Malformación de Dandy-Walker. Protocolo de intervención en CRIT. A propósito de un caso / Dandy-Walker malformation. The CRIT protocol. A propos of a case

La malformación de Dandy Walker se define por hipoplasia del vermis cerebeloso y dilatación quística del cuarto ventrículo. Algunas de las manifestaciones clínicas son hidrocefalia, retraso en el desarrollo motor, hipotonía y ataxia. El objetivo del tratamiento es mejorar el funcionamiento general del individuo y proporcionar una mejor calidad de vida a través de un equipo multidisciplinario. En el presente caso clínico se describe la evolución de un paciente diagnosticado con malformación de Dandy Walker tras la intervención del modelo médico del Centro de Rehabilitación e Inclusión Infantil Teletón Guanajuato (CRIT) el cual se centra en la rehabilitación del paciente y la familia, cubriendo cada una de las áreas que engloban al paciente

Dandy-Walker malformation is characterised by hypoplasia of the cerebellar vermis and cystic dilation of the fourth ventricle. Some of the clinical manifestations of this malformation are hydrocephalus, delayed motor development, hypotonia, and ataxia. Treatment aims to improve the individual's overall functioning and enhance quality of life through a multidisciplinary team. This case report describes the outcome of a patient diagnosed with Dandy-Walker malformation, after the intervention of the medical model at Centro de Rehabilitación e Inclusión Infantil Teletón Guanajuato (CRIT), which focuses on rehabilitating the patient and the family, covering each of the areas encompassing the patient

[Dandy-Walker malformation. The CRIT protocol. A propos of a case]. / Malformación de Dandy-Walker. Protocolo de intervención en CRIT. A propósito de un caso.

Dandy-Walker malformation is characterised by hypoplasia of the cerebellar vermis and cystic dilation of the fourth ventricle. Some of the clinical manifestations of this malformation are hydrocephalus, delayed motor development, hypotonia, and ataxia. Treatment aims to improve the individual's overall functioning and enhance quality of life through a multidisciplinary team. This case report describes the outcome of a patient diagnosed with Dandy-Walker malformation, after the intervention of the medical model at Centro de Rehabilitación e Inclusión Infantil Teletón Guanajuato (CRIT), which focuses on rehabilitating the patient and the family, covering each of the areas encompassing the patient.

Evolución de la marcha en pacientes con parálisis cerebral y desplazamiento asistido, mediante su entrenamiento con equipo de asistencia robótica / Evolution of gait in patients with cerebral palsy and assisted movement by training with robotic help equipment

Introducción: La marcha es una compleja actividad humana, importante para la calidad de vida, y la participación en la vida social y económica. Es difícil lograrla en los pacientes con parálisis cerebral (PC), actualmente es posible mejorar su patrón mediante el entrenamiento robótico. El objetivo del estudio fue determinar si 40 sesiones de entrenamiento robótico influyen en lograr la independencia para la marcha en los pacientes con PC. Método: Se incluyeron 33 pacientes con PC que utilizaban un auxiliar para la marcha, 9 fueron femeninos y 24 masculinos, de los cuales 19 (57%) utilizaban asistencia tipo caminador, y 14 (43%) asistencia física; todos recibieron 40 sesiones de entrenamiento robótico de marcha. Para el análisis de datos se utilizó la prueba de Wilcoxon. Resultados: De los 33 pacientes incluidos, 8 (24%) lograron la marcha sin asistencia posterior a las sesiones de entrenamiento robótico, 25 (76%) continuaron utilizando ayuda técnica para la marcha; se encontró una asociación estadísticamente significativa entre el entrenamiento robótico y la independencia para la marcha. Otras variables analizadas fueron la velocidad de marcha, la descarga de peso, y la fuerza guía, no hubo diferencia estadísticamente significativa en las medias iniciales y finales. Conclusión: En el grupo estudiado se encontró una diferencia significativa en la independencia para la marcha de los pacientes antes y después del entrenamiento robótico de 40 sesiones (AU)

Introduction: Walking is a complex human activity that is very important for quality of life, and participation in social and economic activities. It is very difficult to achieve in patients with cerebral palsy (CP). At present, it is possible to enhance their gait pattern with robotic training. The purpose of this study was to determine if 40 sessions of robotic training makes a difference in achieving walking independence in cerebral palsy patients. Method: We included 33 patients with CP who required an auxiliary aid for walking: 9 female,24 male, 19 (57%) of whom used a walker while 14 (43%) were helped by a family member. They all received 40 robotic walking training sessions. Data analysis was performed with the Wilcoxon test. Results: Out of the 33 patients, 8 (24%) were able to walk without any help after attending the robotic training sessions, 25 (76%) continued using an auxiliary aid for gait. However, a statistically significant association was found between the robotic training and walking independence. Other variables analyzed included walking velocity, weight bearing and guide force. There was no statistically significant difference in the starting and final mean values. Conclusion: In the group studied, we found a significant difference in independence for the gait of patients before and after 40 sessions of robotic training (AU)

[Percutaneous tenotomy and aponeurotomy (PTA) for knee flexor contracture in children with spastic cerebral palsy]. / Tenotomía y aponeurotomía percutánea (TAP) para la contractura de los flexores de rodilla en niños con parálisis cerebral espástica.

UNLABELLED: Knee flexor muscle contracture is frequent in patients with spastic cerebral palsy. The purpose of the study was to determine whether percutaneous tenotomy and aponeurotomy may decrease knee flexor contracture in children with spastic cerebral palsy. MATERIAL AND METHODS: A prospective study of consecutive cases was conducted from January to December 2009 in 24 children with a diagnosis of moderate to severe spastic cerebral palsy who had knee flexor contracture with a popliteal angle > or = 45 degrees and a gross motor function classification scale of 4 or 5; they underwent percutaneous tenotomy and aponeurotomy surgery and were followed-up for 24 months. Variance analysis with a factorial design was used for data analysis. RESULTS: The mean popliteal angle was 83.48 degrees preoperatively and 27.30 degrees by the end of the follow-up, with an improvement of 56.18 degrees (p < 0.01). Statistically significant differences were found in all measurements comparing them with the baseline values. DISCUSSION: Percutaneous aponeurotomy of knee flexor muscles is described. Compared to other procedures it provides the benefits of minimally invasive surgery, mild postoperative pain, short hospital stay -without using immobilization during the entire process- and children returned to their therapy program within five days. CONCLUSION: Percutaneous tenotomy and aponeurotomy of knee flexors was shown to be a good alternative for the treatment of knee flexor contracture in patients with spastic cerebral palsy.