各平均提高11.72和13.56;较治疗前亦明显提高(t值分别为5.376和7.552,P<0.01).28例(87.5%)患儿构音能力明显改善.结论口腔感觉运动刺激治疗法治疗脑瘫患儿的口运动功能和构音障碍疗效显著,对语言理解和言语表达能力的提高亦有明显治疗效果.     

D-9二聚体对老年人骨科大手术后深静脉血栓的诊断价值

目的探讨血浆D-9二聚体对老年人骨科大手术后发生深静脉血栓的临床价值。方法本组入选对象为我院2008年1月-2010年骨科住院患者60例,60例老年骨科手术根据是否深静脉血栓分为A组并发深静脉血栓22例、B组未并发深静脉血栓38例,采用酶联免疫吸附试验双抗体夹心法分别检测患者术前、术后第1天、第3天的血浆D-9二聚体的含量,并进行比较。结果两组术前血浆D-9二聚体含量比较差异无显著性,随着时间的增加,两组血浆D-9二聚体含量也呈渐进性增加,且术后第1天、术后第3天的血浆D-9二聚体含量两组间分别比较,差异有显著性。结论观察骨科老年人患者术后D-9二聚体的变化水平,对于了解是否并发深静脉血栓及病情变化和预后具有重要的临床意义。     

3岁以内脑性瘫痪患儿的康复治疗

目的：探讨３ 岁以内脑瘫患儿的康复治疗效果。方法： 运用综合康复疗法对３ 岁以内患儿进行了治疗观察。结果：经精神发育检测所得发育商（ＤＱ）对治疗效果进行评定,总有效率达７７．９１％ 。结论：说明只要早期诊断, 早期康复治疗, 大多数患儿的运动功能和智力都能得到改善。