Influence of Body Weight Unloading on Hemiplegic Gait

OBJECTIVE: To investigate the biomechanic influence of body weight unloading on the hemiplegic gait and to provide database for producing optimal strategies of gait training through body weight unloading (BWU) in hemiplegic patients. METHOD: We evaluated dynamic electromyographic data, temporal parameters of gait, and energy consumption in 20 hemiplegic patients walking on a treadmill with 0%, 10%, 20%, 30% and 40% of their BWU at their comfortable walking speed. RESULTS: 1) Stance phase and double limb support phase significantly decreased, and swing phase and single limb support phase increased according to BWU. 2) Asymmetricity of temporal parameters of gait improved according to BWU. 3) O2 rate, O2 cost, O2 pulse and heart rate significantly decreased with increasing BWU. 4) Muscular activities of rectus femoris, vastus medialis and biceps femoris decreased at initial contact and first half of stance phase and activities of medial gastrocnemius significantly decreased during entire stance phase with increasing BWU. CONCLUSION: BWU during treadmill locomotion would be advantageous as a therapeutic approach to retrain gait in hemiplegic patients.

Evoked Potentials, Brain MRI and EEG in Cerebral Palsied Children

OBJECTIVE: The present study was undertaken to evaluate the findings of multimodality evoked potentials, brain MRI and EEG in cerebral palsy children and to identify the correlations between these findings. METHOD: We examined Brain MRI, EEG and evoked potentials including visual evoked potentials(VEPs), brainstem auditory evoked potentials(BAEPs) and somatosensory evoked potentials(SSEPs) in 80 cerebral palsy children. RESULTS: 1) Abnormal findings of brain MRI and EEG were 79.4% and 81% respectively. 2) Abnormal responses of VEPs and BAEPs were 28.1% and 18.8%. 3) In the median and tibial nerve SSEPs, abnormal responses were 14.6% and 28.6%. Abnormal findings of the tibial nerve SSEPs were more frequent than the median nerve SSEPs. 4) In children with spastic hemiplegia, the abnormal SSEPs were much greater in the affected limb than unaffected limbs. 5) There was a significant correlation between the SSEP abnormalities and brain MRI or EEG abnormalities in cerebral palsy children. CONCLUSION: The data obtained in this study would be helpful for identifying and assessing the central nervous system deficits of cerebral palsy children.

The Effectiveness of Selective Posterior Rhizotomy for the Rehabilitation in Children with Cerebral Palsy

Selective posterior rhizotomy (SPR) is a neurosurgical procedure designed to alleviate spasticity and has been successfully used for children with spastic cerebral palsy. We evaluated eleven children who had follow up over 6 months after SPR among sixteen children who underwent SPR from August 1995 to July 1996. The authors have analyzed the status of the children with spastic cerebral palsy before and after operation to determine the effects of this therapy on muscle tone, functional grade, gross motor function and gait pattern. Gross motor function was measured by gross motor function measure(GMFM) scale. Postoperative tests showed reduction in muscle tone in all cases compared with preoperative assessments. Functional grade was increased in 90% of the cases more than one grade. The total gross motor mean score change between the preoperative and 6 months postoperative score was 16. Gross motor scores were analysed in each of 5 dimensions(88 conditions), i.e., lying and rolling, sitting, crawling and kneeling, standing, and walking, running, jumping. Gross motor score for each dimension improved in all cases. The greatest improvement was seen in sitting scores. The results of gait analysis of 2 ambulatory patients showed increased range of motion of hip and knee joints throughout the gait cycle and increased ankle dorsiflexion during swing phase. These results showed that SPR combined with intensive postoperative rehabilitation for children with spastic cerebral palsy had a significant positive effect on gross motor function.