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ObjectiveTo investigate the short-term efficacy of orthopedic elastic bandages on gait symmetry and walking ability in children with spastic hemiplegic cerebral palsy. MethodsFrom June, 2020 to June, 2023, 31 children with spastic hemiplegic cerebral palsy from Beijing Bo'ai Hospital were randomly divided into control group (n = 15) and experimental group (n = 16). Both groups received routine rehabilitation, while the control group received routine walking training, and the experimental group wore an orthopedic elastic bandage for walking training, for four weeks. The indexes of gait symmetry of foot deviation angle ratio (affected/healthy), step length ratio (affected/healthy), gait line ratio (affected/healthy) and standing stage ratio (affected percentage/healthy percentage) were calculated before and after training, and they were measured step width and the optional and maximum walking speed of 10-meter walk test (10MWT). ResultsOne case dropped off in the experimental group. After training, the foot deviation ratio, step length ratio, gait line ratio, and standing stage ratio improved in both groups (|t| > 2.434, P < 0.05), and they were better in the experimental group than in the control group (|t| > 2.230, P < 0.05); while the optional and maximum walking speed of 10MWT improved in both groups (|t| > 9.186, P < 0.001), and they were better in the experimental group than in the control group (|t| > 2.278, P < 0.05). ConclusionWearing orthopedic elastic bandages during rehabilitation can promote the gait symmetry and walking ability of children with spastic hemiplegic cerebral palsy.
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Objective:To investigate the influence of dual-task treadmill training on the motor function of children with spastic hemiplegic cerebral palsy(CP).Methods:A prospective study was carried out on 36 children with spastic hemiplegic CP admitted to the Department of Rehabilitation, Qingdao Women and Children′s Hospital from March 2020 to August 2021.The subjects were divided into the control group (18 cases) and the experimental group (18 cases) by the random number sequence method.During the intervention, 2 cases in the control group dropped out of the study due to cough and fever.Finally, there were 16 cases left in the control group and 18 cases in the experimental group.Both groups received the same routine rehabilitation training.Additionally, the control group were given single-task treadmill training, while the experimental group were treated dual-task treadmill training.Before training and after 4 weeks of training, the children in the two groups were evaluated and compared by using Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale (PBS), Maximum Walking Speed test(MWST), single-task modified Timed Up and Go test (mTUG) and dual-task mTUG.Gender and Gross Motor Function Classification System(GMFCS) classification in general data were compared by using the Chi-square test or Fisher′ s exact test.Age and indices of rehabilitation assessment were compared by using the paired-samples t-test within groups and indepen-dent-samples t-test between the two groups. Results:There was no significant difference in the evaluation data of the GMFM-88 D score [(34.25±1.61) points vs.(34.56±1.76) points], GMFM-88 E score [(50.53±7.20) points vs. (50.61±6.75) points], PBS score [(39.06±4.34) points vs. (38.89±4.44) points], MWST time [(12.69±3.07) s vs. (13.56±2.97) s], single-task mTUG time [(11.38±2.58) s vs. (11.94±2.51) s], and dual-task mTUG time [(30.06±8.08) s vs. (31.50±8.56) s]between the control group and the experimental group before training (all P>0.05). After 4 weeks of training, the GMFM-88 score of the control group was (35.88±1.82) points in the D dimension and (51.20±6.64) points in the E dimension.Besides, the PBS score of the control group was (40.75±4.14) points, the MWST time was (10.81±2.95) s, and the single-task mTUG time was (10.06±2.52) s. As for the experimental group, the GMFM-88 score was (36.28±1.99) points in the D dimension and (53.94±6.98) points in the E dimension, the PBS score was (43.06±4.94) points, the MWST time was (10.44±2.83) s, and the single-task mTUG time was (10.56±2.73) s. The evaluation indexes of the two groups after training for 4 weeks were significantly better than those before training ( t=-3.058, -2.197, -7.132, 1.235, 2.952 in the control group, and t=-5.953, -12.432, -8.333, 3.149, 7.578 in the experimental group, all P<0.05). There was no significant difference in GMFM-88 scores in D and E dimensions, PBS scores, MWST time and single-task mTUG time between the two groups ( P>0.05). The dual-task mTUG time of the control group was (29.10±8.28) s after 4 weeks of training, which was not statistically different from that before training ( t=1.578, P>0.05). The dual-task mTUG time of the experimental group was (23.06±7.30) s after 4 weeks of training, which was significantly better than that before training ( t=13.930, P<0.05) and that of the control group ( t=2.296, P<0.05). Conclusions:Both single-task and dual-task treadmill training can remarkably improve the motor function of children with spastic hemiplegic CP.Single-task training cannot improve the motor function of children with spastic hemiplegic CP in the dual-task condition, while dual-task training can effectively improve the motor function with spastic hemiplegic CP in the dual-task condition.
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OBJECTIVE: To investigate the effect of Baixiao moxibustion at meridian sinew nodal points combined with routine rehabilitation on upper limb motor function in children with spastic hemiplegic cerebral palsy. METHODS: A total of 50 children with spastic hemiplegic cerebral palsy were divided into control group and treatment group using a random number table, with 25 children in each group. The children in the control group were given routine rehabilitation training of the ipsilateral upper and lower limbs, and those in the treatment group were given Baixiao moxibustion at the meridian sinew nodal points of the ipsilateral upper limb in addition to the treatment in the control group, once a day and five times a week. Each course of treatment was 4 consecutive weeks, and both groups were treated for 3 courses. Before treatment and at weeks 4 and 12 of treatment, modified Ashworth score was used to evaluate muscle tension of the ipsilateral upper limb, and 88-item version of the Gross Motor Function Measure (GMFM-88) and Carroll upper extremities functional test (UEFT) were used to assess the motor function of the ipsilateral upper limb. RESULTS: At weeks 4 and 12 of treatment, both groups had a significant reduction in modified Ashworth score (P<0.05) and significant increases in GMFM-88 and UEFT scores (P<0.05). Both groups had significant changes in modified Ashworth score, GMFM-88 score, and UEFT score from week 4 to week 12 of treatment (P<0.05). Compared with the control group at week 12 of treatment, the treatment group had a significant reduction in modified Ashworth score (P<0.05) and significant increases in GMFM-88 and UEFT scores (P<0.05). CONCLUSION: Baixiao moxibustion at meridian sinew nodal points can significantly improve the muscle tension and motor function of the ipsilateral upper limb in children with spastic hemiplegic cerebral palsy, and the improvement becomes more apparent as the treatment lasts longer.
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OBJECTIVE: To investigate the therapeutic effect of scalp acupuncture and rehabilitation training on balance dysfunction in children with spasmodic hemiplegia so as to provide the reference to the optimization of treatment scheme. METHODS: A total of 60 children with spastic hemiplegia were divided into a routine group and a scalp acupuncture group, 30 cases in each one according to random number table. In the routine group, the rehabilitation training was provided, including exercise training, balance training, spasmotherapy apparatus, electromyography biofeedback apparatus and orthoses. In the scalp acupuncture group, on the base of the treatment as the routine group, scalp acupuncture was supplemented at motor area, foot motor sensory area, equilibrium area and parietal temporal anterior oblique line. Separately, before the treatment, after 3 months treatment and after 6 months treatment, the dimension D and E of the gross motor function measure-88 (GMFM-88) and Berg balance scale (BBS) were adopted to evaluate balance related motor functions and equilibrium function. The differences in the above 3 indicators at different time stages were compared in children between the two groups. RESULTS: Compared with the score before the treatment, BBS score was obviously increased after 3 and 6 months treatment in the patients of the two groups respectively (P<0.05). The score in the dimension D and E after 6-month treatment was increased significantly as compared with the score before treatment and after 3-month treatment in the same group respectively (P<0.05). Compared with the routine group, the score of dimension D and E of GMFM-88 as well as BBS score were all increased obviously in the scalp acupuncture group after 3 and 6 months treatment (P<0.05). CONCLUSION: On the base of routine rehabilitation training, scalp acupuncture can improve balance function of children with spastic hemiplegia better.
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Objective To investigate the effectiveness of task-oriented bilateral arm training on upper limb function in children with spastic hemiplegia. Methods 27 children within 4-6 years with spastic hemiplegic were randomly divided into control group (n=13) and experiment group (n=14). The children in control group received routine occupational therapy. The bilateral arm task-oriented training was added for children in experiment group. The Peabody development motor scale-2 (PDMS-2) and Upper Limb Physician's Rating Scale (ULPRS) were used to assess the upper limb function before and after 10 weeks intervention. Results After treatment, the scores of grasping function and visual-motor integration in PDMS-2 were significantly higher than those before treatment (P＜0.05), and the scores of experimental group werehigher than that of control group (P ＜0.05), and the difference of the added value between two groups were statistically significant (P＜0.05).The ULPRS scores of both groups increased after treatment (P＜0.05), scores between the treatment group and the control group were not statistically significant (P＞0.05), and the difference of the added value between two groups was not statistically significant (P＞0.05). Conclusion The task-oriented bilateral arm training can promote recovery for upper limb and hand function in children with spastic hemiplegia compared with routine occupational therapy.
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@# Objective To observe the effect of Kinesio taping combining with sling exercise therapy (SET) on the motor function for children with spastic hemiplegia. Methods From October, 2014 to April, 2016, 60 children with spastic hemiplegia of cerebral palsy were randomly divided into control group (n=20), SET group (n=20) and observation group (n=20), who accepted routine rehabilitation, routine rehabilitation+SET and routine rehabilitation+SET+Kinesio taping, respectively. They were assessed with Mallet Score, modified Ashworth Scale (MAS), Peabody Developmental Motor Scale-fine motor (PDMS-2FM) and Gross Motor Function Measure (GMFM)-C zone before and three months after treatment. Results The Mallet Score and the scores of PDMS-2FM and GMFM-C improved in all the groups after treatment (t>2.074, P<0.05), and improved the most in the observation group (F>10.032, P<0.001). The score of MAS decreased in the observation group after treatment (t=4.767, P<0.001), and was the least among these groups (F=4.262, P<0.05). Conclusion Kinesio taping combining with SET can improve the motion in the children with spastic hemiplegia, and promote the development of both fine and gross motor function.
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@#Objective To observe the effects of Dong's Extraordinary Acupoints acupuncture and rehabilitation on upper limb spastic hemiplegia after stroke. Methods 105 patients with upper limb spastic hemiplegia after stroke were randomized into 3 groups as groups A, B, C equally, and receiving Baclofen and rehabilitation training, acupuncture at Dong's Extraordinary Acupoints, and both acupuncture at Dong's Extraordinary Acupoints and rehabilitation training for 8 weeks, respectively. They were assessed with China Stroke Scale (CSS) and modified Ashworth Scale (MAS) before and after treatment Results The CSS and MAS scores obviously improved after treatment in each group (P<0.01), and improved more in the group C than in the group A and B for CSS (P<0.05). Conclusion Both acupuncture at Dong's Extraordinary Acupoints and rehabilitation can improve the neural function and upper limb muscle tension in patients with upper limb spastic hemiplegia after stroke, with the synergistic effects.
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@#Objective To observe the effect of homemade ankle-foot orthopedic band on motor function of lower extremities in children with foot drop post spastic hemiplegic cerebral palsy (CP). Methods 24 spastic hemiplegic CP children were randomly divided into observation group (n=12) and control group (n=12). Both groups accepted roution rehabilitation training. The control group accepted walking training, and the observation group accepted walking training wearing the homemade ankle-foot orthopedic band, for 12 weeks. They were assessed with modified Ashworth Scale (MAS) of gastrocnemius, range of motion (ROM) of ankle active dorsiflexion, and D and E domains of Gross Motor Function Measure (GMFM-88) before and after treatment. Results The score of MAS significantly decreased in both groups after treatment (P<0.01), and decreased more in the observation group than in the control group (P<0.05). ROM and scores of D and E domains of GMFM-88 significantly increased in both groups after treatment (P<0.01), and increased more in the observation group than in the control group (P<0.05). Conclusion Walking training with the homemade ankle-foot orthopedic band may further decrease the muscle tone of gastrocnemius, increase the active range of motion of ankle and improve the motor function of lower extremities in children with foot drop post spastic hemiplegic CP.
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Objective To observe the effect of homemade ankle-foot orthopedic band on motor function of lower extremities in children with foot drop post spastic hemiplegic cerebral palsy (CP). Methods 24 spastic hemiplegic CP children were randomly divided into observa-tion group (n=12) and control group (n=12). Both groups accepted roution rehabilitation training. The control group accepted walking train-ing, and the observation group accepted walking training wearing the homemade ankle-foot orthopedic band, for 12 weeks. They were as-sessed with modified Ashworth Scale (MAS) of gastrocnemius, range of motion (ROM) of ankle active dorsiflexion, and D and E domains of Gross Motor Function Measure (GMFM-88) before and after treatment. Results The score of MAS significantly decreased in both groups after treatment (P<0.01), and decreased more in the observation group than in the control group (P<0.05). ROM and scores of D and E do-mains of GMFM-88 significantly increased in both groups after treatment (P<0.01), and increased more in the observation group than in the control group (P<0.05). Conclusion Walking training with the homemade ankle-foot orthopedic band may further decrease the muscle tone of gastrocnemius, increase the active range of motion of ankle and improve the motor function of lower extremities in children with foot drop post spastic hemiplegic CP.
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Objective To observe the effects of Dong's Extraordinary Acupoints acupuncture and rehabilitation on upper limb spastic hemiplegia after stroke. Methods 105 patients with upper limb spastic hemiplegia after stroke were randomized into 3 groups as groups A, B, C equally, and receiving Baclofen and rehabilitation training, acupuncture at Dong's Extraordinary Acupoints, and both acupuncture at Dong's Extraordinary Acupoints and rehabilitation training for 8 weeks, respectively. They were assessed with China Stroke Scale (CSS) and modified Ashworth Scale (MAS) before and after treatment Results The CSS and MAS scores obviously improved after treatment in each group (P<0.01), and improved more in the group C than in the group A and B for CSS (P<0.05). Conclusion Both acupuncture at Dong's Ex-traordinary Acupoints and rehabilitation can improve the neural function and upper limb muscle tension in patients with upper limb spastic hemiplegia after stroke, with the synergistic effects.
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@#Objective To observe the effect of homemade ankle-foot orthopedic band on motor function of lower extremities in children with foot drop post spastic hemiplegic cerebral palsy (CP). Methods 24 spastic hemiplegic CP children were randomly divided into observation group (n=12) and control group (n=12). Both groups accepted roution rehabilitation training. The control group accepted walking training, and the observation group accepted walking training wearing the homemade ankle-foot orthopedic band, for 12 weeks. They were assessed with modified Ashworth Scale (MAS) of gastrocnemius, range of motion (ROM) of ankle active dorsiflexion, and D and E domains of Gross Motor Function Measure (GMFM-88) before and after treatment. Results The score of MAS significantly decreased in both groups after treatment (P<0.01), and decreased more in the observation group than in the control group (P<0.05). ROM and scores of D and E domains of GMFM-88 significantly increased in both groups after treatment (P<0.01), and increased more in the observation group than in the control group (P<0.05). Conclusion Walking training with the homemade ankle-foot orthopedic band may further decrease the muscle tone of gastrocnemius, increase the active range of motion of ankle and improve the motor function of lower extremities in children with foot drop post spastic hemiplegic CP.
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@#ObjectiveTo evaluate the effect of electromyography biofeedback on motor function in children with spastic hemiplegia. Methods40 children with spastic hemiplegia were divided into control group (n=20) and treatment group (n=20). Both groups received comprehensive rehabilitation treatment. The treatment group received electromyography biofeedback in addition. They were assessed with Gross Motor Functional Measure (GMFM-88) in D and E items before and after treatment. ResultsThe scores of GMFM-88 in both D and E items were significantly different (P<0.01) before and after treatment in both groups, and significantly different between the treatment group and control group (P<0.05) after treatment. ConclusionElectromyography biofeedback can improve the motor capacity in children with spastic hemiplegia.
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@#Objective To compare the isometric muscle strength of muscle groups in the lower extremities of children with spastic hemiplegia among sides or ages. Methods17 spastic hemiplegic children were measured the muscle strength of hip, knee and ankle muscle groups with hand-held dynamometry (HHD). ResultsMuscle strength was weaker in the involved side than in the other side. In younger children, it was weaker of overall extremity, while in the older it was of the distal end mainly. ConclusionWhen applying strength training to spastic hemiplegic children, it is important to notice strength of all groups in lower extremity in younger children and the distal groups in older ones.
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El tratamiento adecuado de patologías que alteran la marcha normal, como por ejemplo, encefalopatías estáticas tales como la parálisis cerebral infantil, requiere de la identificación precisa de los patrones de movimiento asociados y sus causas, con el propósito de seleccionar el tratamiento más apropiado en términos de efectividad. Identificar y caracterizar patrones cinemáticos de la pelvis en el plano transverso como respuesta compensatoria a deformidades de los miembros inferiores en pacientes pediátricos con hemiplejía espástica. La muestra utilizada fue de 66 pacientes con disfunción motora subtipo hemiplejia espástica secuela de parálisis cerebral infantil, del Hospital Ortopédico Infantil de Caracas, entre los años 1999 y 2004. A cada paciente se le realizó un análisis de marcha siguiendo el protocolo del Laboratorio de Marcha del Hospital Ortopédico Infantil. A los patrones de cinemática obtenidos se les midieron las desviaciones de los movimientos pélvicos en los tres planos así como también la progresión del pie y la rotación de cadera evidenciadas por el examen físico (anteversión femoral). Particular énfasis se realizó en el análisis de las desviaciones en el plano transverso. Se obtuvieron los patrones de movimiento con características propias para cada subgrupo: Tipo I, Tipo II, Tipo III y Tipo IV. Los hallazgos son consistentes con los reportados en la literatura en lo concerniente a los planos sagital y coronal. Sin embargo, en el plano transverso se demostraron patrones consistentes con deformidad ósea presente en el miembro ipsilateral. Las respuestas compensatorias observadas en pelvis en dicho plano tienen como objetivo mantener ambos pies en la línea de progresión.
Adequate treatment of pathologies that alter normal gait, for example, spastic encephalopaties such as cerebral palsy, require precise identification of their movement patterns and causes, in order to select the most effective treatment. To identify and characterize transverse plane kinematic patterns of the pelvis as a compensatory response to lower limb deformities in pediatric patients with spastic hemiplegias. 66 patients with spastic hemiplegia subtype motor dysfunction, from the Hospital Ortopédico Infantil (HOI) at Caracas,Venezuela, were studied between 1999 and 2004. A gait analysis was performed in each patient following the HOIs protocol. Deviations of pelvic movements were measured on all three planes to the kinematics gait patterns obtained, Measurements of foot progression and hip rotation (femoral anteversion) were achieved via clinical examination. Movement patterns on spatial planes were obtained and characterized in terms of its deviations, then classified in four wellfeatured subtypes: Type I, Type II, Type III y Type IV. Special emphasis was placed on analysis of deviations in the transverse plane. Findings for sagital and coronal planes are consistent with those reported by the literature. However, movement patterns that are consistent with bone deformities in the ipsilateral limb were demonstrated for transverse plane, and the pelvic coping responses for that plane tend to maintain both feet aligned with the gait progression line.
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Humans , Male , Female , Child, Preschool , Child , Adolescent , Brain Diseases/pathology , Hemiplegia/pathology , Hemiplegia/therapy , Muscle, Skeletal/pathology , Cerebral Palsy/diagnosis , Orthopedics , Pediatrics , Gait Disorders, Neurologic/complicationsABSTRACT
PURPOSE: We are trying to develop the objective index, which represents the gait pathology of transverse plane in cerebral palsy for outcome assessment of surgical intervention. MATERIALS AND METHODS: We evaluate 23 spastic hemiplegics with pre- and post-operative 3D gait analysis and 13 able-bodies. Mean pelvic rotation (MPR), maximum pelvic rotation (XPR), Mean hip rotation (MHP), Foot progression angle (FPA) in stance were extracted from the kinematic data and principal component analysis was used to make an index for transverse plane gait pathology, so-called transverse index (TI) . RESULTS: Transverse index for able-bodies was 40+/-29. In spastic hemiplegics, transverse indices were 151+/-59 preoperatively, 68+/-44 postoperatively. CONCLUSION: We present the index for transverse plane gait pathology by the way of multivariate study.
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Cerebral Palsy , Congenital Abnormalities , Foot , Gait , Hemiplegia , Hip , Muscle Spasticity , Principal Component AnalysisABSTRACT
0.05) on 15 day. There was a significant difference (P
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PURPOSE: To evaluate the effects of surgery for an equinus gait on the kinematic and kinetic parameters of ankle and proximal joints in cerebral palsy spastic hemiplegics. MATERIALS AND METHODS: Sixteen spastic hemiplegic patients who had undergone a surgical correction for equinus were enrolled in this study. The kinematic and kinetic parameters during gait were assessed using computed gait analysis before and after surgery. RESULTS: Postoperatively, the ankle range of motion was significantly improved and the temporospatial parameters were not significantly changed. The angular movement of the ankle joint and pelvis were improved. However, the kinetic parameters of the ankle joint were unaffected. In patients with a recurvatum knee gait pattern prior to surgery, the kinematic and kinetic parameters of the knee joint were significantly improved. The angular movements of pelvis after surgery were improved in patients with pelvic external rotation preoperatively. CONCLUSION: Genu recurvatum and pelvic external rotation during the gait in spastic hemiplegic CP might be improved by a surgical correction of the equinus deformity.
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Humans , Ankle , Ankle Joint , Cerebral Palsy , Equinus Deformity , Gait , Hemiplegia , Joints , Knee , Knee Joint , Muscle Spasticity , Pelvis , Range of Motion, ArticularABSTRACT
@#Objective To observe the effect of Shujinkeli on stroke patients with spastic hemiplegia. Methods The double blind test was applied in this study. 77 stroke patients with spastic hemiplegia were randomly divided into the group A (n=38) and the group B (n=39). Under the guidance of the criterion and routine treatment, patients of the group A were treated with Shujinkeli A and patients of the group B were treated with Shujinkeli B. After treatment, curative effect of patients was evaluated. Results The group A was the treatment group, and the group B was the control group. After treatment, the treatment group was superior to the control group in the improvement of muscular tension, Fugel-Meyer score and Barthel index. Conclusion The Shujinkeli can make the high muscular tension lower, which will accelerate the disabled limbs' recovery and improve patients' motor function and self-care ability of daily life.
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OBJECTIVE: The purpose of this study is to evaluate the effects of intramuscular botulinum toxin A injection for the improvement of hand function in spastic hemiplegia. METHOD: We have studied 8 patients with spastic hemiplegia. Botulinum toxin A was injected into target muscles with electromyographic guidance. Before injection, muscle activity patterns were evaluated by dynamic electromyography. Follow-up assessments were performed at three months after injection. RESULTS: There were continuous activity patterns in all dynamic electromyography of target muscles. Dynamic electromyography of antagonist muscles in five patients showed normal phasic activity pattern but it showed absent pattern in other three patients. Mean modified Ashworth scale decreased significantly after injection. There were an improvement in functional classification and a significant increase of mean scores of unilateral hand skills after injection in patients with normal phasic pattern of antagonist muscles. CONCLUSION: Botulinum toxin A can improve the impaired hand movement and function in spastic hemiplegia by reducing spasticity and contracture of the target muscles in cases of normal phasic activity in antagonist muscles and continuous activity in target muscles.