Effectiveness of resistance training in combination with botulinum toxin-A on hand and arm use in children with cerebral palsy: A pre-post intervention study

ABSTRACT: BACKGROUND: The aim of this study was to investigate effects of additional strength training after use of Botulinum Toxin-A (BoNT-A) in the upper limbs of children with cerebral palsy (CP). METHODS: Ten children with CP (range 9 - 17 years, Manual Ability Classification System II) with unilaterally affected upper limbs were assigned to two intervention groups. One group received BoNT-A treatment (group B), the other BoNT-A plus 8 weeks strength training (group BT). Hand activity was measured with Melbourne assessment of unilateral upper limb function (Melbourne) and Assisting Hand Assessment (AHA). Measures of muscle strength, muscle tone, and active range of motion were used to assess neuromuscular body function. Measurements were performed before and two and five months after intervention start. Change scores and differences between the groups in change scores were statistically tested in SPSS version 18, using Mann-Whitney U test and Wilcoxon Signed Rank test, respectively. RESULTS: Both groups had very small improvements in AHA and Melbourne two months after BoNT-A injections, without differences between groups. There were significant, or close to significant, short-term treatment effects in favour of group BT for muscle strength in injected (elbow flexion strength, p=0.08) and non-injected muscles (elbow extension and supination strength, both p=0.05), without concomitant increases in muscle tone. Active supination range improved in both groups but more so in group BT (p= 0.09). There were no differences between the groups three months after training ended. CONCLUSIONS: Strength training strengthens non-injected muscles temporarily and may reduce short term strength loss that results from BoNT-A injections without increasing muscle tone. Moreover, additional strength training may increase active range of motion to a larger extent than BoNT-A alone. None of the improvements in neuromuscular body functions further improved hand activity. Larger clinical trials are needed to further investigate whether strength training can counteract strength loss caused by BoNT-A, whether the combination of BoNT-A and strength training is superior to BoNT-A or strength training alone in improving active range of motion, and whether more task-related strength training is a more effective approach to improve hand activity.     

Development and Validation of the Both Hands Assessment for Children With Bilateral Cerebral Palsy

Aims: To develop a hand function test for children with bilateral cerebral palsy (CP) measuring bimanual performance, including quantification of possible asymmetry of hand use. Method: The Both Hands Assessment (BoHA) content was developed through adaptation of the Assisting Hand Assessment (version 5.0). Data from 171 children with bilateral CP, 22-months to 13 years olds (75 females; mean age: 6 years and 6 months) classified at Manual Ability Classification System (MACS) levels I-III, was entered into Rasch measurement model analyses to evaluate internal scale validity and aspects of reliability. Results: Sixteen items (11 unimanual and 5 bimanual) exhibited evidence for good internal scale validity and item and person reliability when analyzed separately for children with asymmetric or symmetric hand use. By calibrating the BoHA logit measures into the same frame of reference through linking, the overall measure of bimanual performance is comparable between children with asymmetric or symmetric hand use, still allowing use of separate item difficulty hierarchies. Conclusions: The Both Hands Assessment (BoHA), showed strong evidence of internal construct validity for measuring effectiveness of bimanual performance and the extent of asymmetric hand use in children with bilateral cerebral palsy, MACS levels I-III.     

Increased expression of HMGB-1 in the skin lesions of erythema toxicum

Abstract:  At birth, commensal microbes penetrate into the skin of the human newborn, eliciting an acute rash, erythema toxicumn neonatorum . Histologically, the rash is characterized by an upregulation of proinflammatory activity and a local recruitment of immunocytes, including macrophages. High mobility group box chromosomal protein 1, a nuclear and cytosolic protein, is also a pro-inflammatory cytokine released by macrophages in response to microbial stimulation. Here, we reasoned that macrophages but also keratinocytes might upregulate this protein in response to the first colonization and that high mobility group box chromosomal protein 1 might play a role as a proinflammatory mediator in the development and progression of erythema toxicum . Punch biopsy specimens from 1-day-old healthy infants, seven with and four without erythema toxicum were analyzed with indirect immunohistochemistry and two different antihigh mobility group box chromosomal protein 1 antibodies, immunofluorescence, nuclear counterstaining, confocal and immunoelectron imaging. We found relocation of nuclear high mobility group box chromosomal protein 1 into the cytoplasm in keratinocytes and macrophages in erythema toxicum. Cytoplasmatic high mobility group box chromosomal protein 1 was also found in melanocytes and did neither co-locate with lysosomal-associated membrane proteins nor with melanosomes. We speculate that terrestrial adaptation triggers the induction of the endogenous "danger signal" high mobility group box chromosomal protein 1 in the skin of the newborn infant, perhaps in response to the first commensal colonization and that this signal may contribute to alert the immune system and promote a protective immune response.     

Changes in views on aging in later adulthood: the role of cardiovascular events

A number of longitudinal studies have pointed to the long-term impact of different views on aging (VoA) on health in later life, whereas the reverse relationship has rarely been examined. Serious cardiovascular events such as myocardial infarction or stroke are life-threatening events which might in turn lead to changes in VoA. The present longitudinal study examined the effect of a cardiovascular event (CVE) on VoA over a three-year period using pooled data from three waves of the German Ageing Survey (2008, 2011, 2014, age range: 40–95 years). In order to account for alternative explanations for changes in VoA, individuals without CVE (n = 200) were matched to individuals who experienced a CVE (n = 202) using a propensity score matching procedure. Compared to individuals without CVE, individuals who experienced a CVE showed adverse changes in three VoA indicators (self-perceptions of aging as associated with physical losses/with ongoing development; subjective age). These results suggest that CVE can in fact change how individuals view their own aging. According to previous studies, this can lead to future health changes and thus become a health-related downward spiral. Health promotion programs could, therefore, profit by adding specific VoA interventions for individuals who experienced a CVE.     

Physical capacity,not skeletal maturity,distinguishes competitive levels in male Norwegian U14 soccer players

The main aim of the present study was to compare skeletal maturity level and physical capacities between male Norwegian soccer players playing at elite, sub-elite and non-elite level. Secondary, we aimed to investigate the association between skeletal maturity level and physical capacities. One hundred and two U14 soccer players (12.8-14.5 years old) recruited from four local clubs, and a regional team were tested for bone age and physical capacities. Bone age was estimated with x-ray of their left hand and used to indicate maturation of the skeleton. Players went through a comprehensive test battery to assess their physical capacities. Between-groups analysis revealed no difference in chronological age, skeletal maturity level, leg strength, body weight, or stature. However, elite players were superior to sub-elite and non-elite players on important functional characteristics as intermittent-endurance capacity (running distance: 1664 m ± 367 vs 1197 m ± 338 vs 693 m ± 235) and running speed (fastest 10 m split time: 1.27 seconds ± 0.06 vs 1.33 seconds ± 0.10 vs 1.39 seconds ± 0.11), in addition to maximal oxygen uptake (), standing long jump, and upper body strength (P < .05 for all comparisons). Medium-to-large correlations were found between skeletal maturity level and peak force (r = 695, P < .01), power (r = 684, P < .01), sprint (r = −.471, P<.001), and jump performance (r = .359, P < .01), but no correlation with upper body strength, , or intermittent-endurance capacity. These findings imply that skeletal maturity level does not bias the selection of players, although well-developed physical capacity clearly distinguishes competitive levels. The superior physical performance of the highest-ranked players seems related to an appropriate training environment.     

„Rebound pain“ – von der Definition bis zur Therapie

Die Anaesthesiologie - Rebound pain als Nebenwirkung einer Regionalanästhesie ist ein übermäßiges Schmerzempfinden nach Abklingen der Wirkung der lokalen Betäubung, welches...