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1.
IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context. 相似文献
2.
Overview Excess spasticity leads to disability that is marked by impaired locomotion, handicapping deformities and, if not controlled,
discomfort and pain. Selective peripheral neurotomy in the child is indicated for severe focal spasticity, when botulinum
toxin injections cannot delay surgery any longer.
Materials and methods Preoperative motor blocks mimicking the outcome of the surgical procedure are essential to establish the objectives of neurotomy.
In the lower limb, obturator neurotomy is indicated for spasticity in the adductor muscles, hamstring neurotomy for the knee flexion and tibial
neurotomy for the spastic foot. Anterior tibial neurotomy is indicated for the extensor hallucis spasticity and femoral neurotomy
for spasticity in the quadriceps. In the upper limb, neurotomy of the pectoralis major and teres major nerves is indicated for spasticity of the internal rotators of the shoulder.
Neurotomy of the musculocutaneous nerve is indicated for spasticity of the flexors of the elbow, and neurotomy of median and
ulnar nerves are indicated for spasticity of the pronators and flexors of the wrist and fingers.
Conclusion Selective peripheral neurotomy is a valuable neurosurgical procedure in well-trained surgical hands for severe focalised spasticity. 相似文献
3.
Nobuhito Morota 《Child's nervous system》2007,23(9):1007-1014
Purpose The author describes the history of functional posterior rhizotomy (FPR), the surgical procedure currently used, and the results
together with its future perspective in Japan. The modern form of FPR was introduced to Japan in 1995, and the first surgery
was carried out in 1996. Despite initial resistance from orthopedic surgeons, the procedure has eventually gained wide recognition
in the country.
Materials and Methods The author has operated on 98 patients (60 boys and 38 girls, aged from 2 to 19 years old) by the end of 2006. Most patients
were mild to severely disabled children with spastic hypertonia because of cerebral palsy and other diseases. The surgical
procedure used is based on the Peacock’s procedure with some modification for the mildly disabled children whose spasticity
was predominantly the muscles of the ankle joint. Intraoperative neurophysiology was an indispensable tool for preserving
urogenital function and for judging which root/rootlet to be cut.
Results Seventeen to 83% of the root/rootlets were found to be abnormal and were cut, clearly correlating with the degree of disability.
However, there was a wide difference in the cutting rate, even in children with the same degree of disability. The result
of surgery in this group of patients was the same as in previously published data. Twenty out of 51 patients (39%) followed
for more than a year at the current institute showed improved locomotion after FPR. Thirty patients (59%) demonstrated suprasegmental
effects after FPR.
Conclusion The role of FPR will grow in importance as a treatment for spasticity in Japan in the future. 相似文献
4.
肛门括约肌肌电图监测下双侧L2~S2选择性脊神经后根切断术治疗痉挛性脑瘫 总被引:2,自引:1,他引:1
目的为提高手术安全性,在L2~S2选择性脊神经后根切断(SPR)手术时,对肛门括约肌进行肌电图(EMG)监测,并评价其作用。方法在SPR手术监测中,当对S2后根小束进行电刺激时,采用针状电极记录双侧肛门括约肌的反应情况,有明显反应的后根小束予以保留。手术后随访患者踝痉挛改善情况和括约肌功能变化情况。结果所有患者手术后踝痉挛均有明显改善,无大小便功能障碍发生。结论SPR手术包括S2后根时,术中括约肌EMG监测对保证疗效,保护括约肌功能,提高手术安全,具有重要意义。 相似文献
5.
《Fu? & Sprunggelenk》2021,19(3):167-174
BackgroundThe extension deformity of the interphalangeal (IP) joint of the hallux is a rare focal clinical entity usually detected in patients with no underlying pathology. It may be due to extensor hallucis longus (EHL) overactivity, although it has not been previously reported in patients with neurological disorders. The lesion should be differentiated from the persistent hyperextension of the great toe at the metatarsophalangeal (MTP) joint. Although MTP hyperextension of the hallux due to hypertonia of the EHL is a typical sequel of stroke, it has also been detected in a wide variety of disorders.Materials and MethodsA patient with right hemiparesis following stroke, which had an almost complete functional recovery, is presented. She was disabled by focal spasticity of the EHL, leading to persistent hyperextension of the IP joint of the hallux. The deformity appeared on the long-term follow-up, on both sides within a 3-year period. It was treated with bilateral percutaneous distal EHL tenotomy. On the left side, a percutaneous dorsal IP joint capsulotomy was additionally performed.Results and ConclusionA complete reduction of the deformity was achieved on both sides with functional rehabilitation. It is assumed that EHL hyperactivity following stroke in our patient was complicated by IP instead of MTP extension deformity, due to the coexistent flexor hallucis longus weakness. Bilateral distal EHL tenotomy, associated with percutaneous dorsal IP joint capsulotomy on the left side, provided satisfactory long-term results. 相似文献
6.
Biomechanical assessment with electromyography of post-stroke ankle plantar flexor spasticity 总被引:1,自引:0,他引:1
Spasticity has been defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone). Muscle tone consists of mechanical-elastic characteristics, reflex muscle contraction and other elements. The aims of this study were to determine whether to assess spasticity quantitatively, and to characterize biomechanical and electromyographic spasticity assessment parameters. These assessment parameters were described by investigating the correlation between clinical measures and the response to passive sinusoidal movement with consecutive velocity increments. Twenty post-stroke hemiplegic patients and twenty normal healthy volunteers were included in the study. Five consecutive sinusoidal passive movements of the ankle were performed at specific velocities (60, 120, 180, and 240 degrees/ sec). We recorded the peak torque, work, and threshold angle using a computerized isokinetic dynamometer, and simultaneously measured the rectified integrated electromyographic activity. We compared these parameters both between groups and between different velocities. The peak torque, threshold angle, work, and rectified integrated electromyographic activity were significantly higher in the post-stroke spastic group at all angular velocities than in the normal control group. The threshold angle and integrated electromyographic activity increased significantly and linearly as angular velocity increased, but the peak torque and work were not increased in the post-stroke spastic group. Peak torque, work, and threshold angle were significantly correlated to the Modified Ashworth scale, but the integrated electromyographic activity was not. The biomechanical and electromyographic approach may be useful to quantitatively assess spasticity. However, it may also be very important to consider the different characteristics of each biomechanical parameter. 相似文献
7.
This study of plantar flexor spasticity describes relationships among a traditional qualitative spasticity scale, three potential quantitative spasticity measures and a measure of voluntary ankle muscle function. Thirty-four volunteer adult patients with traumatic brain injuries participated. There were 28 males and 6 females; the mean age was 30.3 years. A battery of five randomly sequenced tests was performed for each subject on one ankle. Tests were: modified Ashworth scale (MAS) scoring; H-reflex testing with and without Achilles tendon vibration; H-reflex testing with and without dorsiflexor contraction; reflex threshold angle and timed toe tapping (TTT). Twenty-six subjects returned to have the second ankle tested, resulting in 60 ankles for the analyses. Spearman's coefficients for correlation of quantitative spasticity measures with MAS scores ranged from 0.39 to 0.49 with associated probabilities 0.002. Pearson coefficients for correlation of quantitative spasticity measures with TTT scores were lower but also significant (P 0.07). Multiple correlation for the set of quantitative measures yieldedR = 0.614 (P < 0.001) with MAS scores andR = 0.365 (P = 0.045) with TTT scores. These findings reveal statistically significant relationships of low to moderate strength among potential quantitative spasticity measures, a traditional qualitative spasticity scale and a simple measure of voluntary ankle muscle function. Understanding these relationships is an essential part of the ongoing search for quantitative spasticity measures.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. 相似文献
8.
腹针治疗脑血管病后痉挛性瘫痪的疗效观察 总被引:19,自引:0,他引:19
目的:探讨治疗脑血管病后痉挛性瘫痪的最佳针刺组穴配方.方法:将60例脑血管病后痉挛性瘫痪的患者按入院先后随机分为腹针组及体针组各30例,均每周治疗5次,连续治疗3周观察疗效.结果:腹针组患者痉挛得到明显改善,相关指标有统计学意义,体针组患者痉挛也有改善,相关指标无统计学意义.两组疗效比较腹针组疗效优于体针组,差异有显著性意义.结论:腹针疗法治疗脑血管病后痉挛性瘫痪是一种安全有效的治疗方法. 相似文献
9.
Background and purposeThe use of dry needling (DN) with other treatments may be more beneficial in managing post-stroke spasticity. We report the effects of DN plus exercise therapy (ET) on wrist flexor spasticity.Patient presentationThe patient was a 45-year-old man with an 8-year history of stroke. The outcome measures included the Modified Modified Ashworth Scale (MMAS), Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), and range of motion (ROM) which were assessed before (T1), after (T2), and after 3-week follow-up (T3).ConclusionThe MMAS was improved at T2 from “3” to “2”. The Hmax/Mmax decreased from 0.77 to 0.53 at T3. The H-reflex latency increased from 15.4 ms to 18.5 ms at T3. The wrist active and passive ROM increased ∼30° and ∼20° at T2, respectively.A 4-session DN plus ET may improve spasticity and ROM. No meaningful improvement was observed in function. 相似文献
10.
脑病变的部位及大小与Brunnstrom偏瘫恢复阶段及痉挛程度的关系 总被引:3,自引:0,他引:3
目的 探讨脑病变的部位及大小与Brunnstrom偏瘫阶段及痉挛程度的关系。方法 36例患者,男26例。女10例;年龄16-70岁;左侧脑病变17例。右侧19例;脑血肿17例。脑梗死及脑皮质软化灶19例。结果 脑皮质受损部位患者呈跳跃式恢复,痉挛主要表现为不能伸腕,指及踝背屈障碍,当上肢伸肌功能恢复后,屈肌痉挛消失;顶叶受损(病变体积为30-50cm^3)患者残留症状为不能并指,分指,对掌运动及踝自主背屈障碍;内囊部分病变患者主要表现为肢体远端痉挛。痉挛期与分离期重叠出现。即出现伸腕,指运动时,屈腕,指肌及屈拇长肌仍有痉挛现象存在;内囊大部分或完全病变患者,痉挛表现在四肢所有关节,运动功能恢复较差。结论 脑病变部位及大小不同,痉挛程度不同,痉挛程度与运动训练疗效关系密切。均有助于判断患者康复后期日常生活活动能力及运动功能恢复状况。 相似文献