Long-term motor, functional, and academic outcome following childhood ischemic and hemorrhagic stroke: A large rehabilitation center-based retrospective study.

OBJECTIVE: To study the long-term outcomes following childhood ischemic and hemorrhagic stroke. METHODS: This was a retrospective study, looking at children consecutively admitted to a rehabilitation department following childhood stroke. We collected demographic, medical, and severity data, motor deficit, cognitive assessment, and long-term academic outcome. RESULTS: One hundred and twenty-eight children were included, following arterial ischemic (AIS; n = 46) or hemorrhagic (HS; n = 82) stroke. At discharge, motor deficit was still present in 70% of children (versus 89% immediately after stroke). HS predicted significantly better motor and functional outcomes than AIS. After a median follow-up of 43 months, 40% received special education. The receipt of special education was predicted by persistent motor deficit, but when full-scale IQ was taken into account, IQ was the only significant predictor of special education. CONCLUSIONS: Childhood stroke leads to severe and long lasting motor, functional, cognitive, and academic impairments, in a population of children admitted in a rehabilitation department.

Quiet postural control of patients with total hip arthroplasty following joint arthritis.

To assess the postural strategies developed by patients after total hip arthroplasty (THA), 14 patients were measured 12 days after surgery. The respective role played by both sound and prosthetic legs and the compensatory mechanisms were assessed through a separate measure of the center-of-pressure (CP) trajectories under each foot. The movements of the center-of-gravity (CG) were estimated from those of the resultant CP to determine postural performance. The postural behavior was compared with those of a group of age-matched healthy subjects required to adopt a slightly asymmetrical weight distribution. Patient results indicate greater movements for both plantar and resultant CP displacements, principally along the antero-posterior (AP) axis, a decreased contribution of the hip mechanisms in the production of CP displacements along the medio-lateral (ML) axis, greater resultant CP and CG movements along the AP axis and increased differences between CP and CG along both ML and AP axes. The postural specificity of the THA patients appears to be due to a global sensorimotor impairment that alters the control of the loading-unloading mechanism at the hip level.

Disabling overactivity of the extensor hallucis longus after stroke: clinical expression and efficacy of botulinum toxin type A.

OBJECTIVES: To describe the clinical characteristics of persistent extension of the great toe related to overactivity of the extensor hallucis longus (EHL) after a stroke and to explore the efficacy of treatment with botulinum toxin type A. DESIGN: Case series. SETTING: A physical medicine and rehabilitation department in France. PARTICIPANTS: Eleven patients with hemiplegia disabled by overactivity of the EHL were classified according to the different ways in which that overactivity was triggered. Disability was related to pain in 5 patients, to shoe difficulties in 10 patients, and to varus foot in 6 patients. INTERVENTION: Injection of botulinum toxin type A into the EHL. MAIN OUTCOME MEASURES: Efficacy was assessed on day 15 by triggering of pain, shoe difficulties, and varus deformity and by patients' subjective assessment on day 15, at 3 months, and at 6 months. RESULTS: On day 15, EHL overactivity disappeared after 16 of the 18 injections in 10 patients; subjective assessment was very good for pain and shoe difficulties and remained good or very good at 3 months for 8 patients who received 12 injections. CONCLUSION: Botulinum toxin type A is effective in treating disability related to poststroke overactivity of the EHL.