Ce rebral palsy is a diagnostic term utilized to describe a group of permanent disorders affecting movement and posture.Patients with cerebral palsy are often only capable of limited activity,resulting from non-progre...Ce rebral palsy is a diagnostic term utilized to describe a group of permanent disorders affecting movement and posture.Patients with cerebral palsy are often only capable of limited activity,resulting from non-progressive disturbances in the fetal or neonatal brain.These disturbances severely impact the child’s daily life and impose a substantial economic burden on the family.Although cerebral palsy encompasses various brain injuries leading to similar clinical outcomes,the unde rstanding of its etiological pathways remains incomplete owing to its complexity and heterogeneity.This review aims to summarize the current knowledge on the genetic factors influencing cerebral palsy development.It is now widely acknowledged that genetic mutations and alterations play a pivotal role in cerebral palsy development,which can be further influenced by environmental fa ctors.Des pite continuous research endeavors,the underlying fa ctors contributing to cerebral palsy remain are still elusive.However,significant progress has been made in genetic research that has markedly enhanced our comprehension of the genetic factors underlying cerebral palsy development.Moreove r,these genetic factors have been categorized based on the identified gene mutations in patients through clinical genotyping,including thrombosis,angiogenesis,mitochondrial and oxidative phosphorylation function,neuronal migration,and cellular autophagy.Furthermore,exploring targeted genotypes holds potential for precision treatment.In conclusion,advancements in genetic research have substantially improved our understanding of the genetic causes underlying cerebral palsy.These breakthroughs have the potential to pave the way for new treatments and therapies,consequently shaping the future of cerebral palsy research and its clinical management.The investigation of cerebral palsy genetics holds the potential to significantly advance treatments and management strategies.By elucidating the underlying cellular mechanisms,we can develop to rgeted interventions to optimize outcomes.A continued collaboration between researchers and clinicians is imperative to comprehensively unravel the intricate genetic etiology of cerebral palsy.展开更多
BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and ...BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and patients are affected for the rest of their lives.Currently,treatment involves various pharmacotherapies for different types of CP,including antiepileptics for epilepsy and Botox A for focal spasticity.However,none of these methods can provide full symptom relief.This has prompted researchers to look for new treatment modalities,one of which is mesenchymal stem cell therapy(MSCT).Despite being a promising tool and offering a wide array of possibilities,mesenchymal stem cells(MSCs)still need to be investigated for their efficacy and safety.AIM To analyze the efficacy and safety of MSCT in CP patients.METHODS Our sample consists of four CP patients who cannot stand or walk without external support.All of these cases received allogeneic MSCT six times as 1×106/kg intrathecally,intravenously,and intramuscularly using umbilical cord-derived MSCs(UC-MSC).We monitored and assessed the patients pre-and post-treatment using the Wee Functional Independence Measure(WeeFIM),Gross Motor Function Classification System(GMFCS),and Manual Ability Classification Scale(MACS)instruments.We utilized the Modified Ashworth Scale(MAS)to measure spasticity.RESULTS We found significant improvements in MAS scores after the intervention on both sides.Two months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;four months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;12 months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046.However,there was no significant difference in motor functions based on WeeFIM results(P>0.05).GMFCS and MACS scores differed significantly at 12 months after the intervention(P=0.046,P=0.046).Finally,there was no significant change in cognitive functions(P>0.05).CONCLUSION In light of our findings,we believe that UC-MSC therapy has a positive effect on spasticity,and it partially improves motor functions.展开更多
Objective: To investigate the effect of VOJTA therapy on gross motor function in children with cerebral palsy. Methods: The 86 children with cerebral palsy were all from the First People’s Hospital of Jingzhou City f...Objective: To investigate the effect of VOJTA therapy on gross motor function in children with cerebral palsy. Methods: The 86 children with cerebral palsy were all from the First People’s Hospital of Jingzhou City from January 2023-December 2023, and were divided into the control group and the study group with 43 cases according to the principle of voluntariness. Results: In terms of total effective rate of treatment, the gross motor function scale-88 (GMFM-88) was used to evaluate the effective rate before and after treatment, and the effective rate of the study group was higher than that of the control group, and the difference was statistically significant, and the scores of gross motor items of GMFM-88 were better than those of the control group after treatment, and the difference was statistically significant (P 0.05). Conclusion: The application of VOJTA therapy in the treatment of children with cerebral palsy can not only promote the rehabilitation of gross motor function, but also help to improve the treatment effect, and the earlier the treatment, the better.展开更多
Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited moto...Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.展开更多
BACKGROUND Herein,we report the case of a 13-year-old boy with spastic quadriplegia cerebral palsy(CP)at Gross Motor Function Classification System(GMFCS)level II,en-gaging in a 6-wk video game-based therapy(VBT)progr...BACKGROUND Herein,we report the case of a 13-year-old boy with spastic quadriplegia cerebral palsy(CP)at Gross Motor Function Classification System(GMFCS)level II,en-gaging in a 6-wk video game-based therapy(VBT)program.This study aimed to offer essential insights regarding VBT’s impact on enhancing the physical function and improving the quality of life(QoL)of adolescents diagnosed with CP.This report provides a distinctive viewpoint that can inform and direct future clinical practices and research endeavors.CASE SUMMARY The boy presented with moderate mobility,balance,and overall well-being.He faced challenges with diminished lower limb strength,which affected his daily living and physical fitness capabilities.Our participant was diagnosed with spas-tic quadriplegic CP at GMFCS level II.He participated in a 6-wk program of VBT using a play station.This innovative approach incorporates warm-up exercises,interactive activities,and cool-down routines,targeting various movements,in-cluding single-leg stance,weight shifting,kicking,jumping,marching,and squatting.After VBT,the strength of the left hip extensor significantly increased from 199.3 N to 541.3 N.Distance covered as part of a 6-min walk test increased by 82 m.His Paediatric QoL Inventory score increased dramatically by 25.9%.CONCLUSION VBT is an innovative,individualized therapy that enhances physical function and QoL in CP,emphasizing its role in ambulatory patients.展开更多
This paper explores the effect of precise rehabilitation strategies under the international classification of functioning,disability and health for children and youth(ICF-CY)on the motor function of children with cere...This paper explores the effect of precise rehabilitation strategies under the international classification of functioning,disability and health for children and youth(ICF-CY)on the motor function of children with cerebral palsy.Under the framework of ICF-CY,the observation team is designed and evaluated from physical functions,activities and participation,environmental factors,and devel-ops individualized rehabilitation strategies that are tailored to individual character-istics.The control group was assessed by traditional methods and treatment plans and measures were formulated and guided.The course of treatment was 12 months.The scores of GMFM-88,Peabody Motor Development Scale-2con-cluding fine motor quotient(PDMS-FM),WeeFIM and the ability of daily living(ADL)scale(Barthel index,BI)score were compared before and after treatment.The research shows that precise rehabilitation strategy mode for children with cer-ebral palsy under the ICF-CY framework can effectively improve the motor func-tion and the ability of daily living(ADL)in children with cerebral palsy.Rehabilitation evaluation and treatment mode of children with cerebral palsy under ICF-CY framework can effectively improve the gross motor function of children with cerebral palsy.Individualized evaluation and analysis and guidance of comprehensive rehabilitation treatment have certain advantages.The overall treatment effect is better than that of traditional rehabilitation evaluation.展开更多
Background:Botulinum toxin type A(BTX-A)is a neuromuscular blocking agent.BTX-A inhibits acetylcholine release,causes neuromuscular transmission impairment,and decreases muscle spasms.Objective:To explore the efficacy...Background:Botulinum toxin type A(BTX-A)is a neuromuscular blocking agent.BTX-A inhibits acetylcholine release,causes neuromuscular transmission impairment,and decreases muscle spasms.Objective:To explore the efficacy and safety of BTX-A injection in the treatment of spastic cerebral palsy through systematic evaluation and to provide a reference for the clinical use of BTX-A.Methods:We used“Cerebral palsy”and“BTX-A”as the subject terms and used a combination of subject terms and free words for the search.We searched 7 databases,including CNKI,Wanfang,VIP,Sinomed,PubMed,Embase,and Web of science.Based on the inclusion and exclusion criteria,we screened the articles by reading their titles,abstracts,and full texts and finally included relevant literature for systematic evaluation.Result:A total of 93 papers were systematically evaluated,revealing that BTX-A injection treatment can effectively reduce muscle tone,increase joint mobility,improve gait and motor posture,and enhance gross motor movements in patients with spastic cerebral palsy.The benefits of BTX-A treatment can be sustained for 3–6 months,with motor ability improvement lasting up to 1 year.Combining BTX-A treatment with rehabilitation or external fixation therapy can enhance its efficacy.However,the effectiveness of BTX-A treatment is influenced by several factors,such as the dosage,number of injections,and patient age.Adverse reactions to BTX-A treatment are typically mild and can be relieved within 1–2 weeks.Conclusion:BTX-A injection is relatively safe but reversible.展开更多
Objective: To observe the effect of lumbar spinal point injection on sitting function in children with cerebral palsy. Method: Sixty-two children with post-confirmed cerebral palsy were randomly divided into control g...Objective: To observe the effect of lumbar spinal point injection on sitting function in children with cerebral palsy. Method: Sixty-two children with post-confirmed cerebral palsy were randomly divided into control group and treatment group, 31 each. The control group was given conventional rehabilitation treatment, and the treatment group was given lumbar chiropspinal acupoint injection on the basis of the treatment method of the control group. After 3 consecutive courses of treatment, the sitting score of the two groups before and after treatment (GMFM88) was used to evaluate the sitting score before and after treatment. Outcome: Before treatment, the two groups were evaluated and the differences were not statistically significant (p > 0.05), which was comparable. The two groups (GMFM88) after treatment had significantly increased the differential values, and the difference was statistically significant compared with the same group before treatment (p Conclusion: Conventional rehabilitation combined with lumbar spinal point injection can effectively improve the sitting motor function of children with cerebral palsy.展开更多
Cerebral palsy is a group of clinical disorders characterized by persistent central motor deficits and postural abnormalities due to non-progressive damage to the fetal or infant brain.Malnutrition is one of the most ...Cerebral palsy is a group of clinical disorders characterized by persistent central motor deficits and postural abnormalities due to non-progressive damage to the fetal or infant brain.Malnutrition is one of the most common clinical comorbidities in children with cerebral palsy and is the result of a combination of internal factors,such as the child’s structural and functional abnormalities,and external factors,such as the child’s feeding habits and family/social factors.The nutritional status of children with cerebral palsy is closely related to their development,quality of life,social participation,and life expectancy;thus,an objective and accurate understanding of the nutritional status of these children through rehabilitation assessment is essential for their growth and development.The current nutritional assessments include routine measurements of human nutritional parameters,scale-based assessments,and instrumental assessments.It is important to detect malnutrition in children with cerebral palsy at an early stage,reduce the prevalence of malnutrition,and improve the quality of survival.Therefore,this review aimed to analyze and summarize the nutritional status and assessment methods of children with cerebral palsy,to assess the nutritional status of children with cerebral palsy from multiple perspectives,indicators and directions,and to provide reference for the early detection of co-morbid malnutrition in children with cerebral palsy.展开更多
Purpose: The aim of this study was to investigate the effects of trunk control on motor function, which plays an important role in the daily activities of children with Cerebral Palsy (CP) and is often observed as a d...Purpose: The aim of this study was to investigate the effects of trunk control on motor function, which plays an important role in the daily activities of children with Cerebral Palsy (CP) and is often observed as a deficiency in children with CP. Material and Methods: Forty children with spastic bilateral CP, ages between 3 to 10 years and with Gross Motor Function Classification System (GMFCS) level I, II, and III were included in this study. Children were divided into two groups using randomization and in training group;Bobath Therapy for trunk control in addition to classical physiotherapy programs was performed for 45 minutes, for two days a week, for 6 weeks. In control group, existing physiotherapy program, 45 minutes for two days a week, continued. Any addition was not made into the existing program of the control group. Modified Ashworth Scale (MAS), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), 1 Minute Walking Test (1MWT), Timed Up and Go Test (TUG) were applied to both groups before and after 6 weeks. Moreover, trunk muscle strength of children was evaluated. Results: After therapy, differences were found in results of MAS and PBBS, and trunk extensor strength between the training group and the control group in favor of the training group (p Conclusion: This study shows that adding exercises which aim trunk to conventional physiotherapy and exercise programs of children with CP, affects motor function positively.展开更多
In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatme...In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatment of children with spastic cerebral palsy in the world.This study summarizes the latest progress of traditional Chinese and Western medicine in the treatment of children with spastic cerebral palsy in recent years,hoping that the whole work can serve as a clinical and theoretical basis and provide certain reference significance.展开更多
Cerebral palsy is the most common disease in children associated with lifelong disability in many countries.Clinical research has demonstrated that traditional physiotherapy and rehabilitation therapies cannot alone c...Cerebral palsy is the most common disease in children associated with lifelong disability in many countries.Clinical research has demonstrated that traditional physiotherapy and rehabilitation therapies cannot alone cure cerebral palsy.Stem cell transplantation is an emerging therapy that has been applied in clinical trials for a variety of neurological diseases because of the regenerative and unlimited proliferative capacity of stem cells.In this review, we summarize the design schemes and results of these clinical trials.Our findings reveal great differences in population characteristics, stem cell types and doses, administration methods, and evaluation methods among the included clinical trials.Furthermore, we also assess the safety and efficacy of these clinical trials.We anticipate that our findings will advance the rational development of clinical trials of stem cell therapy for cerebral palsy and contribute to the clinical application of stem cells.展开更多
Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)mo...Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)motion recognition technology is combined with Kinect to improve the effect of cerebral palsy rehabilitation training.In this system,Kinect's bone recognition method is used to judge the patient's training movements,and the collected bone movement information is judged.The human-computer interaction function is based on the Microsoft foundation classes function of Visual Studio based on DSLM development,which can realize real-time interactive training and evaluation of people and actions,and record the training information of patients.The system combines the designed small game to train the upper limb movement ability and reaction ability of the cerebral palsy patient,and provides key technology for improving the cerebral palsy rehabilitation training system.展开更多
Background: Cerebral palsy is a group of disorders arising from a static damage or brain development defects occurring during fetal life and in the first months of life. Methods: The sample consisted of 800 individual...Background: Cerebral palsy is a group of disorders arising from a static damage or brain development defects occurring during fetal life and in the first months of life. Methods: The sample consisted of 800 individuals living in 50 districts of the city of Maceio. A standardized questionnaire was applied. Results: The prevalence of cerebral palsy in the sample was 5/1000. All were born at term, 75% were male, 50% had severe cerebral palsy and 50% was moderate. 75% had quadriplegia and 25% had diplegia. Fifty percent of the cerebral palsy was caused by meningitis and 50% for prolonged labor. Conclusions: The prevalence of cerebral palsy in Maceió is 140.38% higher than the highest prevalence found in developed countries, predominantly in low-income and related to postnatal infection in families.展开更多
Objective:To evaluate the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in treating infantile cerebral palsy by meta-analysis.Methods:CNKI,VIP,Wanfang knowledge service platform,CBM,PubMed,Embase a...Objective:To evaluate the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in treating infantile cerebral palsy by meta-analysis.Methods:CNKI,VIP,Wanfang knowledge service platform,CBM,PubMed,Embase and Cochrane library databases were searched.The retrieval time period was pushed back to the establishment of the database in March 2021.Through layers of screening and quality evaluation of the included literature,the data were analyzed with Revman 5.4.Results:9 articles were included,a total of 748 cases.The results of meta-analysis showed that compared with other therapies(control group),Xingnao Kaiqiao acupuncture combined therapy(treatment group)could improve the total clinical effective rate(or=3.32,95%CI[2.14,5.13],P<0.00001),improve the ability of language acceptance(MD=1.13,95%CI[0.92,1.34],P<0.00001),and improve the ability of language expression(MD=1.28,95%CI[1.03,1.54],P<0.00001),improve gmfm88 score(MD=23.13,95%CI[18.75,27.51],P<0.00001),improve dysarthria score(MD=0.33,95%CI[0.26,0.41],P<0.00001),improve MCA of cerebral ultrasound blood flow examination(MD=13.12,95%CI[9.22,17.01],P<0.00001),and ACA of cerebral ultrasound blood flow examination(MD=9.45,95%CI[6.28,12.62],P<0.00001).Conclusion:Compared with other therapies,Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy can improve the total clinical efficiency,and has obvious advantages in improving language function,gross motor function,dysarthria,MCA and ACA of cerebral ultrasonic blood flow examination,but it still needs more and higher quality literature to prove it.展开更多
BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity.Scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion.While consens...BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity.Scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion.While consensus is reached regarding the proximal starting point of fusion,controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic obliquity.AIM To assess the role of pelvic fusion in posterior spinal instrumentation and fusion,particularly it impact on pelvic obliquity correction,and to assess if the rate of complications differed as a function of pelvic fusion.METHODS This was a retrospective,cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single institution.Minimum follow-up was six months.Patients were stratified into two groups:Those who were fused to the pelvis and those fused to L4/L5.The major outcomes were complications and radiographic parameters.The former were stratified into major and minor complications,and the latter consisted of preoperative and final Cobb angles,L5-S1 tilt and pelvic obliquity.RESULTS The study included 47 patients.The correction of the L5 tilt was 60%in patients fused to the pelvis and 67%in patients fused to L4/L5(P=0.22).The pelvic obliquity was corrected by 43%and 36%in each group,respectively(P=0.12).Regarding complications,patients fused to the pelvis had more total complications as compared to the other group(63.0%vs 30%,respectively,P=0.025).After adjusting for differences in radiographic parameters(lumbar curve,L5 tilt,and pelvic obliquity),these patients had a 79%increased chance of developing complications(Relative risk=1.79;95%CI:1.011-3.41).CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative complications.The added value that pelvic fusion offers in terms of correcting pelvic obliquity is not clear,as these patients had similar percent correction of their pelvic obliquity and L5 tilt compared to children whose fusion was stopped at L4/L5.Therefore,in a select patient population,spinal fusion can be stopped at the distal lumbar levels without adversely affecting the surgical outcomes.展开更多
BACKGROUND: Researches prove that the treatment of cerebral palsy by botulinus toxin (BTX-A) can improve effect and prolong effective duration. Current intensity is the important factor during injection.OBJECTIVE: To ...BACKGROUND: Researches prove that the treatment of cerebral palsy by botulinus toxin (BTX-A) can improve effect and prolong effective duration. Current intensity is the important factor during injection.OBJECTIVE: To observe the changes of motor function and muscular intensity of children with spastic cerebral palsy after injecting BTX-A and analyze correlation between current intensity and effective duration. DESIGN: Cases control trial before and after nerves block.SETTING: Capital University of Medical Sciences, China Rehabilitation Research Center.PARTICIPANTS: From June 2002 to November 2004, 14 children with spastic cerebral palsy were treated by BTX-A block. All children were hospitalized in the Children Rehabilitation Department of China Rehabilitation Research Center. The children included 9 male and 5 female, and ranged from 4 to 13 years old, and average age was (6±2) years. Muscular tension ranged from grade 1 to grade 3. The diagnosis and the tape of cerebral palsy based on standard of the Fist Nationwide Cerebral Palsy Symposium, and all children were diagnosed with electroencephalogram (EEG), CT and MRI, and permitted by their guardians.METHODS: ① Locating and calculation: To locate block points by G6805-2A electro-therapeutic apparatus (Shanghai Huayi Electronic Instrument Plant) at the least stimulating current (continuous wave; impulse frequency; 2.667-83.333 Hz; current intensity: 0-6 mA; voltage: 6 V) to touch off muscles contraction. The current intensity of each point was recorded, and the average current intensity of each patient was calculated at the same time. ② Dose of BTX-A: Basing upon the spastic degree and weight of patients, the dose was made certain: dose (IU)=(scores of Modified Ashworth Scale +2.5) ×weight (kg). The number of the block points was in all 4. The dose of injection ranged from 50 IU to 160 IU with the average of (73.6±25.8) IU. The BTX-A was made by Lanzhou Institute of Biological Products, and each bottle contains 100 IU BTX-A. Muscular tension was evaluated by Modified Ashworth Scale. The scale ranged from grade 0 to grade 4, and the scores were from 0 to 4. The higher the scores were, the higher the muscular tension was. ③ Effect: Changes of muscular tension were evaluated by modified Ashworth Scale before and after block. Motor function was evaluated by Physician Rating Scale (PRS) before and after treatment. It contained Gait pattern, Hindfoot (ankle) position (stance-floor contact), Hindfoot position (foot strike), Knee position (degree of recurvation), Crouch and Speed of gait. The scores ranged from 0 to 14. The higher the points were, the better the motor function was. ④ Effective duration: The duration was definited by the recovering of the Modified Ashworth Scale. ⑤ Statistic analysis: Firstly, the current intensity and the effect duration were analyzed by One-Sample Kolmogorov-Smirnov Test, the current intensity: Z = 0.456, P = 0.985, the effective duration: Z = 0.557, P = 0.915. Both data were normal distribution. Secondly, both data were analyzed by Linear Regression. The efficiency of the BTX-A block was analyzed by paired-samples t test.MAIN OUTCOME MEASURES: ① Changes of motor function of muscular tension; ② correlation between current intensity and effective duration. RESULTS: Fourteen children with spastic cerebral palsy were all involved in the final analysis. ① Therapeutic effect: The average score of Ashworth scale after block was lower than that before block [(1.02±0.34) points vs. (2.12±0.48) points, t = 3.644, P < 0.01]. The average score of RPS after block was higher than that before block [(9.75±2.78) points vs. (6.16±0.58) points, t =13.222, P < 0.01]. ② Relation between the current intensity and the effective duration: The current intensity was (0.1857±0.0506) mA, and the effective duration was (26.36±4.48) weeks. The current intensity was negative correlation with effective duration (r = -0.775, P = 0.01).CONCLUSION: ① BTX-A occlusion can decrease muscular tension and improve motor function of lower limbs of children with spastic cerebral palsy. ② The lower the current intensity is, the longer the effective duration is.展开更多
<strong>Background:</strong><span><span><span style="font-family:;" "=""> CNS lesions that are acquired early in life e.g. cerebral palsy (CP) disturb muscle deve...<strong>Background:</strong><span><span><span style="font-family:;" "=""> CNS lesions that are acquired early in life e.g. cerebral palsy (CP) disturb muscle development and growth, while CNS injuries acquired later in life e.g. stroke</span></span></span><span><span><span style="font-family:;" "="">,</span></span></span><span><span><span style="font-family:;" "=""> affect fully matured muscles and <span>cause</span> paresis and atrophy. These differences may result in different contracture phenotypes. <b>Aim:</b> The purpose of this study was to compare systemic biomarkers and gene expression levels in muscle of individuals with CNS lesions acquired early and later in life. <b>Methods:</b> Blood samples and muscle biopsies were analyzed using Enzyme-linked immunosorbent assay and Real-time PCR from n = 24 control participants, n = 14 individuals with cerebral palsy, and n = 12 stroke survivors. <b>Results:</b> <b>Systemic</b> <b>markers:</b> Myostatin was significantly decreased in both the cerebral palsy (p = 0.0051<span>),</span> and the stroke group (p = 0.036). Creatine Kinase-MB and C-Reactive Protein were significantly elevated in stroke patients only (p < 0.007 & p > 0.034 respectively). <b>Gene</b> <b>expressions:</b> The expression of myostatin (MSTN) was significantly lower in both the ST and the CP group when compared to Ctrl (p = 0.02). <span>In addition</span>, collagen type 4A1 (COL4A1) was significantly lower in the CP group compared to the other groups (p = 0.015). Finally, the troponin 1 slow skeletal muscle type was significantly increased in the ST group when compared to both CP and Ctrl (p = 0.03). <b>Conclusion:</b> The downregulation of myostatin in individuals with both early and late CNS injury is likely a compensatory reaction to muscle weakness, reduced muscle mass <span>and</span>/or muscle atrophy. Changes in gene expression may reflect <span>a specific</span> alteration depending on when in life the CNS lesions were acquired.</span></span></span>展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the m...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>展开更多
Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral pals...Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.展开更多
基金supported by the National Natural Science Foundation of China,No.U21A20347(to CZ)the National Key Research and Development Program of China,No.2022YFC2704801(to CZ)+1 种基金the Henan Key Laboratory of Population Defects Prevention,No.ZD202103(to YX)the Department of Science and Technology of Henan Province of China,No.212102310221(to YX)。
文摘Ce rebral palsy is a diagnostic term utilized to describe a group of permanent disorders affecting movement and posture.Patients with cerebral palsy are often only capable of limited activity,resulting from non-progressive disturbances in the fetal or neonatal brain.These disturbances severely impact the child’s daily life and impose a substantial economic burden on the family.Although cerebral palsy encompasses various brain injuries leading to similar clinical outcomes,the unde rstanding of its etiological pathways remains incomplete owing to its complexity and heterogeneity.This review aims to summarize the current knowledge on the genetic factors influencing cerebral palsy development.It is now widely acknowledged that genetic mutations and alterations play a pivotal role in cerebral palsy development,which can be further influenced by environmental fa ctors.Des pite continuous research endeavors,the underlying fa ctors contributing to cerebral palsy remain are still elusive.However,significant progress has been made in genetic research that has markedly enhanced our comprehension of the genetic factors underlying cerebral palsy development.Moreove r,these genetic factors have been categorized based on the identified gene mutations in patients through clinical genotyping,including thrombosis,angiogenesis,mitochondrial and oxidative phosphorylation function,neuronal migration,and cellular autophagy.Furthermore,exploring targeted genotypes holds potential for precision treatment.In conclusion,advancements in genetic research have substantially improved our understanding of the genetic causes underlying cerebral palsy.These breakthroughs have the potential to pave the way for new treatments and therapies,consequently shaping the future of cerebral palsy research and its clinical management.The investigation of cerebral palsy genetics holds the potential to significantly advance treatments and management strategies.By elucidating the underlying cellular mechanisms,we can develop to rgeted interventions to optimize outcomes.A continued collaboration between researchers and clinicians is imperative to comprehensively unravel the intricate genetic etiology of cerebral palsy.
文摘BACKGROUND Cerebral palsy(CP)describes a group of disorders affecting movement,balance,and posture.Disturbances in motor functions constitute the main body of CP symptoms.These symptoms surface in early childhood and patients are affected for the rest of their lives.Currently,treatment involves various pharmacotherapies for different types of CP,including antiepileptics for epilepsy and Botox A for focal spasticity.However,none of these methods can provide full symptom relief.This has prompted researchers to look for new treatment modalities,one of which is mesenchymal stem cell therapy(MSCT).Despite being a promising tool and offering a wide array of possibilities,mesenchymal stem cells(MSCs)still need to be investigated for their efficacy and safety.AIM To analyze the efficacy and safety of MSCT in CP patients.METHODS Our sample consists of four CP patients who cannot stand or walk without external support.All of these cases received allogeneic MSCT six times as 1×106/kg intrathecally,intravenously,and intramuscularly using umbilical cord-derived MSCs(UC-MSC).We monitored and assessed the patients pre-and post-treatment using the Wee Functional Independence Measure(WeeFIM),Gross Motor Function Classification System(GMFCS),and Manual Ability Classification Scale(MACS)instruments.We utilized the Modified Ashworth Scale(MAS)to measure spasticity.RESULTS We found significant improvements in MAS scores after the intervention on both sides.Two months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;four months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046;12 months:Rightχ^(2)=4000,P=0.046,leftχ^(2)=4000,P=0.046.However,there was no significant difference in motor functions based on WeeFIM results(P>0.05).GMFCS and MACS scores differed significantly at 12 months after the intervention(P=0.046,P=0.046).Finally,there was no significant change in cognitive functions(P>0.05).CONCLUSION In light of our findings,we believe that UC-MSC therapy has a positive effect on spasticity,and it partially improves motor functions.
文摘Objective: To investigate the effect of VOJTA therapy on gross motor function in children with cerebral palsy. Methods: The 86 children with cerebral palsy were all from the First People’s Hospital of Jingzhou City from January 2023-December 2023, and were divided into the control group and the study group with 43 cases according to the principle of voluntariness. Results: In terms of total effective rate of treatment, the gross motor function scale-88 (GMFM-88) was used to evaluate the effective rate before and after treatment, and the effective rate of the study group was higher than that of the control group, and the difference was statistically significant, and the scores of gross motor items of GMFM-88 were better than those of the control group after treatment, and the difference was statistically significant (P 0.05). Conclusion: The application of VOJTA therapy in the treatment of children with cerebral palsy can not only promote the rehabilitation of gross motor function, but also help to improve the treatment effect, and the earlier the treatment, the better.
基金supported by the Science and Technology Fund of Chengdu Medical College(CYZ18-29)the Sichuan Science and Technology Program(2022JDRC0127).
文摘Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.
基金the Ministry of Higher Education of Malaysia,No.FRGS/1/2021/SKK06/UKM/03/2.
文摘BACKGROUND Herein,we report the case of a 13-year-old boy with spastic quadriplegia cerebral palsy(CP)at Gross Motor Function Classification System(GMFCS)level II,en-gaging in a 6-wk video game-based therapy(VBT)program.This study aimed to offer essential insights regarding VBT’s impact on enhancing the physical function and improving the quality of life(QoL)of adolescents diagnosed with CP.This report provides a distinctive viewpoint that can inform and direct future clinical practices and research endeavors.CASE SUMMARY The boy presented with moderate mobility,balance,and overall well-being.He faced challenges with diminished lower limb strength,which affected his daily living and physical fitness capabilities.Our participant was diagnosed with spas-tic quadriplegic CP at GMFCS level II.He participated in a 6-wk program of VBT using a play station.This innovative approach incorporates warm-up exercises,interactive activities,and cool-down routines,targeting various movements,in-cluding single-leg stance,weight shifting,kicking,jumping,marching,and squatting.After VBT,the strength of the left hip extensor significantly increased from 199.3 N to 541.3 N.Distance covered as part of a 6-min walk test increased by 82 m.His Paediatric QoL Inventory score increased dramatically by 25.9%.CONCLUSION VBT is an innovative,individualized therapy that enhances physical function and QoL in CP,emphasizing its role in ambulatory patients.
基金This work is supported by General Project of Nanjing Municipal Health Commission(No.YKK19108).
文摘This paper explores the effect of precise rehabilitation strategies under the international classification of functioning,disability and health for children and youth(ICF-CY)on the motor function of children with cerebral palsy.Under the framework of ICF-CY,the observation team is designed and evaluated from physical functions,activities and participation,environmental factors,and devel-ops individualized rehabilitation strategies that are tailored to individual character-istics.The control group was assessed by traditional methods and treatment plans and measures were formulated and guided.The course of treatment was 12 months.The scores of GMFM-88,Peabody Motor Development Scale-2con-cluding fine motor quotient(PDMS-FM),WeeFIM and the ability of daily living(ADL)scale(Barthel index,BI)score were compared before and after treatment.The research shows that precise rehabilitation strategy mode for children with cer-ebral palsy under the ICF-CY framework can effectively improve the motor func-tion and the ability of daily living(ADL)in children with cerebral palsy.Rehabilitation evaluation and treatment mode of children with cerebral palsy under ICF-CY framework can effectively improve the gross motor function of children with cerebral palsy.Individualized evaluation and analysis and guidance of comprehensive rehabilitation treatment have certain advantages.The overall treatment effect is better than that of traditional rehabilitation evaluation.
文摘Background:Botulinum toxin type A(BTX-A)is a neuromuscular blocking agent.BTX-A inhibits acetylcholine release,causes neuromuscular transmission impairment,and decreases muscle spasms.Objective:To explore the efficacy and safety of BTX-A injection in the treatment of spastic cerebral palsy through systematic evaluation and to provide a reference for the clinical use of BTX-A.Methods:We used“Cerebral palsy”and“BTX-A”as the subject terms and used a combination of subject terms and free words for the search.We searched 7 databases,including CNKI,Wanfang,VIP,Sinomed,PubMed,Embase,and Web of science.Based on the inclusion and exclusion criteria,we screened the articles by reading their titles,abstracts,and full texts and finally included relevant literature for systematic evaluation.Result:A total of 93 papers were systematically evaluated,revealing that BTX-A injection treatment can effectively reduce muscle tone,increase joint mobility,improve gait and motor posture,and enhance gross motor movements in patients with spastic cerebral palsy.The benefits of BTX-A treatment can be sustained for 3–6 months,with motor ability improvement lasting up to 1 year.Combining BTX-A treatment with rehabilitation or external fixation therapy can enhance its efficacy.However,the effectiveness of BTX-A treatment is influenced by several factors,such as the dosage,number of injections,and patient age.Adverse reactions to BTX-A treatment are typically mild and can be relieved within 1–2 weeks.Conclusion:BTX-A injection is relatively safe but reversible.
文摘Objective: To observe the effect of lumbar spinal point injection on sitting function in children with cerebral palsy. Method: Sixty-two children with post-confirmed cerebral palsy were randomly divided into control group and treatment group, 31 each. The control group was given conventional rehabilitation treatment, and the treatment group was given lumbar chiropspinal acupoint injection on the basis of the treatment method of the control group. After 3 consecutive courses of treatment, the sitting score of the two groups before and after treatment (GMFM88) was used to evaluate the sitting score before and after treatment. Outcome: Before treatment, the two groups were evaluated and the differences were not statistically significant (p > 0.05), which was comparable. The two groups (GMFM88) after treatment had significantly increased the differential values, and the difference was statistically significant compared with the same group before treatment (p Conclusion: Conventional rehabilitation combined with lumbar spinal point injection can effectively improve the sitting motor function of children with cerebral palsy.
基金The authors would like to thank Research Project of Sichuan Traditional Chinese Medicine Administration(2020LC0122)Key Specialty of Chengdu(CDS2018Z005)Scientific research projects supported by the Science and Technology Fund of Chengdu Medical College(CYZ18-29)for the financial support.
文摘Cerebral palsy is a group of clinical disorders characterized by persistent central motor deficits and postural abnormalities due to non-progressive damage to the fetal or infant brain.Malnutrition is one of the most common clinical comorbidities in children with cerebral palsy and is the result of a combination of internal factors,such as the child’s structural and functional abnormalities,and external factors,such as the child’s feeding habits and family/social factors.The nutritional status of children with cerebral palsy is closely related to their development,quality of life,social participation,and life expectancy;thus,an objective and accurate understanding of the nutritional status of these children through rehabilitation assessment is essential for their growth and development.The current nutritional assessments include routine measurements of human nutritional parameters,scale-based assessments,and instrumental assessments.It is important to detect malnutrition in children with cerebral palsy at an early stage,reduce the prevalence of malnutrition,and improve the quality of survival.Therefore,this review aimed to analyze and summarize the nutritional status and assessment methods of children with cerebral palsy,to assess the nutritional status of children with cerebral palsy from multiple perspectives,indicators and directions,and to provide reference for the early detection of co-morbid malnutrition in children with cerebral palsy.
文摘Purpose: The aim of this study was to investigate the effects of trunk control on motor function, which plays an important role in the daily activities of children with Cerebral Palsy (CP) and is often observed as a deficiency in children with CP. Material and Methods: Forty children with spastic bilateral CP, ages between 3 to 10 years and with Gross Motor Function Classification System (GMFCS) level I, II, and III were included in this study. Children were divided into two groups using randomization and in training group;Bobath Therapy for trunk control in addition to classical physiotherapy programs was performed for 45 minutes, for two days a week, for 6 weeks. In control group, existing physiotherapy program, 45 minutes for two days a week, continued. Any addition was not made into the existing program of the control group. Modified Ashworth Scale (MAS), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), 1 Minute Walking Test (1MWT), Timed Up and Go Test (TUG) were applied to both groups before and after 6 weeks. Moreover, trunk muscle strength of children was evaluated. Results: After therapy, differences were found in results of MAS and PBBS, and trunk extensor strength between the training group and the control group in favor of the training group (p Conclusion: This study shows that adding exercises which aim trunk to conventional physiotherapy and exercise programs of children with CP, affects motor function positively.
基金supported by the Project of Shaanxi Administration of traditional Chinese medicine on clinical collaborative innovation of integrated traditional Chinese and Western Medicine-real world clinical research of integrated traditional Chinese and Western medicine in spastic cerebral palsy(2020-ZXY-004).
文摘In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatment of children with spastic cerebral palsy in the world.This study summarizes the latest progress of traditional Chinese and Western medicine in the treatment of children with spastic cerebral palsy in recent years,hoping that the whole work can serve as a clinical and theoretical basis and provide certain reference significance.
基金supported by the National Natural Science Foundation of China, No.81471308(to JL)the Stem Cell Clinical Research Project of China, No.CMR-20161129-1003(to JL)the Dalian Innovation Technology Funding of China, No.2018 J11 CY025(to JL)。
文摘Cerebral palsy is the most common disease in children associated with lifelong disability in many countries.Clinical research has demonstrated that traditional physiotherapy and rehabilitation therapies cannot alone cure cerebral palsy.Stem cell transplantation is an emerging therapy that has been applied in clinical trials for a variety of neurological diseases because of the regenerative and unlimited proliferative capacity of stem cells.In this review, we summarize the design schemes and results of these clinical trials.Our findings reveal great differences in population characteristics, stem cell types and doses, administration methods, and evaluation methods among the included clinical trials.Furthermore, we also assess the safety and efficacy of these clinical trials.We anticipate that our findings will advance the rational development of clinical trials of stem cell therapy for cerebral palsy and contribute to the clinical application of stem cells.
基金Supported by the China-Slovenia Intergovernmental Science and Technology Cooperation and Exchange Project(2017-21-12-16)China-Serbia Intergovernmental Science and Technology Cooperation and Exchange Project(266-3-1).
文摘Based on domain specified language mechanism(DSLM),the architecture of the robotic training system for the rehabilitation of children with cerebral palsy(CP)is designed.Application of human-computer interaction(HCI)motion recognition technology is combined with Kinect to improve the effect of cerebral palsy rehabilitation training.In this system,Kinect's bone recognition method is used to judge the patient's training movements,and the collected bone movement information is judged.The human-computer interaction function is based on the Microsoft foundation classes function of Visual Studio based on DSLM development,which can realize real-time interactive training and evaluation of people and actions,and record the training information of patients.The system combines the designed small game to train the upper limb movement ability and reaction ability of the cerebral palsy patient,and provides key technology for improving the cerebral palsy rehabilitation training system.
文摘Background: Cerebral palsy is a group of disorders arising from a static damage or brain development defects occurring during fetal life and in the first months of life. Methods: The sample consisted of 800 individuals living in 50 districts of the city of Maceio. A standardized questionnaire was applied. Results: The prevalence of cerebral palsy in the sample was 5/1000. All were born at term, 75% were male, 50% had severe cerebral palsy and 50% was moderate. 75% had quadriplegia and 25% had diplegia. Fifty percent of the cerebral palsy was caused by meningitis and 50% for prolonged labor. Conclusions: The prevalence of cerebral palsy in Maceió is 140.38% higher than the highest prevalence found in developed countries, predominantly in low-income and related to postnatal infection in families.
文摘Objective:To evaluate the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in treating infantile cerebral palsy by meta-analysis.Methods:CNKI,VIP,Wanfang knowledge service platform,CBM,PubMed,Embase and Cochrane library databases were searched.The retrieval time period was pushed back to the establishment of the database in March 2021.Through layers of screening and quality evaluation of the included literature,the data were analyzed with Revman 5.4.Results:9 articles were included,a total of 748 cases.The results of meta-analysis showed that compared with other therapies(control group),Xingnao Kaiqiao acupuncture combined therapy(treatment group)could improve the total clinical effective rate(or=3.32,95%CI[2.14,5.13],P<0.00001),improve the ability of language acceptance(MD=1.13,95%CI[0.92,1.34],P<0.00001),and improve the ability of language expression(MD=1.28,95%CI[1.03,1.54],P<0.00001),improve gmfm88 score(MD=23.13,95%CI[18.75,27.51],P<0.00001),improve dysarthria score(MD=0.33,95%CI[0.26,0.41],P<0.00001),improve MCA of cerebral ultrasound blood flow examination(MD=13.12,95%CI[9.22,17.01],P<0.00001),and ACA of cerebral ultrasound blood flow examination(MD=9.45,95%CI[6.28,12.62],P<0.00001).Conclusion:Compared with other therapies,Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy can improve the total clinical efficiency,and has obvious advantages in improving language function,gross motor function,dysarthria,MCA and ACA of cerebral ultrasonic blood flow examination,but it still needs more and higher quality literature to prove it.
文摘BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity.Scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion.While consensus is reached regarding the proximal starting point of fusion,controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic obliquity.AIM To assess the role of pelvic fusion in posterior spinal instrumentation and fusion,particularly it impact on pelvic obliquity correction,and to assess if the rate of complications differed as a function of pelvic fusion.METHODS This was a retrospective,cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single institution.Minimum follow-up was six months.Patients were stratified into two groups:Those who were fused to the pelvis and those fused to L4/L5.The major outcomes were complications and radiographic parameters.The former were stratified into major and minor complications,and the latter consisted of preoperative and final Cobb angles,L5-S1 tilt and pelvic obliquity.RESULTS The study included 47 patients.The correction of the L5 tilt was 60%in patients fused to the pelvis and 67%in patients fused to L4/L5(P=0.22).The pelvic obliquity was corrected by 43%and 36%in each group,respectively(P=0.12).Regarding complications,patients fused to the pelvis had more total complications as compared to the other group(63.0%vs 30%,respectively,P=0.025).After adjusting for differences in radiographic parameters(lumbar curve,L5 tilt,and pelvic obliquity),these patients had a 79%increased chance of developing complications(Relative risk=1.79;95%CI:1.011-3.41).CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative complications.The added value that pelvic fusion offers in terms of correcting pelvic obliquity is not clear,as these patients had similar percent correction of their pelvic obliquity and L5 tilt compared to children whose fusion was stopped at L4/L5.Therefore,in a select patient population,spinal fusion can be stopped at the distal lumbar levels without adversely affecting the surgical outcomes.
文摘BACKGROUND: Researches prove that the treatment of cerebral palsy by botulinus toxin (BTX-A) can improve effect and prolong effective duration. Current intensity is the important factor during injection.OBJECTIVE: To observe the changes of motor function and muscular intensity of children with spastic cerebral palsy after injecting BTX-A and analyze correlation between current intensity and effective duration. DESIGN: Cases control trial before and after nerves block.SETTING: Capital University of Medical Sciences, China Rehabilitation Research Center.PARTICIPANTS: From June 2002 to November 2004, 14 children with spastic cerebral palsy were treated by BTX-A block. All children were hospitalized in the Children Rehabilitation Department of China Rehabilitation Research Center. The children included 9 male and 5 female, and ranged from 4 to 13 years old, and average age was (6±2) years. Muscular tension ranged from grade 1 to grade 3. The diagnosis and the tape of cerebral palsy based on standard of the Fist Nationwide Cerebral Palsy Symposium, and all children were diagnosed with electroencephalogram (EEG), CT and MRI, and permitted by their guardians.METHODS: ① Locating and calculation: To locate block points by G6805-2A electro-therapeutic apparatus (Shanghai Huayi Electronic Instrument Plant) at the least stimulating current (continuous wave; impulse frequency; 2.667-83.333 Hz; current intensity: 0-6 mA; voltage: 6 V) to touch off muscles contraction. The current intensity of each point was recorded, and the average current intensity of each patient was calculated at the same time. ② Dose of BTX-A: Basing upon the spastic degree and weight of patients, the dose was made certain: dose (IU)=(scores of Modified Ashworth Scale +2.5) ×weight (kg). The number of the block points was in all 4. The dose of injection ranged from 50 IU to 160 IU with the average of (73.6±25.8) IU. The BTX-A was made by Lanzhou Institute of Biological Products, and each bottle contains 100 IU BTX-A. Muscular tension was evaluated by Modified Ashworth Scale. The scale ranged from grade 0 to grade 4, and the scores were from 0 to 4. The higher the scores were, the higher the muscular tension was. ③ Effect: Changes of muscular tension were evaluated by modified Ashworth Scale before and after block. Motor function was evaluated by Physician Rating Scale (PRS) before and after treatment. It contained Gait pattern, Hindfoot (ankle) position (stance-floor contact), Hindfoot position (foot strike), Knee position (degree of recurvation), Crouch and Speed of gait. The scores ranged from 0 to 14. The higher the points were, the better the motor function was. ④ Effective duration: The duration was definited by the recovering of the Modified Ashworth Scale. ⑤ Statistic analysis: Firstly, the current intensity and the effect duration were analyzed by One-Sample Kolmogorov-Smirnov Test, the current intensity: Z = 0.456, P = 0.985, the effective duration: Z = 0.557, P = 0.915. Both data were normal distribution. Secondly, both data were analyzed by Linear Regression. The efficiency of the BTX-A block was analyzed by paired-samples t test.MAIN OUTCOME MEASURES: ① Changes of motor function of muscular tension; ② correlation between current intensity and effective duration. RESULTS: Fourteen children with spastic cerebral palsy were all involved in the final analysis. ① Therapeutic effect: The average score of Ashworth scale after block was lower than that before block [(1.02±0.34) points vs. (2.12±0.48) points, t = 3.644, P < 0.01]. The average score of RPS after block was higher than that before block [(9.75±2.78) points vs. (6.16±0.58) points, t =13.222, P < 0.01]. ② Relation between the current intensity and the effective duration: The current intensity was (0.1857±0.0506) mA, and the effective duration was (26.36±4.48) weeks. The current intensity was negative correlation with effective duration (r = -0.775, P = 0.01).CONCLUSION: ① BTX-A occlusion can decrease muscular tension and improve motor function of lower limbs of children with spastic cerebral palsy. ② The lower the current intensity is, the longer the effective duration is.
文摘<strong>Background:</strong><span><span><span style="font-family:;" "=""> CNS lesions that are acquired early in life e.g. cerebral palsy (CP) disturb muscle development and growth, while CNS injuries acquired later in life e.g. stroke</span></span></span><span><span><span style="font-family:;" "="">,</span></span></span><span><span><span style="font-family:;" "=""> affect fully matured muscles and <span>cause</span> paresis and atrophy. These differences may result in different contracture phenotypes. <b>Aim:</b> The purpose of this study was to compare systemic biomarkers and gene expression levels in muscle of individuals with CNS lesions acquired early and later in life. <b>Methods:</b> Blood samples and muscle biopsies were analyzed using Enzyme-linked immunosorbent assay and Real-time PCR from n = 24 control participants, n = 14 individuals with cerebral palsy, and n = 12 stroke survivors. <b>Results:</b> <b>Systemic</b> <b>markers:</b> Myostatin was significantly decreased in both the cerebral palsy (p = 0.0051<span>),</span> and the stroke group (p = 0.036). Creatine Kinase-MB and C-Reactive Protein were significantly elevated in stroke patients only (p < 0.007 & p > 0.034 respectively). <b>Gene</b> <b>expressions:</b> The expression of myostatin (MSTN) was significantly lower in both the ST and the CP group when compared to Ctrl (p = 0.02). <span>In addition</span>, collagen type 4A1 (COL4A1) was significantly lower in the CP group compared to the other groups (p = 0.015). Finally, the troponin 1 slow skeletal muscle type was significantly increased in the ST group when compared to both CP and Ctrl (p = 0.03). <b>Conclusion:</b> The downregulation of myostatin in individuals with both early and late CNS injury is likely a compensatory reaction to muscle weakness, reduced muscle mass <span>and</span>/or muscle atrophy. Changes in gene expression may reflect <span>a specific</span> alteration depending on when in life the CNS lesions were acquired.</span></span></span>
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>
文摘Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.
