Development and clinical application of weight－adjustable suit for children with dyskinetic cerebral palsy / 中华实用儿科临床杂志

Objective To explore the development and clinical effect of weight_adjustable suit for children with dyskinetic cerebral palsy. Methods Twenty_six cerebral_palsy children with involuntary movement admitted to the Third Hospital Affiliated to Jiamusi University from March to October 2016 were randomly divided into the observa_tion group and the control group,13 cases in each group. The control group was treated with routine rehabilitation trai_ning. The observation group was put on adjustable heavy clothes besides conventional rehabilitation. Before and after treatment,childrenˊs functional independence and gross motor function were assessed and compared by using Wee Punc_tional Independence Measure(Wee_PIM)and Gross Motor Punction Rating Scale(GMPM_88). Results After treat_ment the Wee_PIM score of the control group was(43. 24 ± 5. 58),the GMPM score was(61. 81 ± 9. 46),the Wee_PIM score of the observation group was(50. 21 ± 6. 03),and the GMPM score was(65. 73 ± 10. 17). There were sig_nificant differences between the two groups(P〈0. 05),while the scores of the observation group were significantly higher than those of the control group,and the difference was significant(t﹦2. 582,2. 346,all P〈0. 05). Conclusions The adjustable heavy suit can effectively improve the functional independence and gross motor function of cerebral palsy children with involuntary movement and their comprehensive ability,and it is worth trying clinically.

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.

Chronic Pain and Psychosocial Functions in Adults with Athetoid Cerebral Palsy

OBJECTIVE: To evaluate the effect of chronic pain on psychosocial functions in adults with athetoid cerebral palsy. METHOD: Thirty-five adults with athetoid cerebral palsy were recruited as subjects, then the radiologic and electrodi agnostic studies were assessed. The characteristics of pain in severity and disability status with Von Korff's chronic pain grade classification system and psychosocial functional status using affect balance scale, Beck depression inventory, social adjustment scale and satisfaction with life scale were evaluated. RESULTS: Twenty-eight (80.0%) subjects had the pain lasting more than 3 months. The mean score of characteristic pain intensity was 65.5+/-11.5. Eleven subjects (31.4%) showed both abnormal radiologic and electrodiagnostic findings, and these subjects had higher disability score among the subjects who complaint of chronic pain (p<0.05). The pain intensity had significant relationship with negative affects such as depression and dissatisfaction with life style (p<0.05). In addition, social adjustment tended to be lower in subjects with severe chronic pain. CONCLUSION: Chronic pain was commonly observed in adults with athetoid cerebral palsy, and the pain adversely affected psychosocial functions. Therefore, proper management of chronic pain might be helpful for enhancing their psycho social functions in these subjects.

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.

Short period Clinical Observations of Cerebral Palsied Children with Athetosis Treated with Madopar / 中国康复理论与实践

@# In this paper,we studied the clinical effects,side effects,doses ,dosing interval,relations between doses and effects of using Madopar in 61 children with athetoid cerebral palsy.Taking ADL Evaluation Scheme for Cerebral Palsied Children as main efficacy value,very marked statistic difference exists when two groups with or without Madopar were assessed on the third evaluation in our study,and it shows the effects of Madopar while its adverse events are mild and transient.The average and maximal initial dose is 9mg/kg/d and 26mg/kg/d respectively,and the average titration interval is one week while the shortest inetrval is a day.It can be titrated to 20mg/kg/d on average and 38mg/kg/d on maximal dose.There was no correlation between doses and effects.Suggestion was made for further investigation.

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.