Peripheral late reactivation of a previously typical monofocal Baló's concentric sclerosis lesion.

We report a 41-year-old woman with rapidly progressive left hemiparesis, revealing an inflammatory reactivation of a previously known parietal Baló's concentric sclerosis lesion. The first attack occurred five years before. After a slow recovery following high-dose steroid infusions the patient stabilized. Because of recurrent ataxia and left hemiparesis a new magnetic resonance imaging was performed showing an extension of the initial lesion with a peripheral gadolinium enhancement on T1-weighted images. Such a reactivation pattern of an isolated Baló's concentric sclerosis lesion, occurring some years later, is described for the first time.

[Value of CT perfusion for the diagnosis of early middle cerebral artery stroke]. / Intérêt de la TDM de perfusion dans le diagnostic d'un AVC ischémique sylvien à la phase précoce.

The need for early diagnosis of stroke at the acute phase has increased with the validation of intravenous thrombolysis therapy. The purpose of this article was to determine the accuracy of CT perfusion for the diagnosis of acute MCA stroke. We have retrospectively compared the results on CT perfusion obtained at acute presentation with follow-up imaging in 30 non consecutive patients admitted for suspected stroke that did not undergo thrombolysis. In our series, the sensitivity of CT perfusion for the diagnosis of MCA infarction was 84%. CT perfusion was poor for the diagnosis of lacunar and strictly cortical infarcts with a sensitivity of 20%. CT perfusion can easily and routinely be performed for the diagnosis of acute stroke, especially in centers where MRI may not be readily available.

Carotidynia: a new case for an old controversy.

Whereas International Headache society (IHS) criteria of carotidynia were defined in 1988, its validity as a distinct nosological entity has recently been questioned, leading this entity to be removed from the second IHS classification in 2004. We report the case of a 30-year-old woman who developed a pain located at the left carotid bulb, associated with typical findings on ultrasonography and MRI. We discuss new criteria and denomination of this clinical entity.

Central auditory processing and social functioning following brain injury in children.

PRIMARY OBJECTIVE: To describe the percentage of children with central auditory processing disorders (CAPD) and examine the recovery patterns of social functional skills in children with and without CAPD admitted to inpatient rehabilitation following an acquired brain injury (ABI). RESEARCH DESIGN: Retrospective, descriptive. METHODS AND PROCEDURES: Repeated measures ANOVAs were used to examine overall differences in social functioning between groups, within groups and interaction effects for the Paediatric Evaluation of Disability Inventory (PEDI) Social Functional Skills and Caregiver Assistance scales for 31 children admitted to inpatient rehabilitation following ABI. MAIN OUTCOMES AND RESULTS: Significant overall effects were found in group differences and test occasions, but no significant interaction for either PEDI scale. Both groups showed significant intra-group changes between admission and discharge on both scales. CONCLUSIONS: Children with and without CAPD recovered social functional skills during inpatient rehabilitation. Children with CAPD were admitted and discharged with lower Social Function scores but demonstrated greater changes. The identification of CAPD during inpatient rehabilitation allows for appropriate discharge recommendations and realistic recovery expectations.

[Post mortem brain MRI: an alternative for pathology examination in Bourneville tuberous sclerosis of the fetus?]. / IRM cérébrale post mortem: une substitution à l'examen anatomo-pathologique dans la sclérose tubéreuse de Bourneville du foetus?

Antenatal discovery of cardiac rhabdomyomes evokes the diagnosis of Bourneville's disease. Antenatal brain exploration with ultrasonography and magnetic resonance imaging (MRI) can highlight cerebral localizations. In the event of termination of pregnancy, confirmation of the cerebral lesions can be achieved with post mortem MRI as well as pathology examination. MRI can be usefully employed in the event pathology examination is not feasible.

Short-term durability and improvement of function in traumatic brain injury: a pilot study using the Paediatric Evaluation of Disability Inventory (PEDI) classification levels.

PRIMARY OBJECTIVE: To describe the short-term durability and improvement of functional outcomes for children and adolescents with traumatic brain injury (TBI) up to 6 months after discharge from inpatient rehabilitation. RESEARCH DESIGN: Retrospective, descriptive. METHODS AND PROCEDURES: Twenty-five (28.1%) of 89 children discharged from inpatient rehabilitation were available for outpatient follow-up within 6 months. The Paediatric Evaluation of Disability Inventory (PEDI) functional skill classification levels in the domains of self-care, mobility, and social function, recorded at discharge and follow-up, were examined using the Wilcoxon matched pairs signed rank test (two-tailed). MAIN OUTCOMES AND RESULTS: Most (64-80%) of the children sustained the outcome level achieved at hospital discharge in one or more of the three domains. Significant differences (p < 0.05) from discharge to follow-up were detected in mobility and social function levels. Differences between children with and without follow-up were non-significant in all but one variable (social function level at hospital discharge). CONCLUSIONS: The results of this study suggest that children after TBI sustain outcomes achieved during inpatient rehabilitation and make significant gains in mobility and social function skills within 6 months of returning home. More research is needed to predict those children who will continue to recover and to identify factors that facilitate recovery in the community setting.

Variation by diagnostic and practice pattern groups in the mobility outcomes of inpatient rehabilitation programs for children and youth.

BACKGROUND AND PURPOSE: The purpose of this study was to describe variation in functional mobility outcomes among children and youth with different diagnoses and belonging to groups with different practice patterns from an inpatient pediatric rehabilitation hospital setting. SUBJECTS: A sample of 138 individuals between the ages of 1 and 22 years (mean=9.4, SD=5.3) was enrolled. METHODS: Physical therapists administered the "Mobility" domain of the Pediatric Evaluation of Disability Inventory at the time of admission and at the time of discharge. Mobility level (combined admission and discharge scores) and amount of change between and within 4 diagnostic groups (traumatic brain injury, non-traumatic brain injury, orthopedic, and neurological) and 5 neuromuscular and musculoskeletal practice pattern groups were calculated, and post hoc analyses were done for specific contrast comparisons. RESULTS: Mobility scores between admission and discharge for all subgroups were different. Practice pattern groups were useful for identifying variations in level of motor performance. Diagnostic groups best described differences in mobility change during inpatient rehabilitation. DISCUSSION AND CONCLUSION: The use of practice patterns as grouping categories may enhance our understanding of variation in clinical outcomes of children during inpatient rehabilitation.

Aquatic therapy in pediatrics: annotated bibliography.

"Aquatic therapy" refers to therapeutic intervention taking place in water. The purpose of this review is to summarize the published articles in the rehabilitation literature from 1979 through 1999 that relate to the use of aquatic therapy as an intervention for children and adolescents with neuromuscular and musculoskeletal diagnoses. Despite the trend toward evidence-based practice, a paucity of literature exists related to aquatic therapy for children. Most of the available articles are case reports and other descriptions of clinical practice. The research reports are limited in design and scope, and subjects had a wide variety of ages and diagnoses.

Social function changes in children and adolescents with acquired brain injury during inpatient rehabilitation.

OBJECTIVE: To examine changes in social function capabilities between and within groups of children with six subtypes of acquired brain injury during inpatient rehabilitation. MEASURE: The Pediatric Evaluation of Disability Inventory (PEDI) Social Functional Skills Scale was administered to 139 children with acquired brain injury (mean age=9.28 years; SD = 5.27). METHODS: Scaled summary score changes from hospital admission to discharge for the total group and six diagnostic sub-groups were calculated. One-way ANOVAs were performed for the total group and six sub-groups to determine between group differences in amount of change. Within-group changes were examined by paired t-tests, effect sizes and the proportion of children who made a clinically meaningful change (> or = 10 points). RESULTS: Children with traumatic brain injury demonstrated the greatest amount of change during inpatient rehabilitation, but only significantly greater than children with seizures. Scores were significantly higher at discharge for the total group (p < 0.001) and all sub-groups except for the anoxia group. Forty-five per cent of all children made clinically meaningful changes. CONCLUSIONS: Children with acquired brain injury made significant changes in social functioning from admission to discharge. Varying degrees of change existed for diagnostic sub-groups. Further research is needed to examine clinically meaningful changes and in which areas of social functioning children are changing during inpatient rehabilitation.

Expert consensus on physical therapist intervention after botulinum toxin a injection for children with cerebral palsy.

PURPOSE: The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability. METHODS: The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions. RESULTS: All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups. DISCUSSION AND CONCLUSIONS: All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists' intervention choices.

Self-care recovery of children with brain injury: descriptive analysis using the Pediatric Evaluation of Disability Inventory (PEDI) functional classification levels.

The purpose of this study was to describe self-care recovery of children and adolescents with acquired brain injury using six newly derived self-care functional classification levels, to examine the responsiveness of the levels, and to compare level changes with scaled score changes. Upon admission and discharge to inpatient rehabilitation, the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Self-Care domain was administered by occupational therapy staff to 152 children and adolescents with brain injury (mean age = 9.3 years; SD = +/- 5.2). Scaled scores were converted to self-care classification levels. Using the Wilcoxon matched pairs signed rank test, a difference between admission and discharge level was found for the entire group. Children with traumatic brain injury and stroke demonstrated the most change. When compared with scaled score changes, minimal sensitivity was lost when using classification levels. The PEDI self-care levels provide a responsive analysis of recovery and offer an alternative to the reporting of change scores.

[Collagen and its technological possibilities]. / Le collagène et ses possibilités technologiques.

Collagen enjoys a privileged position as a biomaterial in its cosmetic applications. It exists under different forms and is more particularly able to reticulate. The process which is used allows a modulated reticulation. This means that a collagenous matrix having a varying degree of solubility can be obtained, which can lend itself to different applications. The prilling technique consists in producing microspheres consisting of a more or less reticulated collagenous matrix being able or not to imprison an insoluble or lipophilic active substance having previously been incorporated in the original solution. In this way, it is possible to obtain either strongly reticulated and mechanically resistant microspheres of particles which dissolve when crushed. The cosmetic significance of these new products is connected with the biocompatibility characteristics of the collagenous material and with the characteristics relating to the modulated reticulation of the obtained product.

In vitro and post-transplantation differentiation of human keratinocytes grown on the human type IV collagen film of a bilayered dermal substitute.

Using human type IV and type I + III collagens and a new, nontoxic cross-linking procedure, we have developed a cell-free bilayered human dermal substitute for organotypic culture and transplantation of human skin keratinocytes. We have studied the formation of the basement membrane, and the differentiation of keratinocytes grown on the type IV collagen layer of this dermal substitute, in vitro and after grafting onto nude mice. These studies demonstrated the formation of essential constituents of the basement membrane in culture: hemidesmosomes and deposition of extracellular matrix on the top of the type IV collagen were observed as early as 6 days after plating of human keratinocytes. Although the keratinocytes formed a well-organized multilayered epithelium, they exhibited limited differentiation when grown submerged in liquid medium. However, the multilayered sheet obtained after 14 days in submerged culture was composed of a regular basal cell layer, several nucleated suprabasal cell layers containing granular cells, and several dense, anucleated cell layers. The grafting experiments have shown a good biocompatibility of the dermal substitute. It is repopulated by fibroblasts, newly synthesized collagen, vessels, and a few mononuclear cells. At Day 14 after grafting, the type IV collagen layer was still present and very dense, and the basement membrane appeared as in culture, with numerous well-structured hemidesmosomes and deposition of extracellular matrix resembling lamina densa. At Day 55 after transplantation, even if the epidermal graft did not exhibit all the characteristics of the normal epidermis in vivo, it was very close to it. At this stage, the basement membrane was complete, with structures clearly indicative of anchoring fibrils. This new dermal substitute offers many advantages. It is stable and easy to handle. Its production is standardized. The oxidation induced by periodic acid led to a nontoxic cross-linked matrix. This dermal substitute is the first one entirely composed of human collagens. The type I + III collagen underlayer is reorganized when grafted. It supports a type IV collagen top layer which offers an excellent substrate for keratinocytes, favors their anchorage, and favors the formation of the basement membrane in vitro. This dermal substitute could be useful for wound coverage or as an in vitro model for toxicological and pharmacological studies.

Fibroblast behavior on gels of type I, III, and IV human placental collagens.

Various collagens were extracted and purified from human placenta after partial pepsin digestion. We prepared type III + I (57:43), enriched type I, type III, and type IV collagens on an industrial level, and studied their biological properties with MRC5 fibroblast cells. Using the process of contraction of a hydrated collagen lattice described by Bell, we found tha the contraction rate was dependent on collagen type composition. The contraction was faster and more pronounced with pepsinized type I collagen than with pepsinized type III + I (57:43) collagen; the lowest rate was obtained with the pepsinized type III collagen. Using a new technique of collagen cross-linking, a gel was made with type IV collagen. This cross-linking procedure, based on partial oxidation of sugar residues and hydroxylysine by periodic acid, followed by neutralization, resulted in an increased number of natural cross-link bridges between oxidized and nonoxidized collagen molecules, without internal toxic residues. The fibroblasts were unable to contract type IV/IVox collagen gels. The type IV/IVox collagen gel was transparent and its amorphous ultrastructure lacked any visible striated fibrils. Fibroblast cells exhibited atypical behavior in these type IV/IVox collagen gels as evidenced by optical and electron microscopy. The penetration of fibroblasts could be measured. Fibroblasts penetrated faster in type IV/IVox collagen gels than in untreated type III + I collagen gels. The lowest rate of penetration was obtained with cross-linked type III + I gels. Fibroblast proliferation was similar on untreated or cross-linked type III + I collagen gels and slightly increased on type IV/IVox collagen gels, suggesting that this cross-linking procedure was not toxic.