Oral Health Care of Children and Adolescents with Different Impairments of Cerebral Palsy: Barriers and Challenges

Abstract Objective: To evaluate the barriers to access and oral health care faced by children and adolescents with Cerebral Palsy (CP) according to their motor impairment through the perception of caregivers. Material and Methods: A case series study was carried out at three health institutions in Pernambuco, Brazil. The study sample consisted of 94 caregivers of 5-to-18-year-old patients with CP, according to GMFCS (The Gross Motor Function Classification System). Data were collected using a semi-structured form to evaluate the barriers to access and analyzed statistically by the chi-square and Fisher exact tests, adopting a 5% level of significance. In addition, binary logistic regression was performed to determine the weight of the variables in explaining the outcome variable. Results: There were major difficulties involving transportation (p=0.04) and structural accessibility to dental services (p<0.01) among children and adolescents with severe CP. In addition, the more severe the CP, the greater the difficulty of accessibility (OR=4.09,) and the lower the income (OR=8.80), the greater the motor impairment. Conclusion: Despite the availability of access to dental services, low-income families have more severe CP patients, contributing to the daily difficulties already faced by them in oral health care.

Errores innatos metabólicos en parálisis cerebral: estudio en 174 infantes / Inborn errors of metabolism in 174 cases of cerebral palsy

La Parálisis Cerebral (PC) es un conjunto de alteraciones motrices no progresivas en la población infantojuvenil, ocasionadas por lesión ­a nivel cerebral- de neuronas o fibras de esa vía, de sus aferencias o de las que la modulan; para su diagnóstico deben conocerse otras patologías también frecuentes y que pueden incidir simultánea o causalmente en la motricidad del paciente; la resultante sería disfunción motora tanto voluntaria como involuntaria, refleja o con propósito, de la postura y/o del tono muscular. Objetivo: detectar errores innatos metabólicos (EIM) que causan o se asocian con PC en una serie significativa. Métodos: Estudio descriptivo-interpretativo, se revisaron los expedientes clínicos del Centro de Parálisis Cerebral de Caracas, en cuyos diagnósticos se presentaron ambas alteraciones, entre los años 1988 y 2018. Resultados: De las 2.000 historias clínicas revisadas, el exámen clínico y las pruebas de laboratorio permitieron seleccionar 174 casos de EIM. Conclusiones: Se tipificaron los errores innatos metabólicos en diez formas clínicas distintas, se evidenciaron en pacientes con PC atendidos en un centro público de Caracas, es posible que la casuística sea varias veces mayor en Venezuela dado que ya no se aplica la pesquisa en los centros de atención pública(AU)

Cerebral Palsy (CP) is a set of non-progressive motor alterations in the child and youth population, caused by injury - at the brain level - of neurons or fibers of that pathway, their afferences or those that modulate it; for its diagnosis, other pathologies that are also frequent and that can simultaneously or causally affect the motor skills of the same patient must be known; The result would be both voluntary and involuntary motor dysfunction, reflected or with purpose, of posture and / or muscle tone. Objective: to detect inborn metabolic errors (EIM) that cause or are associated with CP in a significant series. Methods: Descriptive-interpretive study, we reviewed the clinical records of the Cerebral Palsy Center of Caracas, in whose diagnoses both alterations were presented, between the years 1988 and 2018. Results: Of the 2,000 clinical histories reviewed, the clinical examination and tests Laboratory tests allowed the selection of 174 cases of IMD. Conclusions: Inborn metabolic errors were typified in ten different clinical forms, they were evidenced in patients with CP treated in a public center in Caracas, it is possible that the casuistry is several times greater in Venezuela since the investigation is no longer applied in the centers of public attention(AU)

Factors Associated with the Caregivers' Perception of the Oral Health of Individuals with Cerebral Palsy

Abstract Objective: To evaluate factors associated with the caregivers' perception of the oral health of children and adolescents with cerebral palsy. Material and Methods: A cross-sectional study was carried out with 80 children and adolescents with cerebral palsy aged 2-18 years, registered at a reference institution and their respective caregivers. Caregivers provided socioeconomic, systemic and health perception and access to dental services data. A calibrated researcher (Kappa=0.75-0.98) performed oral examinations using DMF-T, dmf-t, dental trauma, gingival bleeding index, community periodontal index, malocclusion index and the dental aesthetic index. The Poisson Regression was used (α=0.05) Results: According to the caregivers' perception, the oral health reports of children and adolescents with cerebral palsy considered good and poor was 73.8% and 26.3%, respectively. The poor oral health perception is associated with the presence of dental caries in anterior teeth (PR 1.34, 95% CI=1.11-1.63) and bleeding during tooth brushing (PR 1.20, 95% CI=1.04-1.40) Conclusion: Children and adolescents with cerebral palsy who presented lesions of caries in the anterior teeth and gingival bleeding during tooth brushing, more frequently, had poor oral health by their caregivers.

A influência do tratamento intensivo com suporte de peso corporal na função motora de crianças com paralisia cerebral / Effects of intensive treatment with body weight support in children with cerebral paralysis

A aquisição da marcha sob o aspecto neuromotor da reabilitação vem a ser o principal desígnio do terapeuta durante a elaboração do plano de tratamento do paciente com paralisia cerebral, uma vez que a marcha representa não só um ganho da habilidade de locomover-se, mas também um conjunto de reações e padrões de movimento que auxiliam na função motora. Objetivo: Analisar os efeitos de um tratamento intensivo por meio do suporte de peso corporal em crianças com paralisia cerebral. Métodos: Participaram do estudo 10 crianças com paralisia cerebral, GMFCS nível IV ou V, idade entre 4 a 9 anos. Onde foram realizadas sessões diárias com suporte de peso corporal em esteira ergométrica com auxílio de terapeutas para executar o padrão de marcha mais próximo da normalidade, com pontos chaves em joelho e tornozelo com duração de 30 minutos de tratamento e intervalo de 24 horas, por um período de 10 dias. Para fins de avaliação pré e pós-intervenção, utilizando a escala de medição da função motora grossa GMFM, e da flexibilidade pelo Flexiteste. Resultados: Foi possível constatar um aumento relevante na função motora grossa dos sujeitos, onde o domínio Deitar e Rolar obteve maior pontuação, com um aumento de 10,77%. Sentar demonstrou aumento de 3,80%, Engatinhar e Ajoelhar 6,43% e o domínio Em Pé 3,45%. Relativo ao Flexiteste, a média entre os sujeitos relatou aumento expressivo de 4,2 pontos. Já em análise individual, percebe-se que 3 indivíduos obtiveram aumento de score de 6 pontos. Conclusão: Um protocolo intensivo de curta duração é capaz de trazer ganhos de flexibilidade e motores rápidos a crianças que possuem quadro de paralisia cerebral.

The acquisition of gait under the neuromotor aspect of rehabilitation is the main goal of the therapist during the elaboration of the treatment plan of the patient with cerebral palsy, since gait represents not only a gain in the ability to move, but also a set of reactions and movement patterns that aid in motor function. Objective: To analyze the effects of intensive treatment by means of body weight support in children with cerebral palsy. Method: Ten children with cerebral palsy, GMFCS level IV or V, age between 4 and 9 years participated in the study. Where daily sessions were performed with body weight support on a treadmill with the help of therapists to perform the walking pattern closest to normal, with key points in the knee and ankle lasting 30 minutes of treatment and 24 hour intervals for one period of 10 days. For purposes of pre and post-intervention evaluation, using the GMFM gross motor function measurement scale, and Flexitest flexibility. Results: It was possible to observe a significant increase in the gross motor function of the subjects, where the lie down and roll domain obtained a higher score, with an increase of 10.77%. To sit demonstrated a 3.80% increase, Crawling and Kneeling 6.43% and the Standing Foot 3.45%. Relative to Flexitest, the mean between subjects reported a significant increase of 4.2 points. In the individual analysis, it was observed that 3 subjects had a 6-point score increase. Conclusions: An intensive short-duration protocol is capable of bringing flexibility gains and fast motor to children with cerebral palsy.

An evaluation of an animal model of cerebral palsy: the effects on the morphology of the extensor digitorum longus muscle / Evaluación de un modelo animal de parálisis cerebral: los efectos sobre la morfología del músculo extensor largo de los dedos

Cerebral Palsy (CP) refers to chronic childhood encephalopathy. The objective of this study was to verify effects of CP model that combines prenatal exposure to LPS, perinatal anoxia and sensorimotor restriction on EDL muscle. Male Wistar rat pups were separated: a) Control - pups of mothers injected with saline during pregnancy and b) Cerebral Palsy - pups of mothers injected with LPS during pregnancy, and submitted to perinatal anoxia and sensorimotor restriction. The CP group presented hypertrophy in the type IIB fibers and increase of nuclei/fiber and capillary/fiber ratios. The intrafusal fibers of CP group presented 26 % atrophy in the crosssectional area and intramuscular collagen volume increase 34 %. CP group showed myofibrillar disruption and Z-line disorganization and the NMJs presented increases of 22 % in area.This animal model of CP produces motor deficits and macro and microscopic alterations and in the ultrastructure of the EDL muscle.

La parálisis cerebral (PC) se refiere a la encefalopatía crónica infantil. El objetivo de este estudio fue verificar los efectos del modelo PC que combina la exposición prenatal a LPS, la anoxia perinatal y la restricción sensitivo-motora en el músculo extensor largo de los dedos (MELD). Se separaron las crías de ratas Wistar machos: a) Control: crías de madres inyectadas con solución salina durante la preñez y b) Parálisis cerebral: crías de madres inyectadas con LPS durante la preñez y sometidas a anoxia perinatal y restricción sensitivo-motora. El grupo PC presentó hipertrofia en las fibras tipo IIB y aumento de la relación núcleo / fibra y capilar / fibra. Las fibras intrafusales del grupo PC presentaron un 26 % de atrofia en el área de la sección transversal y el volumen de colágeno intramuscular aumentó un 34 %. El grupo PC mostró disrupción miofibrilar y desorganización de la línea Z y los NMJ presentaron aumentos de 22 % en el área. Este modelo animal de PC produce déficit motores y alteraciones macro y microscópicas y cambios en la ultraestructura del MELD.

Tratamiento Odontológico Ambulatorio de Pre-Escolar con Parálisis Cerebral / Dental Treatment in Pre-School Outpatient with Cerebral Palsy

Los avances en medicina y en particular en pediatría han permitido sobrevivir a más niños que nacen prematuros. Aunque la mayoría de los sobrevivientes no tienen inconvenientes en su desarrollo, un significativo número de niños demuestran discapacidad en su neurodesarrollo. En los prematuros, las complicaciones y las secuelas neurológicas, aumentan con la disminución de la edad gestacional y el peso al nacer. La parálisis cerebral es la discapacidad neuromuscular más frecuente que afecta a los niños, y constituyen un grupo de alto riesgo de patologías orales. El reporte del presente caso clínico, muestra el tratamiento odontológico de un pre-escolar con parálisis cerebral, realizado en forma ambulatoria, sin premedicación ni anestesia general, sustentado en un conocimiento profundo de la patología basal médica y características individuales. La compresión de las enfermedades orales, la aplicación de técnicas de manejo conductual y la sensibilización del clínico, permitieron controlar y mejorar el deplorable estado de salud oral del pre-escolar, contribuyendo por lo tanto a una mejor calidad de vida. La promoción, la prevención y recuperación de la salud oral en los pacientes con necesidades de cuidados especiales de salud debe ser una parte integral de la odontología, para lo cual el odontopediatra debe estar integrado al equipo multidisciplinario, que busca brindar atenciones adecuadas a las necesidades de este grupo en particular.

Advances in medicine, particularly in pediatric medicine, have enabled more premature babies to survive. While the majority of the survivors present trouble-free development, a significant number of all children present disabilities in their neural development. In premature babies, the neurological complications and consequences increase inversely with the gestational age and weight at birth. Cerebral palsy is the most common neuromuscular disability affecting these children, and as a group they also present a high risk of oral pathologies. The report of the present clinical case describes the dental treatment of a pre-school child with cerebral palsy, in outpatient conditions and without either pre-medication or general anaesthesia, based on a profound knowledge of the basic medical pathology and individual characteristics. The understanding of oral disease, the use of behavioral management techniques and raising awareness in the clinic, enabled the child's deplorable state of oral health to be controlled and improved, thus contributing to a better quality of life. Preventative measures and the promotion and recovery of oral health in patients requiring special health care must be an integral part of dentistry. This requires the dental-pediatrician to form part of a multidisciplinary team specializing in providing proper treatment for the needs of this particular group.

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation / Discrepâncias no crescimento dos dimídios em crianças com paralisia cerebral hemiplégica: associação com a função, atividades e participação social

Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth. .

Objetivo: Avaliar a discrepância entre o crescimento dos lados do corpo em crianças com paralisia cerebral hemiplégica (PCH), e investigar sua associação com a idade de início do tratamento de fisioterapia, função motora e cognitiva, grau de atividades e participação social. Método: Comparamos oito medidas obtidas de 24 crianças com PCH e com média de idade de 49,3±5,2 meses. Resultados: O início precoce da fisioterapia se relacionou à menor discrepância no comprimento da mão (p=0,037). A menor discrepância no comprimento do pé se relacionou à menor necessidade de ajuda do cuidador em atividades de mobilidade. A maior discrepância esteve relacionada à menor extensão de punho e à maior espasticidade. A discrepância foi mais importante em crianças com heminegligência e com envolvimento à direita. Conclusão: Crianças com PCH com maior discrepância apresentaram menor atividade/participação social. Os resultados sugerem associação entre o uso funcional da mão e o crescimento das extremidades. .

Estimation of Gastrocnemius Muscle Volume Using Ultrasonography in Children with Spastic Cerebral Palsy

PURPOSE: This study aimed to investigate useful parameters for estimating gastrocnemius (GCM) muscle volume (MV) using ultrasonography (US) and anthropometry in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: Eighteen legs from nine children with spastic CP aged 2 to 6 years were investigated in this study. Tibial length (TL) of each leg was measured and muscle thickness (MT) and anatomical cross-sectional area (aCSA) of GCM muscles were assessed using US. The volume of the GCM was measured by magnetic resonance imaging (MRI) scans. The relationship of TL, MT, and aCSA with MV measured by MRI was investigated. Simple and multiple regression analyses were performed to establish muscle volume prediction equations. RESULTS: Resting MT, aCSA, and TL were highly related to MV of both medial and lateral head of GCM determined by MRI. The MV prediction equation based on simple regression analysis resulted in r2 values ranging from 0.591 to 0.832 (p<0.05). The r2 values were higher using aCSA as independent variable than using MT. The MV prediction equation based on multiple regression analysis resulted in r2 values ranging from 0.779 to 0.903 (p<0.05). However, the relatively high standard error of the estimate values ranged from 18.0-33.6% on simple regression and 15.5-25.6% on multiple regression. The contribution of aCSA was higher than that of MT for predicting MV of GCM. CONCLUSION: Our study demonstrated the suitability of US assessment of aCSA and MT combined with TL for estimating MV of GCM in children with spastic CP and showed that aCSA is more useful parameter than MT.

En nuevo enfoque en el manejo de la marcha agazapada: laboratorio de análisis de la marcha, Hospital Ortopédico Infantil / New approach in the management of the crouch gait: at gait lab, Hospital Ortopédico Infantil

La marcha agazapada es una de las alteraciones más frecuentes en los pacientes con parálisis cerebral infantil, y aunque es fácilmente reconocible, tampoco ha sido claramente definida. En ella, la rodilla carece de una extensión dinámica, durante la fase de apoyo, el tobillo lo podemos encontrar en flexión plantar, dorsal o neutro, y las caderas generalmente están flexionadas y frecuentemente en rotación interna y en aducción. El presente es un estudio prospectivo, realizado en el Hospital Ortopédico Infantil, empleando los datos obtenidos del departamento de historias médicas y del laboratorio de análisis de la marcha, en el cual hemos utilizado la nueva clasificación cinemática de Michael Schwartz, Director de Bioingeniería del Laboratorio de Análisis de la Marcha del Gillette Children´s Hospital, Saint Paul, Minnesota, para sujetos que presentaban excesiva flexión de rodilla al contacto inicial. Con lo cual se obtiene 5 subtipos cinemáticas de marcha agazapada, de acuerdo a los datos obtenidos en el plano sagital, y que a la vez nos permiten saber a qué nivel se encuentran las alteraciones principales de los pacientes, proporcionándonos de esta manera una guía que nos ayude en la decisión del tratamiento a emplear y al mismo tiempo nos permite realizar una valoración post-quirúrgica

Crouch gait is one of the most frequent alterations in patients with cerebral palsy, and although it is easily recognizable, has not been clearly defined. In it, the knee lacks a dynamic extension during the stance phase, the ankle can be found in plantar flexion, dorsal or neutral, and hips are usually bent and often in internal rotation and adduction. This is a prospective study conducted at the Children's Orthopedic Hospital, using data obtained from the department of medical and gait laboratory, which we have used the new classification Schwartz Michaels kinematics, Director of Bioengineering, Laboratory of Analysis of the March of Gillette Children's Hospital, Saint Paul, Minnesota, for subjects with excessive knee flexion initial contact. Thus obtained five subtypes kinematic crouched running, according to data obtained in the sagittal plane and at the same time let us know at what level are the main changes of the patients, thereby providing a guide help us in deciding the treatment to be applied at the same time allows us to perform a post-surgical evaluation

[Accompanying problems in children with cerebral palsy and their relationship to type and level of motor disability]

There are some accompanying problems in children with cerebral palsy. These problems may affect the children and their family even more than cerebral palsy. The aim of this study was to investigate the rate of six common accompanying problems and their relationship to type and level of motor function. In this study, 120 children aged 2 to 14 years old were selected from 4 rehabilitation centers in Tehran. At first consent of the child's mothers were obtained, and then child's medical history was gathered and accompanying problems were extinguished. The gross motor function level and the type of cerebral palsy were determined. The data was analyzed by SPSS-16 using kolmogrov smironov test and spearman's rho correlation coefficient. The speech disorder was the most and hearing problem was the least common among children. The type of cerebral palsy was associated significantly with intellectual disabilities, speech, feeding problems and number of problems [p<0.05].There was significant correlation between Gross motor function classification system and intellectual disabilities, speech, feeding problems, seizure and number of problems [p<0.05]. According to high occurrence of accompanying problems in children with cerebral palsy especially more severe ones, early detection and treatment of these problems could enhance the quality of life of the children and their family

Cerebral palsy among Kurdish children in the City of Dohuk: a case-series study

Cerebral palsy [CP] is defined as non-progressive disorder of movement and posture due to brain insult or injury occurring in the period of early brain growth [generally under three years of age]. The clinical characteristic of this common problem had not been studied before in any of the Kurdish cities of the north of Iraq. This is a descriptive study of the clinical characteristics of cerebral palsy in the city of Dohuk at the north of Iraq. This is a case series descriptive study conducted in the children rehabilitation unit of Azadi general hospital and Dohuk children's rehabilitation center in the city Dohuk on children with Cerebral palsy. The following information were studied, the first presenting compliant, age distribution, the antenatal illnesses, antenatal drug use, mode of delivery, gestational age, the state at birth, types of CP, associated congenital abnormalities, any other associated problems and the treatment used. The total number of patients were 100, males were outnumbering females [1.3:1]. Spastic CP was the most common type [57%]. Most of the patient presented between the age of 7-12 months [66%], the most common first presenting complaints were the delayed milestones[50%], most of the patients came from a vaginal delivery [68%], the associated problems were: swallowing problems [68%], walking problems [65%], epilepsy and seizure disorders [60%], speech problems [46%], neonatal jaundice which was developed in 95% of cases, and finally, most of the patient came to parents who got married as a result of consanguineous marriage [68%]. This is first descriptive study among children with CP from the Kurdish population highlighting certain demographic and clinical characteristics of them

Patologías bucodentales y alteraciones asociadas prevalentes en una población de pacientes con parálisis cerebral infantil / Dental pathologies and prevalece alteration asociated in a populations with infant cerebral palsy

La Parálisis Cerebral Infantil (PCI) constituye un grupo de desórdenes del desarrollo del movimiento y postura causando limitación. Estos son atribuidos a disturbios no progresivos que ocurren durante el desarrollo fetal o cerebro infantil. Los desórdenes motores en PCI están frecuentemente acompañados por alteraciones sensoriales, cognitivas, de comunicación, percepción, de comportamiento y/o por ataques recurrentes. Para muchos pacientes con PCI, las disfunciones orofaciales y las patologías bucodentales constituyen un severo problema de salud. El 10 por ciento de la población mundial presenta algún tipo de discapacidad, tres cuartas partes de la cual no recibe atención odontológica, por lo cual las necesidades de estos pacientes no son solventadas, complicando aún más su calidad de vida. Este estudio estableció como propósito determinar la prevalencia de patologías bucodentales en pacientes pediátricos con diagnóstico médico de PCI, dentro de las cuales se consideró la caries dental, las alteraciones del esmalte, enfermedad periodontal, candidiasis bucal, maloclusiones dentales, bruxismo, patologías asociadas a disfunciones anatómicas y funcionales como la presencia de babeo, y otras alteraciones relacionadas con la enfermedad de base, que pueden asociarse directamente con la afección del sistema estomatognático como cuadros convulsivos o autolesiones. Para obtener la información se tomó una muestra de 30 pacientes con edades comprendidas entre 3 y 12 años, atendidos en la Clínica Odontológica para Pacientes Discapacitados de la Cruz Roja en Valencia, España; utilizándose para la recolección de los datos, la entrevista estructurada a los padres y la hoja de registro de datos clínicos. Los datos agrupados se presentan graficados para determinar de forma porcentual la prevalencia de cada patología, observándose cifras alarmantes para muchos de los ítems estudiados. Se concluye comparando los resultados con los previamente descritos por la literatura

The Cerebral Palsy (CP) compromises a group of developmental disorders, resulting in motor and posture limitations. The cause for these are “non-progressive disturbances” that take place in-uterus, or during infant brain development. The motor disorders associated to CP also result in multiple development sensorial, cognitive, perception, communication, behavior alterations, as well as seizures. For most CP patients, the dental pathologies and oral-facial dysfunctions become a severe health problem. About 10 percent of the world population has some sort of this incapacity, and three quarters of these do not receive “odontological” attention, worsening considerably their quality of life. The objective of this study is to determine the presence of dental pathologies on CP-diagnosed pediatric patients. The study considered several alterations associated with the main disease, which are directly related with malfunctions of the stomatognathic system, seizures and self-injuries. The specific alterations considered included dental caries, enamel alterations, periodontal disease, oral candidiasis, dental maloclusions, bruxism, and drooling, among others. The study base was 30 patients between 3 - 12 years of age, treated in the Red Cross “Destistry Clinic for handicapped patients”, in Valencia, Spain. The methodology consisted of data collection via surveys given to the parents of the children, as well as their clinical chart. Data is presented on graphs and charts, showing percentages of presence of each pathology, resulting in alarming figures for many of the items under study. To close the analysis, results are compared with previous documented results, providing recommendations on actions that could be taken to improve the oral health of these patients

Comparative study of skin folding of dominant and nondominant hemibodies in spastic hemiplegic cerebral palsy

OBJECTIVE: To compare skin folds in the dominant and nondominant halves of the body in a group (A) of 20 individuals with cerebral palsy and spastic hemiplegia and a group (B) of 30 normal volunteers. METHOD: Body mass, height and skin folds were measured, and the percentage of body fat was estimated by adipose tissue measurement and densitometry. The mean age in group (A) was 24.6 ± 5.6 years (ranging from 16.1 to 38.1 years). The mean age in group (B) was 25.3 ± 3.8 years (ranging from 19.0 to 34.11 years). RESULTS: Statistically significant differences were observed between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in group A; the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in group B; and the percentage fat obtained by adipose tissue measurement in both groups. Statistically significant differences were observed for the triceps skin fold when the dominant halves of the body in groups A and B were compared. Statistically significant differences were also observed for the biceps, triceps, thigh and midcalf skin folds as well as the adipose tissue measurements between the dominant and nondominant halves of the body in the two groups. The percentage fat as estimated by densitometry was significantly correlated with the adipose tissue measurement. CONCLUSION: There were statistically significant differences between the skin folds in the dominant and nondominant halves of the body, both in group A and in group B (greater in group A). There was a statistically significant correlation in the percentage fat as estimated by densitometry and as measured by adipose tissue in groups A and B.

Cerebral palsy among Iraqi children: Case-series study

Cerebral palsy is defined as any non-progressive central motor deficit dating to events in the prenatal or perinatal periods. It is one of the most common crippling conditions of childhood, and is not a specific disease but a group of disorders of varied causes. There is little epidemiological data from developing countries; the prevalence is around 2 / 1000 live births in most developed countries. To describe the epidemiologic distribution of the cerebral palsy cases, its different types and associated abnormalities with determination of common conditions reported with those cases. This is a case-series descriptive study conducted in the Specialized Center of Medical Rehabilitation in Baghdad [Sadir Al Kanat] on 60 children with cerebral palsy who were attending that center from June 2004 - May 2005 inclusive. The present study revealed that the male: female ratio was 1.5:1. Prolonged and vaginal labor were the most frequently reported perinatal conditions [53.4% and 66.6% respectively]; while neonatal jaundice and/or kernicterus with cyanosis and/or asphyxia were the main postnatal reported conditions [46.6% and 31.7% respectively]. Spastic cerebral palsy was found to be the most common type [76.7%]. Hearing, visual and dental problems were the most frequent associated complications [65%, 56.7%, and 53.3% respectively]. There was higher proportion of cerebral palsy in children from consanguine parents [58.3%]. All the associated perinatal and postnatal conditions suggest that good prenatal, natal and early neonatal care can prevent the occurrence of a high proportion of cerebral palsy cases. There is a need for enhancing health education directed both at mothers and at the general public with promotion of maternal child health services in Iraq

Comparison of the Ratio of Upper to Lower Chest Wall in Children with Spastic Quadriplegic Cerebral Palsy and Normally Developed Children

The upper chest wall does not grow properly in children with spinal muscular atrophy (SMA) with paradoxical breathing. This suggests that long-term inability to take a deep breath in developing children may result in underdevelopment of the upper chest wall. In addition, a rapid and paradoxical breathing pattern is frequently observed in children with severe cerebral palsy (CP), which often corresponds to the underdevelopment of the upper chest wall. The present study is designed to evaluate the ratio of the upper to lower chest wall in children with severe spastic quadriplegic CP, compared with normal children. We compared normal children with children that had spastic quadriplegic CP who did not have kyphosis or scoliosis. Test subjects were matched in terms of age, height, and weight. The diameters of upper chest (D(apex)) and of lower chest (D(base)) were measured on the anteroposterior (AP) view of a chest X-ray and the D(apex) to D(base) ratio was calculated. In selected cases the forced vital capacity (FVC) was measured using a Wright Respirometer. The D(apex) to D(base) ratio was significantly lower in the CP group than in the control group (p < 0.001). The ratio increased linearly with age (p < 0.001) in both CP (R = 0.372) and control groups (R = 0.477). The FVC/preFVC showed significant correlation with the D(apex) to D(base) ratio (R = 0.542, p < 0.01). The results of this study suggest a deviation of optimal chest wall structure in children with spastic quadriplegic CP.

Terapias de rehabilitación en niños con o en riesgo de parálisis cerebral / Rehabilitation therapies in childrens whit or in risk of cerebral paralysis

La Parálisis Cerebral Infantil (PC) es un problema de salud importante que genera gran discapacidad en la infancia. Existen múltiples alternativas terapéuticas, sin embargo hay escasa literatura disponible que respalde la indicación de las distintas terapias de neurorehabilitación y que ayude a los médicos clínicos en la recomendación de éstas a los padres. En este artículo se revisa literatura relacionada con las indicaciones y efectos de distintas terapias. Se concluye que la calidad de la metodología de investigación es deficiente, sin embargo ha mejorado en la última década. Hasta ahora no existe evidencia que respalde la indicación de un tipo de terapia de rehabilitación motora por sobre otra, lo que no significa que se deba dejar a los niños con parálisis cerebral sin tratamiento, sino que la indicación de una terapia debe ser basada en objetivos funcionales y adaptativos, y se deben reevaluar periódicamente los resultados en forma crítica. Es fundamental participar activamente en trabajos de investigación que busquen determinar las mejores intervenciones disponibles, considerando las dificultades de la investigación clínica en rehabilitación motora. Se debe estar atento a la aparición de nuevas técnicas validadas científicamente, a fin de ofrecer a los pacientes alternativas terapéuticas racionales y fundamentadas.

Hemiparetic cerebral palsy: etiological risk factors and neuroimaging

The purpose of this paper, which was conducted on 175 children with hemiparetic cerebral palsy (H-CP), was to verify the etiological risk period for this disease. Etiological risk factors (ERF) were detected through anamnesis: 23 percent in the prenatal period, 18 percent in the perinatal period and 59 percent of the patients the period was undefined (ERF in the prenatal and perinatal period was 41 percent and no ERF was 18 percent of the cases. The computerized tomographic scan (CT) and MRI were performed on all the patients, who were then classified according to their etiopathogenic data: CT1= normal (18 percent); CT 2= unilateral ventricular enlargement (25 percent); CT 3= cortical/ subcortical cavities (28 percent); CT4= hemispheric atrophy and other findings (14 percent); CT 5= malformations (15 percent). CT 5 was associated with physical malformations beyond the central nervous system and with prenatal ERF's , while CT 2 was associated with the perinatal ERF's, mainly in premature births. Magnetic resonance imaging was performed on 57 patients and demonstrated a good degree of concordance with the CT. Etiology remained undefined in only 37 percent of the cases after neuroimaging was related to ERF. A high perinatal RF frequency (59 percent) was observed and emphasized the need for special care during this period

Estudio exploratorio sobre patologías conjuntas y/o secuelares a la meningitis y nivel de comunicación en niños paralíticos cerebrales menores de 4 años que concurrieron a rehabilitación (primera vez) al servicio de Fonoaudiología de I.L.A.R Rosario, enero 1986-febrero 1997 / Exploration study about united pathologies and/or sequels to the meningitis and level of communication in cerebral paralitical children younger of 4 years with concur to rehabilitation (first time) to service of Phonoaudiology of I.L.A.R Rosario janu

Este estudio tiene por fin estudiar la meningitis y las patologías consecutivas y/o secuelares y el nivel de comunicación alcanzado por 26 niños paralíticos cerebrales, menores de 4 años que concurrieron a rehabilitación (por primera vez) al Servicio de Fonoaudiología de I.L.A.R. entre enero de 1986 y febrero de 1997. La investigación fue de tipo exploratoria, transversal y retrospectiva. Se trabajó sobre fuentes secundarias (registros de la institución). Un 42,3 por ciento contrajo la enfermedad antes del mes y un 34,65 por ciento en el lapso comprendido entre 1 mes y un día y los 6 meses. La población tiene asociado al diagnóstico de meningitis y de Parálisis Cerebral, hidrocefalia, microcefalia y encefalitis. Se agrega a esto en un casi 43 por ciento la presencia de hipoacusia. La alimentación (funciones vegetativas) está comprometida: solo 2, de los 4 niños menores de un año y 4 de 20 niños mayores a 1 año se alimentan con sólidos, es decir, tienen un patrón alimentario acorde a su edad. El 57,7 por ciento de la población está acorde con el nivel de comunicación correspondiente para su edad, el 42,3 por ciento no accede al nivel correspondiente. El trabajo permitió llegar a la conclusión que el nivel de comunicación alcanzado por un niño está determinado por diferentes factores: la existencia de patologías conjuntas y/o secuelares, la presencia de hipoacusia, la edad en que se produjo la meningitis; pero tampoco se puede dejar de lado la existencia de un compromiso visual, la relación con el medio, la presencia de un componente psicológico, que si bien son factores no investigados en éste trabajo, pueden incidir en el acceso a un determinado nivel lingüístico de comunicacion

Estudo dos fatores de risco desencadeantes de anóxia neonatal e o possível desenvolvimento de paralisia cerebral / Study of risk factors that unchain newborn anoxy and the possible development of cerebral palsy

A proposta deste estudo foi identificar os fatores de risco desencadeantes de anóxia neonatal e o possível desenvolvimento de Paralisia Cerebral. A coleta dos dados foi realizada a partir de informaçöes contidas no Serviço Arquivo Médico (SAME) do Hospital Universitário de Santa Maria (UFSM), RS. Participaram deste estudo crianças atendidadas na UTI neonatal do HUSM durante o ano de 1988, com diagnóstico de anóxia neonatal. Os 59 casos encontrados foram classificados em grupos de recuperaçäo total e recuperaçäo parcial. Sendo submetidos a análise descritiva. Os resultados encontram suporte na literatura onde a anóxia neonatal é considerada como uma das principais causas de paralisia cerebral, confirmando a necessidade de acompanhamento destas crianças até a idade escolar