Hip surveillance in Tasmanian children with cerebral palsy

Background:   Children with cerebral palsy (CP) are at risk of hip subluxation. Over time, subluxation can lead to dislocation, deformity and pain. Hip surveillance in the form of an X-ray and clinical examination of this 'at risk group' can identify early subluxation. Early subluxation can be treated, preventing hip dislocation in many cases. Hip surveillance in CP commenced in Tasmania in 1992.
Aims:   To audit the hip surveillance data to date, perform a literature review to understand the emerging evidence for prevention and management of hip subluxation in CP and update hip surveillance guidelines.
Methods:   New guidelines were written and distributed, and an audit of the previous 12 years performed by review of medical files and X-rays.
Results:   Two hundred and eighteen children had been involved in the hip surveillance programme. Fifteen cases of dislocation were recorded in this time. The incidence of subluxation and surgery, as well as the gross motor function classification system (GMFCS) level, was recorded.
Conclusion:   Data from Tasmania showed a similar incidence of hip subluxation according to GMFCS level, and frequency of different surgical interventions as other recent audits. Some children with minor subluxation improved without orthopaedic intervention once weight bearing occurred, which had not before been appreciated. Migration percentage alone is not adequate to fully describe the outcome of hip subluxation. More appropriate measures of outcome in terms of quality of life for children with CP need to be developed.     

人工关节置换治疗偏瘫侧股骨颈骨骨折分析

目的分析采用人工关节置换治疗偏瘫下肢股骨颈骨折的疗效。方法18例偏瘫侧股骨颈骨折采用全髋关节置换8例,双动型人工股骨头置换10例,进行回顾性分析。结果18例患者均安全渡过围手术期,全部病例均获随访,优15例,占83%,良3例,占17%,无差的病例。结论人工关节置换是治疗偏瘫侧股骨颈骨折的积极、可靠的治疗方法。     

Infantile hemiplegia: clinical,electroencephalographic and computerised tomography study

Thirty-one patients with post-neonatally acquired infantile hemiplegia were assessed clinically, electroencephalographically and by CT scan. The mean age of onset of illness and when first seen in the neurology clinic were 20·2±20·1 months and 16·8±8·4 yr, respectively. Epilepsy was seen in 74 per cent of cases and mental retardation in 70 percent. Among patients with epilepsy, the EEG and CT scan were abnormal in 83 per cent and 87 per cent respectively. There was a positive correlation between an abnormal EEG and CT scan in 84 per cent of cases. The cause of hemiplegia could be clinically determined in only eight cases (26%). However, the CT scan showed abnormalities like cortical atrophy and porencephalic cyst, suggestive of a vascular or inflammatory aetiology in 68 per cent. The usefulness of CT in determining the aetiology in acquired infantile hemiplegia, especially when seen many years after the onset of illness is, emphasized.     

电针治疗40例中风偏瘫肩－手综合征临床观察

运用电针和毫针刺法分别治疗中风偏瘫肩－手综合征４０例，两个疗程后显示电针对手背水肿、手部皮温升高及屈指时手痛的疗效优于毫针刺法（Ｐ＜０．０５）；指关节和肩关节功能积分增加３分以上（包括３分）的疗效电针组分别优于毫针组（Ｐ＜０．０５）；总显效率电针组（７５％）优于毫针组（５０％，Ｐ＜０．０５）。提示电针产生肌肉节律性收缩具有＂肩－手泵＂样作用，这对消除手背水肿，防止手部肌肉萎缩有重要意义。     

小儿急性偏瘫综合征30例

研究目的探讨小儿急性偏瘫综合征的病因、诊断和治疗。研究方法按照诊断标准,对本组病例作必要的实验室检查,脑电图、CT扫描等,对确诊本征的病人,采用低分子右旋醣酐、肾上腺皮质激素和扩血管药物等治疗。结果本征以婴幼儿,冬春季发病者多。闭塞性脑动脉炎为本征的主要病因。本组病例应用低分子右旋醣酐、肾上腺皮质激素和扩血管药物取得较好的疗效。结论小儿急性偏瘫综合征的诊断,除一般实验室检查外,脑电图和CT扫描,不但能了解本征的病因,而且能及时指导适当治疗,以起到减少后遗症的作用。     

Prolonged deficits after focal inhibitory seizures

Introduction: Seizures are most commonly associated with positive phenomena such as tonic, clonic or myoclonic movements, automatisms, paresthesias and hallucinations. Negative phenomena, however, are not an uncommon manifestation of seizure activity. Examples of negative seizure phenomena include speech arrest, aphasia, amaurosis, amnesia, numbness, deafness, neglect and atonic seizures. Less commonly described in the literature are focal inhibitory motor seizures. Methods and Results: Two patients presenting with rapidly progressive, prolonged hemiparesis, sensory neglect and hemi-visual field obscuration are described. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain did not reveal progression of known structural lesions or new lesions. The superficial cortex of the hemisphere contralateral to the hemiparesis and sensory neglect enhanced diffusely with gadolinium on T1-weighted MRI images. Electroencephalography demonstrated periodic lateralized epileptiform discharges (PLEDs) in one patient and lateralized suppression and slowing in the other patient. Single photon emission computed tomography (SPECT) revealed hyperperfusion in the hemisphere contralateral to the hemiparesis and sensory neglect. The changes seen on MRI and SPECT resolved with resolution of the symptoms. Conclusion: Taken together with the clinical history, the results from these investigations suggest focal inhibitory seizure as the underlying etiology. A review of the literature and investigations helpful in making this difficult diagnosis are provided.     

Anosognosia for plegia: specificity, extension, partiality and disunity of bodily unawareness

This study of anosognosia for hemiplegia investigated: whether it is homogeneous; specificity to plegia of unawareness; extension to different kinds of and objects of awareness regarding plegia; partiality of unawareness. Sixty-four hemiplegic stroke patients were assessed with control subjects on (a) motor and somatosensory function, immediately followed by participants' evaluations of performance; (b) conventional structured interview questions addressing awareness of various capacities: (c) Neglect, Mental Flexibility, General Mental State, Verbal Fluency, Short-Term Memory; (d) pre- and post-performance estimates of ability on the last two; (e) estimates of current ability on bilateral and unilateral tasks, addressed by questions in 1st- and 3rd-person forms, explanations of how overestimated tasks would be accomplished, attempts at 3 bimanual tasks and post-attempt estimates of ability on these. Anosognosia for plegia was mostly associated with right-brain damage. No single factor or combination accounted for all patients. Double dissociations indicated that anosognosia can be specific to plegia: and patients do not generally overestimate other abilities. Although unawareness of paralysis and of its consequences appear linked, the latter is more widespread and persistent. Double dissociation showed that concurrent unawareness of movement failures is a separate deficit from these. There was differential awareness of different aspects of plegia. Further, some patients who overestimated current bilateral task ability when asked in 1st-person form did not overestimate when asked how well the examiner, if he was in their current condition, could do each task. This suggests split awareness of a single aspect of plegia. Patients anosognosic on conventional questioning showed two distinctions. (1) Some were unaware of movement failures when they occurred; others were aware but quickly forgot such failures and seem unable to update long-term body knowledge. (2) Some patients' explanations of bimanual task performance reflect unawareness of hemiplegia; others' explanations were bizarre and imply some awareness. The latter group's deficit appears to be nonspecific and linked to right-hemisphere predominance of anosognosia, an account of which is offered. Anosognosia for hemiplegia is not a unitary phenomenon: several factors underlie deficits in bodily awareness.     

大脑前动脉皮质支分布区域梗死所致的偏瘫、缄默或淡漠

目的：提高对大脑前动脉皮质支分布区域梗死的临床认识。方法：本文结合3例患者的临床表现及CT影像学特点进行了回顾性调查分析。结果：3例大脑前动脉皮质支分布区域的额叶矢状窦旁皮质、额叶内侧面包括扣带回前部、中央前回内侧面、运动前区和辅助运动区梗死的病人，出现了以对侧偏身严重瘫痪、精神缄默或淡漠为突出的临床症状。结论：大脑前动脉皮质支闭塞，可以造成对侧偏瘫、精神缄默或淡漠症候群。     

A Comparative Study on the Immediate Effects of Hand Orthoses on Reducation of Hypertonus

This paper compares the immediate effects of dorsal, volar and no splints in reducing hypertonicity in the wrist flexors of spastic hemiplegic subjects. The measures include: (i) passive range of motion; (ii) angle of point of stretch reflex; (iii) resistance to passive wrist extension; and (iv) force of spontaneous wrist flexion. Results of this study indicate a significant reduction in hypertonicity following both dorsal and volar splint application on the passive range of motion and resistance to passive extension measures (P < .05), and a significant reduction in hypertonicity as measured by spontaneous flexion following two hours of dorsal splint wearing (P < .05). No significant reductions in hypertonicity were noted on the angle of point of stretch reflex measure, and on the force of spontaneous flexion measure. Possible explanations for results and suggestions for further resarch are discussed.     

Acupoint electrogymnastics therapy in stroke hemiplegia

BACKGROUND： Electrogymnastics can offer a range of proprioceptive, motor, and cutaneous sensation impulses to the central nerve system. The center receives perception of the paralyzed muscle through the aid of these impulses. During this process, functional reorganization of connecting network between segment and intersegment takes place. OBJECTIVE： To observe the therapeutic efficacy of acupoint electrogymnastics and traditional electroacupuncture on stroke hemiplegia. DESIGN, TIME AND SETTING： A multicenter, randomized, controlled, blinded, clinical study was performed at the College of Acu-moxibustion and Massage in Shanghai University of Traditional Chinese Medicine from May 2004 to September 2006. PARTICIPANTS： A total of 153 patients suffering from stroke hemiplegia, comprising 83 males and 70 females, aged 63-70 years, were admitted to outpatient and inpatient at LongHua Hospital Affiliated Shanghai University of Traditional Chinese medicine, Putuo District Traditional Chinese Medicine Hospital and Changqiao Street Community Health Service Center of Shanghai. METHODS： The patients were randomly divided into treatment （n = 77） and control （n = 76） groups. They were treated with acupoint electrogymnastics and traditional electroacupuncture, respectively. In the treatment group, two pairs of positive and negative JD-2008 type electrodes from a hemiplegia treatment apparatus were directly pasted on the Shousanli （LI 10） and Waiguan （SJ5） acupoints of the upper limb, as well as the Zusanli （S36） and Yanglingquan （GB34） acupoints of the lower limb, respectively. In the control group, needles were consecutively inserted into the above acupoints. Using the method of lifting-inserting and twisting-rotating, the needle was manipulated with small amplitude of 5-7 mm and a fast frequency of 80-120 times/min when the needle was inserted to a suitable depth. When the sensation of needling was attained, the two pairs of positive and negative electrodes of type G6805-Ⅱelectro-acupunctur