Relationship between 3D lower limb bone morphology and 3D gait variables in children with uni and bilateral Cerebral Palsy

BackgroundMedical and surgical interventions to prevent or reduce bone deformities and improve gait in children with cerebral palsy (CP) are based on empirical evidence that there is a relationship between bone deformities and gait deviations.Research questionWhat is the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP?MethodsA retrospective analysis was conducted on data from 121 children with uni- (n = 64, mean age 9.9 (SD 3.4) years) and bi- lateral (n = 57, mean age 10.4 (SD 3.6) years) CP who had undergone 3D gait analysis and biplanar X-rays (EOS® system). The limbs were split as DIP (the more impaired limb of children with bilateral CP), HEMI (the impaired limb of unilateral CP) and REF (the unimpaired limb of unilateral CP). Multi-variable Linear Regressions were performed between 23 kinematic variables, the Gait Deviation Index (GDI) and a model composed of nine 3D bone variables for each limb type.ResultsWhen the whole sample was pooled, 72% of R² values were poor, 16% were fair, and 12% were moderate. Lower limb bone morphology models explained less than 1% of GDI variability. Correlations between tibial-femoral rotational parameters and hip rotation were mostly poor. Mean foot progression angle was the only kinematic parameter that was fairly to moderately correlated with bone variables in the 3 limb types. A tibial-femoral bone model explained 48% of the variability of mean foot progression angle in the REF limbs, 31% in the HEMI limbs and 25% in the DIP limbs.SignificanceTibial-femoral bone morphology was only weakly related to kinematic gait variables, in contrast with common clinical assumptions. These results suggest that factors other than bone morphology influence gait quality and thus a thorough clinical examination and gait analysis is required prior to making treatment decisions.     

Periventricular- intraventricular hemorrhage in the premature infant- A historical perspective

The objective of this chapter is to trace the evolution of intraventricular hemorrhage in the premature infant highlighting the importance of the germinal matrix, a critical role for cerebral blood flow changes in the genesis of hemorrhage, clinical factors that increase the bleeding risk, and potential preventative strategies. In 1976, neuropathological studies demonstrated capillary rupture within the germinal matrix as the precursor of hemorrhage. In 1980, introduction of cranial ultrasound facilitated diagnosis of intraventricular hemorrhage. In 1979, loss of cerebral autoregulation in sick newborn infants was demonstrated. In the 1980’s, studies demonstrated the importance of intravascular factors in provoking hemorrhage. In 1983, the association of cerebral blood flow velocity fluctuations and subsequent hemorrhage was demonstrated. In 1994, antenatal steroids use to accelerate lung development was recommended. This was associated with an unanticipated reduction in hemorrhage. In the mid 1990’s early indomethacin administration was associated with a reduction of severe hemorrhage.     

安徽省农村地区1—8岁儿童脑瘫现况及地区分布的流行病学研究

采用分层整群抽样方法,选取安徽省３ 个自然地理区域７ 个县所辖２０ 个乡镇的５０７１４ 名１ ～８ 岁儿童进行脑瘫调查。结果显示,安徽省农村地区１ ～８ 岁儿童脑瘫患病率为２－０７ ‰,不同性别和不同年龄组脑瘫患病率均无显著性差异,但３ 个地区儿童脑瘫患病率呈显著性差异,以淮北地区最低（１－２８ ‰） ,皖南地区最高（３－３４ ‰） ,江淮地区居中（２－０９ ‰） 。其地区差的原因尚待进一步研究     

舌针治疗假性延髓麻痹45例疗效观察

目的观察舌针治疗中风假性延髓麻痹的疗效.方法将90例患者随机分为治疗组和对照组各45例,治疗组取舌针的心穴、脾穴、肾穴治疗,对照组单纯体针治疗,均12次为一疗程,治疗2个疗程观察疗效.结果治疗组总有效率91.1%,对照组64.4%,两组比较,差异有非常显著性意义(P<0.01).结论舌针治疗中风假性延髓麻痹优于单纯体针治疗,是一种较理想的治疗方法.     

头针结合现代康复治疗小儿脑瘫临床研究

目的观察头针与现代康复疗法在治疗小儿脑瘫中的协同作用.方法90例脑瘫患儿随机分为3组,Ⅰ组采用头针疗法、Ⅱ组采用现代康复疗法和Ⅲ组采用头针结合现代康复疗法,治疗前后进行日常生活能力(ADL)、运动功能评定.结果经60天治疗后,3个组ADL评分明显高于治疗前(P<0.01),Ⅲ组的ADL评分、运动功能评分明显优于Ⅰ、Ⅱ组(P<0.01),Ⅰ、Ⅱ组相比则差异无显著性意义.结论头针与现代康复疗法在治疗小儿脑瘫中有协同作用.     

针刺留针时间与疗效关系的观察

目的:研究针刺治疗单纯性面神经麻痹中留针时间长短与疗效的关系.方法:将单纯性面神经麻痹患者60例随机分为两组,每组各30例,观察组针刺得气后留针10分钟,对照组得气后留针40分钟,每日1次,30天后统计疗效.结果:观察组痊愈率为90.0%,对照组为26.7%,统计学处理差异有非常显著性意义(P＜0.01);观察组平均治疗时间为11.8天,对照组为18.9天,差异有非常显著性意义(P＜0.01),观察组明显优于对照组.结论:治疗单纯性面神经麻痹,短时间留针比长时间留针疗效要好.     

踝足矫形器矫治脑瘫患儿尖足初步疗效分析

目的对痉挛型脑瘫患儿踝足矫形器配戴前后的尖足改善情况进行量化评定。方法对24例痉挛型脑瘫患儿(48足)配戴矫形器6个月后进行疗效评定。结果48只尖足均得到了明显改善,其中显效25%,好转64.6%,无变化10.4%,与配戴踝足矫形器前比较差异有显著意义(P<0.01)。在尖足改善的同时,患儿的站立和步行能力均得到了提高。结论踝足矫形器在纠正脑瘫患儿尖足、提高下肢运动功能方面有积极的作用。     

A型肉毒毒素用于口角歪斜和鼻唇沟不对称的研究

目的在面瘫患者健侧部分面肌中注射A型肉毒毒素用以矫正口角歪斜和不对称的鼻唇沟,以满足美容的需要。方法将2001年1月￣2005年12月来在门诊和住院的部分面瘫患者作为观察对象,除对照组外治疗组分别在健侧面肌中注射A型肉毒毒素,依据注射剂量随机分为5个治疗组:A组(各肌注射1.25U)、B组(各肌注射2.50U)、C组(各肌注射5.00U)、D组(降、提口角肌和颧大、小肌各注射2.50U,笑肌注射5.00U)和E组(降、提口角肌和颧大、小肌各注射5.00U,笑肌注射2.50U),3d后定期观测每例患者双侧口角到门齿中缝的距离差。结果除A组外,各治疗组的口角歪斜和鼻唇沟不对称均得到不同程度的纠正,注射剂量越大起效越快,持续时间越长,但表情动作受到的影响也略大。结论根据口角歪斜和鼻唇沟不对称的程度,在健侧面肌注射相应剂量的A型肉毒毒素,既可以较好地纠正面瘫患者的口角歪斜和鼻唇沟的不对称,又可以避免并发症的发生。     

Transport Mobility for Children and Adolescents with Cerebral Palsy (CP)

Background: The transport mobility of children and adolescents with cerebral palsy (CP) is of vital interest for the individual, as well as for society. Enhanced transport mobility can be related to improved functional health status and a higher degree of autonomy, which in turn may reduce the demand for societal support. UN Resolution 48/96, together with Swedish legislation and ''Vision Zero'' have in different ways established that the transport system must be designed to meet also the needs of children and adolescents with disabilities. Hence, it is necessary to identify and eliminate obstacles hindering children and adolescents with CP from using public transport and other means of transport, such as their own cars, at the same level as other members of society. However, in the case of children and adolescents with CP, the transport situation and the learner driver's educational situation have so far been largely unknown. Aim: The general aim of the thesis was to describe and analyse, from a legislative and a public health perspective, the transport mobility situation for children and adolescents with CP. Furthermore, the general aim was to identify obstacles for the target group to use public transport and other means of transportation, at the same level as other members of the society, and to suggest improvements that will remove the identified obstacles. Material and methods: Several different data collection methods were used. Data, concerning travel habits and parents' perceived risks regarding transportation, were taken from a postal questionnaire addressed to parents of children and adolescents with CP. In order to estimate the numbers of potential learner drivers with CP in each age group in Sweden, a literature review was conducted, based on Swedish material. Furthermore, logbooks for learner drivers with CP were analysed retrospectively, in order to identify procedures, problems and key tasks in their driver education. Visual search strategies for learner drivers with CP were analysed, utilizing an eye tracker, and an attempt was made to introduce a screening tool for predicting the outcome of driver education. Results: Children and adolescents with CP were found to be transported under unsafe conditions, causing worry among their parents. When transporting children in the family vehicle, the parents were exposed to a very heavy burden, which increased their worry. The prevalence of potential learner drivers with CP who were in need of highly specialised driver education, including individually adapted driver training vehicles, was estimated to be 0.15 per 1,000 of a population-based age group of learner drivers in Sweden. Complex procedures, structural problems and financial obstacles made it difficult for adolescents with CP to obtain a driving licence and an adapted vehicle. The total duration of the driving tuition given by a driving instructor was found to be almost nine times higher for learner drivers with CP than for non-disabled learner drivers. Visual search strategies among learner drivers with CP were found to be less flexible than among other learner drivers. This fact indicated a need for better methods of teaching such strategies to this group as an integral component of their driver education. The validity of the motor-free visual perceptual test, TVPS-UL, for predicting the outcome of driver education for learner drivers, was found to be low. In order to find a reliable and valid screening tool for this purpose, future studies should focus on cross-validation of visual perceptual and dual task performance tests for different types of independent variables, such as obtaining a driving licence or not, accident involvement and driving ability. Conclusion: The transport system was found, from a legislative and public health perspective, to be unsuitable to meet the needs of children and adolescents with CP. Suggestions for improving transport mobility for children and adolescents with CP are provided. Several of these suggestions are practical, concrete and contextual for Swedish conditions, and some of them necessitate future research. However, a number of these suggestions are also applicable in an international context.