KINESIO en la WEB

Artículos Seleccionados - NEUROPEDIATRIA - 1998

Quantification of antagonist muscle coactivation in children with spastic diplegia.

Surgical treatment of children with brachial plexus paralysis.

Clinical presentations, differential diagnosis and management of obstetric brachial palsy.

Neurobehavioral development at term in very low-birthweight infants and normal term infants in Taiwan.

Orthopedic management of neuromuscular disorders in children.

Practice of a precision isometric grip-force task by children with spastic cerebral palsy.

We can cure your child's clumsiness! A review of intervention methods.

Spasticity and strength changes as a function of selective dorsal rhizotomy.

Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial.

Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy.

Investigation of the effects of a model of physical therapy on mother-child interactions and the motor behaviors of children with motor delay.

Título en Inglés: Quantification of antagonist muscle coactivation in children with spastic diplegia.

Autor/es: Cowan-MM; Stilling-DS; Naumann-S; Colborne-GR

Lugar: Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada.

Fuente: Clin-Anat. 1998; 11(5): 314-9

ISSN: 0897-3806

Idioma: ENGLISH

Resumen: The purpose of this study was to investigate the use of the Pearson Product-Moment correlation coefficient to quantify muscle coactivation using electromyography. The subjects were two children with spastic diplegia. Surface electrodes were used to record muscle activity from the soleus and tibialis anterior muscles during voluntary attempts at dorsiflexion and plantarflexion of the ankle against resistance. The linear envelope signals were smoothed with a Hamming filter at a cutoff frequency of 4 Hz and intervals of the resultant pairs of curves subjected to the PPM test. Both subjects demonstrated significant coactivation on their right side and independent activity on the left, indicated by high positive and negative coefficients, respectively. This method shows promise for description of side differences in diplegics and for assessing the effects of physical therapy and other interventions.[volver]

Título en Inglés: [Surgical treatment of children with brachial plexus paralysis]

Título Original: Tratamiento quirurgico de los ninos con paralisis del plexo braquial.

Autor/es: Grossman-JA; Ramos-LE; Tidwell-M; Price-A; Papazian-O; Alfonso-I

Lugar: Brachial Plexus Palsy Center, Miami Children's Hospital, Florida 33155, USA.

Fuente: Rev-Neurol. 1998 Aug; 27(156): 271-3

ISSN: 0210-0010

Idioma: SPANISH; NON-ENGLISH

Resumen: OBJECTIVE AND METHODS: A variety of surgical procedures exist for early repair of the nerve injury in obstetrical brachial plexus palsy, including neuroma excision and nerve grafting, neurolysis and neurotization. Secondary deformities of the shoulder, forearm, and hand can similarly be reconstructed using soft tissue and skeletal procedures. This review describes our surgical approach to maximize the ultimate functional outcome in infants and children with obstetrical brachial plexus palsy.[volver]

Título en Inglés: [Clinical presentations, differential diagnosis and management of obstetric brachial palsy]

Título Original: Presentaciones clinicas, diagnostico diferencial y manejo de la paralisis braquial obstetrica.

Autor/es: Alfonso-I; Papazian-O; Grossman-JA

Lugar: Brachial Plexus Palsy Center, Miami Children's Hospital, Florida, USA.

Fuente: Rev-Neurol. 1998 Aug; 27(156): 258-63

ISSN: 0210-0010

Idioma: SPANISH; NON-ENGLISH

Resumen: INTRODUCTION: The brachial plexus originates from C5 to T1 spinal segments. The brachial plexus includes the ventral ramus, trunks, divisions, cords and branches. DEVELOPMENT AND CONCLUSIONS: Brachial plexus injuries produce clinical syndromes. The Duchenne-Erb syndrome is the most frequent presentation of obstetric brachial plexus injury. The differential diagnosis of brachial plexus palsy include decreased arm movements due to pain, or weakness caused by a lesion of the nervous system outside in the brachial plexus, or by a lesion in the brachial plexus due to non-obstetrical causes. Management of these patients initially includes considering the possibility of clavicular and humeral fractures and posterior subluxation of the shoulder; and subsequently considering the possibilities of subscapularis muscle contraction or posterior shoulder subluxation in patients that develop internal rotation contracture of the shoulder; or flexion, pronation or supination contracture in patients with forearm deformation. Treatment consist of physical therapy, administration of botulinum toxin, electrical stimulation, neurolysis, nervatization, removal of neuromas and nerve grafting, treatment of fractures and subluxation, release of muscle contracture and tendon transplantation.[volver]

Título en Inglés: Neurobehavioral development at term in very low-birthweight infants and normal term infants in Taiwan.

Autor/es: Jeng-SF; Yau-KI; Teng-RJ

Lugar: School of Physical Therapy, College of Medicine, National Taiwan University, Taipei. jeng@ha.mc.ntu.edu.tw

Fuente: Early-Hum-Dev. 1998 Jul 10; 51(3): 235-45

ISSN: 0378-3782

Idioma: ENGLISH

Resumen: We compared the neurobehavioral performance at term between very low-birthweight (VLBW) infants and term infants in Taiwan, and investigated the relationships between neonatal factors and neurobehavioral performance in VLBW infants. Sixty VLBW infants and 58 healthy term infants were examined using the Neonatal Neurobehavioral Examination-Chinese version (NNE-C) at 40 weeks postmenstrual age. Medical records of the VLBW infants were reviewed to assess neonatal factors. The mean total score of the preterm infants (67.4+/-5.0) was significantly lower than that of the term infants (73.8+/-3.0) (t = 8.51, P < 0.0001). Furthermore, respiratory illness had a marginal effect on the rate of low neurobehavioral score (defined as 2SD below the mean score of term infants) in the preterm infants after adjustment for gestational age (odds ratio = 7.67, chi2 = 3.36, P = 0.067). Our findings indicate that preterm infants have lower neurobehavioral scores at term than their healthy term counterparts. Furthermore, respiratory illness may be a potential risk factor for low neurobehavioral score at term in preterm infants when gestational age is adjusted for.[volver]

Título en Inglés: Orthopedic management of neuromuscular disorders in children.

Autor/es: Birch-JG

Lugar: Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas 75219, USA.

Fuente: Semin-Pediatr-Neurol. 1998 Jun; 5(2): 78-91

ISSN: 1071-9091

Idioma: ENGLISH

Resumen: In many cases, the orthopedic surgeon may be the first consultant requested to assess complaints of lower extremity weakness or deformity to result from such conditions and must remain alert to the primary diagnosis. In addition, the orthopedic surgeon should be prepared to guide appropriate physical therapy, prescribe orthotics, and perform surgery to improve function, prevent deformity, or provide comfort when necessary. Most deformities of the extremities result from a combination of muscle weakness and imbalance, and surgical procedures are aimed at correcting existing deformity and rebalancing existing musculature by release or transfer. Skeletally immature patients with neuromuscular disorders are also susceptible to the development of scoliosis, which may impair comfortable sitting or already compromised pulmonary function. This article reviews the clinical manifestation and orthopedic management of Duchenne's muscular dystrophy, spinal muscular atrophy, facioscapulohumeral dystrophy, and Charcot-Marie-Tooth disease.[volver]

Título en Inglés: Practice of a precision isometric grip-force task by children with spastic cerebral palsy.

Autor/es: Valvano-J; Newell-KM

Lugar: Department of Physical Therapy, School of Health Professions, Allegheny University of the Health Sciences, Philadelphia, PA 19102-1192, USA.

Fuente: Dev-Med-Child-Neurol. 1998 Jul; 40(7): 464-73

ISSN: 0012-1622

Idioma: ENGLISH

Resumen: The ability to produce and sustain a criterion level of precision isometric grip force was studied in a group of 7- to 12-year-old children with cerebral palsy (CP) and in a control group. On-line visual feedback of the forces produced relative to a stationary target was provided for each 5-second trial. Subjects practised 48 trials on each of 3 consecutive days. Measures of accuracy and variability revealed significantly reduced accuracy and increased variability in isometric force production for the group with CP. Both groups demonstrated improvement with practice, with the significantly greater change in the control subjects. There was substantial variability in performance among subjects with CP. Gains associated with practice were sustained over a 5-day retention interval for both groups. The requirement to control proximal segments of the upper extremity was not associated with increased error in grip-force production of the group with CP.[volver]

Título en Inglés: We can cure your child's clumsiness! A review of intervention methods.

Autor/es: Sigmundsson-H; Pedersen-AV; Whiting-HT; Ingvaldsen-RP

Lugar: Department of Sport Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Fuente: Scand-J-Rehabil-Med. 1998 Jun; 30(2): 101-6

ISSN: 0036-5505

Idioma: ENGLISH

Resumen: Intervention procedures for treatment of clumsiness have come in many guises. We have looked at some of the most powerful methods put forward in the past 30 years--Perceptual-motor training (PMT), Sensory Integration Therapy (SIT), and some promising new approaches. Both the PMT and the SIT have been heavily criticised. It is hard to find support for the idea that the programmes improve academic skills or that they have more than a limited effect on perceptual-motor development as claimed. The more recently introduced Kinaesthetic training is shown to have an effect on general motor competence but that this may be better explained in terms of the general principles on which this training procedure lies rather than the influence on Kinaesthesis per se. Since other recent studies have also shown a dependence on similar general principles, it might be asked whether it is the teacher rather than the programmes that accounts for the differences shown between different intervention programmes.[volver]

Título en Inglés: Spasticity and strength changes as a function of selective dorsal rhizotomy.

Autor/es: Engsberg-JR; Olree-KS; Ross-SA; Park-TS

Lugar: Human Performance Laboratory, Barnes-Jewish and St. Louis Children's Hospitals, Missouri 63108, USA. jre6264@bjcmail.carenet.org

Fuente: J-Neurosurg. 1998 Jun; 88(6): 1020-6

ISSN: 0022-3085

Idioma: ENGLISH

Resumen: OBJECT: The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. METHODS: Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque-angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work-velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque-angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. CONCLUSIONS: The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.[volver]

Título en Inglés: Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial [see comments]

CM: Comment in: Dev Med Child Neurol 1998 Apr;40(4):219

Autor/es: Wright-FV; Sheil-EM; Drake-JM; Wedge-JH; Naumann-S

Lugar: Bloorview MacMillan Centre, Toronto, Ontario, Canada.

Fuente: Dev-Med-Child-Neurol. 1998 Apr; 40(4): 239-47

ISSN: 0012-1622

Idioma: ENGLISH

Resumen: Selective dorsal rhizotomy (SDR) is widely used to treat spasticity in children with diplegic cerebral palsy (CP) but has never been shown conclusively to improve functional outcome. The study was designed to measure changes in gross motor function in children 1 year following rhizotomy compared with a control group receiving equivalent physiotherapy (PT) and occupational therapy (OT) with the exception that the rhizotomy group initially underwent a 6-week postoperative in-patient therapy program. Twenty-four children (mean age 58 months) with mild to moderate CP with spastic diplegia were randomly assigned to a therapy-only control group (CG) (N=12) or rhizotomy and therapy group (RG) (N=12). The Gross Motor Function Measure (GMFM) was administered at the baseline, 6-, and 12-month assessments. Extremity tone, range of motion (ROM), biomechanics of the ankle-stretch reflex, isometric contraction, and temporal gait components were also evaluated. GMFM scores in the RG improved by 12.1 percentage points versus 4.4 percentage points in the CG (P<0.02). RG knee and ankle tone was significantly reduced (P<0.005), associated with increased passive ankle ROM (P<0.001), and decreased soleus EMG reflex activity on forced dorsiflexion (P<0.008). Foot-floor contact pattern improved in the RG compared with the CG (P<0.05). In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared with PT and OT alone. This was achieved in part through reduced knee and ankle tone, increased ankle dorsiflexion ROM, and more normal foot-floor contact during walking.[volver]

Título en Inglés: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial [see comments]

CM: Comment in: Dev Med Child Neurol 1998 Apr;40(4):219

Autor/es: McLaughlin-JF; Bjornson-KF; Astley-SJ; Graubert-C; Hays-RM; Roberts-TS; Price-R; Temkin-N

Lugar: Pediatrics, University of Washington, Seattle, USA. jfmcl@u.washington.edu

Fuente: Dev-Med-Child-Neurol. 1998 Apr; 40(4): 220-32

ISSN: 0012-1622

Idioma: ENGLISH

Resumen: The objective of this single-center investigator-masked randomized clinical trial was to investigate the efficacy and safety of selective dorsal rhizotomy (SDR) in children with spastic diplegia. Forty-three children with spastic diplegia were randomly assigned on an intention-to-treat basis to receive SDR plus physical therapy (PT), or PT alone. Thirty-eight children completed follow-up through 24 months. Twenty-one children received SDR (SDR+PT group) and 17 received PT (PT Only group). SDR was guided with electrophysiological monitoring and performed by one experienced neurosurgeon. All subjects received equivalent PT. Spasticity was quantified with an electromechanical torque measurement device (spasticity measurement system [SMS]). The Gross Motor Function Measure (GMFM) was used to document changes in functional mobility. Primary outcome measures were collected at baseline, 6, 12, and 24 months by evaluators masked to treatment. At 24 months, the SDR+PT group exceeded the PT Only group in mean reduction of spasticity by SMS measurement (-8.2 versus +5.1 newton meters/radian, P=0.02). The SDR+PT group and the PT Only group demonstrated similar improvements in independent mobility on the GMFM (7.0 versus 7.2 total percent score, P=0.94). Outcomes on secondary variables were consistent with primary outcomes. There were no serious adverse events. We conclude that SDR is safe and reduces spasticity in children with spastic diplegia. SDR plus PT and equivalent PT without SDR result in equal improvements in independent mobility at 24 months. SDR may not be an efficacious treatment for children with mild spastic diplegia.[volver]

Título en Inglés: Effects of a movement and swimming program on vital capacity and water orientation skills of children with cerebral palsy.

Autor/es: Hutzler-Y; Chacham-A; Bergman-U; Szeinberg-A

Lugar: Israeli Sport Center for the Disabled and the Zinman College for Physical Education and Sport Sciences, Tel Hashomer.

Fuente: Dev-Med-Child-Neurol. 1998 Mar; 40(3): 176-81

ISSN: 0012-1622

Idioma: ENGLISH

Resumen: Swimming and aquatic exercise are known for their effects on respiration in normal and asthmatic people. The purpose of the present study was to evaluate the effect of a 6-month movement and swimming program on the respiratory function and water orientation skills of children with cerebral palsy (CP). Forty-six kindergarten children aged 5 to 7 years were assigned either to a treatment or control group. The intervention program consisted of swimming sessions twice weekly and sessions of group physical activity in a gym once weekly, each session lasting 30 minutes, for a period of 6 months. Children in the control group were treated (30 minutes, 4 days per week) with Bobath physical therapy. The children in the treatment and control groups had comparable disability types, age, and anthropometric measurements. A 2 x 2 (group x test period) repeated measures ANOVA design confirmed a significant effect of interaction of time with group. The results also confirmed that children with CP have reduced lung function compared with normative data for children in the same age category. The treatment program improved baseline vital capacity results by 65%, while children in the control group improved by only 23%. The movement and swimming exercise program had a better effect than a physical therapy routine implemented in a previous study, consisting of respiratory exercise alone.[volver]

Título en Inglés: Investigation of the effects of a model of physical therapy on mother-child interactions and the motor behaviors of children with motor delay.

Autor/es: Chiarello-LA; Palisano-RJ

Lugar: Department of Physical Therapy, Philadelphia College of Pharmacy and Science, PA 19104, USA.

Fuente: Phys-Ther. 1998 Feb; 78(2): 180-94

ISSN: 0031-9023

Idioma: ENGLISH

Resumen: BACKGROUND AND PURPOSE: Physical therapists strive to promote children's motor function and the parents' abilities to interact with their children, thus aiming to positively influence the parent-child relationship. This study examined a model for provision of home-based physical therapy within the context of motor play on mother-child interactions and motor behaviors of children. SUBJECTS: The subjects were 38 mothers and their children with motor delay, aged 6 to 34 months (mean = 18.8, SD = 7.2), who were receiving center-based early intervention. METHOD: Children were ranked by motor development, using the Bayley Motor Scale, and assigned to either an experimental or control group. The experimental group received five home-based sessions of physical therapy. Conventional physical therapy strategies were incorporated into interactive play activities between mothers and their children. Both groups continued to receive their centered-based services. Mother-child interactions were videotaped before and after intervention and were analyzed using a modification of the response-class matrix. RESULTS: The mothers in the experimental group demonstrated an increase in appropriate holding of their children, whereas mothers in the control group demonstrated a decrease. The mothers in the experimental group became more directive, thus controlling their children's behavior, but they were not less positive or more negative when interacting with their children. CONCLUSION AND DISCUSSION: The integration of conventional physical therapy within the context of interactive play was well received and may promote generalization of motor skills during play without interfering with positive mother-child interactions.[volver]