Intraoperative Vertebral Artery Angiography to Guide C1-2 Transarticular Screw Fixation in a Patient with Athetoid Cerebral Palsy

We present a case of an athetoid cerebral palsy with quadriparesis caused by kyphotic deformity of the cervical spine, severe spinal stenosis at the cervicomedullary junction, and atlantoaxial instability. The patient improved after the first surgery, which included a C1 total laminectomy and C-arm guided righ side unilateral C1-2 transarticular screw fixation. C1-2 fixation was not performed on the other side because of an aberrant and dominant vertebral artery (VA). Eight months after the first operation, the patient required revision surgery for persistent neck pain and screw malposition. We used intraoperative VA angiography with simultaneous fluoroscopy for precise image guidance during bilateral C1-2 transarticular screw fixation. Intraoperative VA angiography allowed the accurate insertion of screws, and can therefore be used to avoid VA injury during C1-2 transarticular screw fixation in comorbid patients with atlantoaxial deformities.

A Study on Acoustic Characteristics of Dysarthria in Athetoid Cerebral Palsy

OBJECTIVE: Athetoid cerebral palsy is a nonprogressive disorder, due to hypoxic injury or jaundice in basal ganglia, characterized by impairment of postural reflexes, arrhythmical involuntary movements, and dysarthria. Dysarthria is a group of motor speech disorder resulting from a disturbance of motor control of the speech mechanism. The purpose of this study is to evaluate the acoustic characteristics of dysarthria in athetoid cerebral palsy. METHOD: We investigated the acoustic characteristics of dysarthria in 8 male patients with athetoid cerebral palsy and 6 males as a control group using Computerized Speech Laboratory (i.e., Multi-Dimensional Voice Program (MDVP), Visi-Pitch, and Electroglottography) and Nasometer. RESULTS: In the MDVP analysis, average fundamental frequency, jitter, and shimmer are significantly increased in patient group as compared to control group (p<0.05). In the Visi-Pitch analysis, maximal phonation and diadochokinetic rate are significantly decreased in patient group (p<0.05). The athetoid cerebral palsied patients have many pitch breaks. Nasalance is not significantly decreased in patient group in comparision with control group. CONCLUSION: We think that average fundamental frequency, jitter and shimmer are increased and maximal phonation time and diadochokinetic rate are decreased in athetoid cerebral palsied patients.

Respiratory Patterns Associated with Swallowing in Athetoid Cerebral-Palsied Patients

OBJECTIVE: To evaluate the changes of the respiratory patterns associated with swallowing in athetoid cerebral palsied patients (CP), and to understand its relationship with their dysphagia and aspiration. METHOD: Seven adult athetoid CP and seven control subjects were selected for this study. Each subject performed swallowing tasks in upright sitting position, and submental electromyography and respirography by pneumobelt on mid-abdomen were recorded simultaneously. Swallowing tasks were composed of swallowing 5 cc, 75 cc of water, and chewing a cookie. And athetoid subjects performed videofluoroscopic swallowing study (VFSS) for each food texture. RESULTS: 1) In athetoid CP, respiratory patterns during swallowing were variable and more irregular than the resting tidal breathing. 2) In athetoid CP, completion time of the swallowing task and recovery time to the resting tidal breathing after swallow were significantly prolonged (p<0.01). 4) Athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of the controls (p<0.01). 5) In correlation with the VFSS findings, aspirated group of the athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of non-aspirated group (p<0.05). CONCLUSION: Respiratory-swallowing coordination was disrupted in the athtoid CP, and their higher rate of postdeglutitive inspiration suggested the higher risk for aspiration of the food materials, especially in drinking of large amounts of liquid.

Respiration Patterns and Abdominal Muscle Activities during Speech Production in Athetoid Cerebral-Palsied Patients

OBJECTIVE: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP). METHOD: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks. RESULTS: The followings were observed in the athetoid CP. 1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter. 2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath. 3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks. CONCLUSION: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.

Management of Cervical Myelopathy in Athetoid Cerebral Palsy: Case report

We present two patients with a cerebral palsy who developed cervical myelopathy long from term involuntary movements. Frequently instability with a premature onset of spondylosis of the cervical spine is found in an athetoid cerebral palsy patient. These structural abnormalities appear to be related to the athetoid motion of neck in a cerebral palsy. The combination of a disk degeneration and listhetic instability with a narrow canal predisposes these patients for the relatively rapid progression to a devastating neurological defect. Early surgical management is a treatment of choice for the cervical myelopathy associated with an athetoid cerebral palsy.