Dosage effects in treating tiptoe deformity in children with spastic cerebral palsy using botulinum toxin type A / 中华物理医学与康复杂志

Objective:To observe the clinical efficacy and side effects of injecting different doses of botulinum toxin type A (BTX-A) into children with spastic cerebral palsy (CP) and tiptoe deformity.Methods:A total of 107 children with tiptoe deformity resulting from CP were divided into group A ( n=35), group B ( n=36) and group C ( n=36) using a random number table. Group A received 3u/kg injections of BTX-A, group B received 4u/kg injections and group C received 5u/kg. The injections were guided by color Doppler ultrasound and followed by 4 courses of rehabilitation therapy. Before and 1, 3 and 6 months after the treatment, the modified Tardieu scale (MTS) was used to assess gastrocnemius spasms, while sections D and E of gross motor function scale 88 (GMFM-88) and the pediatric balance scale (PBS) were used to evaluate motor functioning and balance. Any side effects were also observed. Results:After the treatment, improvement was observed in all of the measurements, though there were no significant differences in the degree of improvement nor in the incidence of side effects among the three groups.Conclusions:There is no significant difference in clinical efficacy or side effects involved in using different doses of BTX-A to treat tiptoe deformity in children with spastic cerebral palsy. The recommended dosage is therefore 3u/kg.

Clinical application of the ICF core set for cerebral palsy children / 中华物理医学与康复杂志

Objective To compare the effectiveness of cerebral palsy rehabilitation patterned on the children and youth version of the international classification of functioning,disability and health (ICF-CY) with traditional patterns.Methods Two children's rehabilitation wards were selected as the ICF-CY group and the control group.The children in the former group were evaluated using the ICF-CY and provided with individual rehabilitation plans according to their evaluation results,while those in the latter group were given traditional rehabilitation without any evaluation.Before and after 3 courses of treatment,both groups were assessed using the pediatric evaluation of disability inventory (PEDI) and the gross motor function measure (GMFM),and their use of assistant devices was assessed.Results After three courses of treatment the ICF-CY group's average PEDI score had improved significantly and was superior to that of the control group.Significant improvement was observed in the GMFM scores in both groups after the treatment,with no significant inter-group differences.Significantly more of the children in the ICF-CY group used the assistive devices (except the lower limb orthoses) compared to the control group.Conclusion Therapy based on the ICF-CY is obviously superior to traditional rehabilitation planning.

Factors affecting the prognosis for children in a persistent vegetative state / 中华物理医学与康复杂志

Objective To explore the factors affecting the prognosis for a child in a persistent vegetative state (PVS).Methods Forty-three PVS children were selected and provided with comprehensive rehabilitation training.It included physical therapy such as Rood approach and range of joint movement training,medication and hydro-acupuncture at the head points.After three months,each patient's state of consciousness was quantified,and multiple-factor unconditional logistic regression was conducted to identify factors relating to any changes.Results By the end of the intervention,29 of the patients had regained consciousness,a recovery rate of 67％.Logistic regression revealed that age,brainstem auditory evoked potentials (BAEP) and PVS score at admission all were closely related with whether a child regained consciousness.Gender,type of damage,EEG score,and the initial time of intervention had no significant relationship with regaining consciousness.Conclusions Older PVS patients with higher BAEPs and PVS scores at admission are more likely to regain consciousness.

The effects of conductive education on gross motor function and Gesell development test results in children with cerebral palsy / 中华物理医学与康复杂志

Objective To observe the effects of conductive education on gross motor function and Gesell development test results in children with cerebral palsy.Methods One hundred and thirty-eight children with cerebral palsy were stratified randomly according to the gross motor function classification system (GMFCS) and sexes into two groups:the conductive education group received conductive education combined with general comprehensive rehabilitation,the control group received general comprehensive rehabilitation only.After 4 months of training,the results of both groups in terms of gross motor function and Gesell development test results were compared.Results The GMFCS evaluation results of the 2 groups were compared through covariance analysis (F =4.479,P =0.036 ＜0.05),the result of conductive education group was better than that of control group; in both groups the result after training was superior to that before training.For Gesell development test results comparison,the differences between conductive education group and control group were statistically significant (P ＜ 0.05) ; the result of conductive education group was better than before the training (t =24.93,P =0.00 ＜ 0.05) ; but in control group the difference between the results before and after training was not significant (t =13.34,P ＞ 0.05).Conclusions Conductive education could improve gross motor function and whole body development.

Impact of the peripheral neurotomy method combined with rehabilitation exercise on gross motor function and balance function of children with cerebral palsy / 中华实用儿科临床杂志

Objective To study the impact of the peripheral neurotomy method combined with rehabilitation exercise on gross motor function and balance function of children with cerebral palsy.Methods Matched pair design was used in the study.Thirty children with spastic cerebral palsy hospitalized from May 2011 to Nov.2013 suffering from peripheral neurotomy were assigned as study group,who were conscious and treated by peripheral neurotomy com bined with rehabilitation exercise.In the meanwhile,30 children inpatients at the same time were employed as the control group,who were similar in age and symptoms,with the same gender and the same Gross motor function classification (GMFCS) grade,and the controls were treated only with ordinary rehabilitation exercise.Modified Ashworth score,Gross Motor Function Measure (GMFM) D and E regions scores,physicians rating scale score in the 2 groups were recorded after treatment for 2,4,6,8,10 weeks.Repeated measure analysis of variance method was introduced to analyze the differences between the 2 groups in improved Ashworth muscle tension,gait improvement,gross motor function and balance function.Results The study group was superior over the control group in muscle tension reduction (F =8.177,P =0.006) and gait improvement(F =24.284,P =0.000).The 2 groups were not different statistically in D region evaluation of GMEM (F =0.072,P =0.790) and E region evaluation of GMFM (F =0.000,P =0.985) ; For Berg balance scale,the 2 groups had also no difference(F =0.150,P =0.700).Conclusions Both peripheral neurotomy method combined with rehabilitation exercise and the ordinary rehabilitation exercise method both could improve the gross function and the balance function.Furthermore,the former was superior over the latter in muscle tension reduction and gait improvement.