Vědeké studie

LÉČBA DĚTSKÉ MOZKOVÉ OBRNY SE SPECIÁLNÍM NEUROREHABILITAČNÍM PROGRAMEM. ZPRÁVA O 100 PACIENTECH ANALYZOVANÝCH S GROSS MOTOR FUNCTION MEASURE (MĚŘENÍ FUNKCE HRUBÉ MOTORIKY)
Alexander B. Kunz, Stefan M. Golaszewski, Ján Hrdý, Franz Gerstenbrand

Zhrnutí/Abstrakt

Výbor pro definici pojmu Cerebral Palsy (CP) označuje tento pojem v německé literatuře jako dětskou mozkovou obrnu (česká zkratka „DMO“, německá zkratka „IZP“). Tento klinický obraz choroby, klasifikované jako nevyléčitelné neurologické onemocnění způsobené poruchou ve vývoji „pohybu a postoje“ postiženého dítěte je charakterisktické ztrátou všech motorických aktivit. Výpadky motoriky jsou nejčastěji spojené s poruchou mentálních funkcí. Poškození vzniká v období vývoje fetálního anebo ranného dětského mozku. Léčba dětí by měla nastat včas a měly se při ní využít všechny možnosti moderní neurorehabilitace. Díky mimořádnosti klinického obrazu onemocnění často i opožděné diagnóze je potřebné aplikovat repetiční formu neurorehabilitace.

V předložené zprávě jsou uvedeny výsledky zprostředkované u 100 osob s diagnózou DMO, které podstoupily léčbu v ADELI Medical Center v Piešťanech (AMC-P) formou speciálního neurorehabilitačního programu. Pomocí systému Gross Motor Function Measure-88 (GMFM-88) se analyzval efekt realizovaného léčebného programu. Na základě vyhodnocených údajů bylo u všech pacientů zjištěno zlepšení už chronicky poškozené motoriky. U žádného pacienta nenastalo zhoršení stavu. Těžiště léčebného programu spočívá v metodě stimulace proprioceptivního systému.

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Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy
Collection of scientific Works
Univ. Prof. Dr. Xenia Semenova
Science Research Institute of Pediatrics,
Russian Academy of Medical Sciences,
Pediatric Clinical Psychoneurological Hospital No. 18, Moscow

Abstract

A new method for the restorative treatment of patients with residual-stage infantile cerebral palsy is described; the method is based on proprioceptive correction using an “Adeli-92” device, which is a modified space suit used in weightless conditions. The “Adeli-92” allows intensification and some extent of normalization of afferent proprioceptive mobility-controlling input. Positive clinical effects were obtained in 70% of patients, with improvements in walking and self-care ability. The positive effects of this method were demonstrated objectively using electroencephalography, electroneuromyography, studies of somatosensory evoked potentials, and studies of the vestibular system.

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PMID:
9406213
[PubMed – indexed for MEDLINE]
Hyperbaric Oxygen Induces Late Neuroplasticity in Post Stroke Patients – Randomized, Prospective Trial
Efrati S, Fishlev G, Bechor Y, Volkov O, Bergan J, Kliakhandler K, Kamiager I, Gal N, Friedman M, Ben-Jacob E, Golan H.
The Institute of Hyperbaric Medicine, Assaf Harofeh Medical Center, Zerifin, Israel ; Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Abstract

Background
Recovery after stroke correlates with non-active (stunned) brain regions, which may persist for years. The current study aimed to evaluate whether increasing the level of dissolved oxygen by Hyperbaric Oxygen Therapy (HBOT) could activate neuroplasticity in patients with chronic neurologic deficiencies due to stroke.

Methods and Findings
A prospective, randomized, controlled trial including 74 patients (15 were excluded). All participants suffered a stroke 6–36 months prior to inclusion and had at least one motor dysfunction. After inclusion, patients were randomly assigned to “treated” or “cross” groups. Brain activity was assessed by SPECT imaging; neurologic functions were evaluated by NIHSS, ADL, and life quality. Patients in the treated group were evaluated twice: at baseline and after 40 HBOT sessions. Patients in the cross group were evaluated three times: at baseline, after a 2-month control period of no treatment, and after subsequent 2-months of 40 HBOT sessions. HBOT protocol: Two months of 40 sessions (5 days/week), 90 minutes each, 100% oxygen at 2 ATA. We found that the neurological functions and life quality of all patients in both groups were significantly improved following the HBOT sessions while no improvement was found during the control period of the patients in the cross group. Results of SPECT imaging were well correlated with clinical improvement. Elevated brain activity was detected mostly in regions of live cells (as confirmed by CT) with low activity (based on SPECT) – regions of noticeable discrepancy between anatomy and physiology.

Conclusions
The results indicate that HBOT can lead to significant neurological improvements in post stroke patients even at chronic late stages. The observed clinical improvements imply that neuroplasticity can still be activated long after damage onset in regions where there is a brain SPECT/CT (anatomy/physiology) mismatch.

Trial Registration: ClinicalTrials.gov NCT00715897
PLoS One. 2013;8(1):e53716. doi: 10.1371/journal.pone.0053716. Epub 2013 Jan 15.
PMID: 23335971 [PubMed – in process] Free PMC Article

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Další studie

THE USE OF THE PROPRIOCEPTIVE CORRECTION PRINCIPLE IN THE RESTORATION OF CONSCIOUS MOVEMENTS IN THE PATIENT’S PARETIC ARM IN THE LATE RESTORATIVE AND RESIDUAL PERIODS OF STROKE

Prokopenko SV, Rudnev VA, Arakchaa EM, Derevtsova SN.

Abstract

A specially designed device for proprioceptive correction is offered for the restoration of motor functions in the proximal parts of the upper extremity in the central paresis syndrome at the late restorative and residual periods of stroke. The device is a logical continuation of the proprioceptive correction systems Penguin, Gravistat aimed at the restoration of equilibrium and walking in post-stroke patients. It consists of a waistcoat, cuffs connected with a system of elastics which are fixed around the upper arm and arm of the paretic upper extremity. The regulation of the tension of elastics allows to create the regimes of “facilitated” work and increased exertion during active movements in the proximal parts of a paretic arm. The effectiveness of the use of the proprioceptive correction suit for restoration of conscious movements in the upper extremity has been proved in 23 patients in the late restorative and residual periods of stroke. As a result of the treatment, most of the patients showed reliable reduction of paresis expression in the arm, the rate of restoration exceeded the indexes in the control group. It is expedient to use the proprioceptive correction suit in the complex of neurorehabilitation measures for restoration of conscious movements in an arm of the post-stroke patient.

18379502
[PubMed – indexed for MEDLINE]

COMPARISON OF EFFICACY OF NEURO DEVELOPMENTAL TREATMENTS IN CHILDREN WITH CEREBRAL PALSY

Bar-Haim S, Harries N, Belokopytov M, Frank A, Copeliovitch L, Kaplanski J, Lahat E.

Source

Faculty of Health Science, Ben-Gurion University, Beer-Sheva, Israel.

Abstract

This study compared the efficacy of Adeli treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). Twenty-four children with CP, Levels II to IV according to the Gross Motor Function Classification System (GMFCS), were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12; eight males, four females; mean age 8.3 y [SD 2.0]), six children had spastic/ataxic diplegia, one triplegia and five spastic/mixed quadriplegia. In the NDT group (n=12; nine males, three females; mean age 8.1 y [SD 2.2]), five children had spastic diplegia and seven had spastic/mixed quadriplegia. Both groups were treated for 4 weeks (2 hours daily, 5 days per week, 20 sessions). To compare treatments, the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EIHB) during stair-climbing were measured at baseline, immediately after 1 month of treatment, and 10 months after baseline. The small but significant time effects for GMFM-66 and EIHB that were noted after 1 month of both intensive physiotherapy courses were greater than expected from natural maturation of children with CP at this age. Improvements in motor skills and their retention 9 months after treatment were not significantly different between the two treatment modes. Post hoc analysis indicated a greater increase in EIHB after 1 month (p=0.16) and 10 months (p=0.004) in AST than that in NDT, predominantly in the children with higher motor function (GMFCS Levels II and III). The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function.

The efficacy of Adeli suit treatment in children with cerebral palsy.Turner AE. Dev Med Child Neurol. 2006 May; 48(5):324.

PMID:
16608538
[PubMed – indexed for MEDLINE]

Ment Retard Dev Disabil Res Rev. 2005;11(2):156-63.

ROLE OF VESTIBULAR AND VISUAL ANALYZERS IN CHANGES OF POSTURAL ACTIVITY OF PATIENTS WITH CHILDHOOD CEREBRAL PALSY IN THE PROCESS OF TREATMENT

Sologubov EG, Iavorskiĭ AB, Kobrin VI, Barer AS, Bosykh VG.

Abstract

The paper presents the findings of stabiligraphic investigations of children afflicted with the hyperkinetic child’s cerebral palsy treated with the method of graduated wearing special therapeutic suit. This device is a modification of space-designated Penguin-suit used to counteract the adverse effect of long-term microgravity on the skeletal muscles and the skeleton. 30 children were investigated prior to, immediately after, and in a delayed period after this treatment. A group of 11 healthy volunteers were also investigated as their control. The program of investigation included routine stabilimetry, the station test, and head rolling tests. The results demonstrate that in healthy subjects the standing pose is primarily acquired and sustained by means of the visual analyzer, whereas the CP patients pose could attain this pose with a significantly weakened control by the visual analyzer. Application of the device increases the role of visual analyzer in the control of standing pose. Following the treatment, the stabilimetric indices of patients changed for the better and approached those in healthy subjects.

PMID:
8664871
[PubMed – indexed for MEDLINE]

Vědeké studie

LÉČBA DĚTSKÉ MOZKOVÉ OBRNY SE SPECIÁLNÍM NEUROREHABILITAČNÍM PROGRAMEM. ZPRÁVA O 100 PACIENTECH ANALYZOVANÝCH S GROSS MOTOR FUNCTION MEASURE (MĚŘENÍ FUNKCE HRUBÉ MOTORIKY)

Zhrnutí/Abstrakt

Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy

Abstract

Hyperbaric Oxygen Induces Late Neuroplasticity in Post Stroke Patients – Randomized, Prospective Trial

Abstract

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