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1.
Rev. cuba. anestesiol. reanim ; 20(3): e717, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1351984

ABSTRACT

Introducción: La administración epidural de esteroides constituye un pilar del tratamiento del dolor radicular cervical y lumbosacro. Objetivo: Describir los mecanismos fisiológicos y características farmacológicas de los corticosteroides utilizados en el tratamiento del dolor, así como las complicaciones derivadas de la administración epidural de esteroides particulados. Métodos: Se realizó una revisión no sistemática de la literatura en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID y el buscador académico Google Scholar, en los meses de julio a septiembre del año 2020. Desarrollo: Los corticoides utilizados en la medicina del dolor son derivados de la prednisolona. Estos se clasifican en particulados (de depósito, de suspensión) o no particulados (de dilución), en función de la presencia o ausencia de un componente molecular sólido (moléculas tipo éster, insolubles en agua). Los fármacos más empleados son la dexametasona, betametasona, triamcinolona y metilprednisolona. Conclusiones: La administración epidural de esteroides particulados está relacionada con la incidencia de complicaciones graves, aunque poco frecuentes, como paraplejía, tetraplejía, infarto de la médula espinal, hemorragia y edema cerebral. La evidencia disponible muestra una efectividad analgésica similar a los compuestos no particulados. Por lo tanto, no se recomienda su utilización rutinaria durante el abordaje del espacio epidural(AU)


Introduction: Epidural administration of steroids is a cornerstone for the treatment of cervical and lumbosacral radicular pain. Objective: To describe the physiological mechanisms and pharmacological characteristics of the corticosteroids used for pain treatment, as well as the complications derived from the epidural administration of particulate steroids. Methods: A nonsystematic review of the literature was carried out, from July to September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID and the academic search engine Google Scholar. Development: The corticoids used in pain medicine are derived from prednisolone. These are classified into particulate (deposit, suspension) or non-particulate (dilution), depending on the presence or absence of a solid molecular component (ester-type molecules, insoluble in water). The most commonly used drugs are dexamethasone, betamethasone, triamcinolone, and methylprednisolone. Conclusions: The epidural administration of particulate steroids is related to the incidence of serious, although infrequent, complications, such as paraplegia, tetraplegia, spinal cord infarction, hemorrhage and cerebral edema. Available evidence shows analgesic effectiveness similar to that of non-particulate compounds. Therefore, its routine usage is not recommended during the managment of the epidural space(AU)


Subject(s)
Humans , Male , Female , Dexamethasone , Prednisolone , Adrenal Cortex Hormones , Analgesics , Quadriplegia
2.
Rev. Pesqui. Fisioter ; 11(3): 593-598, ago.2021. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1292121

ABSTRACT

CONTEXTO: Úlceras por pressão (UP) são a complicação mais comum observada em pacientes acamados. O objetivo deste relato de caso é explorar a eficácia da terapia a laser no infravermelho próximo de classe IV no tratamento de úlceras de pressão grandes e graves. DADOS: Um homem de 53 anos com diagnóstico de tetraplegia devido à tuberculose da coluna cervical no nível C5-C6 foi admitido em um hospital com úlcera por pressão instável sobre o sacro e úlceras de pressão do National Pressure Ulcer Advisory Panel estágio 3 sobre a área trocantérica direita para lesão por pressão. Não havia comorbidades associadas, como diabetes mellitus e hipertensão. Utilizou-se o Lite Cure Gallium-Aluminium-Arsenide (GaAlAs) classe IV laser próximo ao infravermelho, sem contato, emissão de feixe contínuo (não pulsante) no comprimento de onda de 980 nm. Os parâmetros de dosagem usados foram: 7,5 - 10 watts de potência; faixa de dosagem 7 J / cm2 - 9 J / cm2; área sacral (13 × 9) cm2 e área trocantérica (10 × 8) cm2; em diferentes densidades de energia; o tempo de tratamento varia entre 8 a 15 minutos para cada úlcera. No total, 19 sessões durante um período de 6 semanas foram administradas para tratar úlceras de pressão. Dimensões (área) e estágio de gravidade da úlcera por pressão foram anotados antes da intervenção e após a conclusão da intervenção. Os dados pós-tratamento revelaram melhora clínica em ambos os desfechos. CONCLUSÃO / SIGNIFICADO CLÍNICO: Este relato de caso demonstra um efeito anti-inflamatório, analgésico e bioestimulante de cicatrização do tratamento com laserterapia Classe IV, apresentando redução nas dimensões e gravidade das úlceras por pressão.


CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5- C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/ CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.


Subject(s)
Lasers , Quadriplegia , Pressure Ulcer
3.
Arq. ciências saúde UNIPAR ; 24(1): 47-52, jan-abr. 2020.
Article in Portuguese | LILACS | ID: biblio-1095996

ABSTRACT

A fisioterapia utiliza vários recursos e métodos para intervenções no tratamento da Encefalopatia Crônica Não Progressiva da Infância (ECNPI) ou paralisia cerebral (PC), entre eles a Kinesio Taping® (KT) e a Terapia Neuromotora Intensiva (TNMI). Esses métodos podem ser considerados relativamente novos, o que leva à necessidade do desenvolvimento de pesquisas para verificar seus efeitos em crianças com PC. O presente estudo objetivou verificar os efeitos da KT® e da TNMI na postura sentada de crianças com PC do tipo quadriparesia/quadriplegia espástica. Para isso, foram avaliadas 6 crianças, com uma média de idade de 6,25±2,69 anos. As avaliações aconteceram por meio do software SAPO, no qual os dados são obtidos em centímetros e a análise consiste na avaliação da vertical (eixo Y), comparando os lados esquerdo e direito, sendo assim possível a análise das assimetrias de maneira precisa. Com relação aos resultados, não foi identificada diferença significativa (p > 0,05) da aplicação de KT® na comparação entre efeitos imediato, agudo e crônico para os momentos pré e pós aplicação imediata da KT®. No entanto, de forma descritiva, o uso de KT® associado à TNMI favoreceu o alinhamento na postura sentada, principalmente para acrômios e Espinha ilíaca ânterossuperior (EIAS). Nota-se, portanto, que as evidências do uso de KT®, como coadjuvante durante a TNMI, ainda são inconclusivas em crianças com PC do tipo quadriparesia/plegia.


Physical therapy uses various resources and methods for intervention in the Chronic Non-Progressive Childhood Encephalopathy (CNPCE) or cerebral palsy (CP) interventions, including Kinesio Taping® (KT) and Intensive Neuromotor Therapy (INMT). These methods are relatively new, which leads to the need for the development of research to verify effects in children with CP. The present study analyzed the effects of KT® and INMT on the sitting posture of children with spastic quadriplegia. In order to do this, six (6) children (mean age 6.25±2.69 years) were evaluated. The evaluations took place through SAPO software, where data are obtained in centimeters and the analysis consists of the evaluation of the vertical (Y) axis, comparing the left and right side, thus being possible to precisely analyze any asymmetries. Regarding the results, no significant difference (p > 0.05) was observed with the application of KT® in the comparison between immediate, acute and chronic effect for the moments before and immediately after KT® application. However, descriptively, the use of KT® associated with INMT favored alignment in sitting posture, mainly for acromial and anterior superior iliac spine (ASIS). The results show that evidence of the use of KT® as an adjuvant during INMT is still inconclusive in children with CP quadriparesis/plegia.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Brain Diseases/rehabilitation , Cerebral Palsy/rehabilitation , Sitting Position , Quadriplegia/rehabilitation , Software/supply & distribution , Child, Institutionalized , Physical Therapy Modalities
4.
Rev. Pesqui. Fisioter ; 10(2): 334-345, Maio 2020. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1223765

ABSTRACT

O Trauma Raquimedular é uma condição clínica incapacitante que pode desencadear a tetraplegia, descrita como paralisia parcial ou completa do tronco, músculos respiratórios e membros, favorecendo o surgimento de complicações, principalmente de caráter respiratório. Diante disso, o Fisioterapeuta pode utilizar treinamento muscular ventilatório(TMV) objetivando aumentar a força e resistência à fadiga dos músculos ventilatórios, além de prevenir complicações respiratórias. OBJETIVO: Descrever quais os dispositivos, protocolos e técnicas mais utilizadas para treinamento muscular ventilatório e os efeitos associados em indivíduos tetraplégicos pós trauma raquimedular. METODOLOGIA: Foi realizado levantamento bibliográfico entre novembro de 2019 e fevereiro de 2020, nas bases de dados Medline, LILACS e SciELO utilizando as palavraschave: Breathing Exercises, Spinal Cord Injuries, Quadriplegia e os sinônimos utilizando os operadores booleanos "AND" e "OR". RESULTADOS: Após consulta nas bases de dados, foram encontrados 3334 artigos, 36 foram selecionados para leitura de resumo, sucedendo que 23 foram excluídos por não atender aos critérios de seleção, restando 12 artigos para a leitura integral, resultando na seleção final de 12 artigos. CONCLUSÃO: Fica evidenciado que protocolos para TMV através de resistores lineares são os mais utilizados tetraplégicos. Além disso, execução de protocolos com resistores lineares a inspiração, empregando intensidade em torno de 30-60% da PImax, apresentou efeitos significativos em PImax. No entanto, percebeu-se que há muitas discordâncias quanto as variáveis de treinamento, principalmente intensidade e número de séries propostos. Contudo, é notório que a utilização do TMV em tetraplégicos apresenta certas divergências, principalmente relacionado a escolha das técnicas e/ou dispositivos adequados.


Spinal trauma is a disabling clinical condition that can trigger quadriplegia, described as partial or complete paralysis of the trunk, respiratory muscles and limbs, favoring the onset of complications, mainly of a respiratory nature. Therefore, the Physiotherapist can use ventilatory muscle training (TMV) in order to increase the strength and fatigue resistance of the ventilatory muscles, in addition to preventing respiratory complications. OBJECTIVE: To describe which devices, protocols and techniques are most used for ventilatory muscle training and the associated effects in quadriplegic individuals after spinal cord trauma. METHODOLOGY: A bibliographic survey was carried out between November 2019 and February 2020, in the Medline, LILACS and SciELO databases using the keywords: Breathing Exercises, Spinal Cord Injuries, Quadriplegia and synonyms using the Boolean operators "AND" and " OR ". RESULTS: After consulting the databases, 3334 articles were found, 36 were selected for reading the summary, with 23 being excluded for not meeting the selection criteria, leaving 12 articles for the full reading, resulting in the final selection of 12 articles. CONCLUSION: It is evidenced that protocols for TMV through linear resistors are the most used quadriplegics. In addition, execution of protocols with linear resistors to inspiration, using intensity around 30-60% of MIP, had significant effects on MIP. However, it was noticed that there are many disagreements the training variables, mainly intensity and number of series proposed. However, it is clear that the use of TMV in quadriplegics presents certain divergences, mainly related to the choice of appropriate techniques and / or devices.


Subject(s)
Quadriplegia , Spinal Cord Injuries , Breathing Exercises
5.
Rev. cuba. ortop. traumatol ; 33(2): e178, jul.-dic. 2019. tab, ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1126735

ABSTRACT

RESUMEN Introducción: En las personas tetrapléjicas la carencia de la función del miembro superior constituye la mayor barrera para su autonomía, por lo que muchas de ellas consideran muy importante la reconstrucción y la recuperación de sus miembros superiores. Objetivo: Describir el restablecimiento de la pinza y el agarre de la mano tetrapléjica con el uso de las técnicas de Zancolli y House. Método: Se realizó un estudio longitudinal, prospectivo, con 12 pacientes tetrapléjicos que acudieron a la consulta del equipo de Miembro Superior, del Complejo Científico Ortopédico Internacional "Frank País", de enero de 2013 a diciembre de 2016. Las variables de estudio fueron: edad, sexo, etiología de la lesión, clasificación (según la clasificación internacional de Giens), dependencia en la realización de las actividades cotidianas (índice de Barthel), función de la extremidad (clasificación funcional de Mowery), la satisfacción personal (escala de Allien y Machle) y complicaciones. Se utilizaron las técnicas de Zancolli y House. La información se recogió de las historias clínicas de los pacientes ingresados. Los datos se procesaron en una base de datos creada en microcomputadora con los sistemas Word y Excel. También se utilizó el sistema estadístico SPSS 17. Resultados: Del total de pacientes de la muestra, se atendieron once hombres y una mujer (24 manos en total). La edad promedio fue de 30 años, con un período de latencia de 8,6 años. Se recogió como etiología de la lesión medular la traumática. Según la clasificación internacional de Giens, hubo diez pacientes en el grupo 4, y dos pacientes en el grupo 5. Se presentaron complicaciones en tres casos. Con la cirugía se logró que todos los enfermos cambiaran de la condición de dependientes a independientes. En cuanto a la función de la mano, la gran mayoría de la muestra fue clasificada como excelente y, respecto a la satisfacción personal, nueve pacientes refirieron sentirse excelentes. Conclusiones: La técnica de Zancolli y la de House favorecen el restablecimiento de la pinza y el agarre de la mano tetrapléjica, mejoran la movilidad articular, la fuerza muscular y la funcionabilidad de la mano. Estos procedimientos favorecen la autonomía del paciente y tienen un alto grado de satisfacción(AU)


ABSTRACT Introduction: In tetraplegic persons, the lack of function of the upper limb constitutes the utmost barrier to their autonomy, which is why many of them consider the reconstruction and recovery of their upper limbs to be very important. Objective: To describe the restoration of the caliper and the grip of quadriplegic hand with the use of Zancolli and House techniques. Method: A longitudinal, prospective study was carried out in 12 tetraplegic patients who came to the upper limp consultation at Frank País International Orthopedic Scientific Complex, from January 2013 to December 2016. The study variables were age, sex, injury etiology, classification (according to Giens international classification), dependence on daily activities (Barthel index), function of the limb (Mowery functional classification), personal satisfaction (Allien and Machle scale) and complications. Zancolli and House techniques were used. The information was collected from the medical records of the admitted patients. Data was processed in a microcomputer database with Word and Excel systems. The SPSS 17 statistical system was also used. Results: Eleven men and one woman (24 hands in total) were treated from the total of patients in the sample. The average age was 30 years, with 8.6 years of latency period. Traumatic spinal cord injury was collected as the etiology of the spinal cord injury. According to the international Giens classification, there were ten patients in group 4, and two patients in group 5. Complications occurred in three cases. With surgery, all patients were able to change from dependent to independent status. Regarding hand function, the vast majority of the sample was classified as excellent, and regarding personal satisfaction, nine patients reported feeling excellent. Conclusions: Zancolli and House techniques favor the restoration of the caliper and the grip of the quadriplegic hand, improve joint mobility, muscle strength and the functionality of the hand. These procedures favor the autonomy of the patient and have a high degree of satisfaction(AU)


RÉSUMÉ Introduction: Chez les personnes tétraplégiques, l'absence de fonction des membres supérieurs est la barrière la plus grande qui empêche leur autonomie. C'est pourquoi la plupart d'entre elles considèrent la reconstruction et la récupération de leurs membres supérieurs très importantes. Objectif: Décrire le rétablissement de la pince digitale et la préhension de la main tétraplégique par les techniques de Zancolli et de House. Méthode: Une étude longitudinale et prospective de 12 patients tétraplégiques vus en consultation par l'équipe de Membres supérieurs, au Complexe scientifique international d'orthopédie Frank Pais, a été effectuée de janvier 2013 à décembre 2016. Les variables étudiées ont été l'âge, le sexe, l'étiologie de la lésion, la classification (selon la classification internationale de Giens), la dépendance au moment de réaliser les activités quotidiennes (index de Barthel), la fonction de l'extrémité (classification fonctionnelle de Mowery), la satisfaction personnelle (échelle d'Allien et Machhle), et les complications. Les techniques de Zancolli et de House ont été employées. L'information a été obtenue à partir des dossiers médicaux des patients hospitalisés. Les données ont été traitées dans une base des données créée par ordinateur sur la base des applications telles que Word et Excel. On a aussi utilisé le système statistique SPSS 17. Résultats: Sur la totalité de patients de l'échantillon, onze hommes et une femme (24 mains au total) ont été pris en charge. L'âge moyen a été 30 ans, dans une période de latence de 8.6 ans. Les traumatismes sont à l'origine de la lésion médullaire. D'après la classification internationale de Giens, il y a eu dix patients dans le groupe 4 et deux patients dans le groupe 5. Il y a eu des complications dans trois cas. L'intervention a permis que tous les malades atteignent leur autonomie. La fonction de la main a été considérée excellente dans la majorité des patients de l'échantillon, tandis que neuf ont exprimé leur satisfaction. Conclusions: Les techniques de Zancolli et de House favorisent le rétablissement de la pince digitale et la préhension de la main tétraplégique, et améliorent la mobilité articulaire, la force musculaire et la fonction de la main. Ces procédures facilitent l'autonomie du patient, et obtiennent un haut taux de satisfaction(AU)


Subject(s)
Humans , Male , Female , Quadriplegia/rehabilitation , Reconstructive Surgical Procedures/methods , Hand/surgery , Prospective Studies , Longitudinal Studies
6.
Rev. cub. inf. cienc. salud ; 30(3): e1382, jul.-set. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1093077

ABSTRACT

Encontrar estrategias costo-efectivas para la rehabilitación y la educación del paciente con paraplejia, basado en sus necesidades, es menester para su abordaje integral, así como para la disminución de costos directos e indirectos. La telemedicina podría ser una herramienta adecuada. Este trabajo se propuso realizar una revisión crítica de la literatura sobre la utilidad de la telemedicina para la rehabilitación y el manejo del paciente con paraplejia, en el contexto de la Atención Primaria de Salud. Se realizó una búsqueda en las bases de datos PubMed, Medline y EMBASE, con descriptores tipo MeSH y DeCS. No se aplicó ningún filtro de temporalidad, idioma o grupo etario. Se reunieron 134 artículos. El criterio de búsqueda y de selección se basó en los elementos PICO. Luego del análisis de contenido de cada uno, se escogieron 29 artículos. El análisis crítico de la literatura se realizó por medio de los elementos PRISMA. La telemedicina y la telerrehabilitación son herramientas que pudieran ser útiles para pacientes parapléjicos o cuadripléjicos; sin embargo, no existe literatura ni evidencia sobre este tipo de intervenciones en esta población. Intervenciones en pacientes con enfermedades neurológicas diferentes a la paraplejia muestran que potencialmente la telemedicina podría tener beneficios y reducir costos en la rehabilitación. Las herramientas tecnológicas y de telemedicina en pacientes parapléjicos podrían favorecer potencialmente su rehabilitación y el uso eficiente de los recursos; no obstante, es necesaria la realización de estudios en el área, para determinar el beneficio real de la telemedicina como estrategia de Atención Primaria de Salud en el paciente con paraplejia y cuadriplejia(AU)


Finding cost-effective strategies for the rehabilitation and education of patients with paraplegia, based on their needs, is necessary for their comprehensive approach, as well as for the reduction of direct and indirect costs. The objective of this work was to perform a critical review of the literature on the usefulness of telemedicine for the rehabilitation and management of patients with paraplegia, in the context of Primary Health Care. A review of the literature in the PubMed, Medline and EMBASE databases was performed with MeSH and DeCS type descriptors. No filter of temporality, language or age group was applied. 134 articles were collected. The searching and selection criteria were based on the PICO elements; after the content analysis of each one, 29 articles were chosen. The critical analysis of the literature was carried out through the PRISMA elements. Telemedicine and telerehabilitation are tools that could be useful for paraplegic or quadriplegic patients; however, there is no literature or evidence on this type of interventions in this population. Interventions in patients with neurological diseases other than paraplegia show that telemedicine could potentially have benefits and reduce rehabilitation costs. The technological and telemedicine tools in paraplegic patients could potentially favor their rehabilitation and efficient use of resources; however, studies in the area are necessary to determine the real benefit of telemedicine as a care strategy primary health in the patient with paraplegia and quadriplegia(AU)


Subject(s)
Humans , Paraplegia , Primary Health Care , Quadriplegia , Disease , Health Strategies , Telemedicine
7.
Rev. argent. reumatol ; 30(2): 26-28, jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1041882

ABSTRACT

Presentamos el caso clínico de una mujer en la quinta década de la vida, de nacionalidad argentina, que acudió a la guardia de clínica médica de un hospital de tercer nivel por cuadro de mialgias y paresia en las cuatro extremidades, de inicio agudo, progresivo, con dificultad para la movilización de miembros superiores, bipedestación y marcha. Se constató hipocalemia severa, acidosis metabólica, pH urinario alcalino, brecha aniónica urinaria positiva (excreción de amonio), hipocitraturia e hipercalciuria, por lo que se diagnosticó Acidosis Tubular Renal (ATR) tipo I; además se evidenció elevación de creatinkinasa (CK) e insuficiencia renal aguda que corrigió con la reposición de líquidos. Al interrogatorio dirigido, la paciente refirió síndrome seco asociado a artralgias, de varios años de evolución, por lo que se realizaron estudios complementarios que apoyaron el diagnóstico de Síndrome de Sjögren.


We present the clinical case of a woman in the fifth decade of life, argentina, who went to the Internal Medicine emergency room of a third level hospital for symptoms of myalgia and paresis in all four extremities, acute onset, progressive, with difficulty for the mobilization of members superior, standing and walking. Severe hypokalemia, metabolic acidosis, alkaline urinary pH, positive urinary anion GAP (ammonium excretion), hypocitraturia and hypercalciuria were diagnosed. Renal Tubular Acidosis (RTA) type I was diagnosed; acute renal failure was also noted, which corrected with the treatment and elevated creatine kinase (CK). In the anamnesis, the patient reported dry syndrome associated with arthralgias of years of evolution, so that complementary studies were carried out that supported the diagnosis of Sjögren's Syndrome (SS).


Subject(s)
Quadriplegia , Acidosis, Renal Tubular , Sjogren's Syndrome
8.
Article in Korean | WPRIM | ID: wpr-760138

ABSTRACT

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.


Subject(s)
Aged , Emergencies , Head , Humans , Intervertebral Disc , Laminoplasty , Magnetic Resonance Imaging , Neck , Quadriplegia , Spinal Cord Diseases , Spine , Spondylosis , Supine Position
9.
Article in English | WPRIM | ID: wpr-760004

ABSTRACT

OBJECTIVE: In general, quadriplegic patients use their voices to call the caregiver. However, severe quadriplegic patients are in a state of tracheostomy, and cannot generate a voice. These patients require other communication tools to call caregivers. Recently, monitoring of eye status using artificial intelligence (AI) has been widely used in various fields. We made eye status monitoring system using deep learning, and developed a communication system for quadriplegic patients can call the caregiver. METHODS: The communication system consists of 3 programs. The first program was developed for automatic capturing of eye images from the face using a webcam. It continuously captured and stored 15 eye images per second. Secondly, the captured eye images were evaluated for open or closed status by deep learning, which is a type of AI. Google TensorFlow was used as a machine learning tool or library for convolutional neural network. A total of 18,000 images were used to train deep learning system. Finally, the program was developed to utter a sound when the left eye was closed for 3 seconds. RESULTS: The test accuracy of eye status was 98.7%. In practice, when the quadriplegic patient looked at the webcam and closed his left eye for 3 seconds, the sound for calling a caregiver was generated. CONCLUSION: Our eye status detection software using AI is very accurate, and the calling system for the quadriplegic patient was satisfactory.


Subject(s)
Artificial Intelligence , Caregivers , Humans , Learning , Machine Learning , Quadriplegia , Tracheostomy , Unsupervised Machine Learning , Voice
10.
Article in English | WPRIM | ID: wpr-759988

ABSTRACT

Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.


Subject(s)
Botulinum Toxins , Cervical Cord , Dyskinesias , Humans , Laminoplasty , Magnetic Resonance Imaging , Neck , Quadriplegia , Spinal Cord Diseases , Spine , Spondylosis , Tic Disorders , Tics , Tourette Syndrome , Upper Extremity , Young Adult
11.
Article in English | WPRIM | ID: wpr-759971

ABSTRACT

A case of acute quadriplegia resulting from reduction of atlantoaxial subluxation due to os odontoideum is rare. Patient with os odontoideum are at a greater risk for atlantoaxial instability and resultant spinal cord compression. In our case, the patient exhibited mild myelopathic symptoms before the onset of acute quadriplegia. Owing to the clinical presentations, the spinal cord not only seemed to suffer a mechanical compression but also an insufficiency of blood supply to the spinal artery and its branches. No other report has described the findings from magnetic resonance imaging before and after the onset of acute myelopathy after surgery. The aim of our case report is to highlight the pathophysiology and appropriate management strategy of a patient with severe progressive spinal cord myelopathy after surgery, secondary to chronic atlantoaxial subluxation due to os odontoideum. This case depicts the presence of this rare yet possible complication, and emphasizes the importance of preoperative evaluation in cases with chronic progressive myelopathy. Moreover, urgent postoperative treatment and rehabilitation are important for the recovery of neurological symptoms.


Subject(s)
Arteries , Humans , Magnetic Resonance Imaging , Quadriplegia , Rehabilitation , Spinal Cord , Spinal Cord Compression , Spinal Cord Diseases
12.
Article | WPRIM | ID: wpr-763544

ABSTRACT

We report an extremely rare case of a patient with hypoxic-ischemic brain injury who recovered consciousness and motor and cognitive functions due to paradoxical response after zolpidem administration. A 32-year-old woman who had attempted suicide by hanging was admitted. The patient had stabilized in a state of drowsy mentality, quadriparesis, dysphagia, and impaired cognition. Brain magnetic resonance imaging was suggestive of hypoxic ischemic brain injury and unilateral infarction in the right posterior cerebral artery territory. Due to sleep disturbance, zolpidem was administered, and paradoxically consciousness level and function returned to near-normal during the duration of the drug-effect. In addition to previous reports, our case characteristically showed remarkable motor and cognitive function recovery, not only consciousness level. The drug-effect time was gradually decreased after 18 months and absent after 3 years. We have reviewed related literature and discussed possible neuropharmacological and neurobiological mechanism.


Subject(s)
Adult , Brain Injuries , Brain , Cognition , Consciousness , Deglutition Disorders , Female , Humans , Hypoxia-Ischemia, Brain , Infarction , Infarction, Posterior Cerebral Artery , Magnetic Resonance Imaging , Posterior Cerebral Artery , Quadriplegia , Suicide, Attempted
13.
Article in English | WPRIM | ID: wpr-763098

ABSTRACT

Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.


Subject(s)
Adult , Emergencies , Hemorrhage , Humans , Magnetic Resonance Imaging , Male , Neck Pain , Neurilemmoma , Quadriplegia , Spine
14.
Clinical Pain ; (2): 130-132, 2019.
Article in Korean | WPRIM | ID: wpr-811480

ABSTRACT

Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.


Subject(s)
Acupuncture , Arm , Coccyx , Extremities , Hand , Hematoma, Subdural, Spinal , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Muscle Strength , Neuralgia , Quadriplegia , Spine , Urinary Bladder , Urinary Bladder, Neurogenic
15.
Rehabil. integral (Impr.) ; 13(2): 86-94, Diciembre 2018. tab
Article in Spanish | LILACS | ID: biblio-986473

ABSTRACT

Caregiving experience of mothers of young people with traumatic tetraplegia. A qualitative phenomenological study Introduction: Spinal cord injury (SCI) is defined as damage to the spine that results in a temporary or permanent change in its normal motor, sensory or autonomic function, with irreversible consequences. It is classified as paraplegia and tetraplegia, the latter makes the person highly dependent on care, requiring permanent help from another person to perform daily activities. Objective: To describe the experience of caregivers who are mothers of young people with traumatic tetraplegia, and who are patients of Instituto Teletón Santiago. Methodology: Qualitative study with descriptive phenomenological analysis. Data was gathered by means of semi-structured interviews, which were studied through qualitative content analysis with deductive categories. The overall sample was intentional, including the participation of five mothers who were primary caregivers of their children with tetraplegia, from Instituto Teletón Santiago. Results: The categories found were self-description, impact of the accident, care relationship, impact on the family and other significant factors, relation with the health care network, coping measures, beliefs and learning. The highlights of this type of dependent care included work overload, self-neglect, and deteriorated health. Significant situations from the moment of the accident reflect the experience as a whole. In these circumstances, love emerged as a pop-up topic and became known as the main value. The emotional burden of this experience has been contained and compensated by a positive approach to life, based on cultural and religious beliefs. Conclusion: Mothers become expert caregivers, providing holistic care that must be considered in the interventions of the rehabilitation team, to contribute to the reconstruction and resignification of this relationship of maternal/filial care.


Introducción: Lesión medular (LM) se define como un daño en la médula espinal resultando en un cambio transitorio o permanente, en su función normal motora, sensitiva o autonómica; con consecuencias irreversibles si esta es permanente. Se clasifica en paraplejia y tetraplejia, generando esta última gran dependencia en los cuidados personales de la vida diaria para quien la sufre, necesitando de otro de manera permanente. Objetivo: Describir las experiencias de madres cuidadoras de jóvenes con tetraplejia adquirida de origen traumático, usuarios de Teletón Santiago. Metodología: Estudio cualitativo con análisis fenomenológico, descriptivo. Para la recolección de datos se realizaron entrevistas semiestructuradas, las que fueron analizadas a través de análisis de contenido cualitativo con categorías deductivas. La muestra fue intencionada, participando cinco madres cuidadoras principales de hijos con tetraplejia del Instituto Teletón Santiago. Resultados: Las categorías encontradas fueron descripción de sí mismas, impacto del accidente, relación de cuidado, impacto en la familia y otros significativos, relación con la red de salud, medidas de afrontamiento, creencias y aprendizaje. Los aspectos destacados de este tipo de agente de cuidado dependiente incluyeron sobrecarga, abandono del yo y deterioro de su salud. Las situaciones significativas desde el momento del accidente reflejan la experiencia como un todo. En esta vivencia, el amor surgió como tema emergente y se dio a conocer como el valor principal. La carga emocional de esta experiencia ha sido contenida y compensada por un enfoque positivo sobre la vida, basado en creencias culturales y religiosas. Conclusión: Las madres se vuelven expertas cuidadoras, otorgando un cuidado holístico que debe ser considerado en las intervenciones del equipo de rehabilitación, para contribuir a la reconstrucción y resignificación de esta relación de cuidado materno/filial.


Subject(s)
Humans , Female , Adolescent , Adult , Caregivers/psychology , Mothers/psychology , Quadriplegia , Surveys and Questionnaires , Qualitative Research , Mother-Child Relations
16.
Rev. bras. med. esporte ; 24(6): 450-454, Nov.-Dec. 2018. tab, graf, ilus
Article in English | LILACS | ID: biblio-977856

ABSTRACT

OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.


OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.


OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.


Subject(s)
Humans , Male , Adult , Quadriplegia/rehabilitation , Spinal Cord Injuries/rehabilitation , Electric Stimulation Therapy/methods , Upper Extremity , Hand/innervation , Prospective Studies , Treatment Outcome
17.
Rev. bioét. (Impr.) ; 26(4): 574-586, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-985225

ABSTRACT

Resumo O objetivo deste estudo quantitativo e transversal foi avaliar a qualidade de vida de pessoas com tetraplegia e, a partir dos resultados, refletir à luz da bioética sobre ações necessárias para aprimorar práticas de cuidado e acesso a recursos de tecnologia assistiva. Aplicou-se o questionário WHOQOL-bref a 100 indivíduos com tetraplegia, usuários ou não de tecnologias assistivas, e os resultados foram tratados estatisticamente. Os escores mais significativos relacionaram-se a gênero feminino, maiores níveis educacionais, ocupação, maior tempo de lesão e uso de tecnologia assistiva. As reflexões nesse campo, sustentadas pela ética do cuidado de Gilligan e bioética social latino-americana, apontam a necessidade de aprimorar inter-relações da assistência e a formulação de políticas públicas intersetorias de proteção a vulnerabilidades que garantam às pessoas com lesão medular notificação clínica e sociodemográfica, inclusão digital, adaptação domiciliar, acesso a tecnologias e postos de trabalho especiais.


Abstract The objective of this quantitative-transversal study was to evaluate the quality of life of people with tetraplegia and, from its results, to carry out a bioethical reflection directed to the actions necessary to improve care practices and access to assistive technology resources. The WHOQOL-bref questionnaire was applied to 100 individuals with tetraplegia, whether or not users of assistive technologies, and the results were treated statistically. The highest significant scores were related to: female gender, higher educational levels, occupation, longer injury time and use of assistive technology. Bioethical reflections, based on Gilligan's Ethics of Care and Latin American Social Bioethics, have pointed to the need to improve the interrelationships around care and to formulate intersectoral public policies to protect vulnerabilities that would guarantee the following to people with spinal cord injury: clinical and sociodemographic notification, digital inclusion, home adaptation, access to technologies and special jobs.


Resumen El objetivo de este estudio cuantitativo-transversal fue evaluar la calidad de vida de personas con cuadriplejía y realizar una reflexión bioética dirigida a las acciones necesarias para la mejora de las prácticas de cuidado y acceso a recursos de tecnología de asistencia. Se aplicó el cuestionario WHOQOL-bref a 100 individuos con cuadriplejía, usuarios o no de dispositivos de tecnologías de asistencia y los resultados fueron tratados estadísticamente. Los mayores puntajes estuvieron relacionados con: género femenino, mayores niveles educativos, ocupación, mayor tiempo de lesión y uso de tecnología de asistencia. Las reflexiones bioéticas, sostenidas en la Ética del Cuidado de Gilligan y en la Bioética Social latinoamericana, señalaron la necesidad de perfeccionar las interrelaciones en torno a la asistencia y para la formulación de políticas públicas intersectoriales de protección a las vulnerabilidades que garanticen a las personas con lesión medular: notificación clínica y sociodemográfica, inclusión digital, adaptación domiciliaria, acceso a las tecnologías y puestos de trabajo especiales.


Subject(s)
Humans , Male , Female , Quadriplegia , Quality of Life , Self-Help Devices , Bioethics , Cross-Sectional Studies
18.
Medisan ; 22(7)jul.-ago. 2018. ilus
Article in Spanish | LILACS | ID: biblio-955057

ABSTRACT

Se presenta el caso clínico de un paciente con diagnóstico de cuadriparesia debido a una fractura vertebral cervical y compresión medular graves, producidas por una caída desde una altura de 2 metros. Según el examen físico, los estudios radiológicos y la aplicación de escalas neurológicas, presentaba pérdida total de la función motora, de la discriminación sensorial del dolor y de la temperatura por debajo del nivel de lesión. Debido a las secuelas de las lesiones traumáticas en el sistema nervioso central, se aplicó tratamiento bioenergético rehabilitador: magnetoterapia y craneopuntura, complementado con kinesioterapia y terapia ocupacional, y se obtuvo una mejoría de la fuerza, el tono muscular y la capacidad funcional, con coordinación de la marcha.


The case report of a patient with diagnosis of quadriparesis due to a cervical vertebral fracture and severe medullary compression, taking place due to a fall from a height of 2 meters is presented. According to the physical examination, the radiological studies and the use of neurological scales, he presented total loss of the motor function, of the sensorial discrimination of pain and of temperature under the lesion level. Due to the sequels of the traumatic lesions in the central nervous system, bioenergetic rehabilitative treatment was applied: magnetotherapy and craneopuncture, supplemented with kinesiotherapy and occupational therapy, and an improvement of the force, the muscle tone and the functional capacity, with coordination of walking was obtained.


Subject(s)
Humans , Male , Middle Aged , Quadriplegia/rehabilitation , Magnetic Field Therapy , Medicine, Chinese Traditional , Spinal Cord Compression/rehabilitation , Spine , Axis, Cervical Vertebra/injuries
19.
Autops. Case Rep ; 8(2): e2018021, Apr.-May 2018. ilus
Article in English | LILACS | ID: biblio-905521

ABSTRACT

Fungal endocarditis has become an important infection associated with medical progress and the modern lifestyle. In particular, Candida spp. is a rare but important cause of infective endocarditis. We report the case of a 28-year-old woman­quadriplegic and bedridden from birth­who died after repeated episodes of pneumonia treated with different regimens of intravenous antibiotics. A medico legal autopsy was performed, which diagnosed severe Candida native valve infective endocarditis (CIE). This case report illustrates the prolonged use of antibiotic treatment as a possible risk factor for the development of CIE. We also considered how the bedridden condition and the presence of a central venous catheter may be additional risk factors for the development of this entity. Finally, we examined the absence of peripheral embolization in the setting of endocarditis of the right side of the heart.


Subject(s)
Humans , Female , Adult , Anti-Bacterial Agents/adverse effects , Candidiasis/pathology , Endocarditis/etiology , Autopsy , Candidiasis/complications , Fatal Outcome , Quadriplegia/complications , Tricuspid Valve/pathology
20.
Acta fisiátrica ; 25(1): 1-6, mar. 2018.
Article in English, Portuguese | LILACS | ID: biblio-998473

ABSTRACT

Paralisia cerebral (PC) abrange um grupo de síndromes clínicas de causa multifatorial caracterizadas por déficit motor, algumas vezes com disfunção postural. Objetivos: Caracterizar a população dos novos pacientes da clínica de PC na instituição, de Janeiro-2012 a Dezembro-2014. Métodos: Estudo retrospectivo. Avaliados 743 prontuários eletrônicos de pacientes atendidos em consultas iniciais de PC, sendo elegíveis 614 casos. Resultados: Sexo: feminino = 47,4%, masculino = 52,6%. Idade em anos: 29,5% menores de 2; 34% de 2 a 4; 15,5% de 4 a 6; 16,3% de 6 a 12; 4,6% 12 a 18; 0,2% ≥ 18 anos. Ao nascimento 50,7% eram pré-termo e 45% termo. Peso: 9,1% classificados como extremo baixo peso, 16,8% muito baixo peso, 21,8% baixo peso, 43,6% peso adequado, 2,3% macrossômicos. Tipo de parto predominante: cesáreo (56,5%). Classificação clínica e topográfica dos pacientes: 13,4% Hemiparéticos espásticos, 33,9% Diparéticos espásticos, 12,2% Tetraparéticos espásticos, 0,5% Monoparéticos espásticos, 5,9% Discinéticos/atáxicos, 5,7% PC mista, 1% hipotônicos. Em 55,5% das famílias não recebiam auxílio doença. Sobre atendimentos especializados observou-se que para 97,7% dos pacientes tratava-se da primeira consulta com um médico Fisiatra. Conclusão: Maioria das gestantes realizaram pelo menos o número mínimo adequado de consultas de pré-natal. Parto cesariano predominou. Nascimentos pré-termo foi ligeiramente superior comparado com a termo. Tipo de PC predominou o tipo Diparético espástico, com GMFCS nas faixas de 1 a 5 equivalente. Mais da metade das famílias ainda sem acesso a benefício social.


Cerebral palsy (CP) is a group of multifactorial clinical syndromes characterized by motor deficit, sometimes with postural dysfunction. Objective: To characterize a new series of clinical CP patients in the institution from January-2012 to December-2014. Method: Retrospective study of 743 electronic medical records of patients screened at CP outpatient facilities. Results: 614 cases were considered eligible. 47.4% female and 52.6% male subjects. 29.5% were under 2 years of age, 34% were from 2 to 4, 15.5% from 4 to 6, 16.3% from 6 to 12, 4.6% from 12 to 18 and 0.2% were above 18 years of age. At birth, 50.7% were preterm and 45% term. Regarding weight, 9.1% were classified as extreme low weight, 16.8% very low weight, 21.8% low weight, 43.6% adequate weight, 2.3% macrosomic. The predominant type of delivery were cesarean section (56.5%). Regarding clinical and topographic classification, 13.4% had spastic hemiplegia, 33.9% spastic diplegia, 12.2% spastic tetraplegia, 0.5% spastic monoplegia, 5.9% Dyskinetic / ataxic, 5.7% mixed CP, and 1% were hypotonic. In 55.5% of the families they did not receive any social benefits. Regarding specialized care, for 97.7% of the patients that was the first appointment with a Physiatrist. Conclusion: Most pregnant women undertook at least the minimum number of prenatal visits. Cesarean delivery was predominant. Preterm births were slightly higher. The most prevalent type of CP was the spastic diplegic, with GMFCS ranging from 1 to 5. More than half of families did not manage to have access to social benefits.


Subject(s)
Quadriplegia , Health Profile , Cerebral Palsy/physiopathology , Hemiplegia , Data Collection/instrumentation , Retrospective Studies
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