ABSTRACT
Crianças com lesão do neurônio motor superior possuem déficits funcionais desafiadores. As alterações de marcha são conseqüências da espasticidade, padrão primitivo locomotor, pobre controle motor central e controle debilitado da propriocepção. O objetivo do presente estudo é mostrar os benefícios da eletro-estimulação no padrão da marcha do paciente com paralisia cerebral através do laboratório de marcha e teste ergoespirométrico. Método: Paciente do grupo de Neuro-ortopedia do IOT HC-FMUSP, sexo feminino, 24 anos, estudante, portadora de paralisia cerebral do tipo diplégico espástico, deambuladora comunitária e pés eqüinos flexíveis. Equipamento de análise de marcha: HAWK, Motion Analysis Corporation. Analisador metabólico CPX-D, Medgraphics, EUA. Estimulador elétrico modelo EEF-4, Lynx Tecnologia. Frequência de estímulo de 20Hz, ON/OFF 5s/10s, 40min, 3X/semana por 1,5 meses nos compartimentos anterior e lateral das pernas. Resultado: dorsiflexão fase de balanço pé direito e esquerdo anterior ao estímulo: 2,12º e -0,17º, respectivamente. Após 1,5 meses do término do protocolo: dorsiflexão pé direito=7,54º, dorsiflexão pé esquerdo=5,31º. Ergoespirometria: Aumento do tempo de tolerância ao exercício (TT) em 194%, PO2 em 50%, VO2 em 17% e economia energética relativa a 22% da FC. Conclusão: a estimulação elétrica da perna pode ser responsável por alterações na cinemática não só do tornozelo, mas de todo o membro inferior, influenciando o padrão da marcha e a condição cardiopulmonar do paciente com paralisia cerebral.
Children with upper motor neuron injuries have challenging functional deficits. Their gait deviations are a consequence of spasticity, persistent primitive locomotor patterns, poor selective motor control and impaired proprioception. The objective of this study is to show the benefits of electrical stimulation on gait patterns of patients with cerebral palsy through gait analysis and cardiopulmonary exercise test. Methods: patient from Neuro-orthopedic group of IOT HC-FMUSP, female, 24 years-old, student, cerebral palsy with spastic diplegia, communitarian ambulation and flaccid bilateral equinus foot. Gait analysis equipment: HAWK, Motion Analysis Corporation. Metabolic analyzer: CPX-D, Medgraphics, USA. Electrical stimulator: EEF-4, Lynx Tecnologia. Electrical stimulation using 20Hz, ON/OFF 5sec/10sec, 40min, 3 times a week for 1.5 months on anterior and lateral leg muscles. Results: in swing phase, before stimulus, right and left ankle dorsiflexion = 2.12º and -0.17º, respectively. 1.5 months after last stimulus, right and left ankle dorsiflexion = 7.54º and 5.31º, respectively. Cardiopulmonary analysis: improvement in exercise tolerance of 194%, 50% in O2P, 17% in VO2 and energetic economy of 22% of HR. Conclusion: leg`s electrical stimulation may be responsible for cinematic improvements not only of the ankles but all lower limbs, influencing gait patterns and cardiopulmonary conditions of patients with cerebral palsy.
Subject(s)
Humans , Female , Adult , Oxygen Consumption , Equinus Deformity/pathology , Cerebral Palsy/physiopathology , Electric Stimulation/instrumentation , Gait Analysis/instrumentationABSTRACT
Abbreviations PSN Peripheral Selective Neurotomy;SEF Spastic Equinus Foot;SHA Spastic Hip Adduction;SHW Spastic Hand-Wrist Introduction.PSN is a microsurgical partial section of motor branches whose aim is supress the monosinaptic tonic stretching reflex leading to reduction of harmful spasticity without excessive paresis, restoring the tonic agonist-antagonist balance in a limb segment.Aims. Assess the benefits of PSN for treatment of disabling spasticity in children and teenager population. Method.19 consecutive patients (68 por ciento males,age 5-23 ), were treated through PSN.10 patients had SEF or SHA, and 9 had SHW.The inclusion criteria were age of 4 years or more; focused disabling spasticity at least grade 2 in Ashworth Mod. Scale; failure of previous non-surgical therapies; duration of spasticity more than 2 years, positive response to the motor anaesthetic block test; no evidence of irreductible muscle contracture. The goals of surgery were to improve function, cosmetics and confort of the affected limb segment. Clinical evaluation of spasticity (Ashworth Modified Scale), articular mobility (Goniometry), Gait (Video and gait analysis), and Prehension (Functional 440 pts. Scale), were performed. Results.The postoperative follow-up period range from 1 to 18 months. Spasticity was reduced in all the muscles denervated. The triceps surae spasticity reduction in SEF patients remain stable over a follow-up period of 6-18 months. 7/9 SEF patients improved ankle active dorsiflexion, ½ SHA improved hip abduction, while a mean improvement of 31.3° in wrist supination and 28.7° in wrist extension was achieved in the SHW group. 8/9 SEF patients showed improvement in 1 or more of the following gait features: ankle dorsiflexion, length of step, gait speed, proximal kinematic segment performance. The prehension improved in 7 patients (78 por ciento).All SHW patients improved their confort and limb cosmetics. 3 patients 15 por ciento) had transient dysesthesia...
Subject(s)
Male , Female , Child , Adolescent , Humans , Disability Evaluation , Gait , Hand , Hand Strength , Hip , Muscle Spasticity , Nerve Block , Peripheral Nerves/surgery , Equinus Deformity/pathology , Neurosurgical Procedures/methodsABSTRACT
Basados en que la patología del pie varo equino supinado idiopático se centra a nivel del pie subastragalino, podemos inferir que se trata de un pie en inversión y por lo tanto necesita para su realineación lograr la derrotación del calcáneo a través de un técnica de enyesado en la cual se efectúa una maniobra de eversión, donde el astrágalo queda fijo en la mortaja tibioperonea. En nuestra estadística hemos logrado corregir ortopédicamente el 80 por ciento de los casos, dejando establecido que en la misma no fue incluido ningún pie varo equino supinado (PVES) postural. En el 20 por ciento restante se necesitaron cirugías mínimas para completar su corrección. La valoración morfológica, funcional y radiológica nos arrojó resultados satisfactorios