Improvement of hand function in children with cerebral palsy via an orthosis that provides wrist extension and thumb abduction.

BACKGROUND: The present study examines the hand movements of children with cerebral palsy during functional tests and compares the childrens' performance with and without the aid of an orthosis that provides wrist extension and thumb abduction. METHODS: The range of motion of the trapeziometacarpal joint was assessed for 32 participants via a reflexive markers image system. Observed motions included flexion-extension and abduction-adduction motions performed in the course of four tests for manual ability; the rest position, lateral and tripod pinches and cylindrical grasp. Muscle strength and manual ability were evaluated using dynamometry and the Jebsen-Taylor test. FINDINGS: The range of motion tests for the rest position, lateral and tripod pinches and cylindrical grasp demonstrated improvements from 17% to 42% (P<0.001) for flexion/extension and from 36% to 54% for abduction/adduction (P<0.001) with the use of the orthosis. Dynamometry measurements showed that the improvement in muscle strength obtained through use of the orthosis was 50% (P<0.001). Improvements in the time required to perform the movements as determined using the Jebsen-Taylor test varied from 13% to 24% (P<0.01) for the four considered tests of manual ability. INTERPRETATION: The orthosis improved the range of motion of the trapeziometacarpal joint, muscle strength and manual ability. The combination of the three techniques may provide the basis for a quantitative assessment of hand dysfunction/improvement in cerebral palsy that will ultimately guide health professionals in their clinical interventions.

Validade e confiabilidade intra e interexaminadores da Escala Observacional de Marcha para crianças com paralisia cerebral espástica / Validity and intra- and inter-rater reliability of the Observational Gait Scale for children with spastic cerebral palsy

CONTEXTUALIZAÇÃO: A avaliação observacional da marcha é uma abordagem clínica importante para a avaliação das desordens da marcha. Sistemas de análise quantitativa da marcha oferecem informações acuradas, entretanto o alto custo desses instrumentos tornam a análise observacional mais acessível para a prática clínica. OBJETIVOS: Desenvolver uma escala observacional de marcha (EOM) para caracterizar a marcha de crianças com paralisia cerebral espástica (PCE) e testar sua confiabilidade e validade de critério, comparando-a com o sistema computadorizado de análise de movimento, padrão ouro para avaliação cinemática da marcha. MÉTODOS: Vinte e três vídeos de crianças com PCE (9,54±2,22 anos) foram avaliados por meio da EOM por quatro fisioterapeutas em duas sessões. Dados cinemáticos do complexo tornozelo/pé, joelho, quadril e pelve foram obtidos usando o sistema de análise de movimento Qualisys Pro-reflex. Para estabelecer a validade de critério e a confiabilidade intra e interexaminadores, os resultados obtidos da EOM foram comparados com os dados do sistema de análise de movimento, entre as duas sessões e entre examinadores. Teste Kappa ponderado foi aplicado para analisar a concordância entre as avaliações. RESULTADOS: A EOM apresentou validade muito boa para joelho (r=0,64, p<0,05) e boa para o complexo tornozelo/pé (r=0,59, p<0,05). A confiabilidade intraexaminadores foi muito boa para o complexo tornozelo/pé (r=0,79, p<0,05), joelho (r=0,77, p<0,05) e quadril (r=0,73, p<0,05) e boa para a pelve (r=0,59, p<0,05). A confiabilidade interexaminadores foi muito boa para o complexo tornozelo/pé (r=0,68, p<0,05) e joelho (r=0,65, p<0,05) e boa para o quadril (r=0,48, p<0,05). CONCLUSÕES: A EOM demonstrou bons índices de confiabilidade e validade para a observação do tornozelo/pé e joelho. Novas estratégias de observação devem ser criadas para melhorar as propriedades psicométricas dos itens relativos ao quadril e pelve.

BACKGROUND: Observational gait assessment is an important clinical approach to the evaluation of gait disorders. Quantitative gait analysis systems provide accurate information, but the high cost of these instruments makes observational analysis more affordable to clinical practice. OBJECTIVES: To develop an observational gait scale (OGS) for characterizing the gait of children with spastic cerebral palsy (SCP) and to evaluate its validity and reliability criteria in comparison with a computerized motion analysis system representing the gold standard for kinematic gait assessment. METHODS: Twenty-three videos of children with SCP (9.54 ± 2.22 years) were evaluated by four physical therapists using the OGS, in two sessions. Kinematic data from the ankle/foot complex, knee, hip and pelvis were obtained using the Qualisys Pro-reflex motion analysis system. To establish criterion validity and the intra- and inter-rater reliability, the observational data were compared with motion analysis data, between the two sessions and between the raters. The weighted kappa test was applied to analyze the concordance between the evaluations. RESULTS: The OGS presented very good validity for the knee (r=0.64, p<0.05) and good validity for the ankle/foot complex (r=0.59, p<0.05). The intra-rater reliability was very good for the ankle/foot complex (r=0.79, p<0.05), knee (r=0.77, p<0.05) and hip (r=0.73, p<0.05) and good for the pelvis (r=0.59, p<0.05). The inter-rater reliability was very good for the ankle/foot complex (r=0.68, p<0.05) and knee (r=0.65, p<0.05), and good for the hip (r=0.48, p<0.05). CONCLUSIONS: The OGS demonstrated good reliability and validity for the ankle/foot and knee observations. New observational strategies are needed to improve the psychometric properties of the items relating to the hip and pelvis.

Effect of undercuts on the accuracy of reheated addition-reaction silicone impressions.

Addition-reaction silicone impressions were made at 37 degrees C in two cylindrical trays of a truncated cone-shaped chromium-steel die. One tray size was used to obtain impressions with 1 mm thickness, from tray to the gingival margin of the preparation, while the second tray permitted a thickness of 4mm. The die was undercut aplical to the gingival margin using rings as described before permitting a variation of undercut depth from 0.5 to 1.5 mm. Stone dies were made from impressions after (1) cooling to 22 degrees C for 10 min or (2) cooling to 22 degrees C for 10 min and reheating to 37 degrees C for 30 min. Results revealed that reheating the impressions to mouth temperature before pouring the dies improved their accuracy and that depth of undercut had a definite but small effect on the accuracy of dies.

Effect of reheating on the accuracy of polysulfide impressions.

Polysulfide impressions were made at 37 degrees C in two cylindrical trays of a truncated cone-shaped chromium-steel die. One tray size was used to obtain impressions with 1 mm thickness from tray to the gingival margin of the preparation, while the second tray permitted a thickness of 4 mm. Stone dies were made from impressions after (1) cooling to 22 degrees C for 10 min or (2) cooling to 22 degrees C for 10 min and reheating to 37 degrees C for 30 min. Results revealed that reheating impressions to mouth temperature before pouring the dies improved their accuracy.

Aluminum oxalate/glycine solutions as pretreatment in the Gluma bonding system.

Dentin and enamel surfaces were treated with solutions of aluminum oxalate (AO), the pH of which was adjusted by glycine. Gluma as well as an enamel bonding agent were applied to the surfaces before the placement of a composite resin. On shear bond testing, there was obtained a strong adhesion that was influenced by the pH of the AO solutions. Dentin and enamel specimens for examination by scanning electron microscopy (SEM) were also prepared and treated as above. Enamel specimens showed a very definite etching pattern, and on the dentin surfaces a precipitate was observed. The amount of this product seemed to decrease as the pH increased.

Bonding to dentine with a simplified Gluma system.

In the present study, a number of modifications were introduced in the so-called Gluma resin--a new, simplified bonding system. The amount of acetone in its formulation was altered, or the acetone as well as part of the water were substituted by one of several volatile compounds with the purpose of obtaining a pretreatment of easier clinical application. Some modifications of the pH of the mixtures were also tried. Dentine specimens for shear bond testing were prepared and conditioned with an aluminium oxalate/glycine solution. The dentine surfaces were then treated with the modified Gluma resin mixtures before the placement of the composite resin. Gluma resin formulations containing tetrahydrofuran resulted in acceptable bond strengths, and with formulations of reduced pH, high bond strengths were obtained.

Improved accuracy by reheating addition-reaction silicone impressions.

Addition-reaction silicone impressions were made at 37 degrees C in two cylindrical trays of a truncated-cone-shaped chromium-steel die. One tray size was used to obtain impressions with 1 mm thickness from tray to the buccal and lingual surface of the steel die while the second tray permitted a thickness of 4 mm. Stone dies were made from impressions after (1) cooling to 22 degrees C for 10 minutes or (2) cooling to 22 degrees C for 10 minutes and reheating to 37 degrees C for 30 minutes. Results revealed that reheating the impressions to mouth temperature before pouring the dies improved their accuracy.

Effect of material bulk and undercuts on the accuracy of impression materials.

A truncated cone-shaped chromium steel die was used to determine the influence of the bulk of elastomeric impression material and size of undercut on the dimension of stone dies. It was found that both conditions affect the accuracy of stone dies. The possible clinical implications of the inaccuracies were discussed.

Viscoelastic properties of setting elastomeric impression materials.

An instrument was introduced to determine the relationship between induced and permanent tensile deformation of selected elastomeric dental impression materials during and after setting. The method accurately recorded viscoelastic properties of impression materials.

Tissue reaction to dispersion alloy amalgam.

Dental amalgam implanted in rat connective tissue is injurious for the first 16 days. At 32 days, the implanted amalgam is tolerated. The increased copper content of Dispersalloy did not evoke a more serious response of the connective tissue than Fine Cut or Spheraloy amalgam.