Tag: mózgowe porażenie dziecięce

The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna – The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy. Fizjoterapia Polska 2007; 7(1); 38-44

Abstract

Background. The efficacy of botulinum toxin type A (BTX-A) in the management of cerebral palsy was determined in the lower limb. Material and methods. The study was carried out on 51 children with cerebral palsy aged 2-17 years (mean age 8 years and 6 months). The patients were undergoing treatment with BTX-A to reduce spasticity and alleviate dynamic contractures. Between one and four target muscles were selected according to functional goals (improving the gait pattern, increasing the range of motion at joints) and biomechanical assessments and were injected at multiple sites with BTX-A. The patients were evaluated at baseline and at 3 and 12 weeks post-injection. Parameters evaluated comprised Joint Range of Motion (ROM), Modified Ashworth Scale (MAS), Modified Physician Rating Scale (MPRS), Gross Motor Function Measure (GMFM) and Global Clinical Impression (GCI). Patterns of gait were monitored by VHS registration. Results. The statistical tests showed a significant (one degree) improvement over baseline at 3 weeks after the first injection (p<0.05) in MAS, MPRS, and GCI. A deterioration of MPRS and joint range of motion was observed at 12 weeks after the first dose and before the second dose (p<0.01). Two patients started to walk without mobility devices after the BTX-A treatment. The outcomes were worse in the five patients who did not perform the required rehabilitation programme after the BTX-A treatment. Conclusions. The use of BTX-A is indicated in children with diplegia and spastic hemiplegia to improve locomotor ability, and in tetraplegic children to facilitate nursing care and enable the patients to assume a standing position.

Słowa kluczowe:
spasticity, cerebral palsy, botulinum toxin type A (BTX-A), lower limbs
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Assessment of the efficacy of local cryotherapy in children with cerebral palsy

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski – Assessment of the efficacy of local cryotherapy in children with cerebral palsy. Fizjoterapia Polska 2007; 7(3); 275-285

Abstract
Background. The author presents the results of a study of 60 children with infantile cerebral palsy carried out at a rehabilitation centre in the town of Zgorzelec. The study aimed to demonstrate that a 4-week programme of customised kinesiotherapy with cryostimulation of the lower limbs with liquid nitrogen vapour could have a beneficial effect on motor status as well as muscle tone and skin surface temperature in children with infantile cerebral palsy. Material and methods. A group of children of both sexes aged 3-14 with infantile cerebral palsy underwent 4 weeks of customised kinesiotherapy combined with cryostimulation of both lower limbs. Muscle tone was determined with a Szirmai myotonometer using special methodology. The level of spasticity was estimated with the Ashworth test, and motor activity assessment was made before and after the treatment according to a score table designed by the authors. Thermovisual recordings of skin surface temperature in the lower limbs were made immediately before and 5 and 15 minutes after cryostimulation procedures at the beginning and end of the 4-week programme. Results and Conclusions. A comparison of the results of the motor activity assessment, Ashworth test and myotonometry before and after the rehabilitation programme shows that the use of cryostimulation in the rehabilitation of children with infantile cerebral palsy results in a reduction of spasticity in the lower limbs and improvement in motor activity. Thermovisual analysis of skin surface temperature demonstrates full adaptation of the children’s vascular system, i.e. excellent safety of topical cryostimulation.
Key words:
infantile cerebral palsy, spastic muscle tone, local cryostimulation, Ashworth test, motor activity assessment, Szirmai myotonometer, thermovision
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Postural consequences of muscle tone disorders in children with cerebral palsy (hemiparesis)

Andrzej Szopa, Małgorzata Domagalska, Krzysztof Czupryna, Maciej Płaszewski

Andrzej Szopa, Małgorzata Domagalska, Krzysztof Czupryna, Maciej Płaszewski – Postural consequences of muscle tone disorders in children with cerebral palsy (hemiparesis). Fizjoterapia Polska 2007; 7(3); 241-249

Abstract
Background. The spontaneous adjustment of abnormal muscle tone in CP children leads to abnormal postural and motor patterns development. The aim of this work was to recognize and define some of compensatory postural patterns in CP children. Material and methods. The group of 18 children with hemiplegia, aged 5-14, were taken into the examination. The objective measurement of they postural patterns while standing, kneeling (of one and both legs) and sitting was done with a help of photogrammetry. In the same time using baroresistive platform a force distribution on the support base were measured. Results. In case of standing position two kinds of postural patterns were observed — the progravitational pattern and the anti-gravitational pattern. In every children with progravitional pattern lateral spine curvature were observed. Their values were significantly higher than similar in antigravitational pattern. In standing on one leg and half kneeing the arrangement of postural parameters were the same. In sitting in children with progravitional type mutual arrangement of shoulders and pelvis line was changed to parallel and in children with antygravitional type overloaded side changed to opposite. Conclusions. 1. The postural patterns through hemiparetic children are habitual and have differentiated character according to character of paresis. 2. Development of postural patterns is predictable, it is possible to steer the compensation during the treatment.
Key words:
cerebral palsy, compensatory antigravity mechanisms, postural patterns
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Differences in knee movement while walking in children with cerebral palsy (CP)

Alicja Dziuba, Krystyna Kobel-Buys

Alicja Dziuba, Krystyna Kobel-Buys – Differences in knee movement while walking in children with cerebral palsy (CP). Fizjoterapia Polska 2007; 7(4); 447-454

Abstract
Background. Cerebral palsy (CP) affects many children, with about 50,000 CP patients living currently in Poland. The most frequent manifestation of CP is a gait disorder attributable to both neurological and developmental factors. The aim of this study is to analyze children’s walking abilities using basic gait parameters and trace changes of these parameters during rehabilitation.Material and methods. This paper presents the results of two-dimensional gait analysis using two cameras positioned perpendicular to the direction of the child’s walk and recording at 50 Hz the movement of the right and left side of the body in the sagittal plane. The paper describes the walking skills of three CP boys born in 2000 (3/JK/02, 8/SA/02 and 20/BM/03) who were able to walk with help. The locomotion analysis was based on change over time of angular displacements in the right and left knee in the support and swing phases of gait. Results. The analysis showed that child 3/JK/02 had the best knee movement pattern, as suggested by the approximation of mean angular displacements in selected points in the swing and stance phases to those established for normal children. Child 8/SA/02 displayed greater deterioration of the gait pattern, as the knee movement pattern differed more considerably from that of a healthy child. The knee movement of child 20/MB/03 improved very little. Conclusion. The type of kinematic analysis conducted in this study is of diagnostic significance, helping to identify an improvement or deterioration of gait in children undergoing rehabilitation, and can aid the physician or physiotherapist in selecting exercises addressing specific elements of the gait pattern in order to effect lasting improvements.
Key words:
cerebral palsy, gait analysis, knee movement
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The use of botulinum toxin in clinical practice

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta – The use of botulinum toxin in clinical practice. Fizjoterapia Polska 2008; 8(2); 105-114

Abstract
Botulinum toxin is increasingly used in clinical practice as a basic or adjunctive agent in many fields modern medicine. In the field of rehabilitation of the musculoskeletal system, the introduction of botulinum toxin has opened new unexpected therapeutic avenues. This method broadens the possibilities for therapeutic intervention of doctors and physiotherapists, for whom complete recovery or improvement of the patient’s overall physical capacity is the measure of success. Because of its effectiveness and high safety for the patient, it is considered to be a modern and promising medicinal agent. The possibility of applying botulinum toxin selectively and, at the same time, precisely makes for a good clinical effect, while an appropriate pharmacological safety margin is also maintained. Although the range of indications is broad, it is in the treatment of spasticity of particular muscle groups who received the treatment as quickly as possible. Absolute contraindications include: myasthenia gravis, myasthenic syndrome, blood coagulability disorders. The most serious relative contraindications are pregnancy and breast-feeding. Intensive clinical research as well as numerous scientific meetings are making it possible for the method to gain more popularity and also to the clinical experience. Current standards of botulinum toxin use have been elaborated and published by an interdisciplinary group of experts. These standards are guidelines for practicing physicians. The author’s experience and available literature have served to present a state-of-the-art review of the use of botulinum toxin in clinical practice.
Key words:
spasticity, botulinum toxin, cerebral palsy
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Mental impairment and functional status of children with cerebral palsy

Beata Depczyńska, Marek Jóźwiak, Witold Dudziński

Beata Depczyńska, Marek Jóźwiak, Witold Dudziński – Mental impairment and functional status of children with cerebral palsy. Fizjoterapia Polska 2009; 9(2); 122-132

Abstract
Background. Mental impairment associated with infantile cerebral palsy affects approx. 30% of the children and is a serious risk factor influencing the course of functional education and the final functional outcome. The aim of this study was to carry out a functional assessment of motor skills of children with bilateral hemiplegia and intellectual handicaps with respect to locomotion, mobility and dexterity A further goal was to determine the relationship between the degree of intellectual handicap and the functional status ofthe children. Material and methods. The study involved 31 children (16 boys and 15 girls) aged 8-16 years with infantile cerebral palsy presen-ting as bilateral hemiplegia with mental impairment. The children were divided into three groups based on the severity of intellectual impairment (moderate, marked and severe). The paediatric version of the Functional Assessment of Patients scale was used for the functional assessment. We chose three domains: locomotion, mobility and dexterity. Two assessments were carried out 12 months apart. Results. The overall score as well as the domain scores decreased with increasing intellectual handicap. This obsenation ap-plied to the baseline and final assessment alike. However, the degree of functional change between the assessments was not si-gnificantly related to the level of mental impairment. Conclusions. The degree of mental impairment In children with bilateral hemiplegia is strongly correlated with their functional status in the locomotion, mobility and dexterity domains. The degree of change in functional status assessed with the basie questions ofthe paediatric modification of the Functional Assessment of Patients scale was not significantly associated with the se-yerity of intellectual impairment.
Key words:
infantile cerebral palsy, mental impairment, functional evaluation
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Manual Ability Classification System for children with cerebral palsy

Roksana Malak, Ewa Gajewska, Magdalena Sobieska, Włodzimierz Samborski

Roksana Malak, Ewa Gajewska, Magdalena Sobieska, Włodzimierz Samborski – Manual Ability Classification System for children with cerebral palsy. Fizjoterapia Polska 2010; 10(1); 69-77

Abstract
Background. The Manual Ability Classification System is a five-level scale for evaluating the manual ability of children with cerebral palsy aged 4-18 years. The aim of the study was to determine how the manual ability of cerebral palsied children and youth is influenced by the type of cerebral palsy and daily activities indicating various levels of psychomotor development. Material and methods. The study involved a group of 40 children with cerebral palsy aged 4-18 years attending Special Education School Complex No. 103 and Special Education Kindergarten No. 164 in Poznań. The research tool was a questionnaire containing the Manual Ability Classification System filled in by the parents. ICP type according to the Ingram classification was determined together with the level of psychomotor development.Results. Children with bilateral hemiplegia (16) represented the poorest manual abilities compared to children with spastic diplegia (13) or spastic hemiplegia (11). There was a correlation between the ease of handling everyday objects and the ability to crawl (F (1.38) = 21.466, p = 0.0004) and between the ability to stand up unassisted and the ability to stand unassisted(F(1.38)=35.894,p=. 00000).Conclusions. 1. Children with bilateral hemiplegia were most limited in their ability to handle everyday objects. 2. The ability to crawl, stand up unassisted and stand unassisted were correlated with good object handling skills.
Key words:
manual ability, infantile cerebral palsy, psychomotor development
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Posture parameters vs. motor ability of children with cerebral palsy

Roksana Malak, Ewa Gajewska, Magdalena Sobieska, Włodzimierz Samborski

Roksana Malak, Ewa Gajewska, Magdalena Sobieska, Włodzimierz Samborski – Posture parameters vs. motor ability of children with cerebral palsy. Fizjoterapia Polska 2010; 10(2); 113-122

Abstract
The aim of the study was to demonstrate that posture quality influences psychomotor development among children with cerebral palsy. Materials and method: The study involved 33 children (16 girls, 17 boys) aged 1–18 years diagnosed with cerebral palsy who attended Special School Complex No. 103, the Wielkopolska Outpatient Clinic of Neurology, Department of Paediatric Orthopaedics and Traumatology in Teaching Hospital No. 4, and Bartek Rehabilitation Center in Poznań. The children were assessed in late 2007/early 2008 according to a standardised examination protocol. The results were analysed with Statistica 7.1 software.Results:1. There was a clear correlation between cervical spine position in the frontal plane and the ability to lift the head (p=.035). 2. There was a significant correlation between the presence of a deviation of the lumbar spine in the frontal plane and the ability to lift the head in a proper manner (p=,035). 3. Shoulder protraction influenced inappropriate forearm support patterns in a non-significant manner. Conclusions:1. The postural parameters that significantly influence the development of motor function are the position of the cervical and lumbar spine in the frontal plane. 2. Spinal shape influences the motor ability of children with cerebral palsy.
Key words:
body posture, motor activity, cerebral palsy
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The Usefulness of Hippotherapy in the Rehabilitation of Cerebrally Palsied Children. Pilot Study

Dariusz Białoszewski, Izabela Korabiewska, Monika Lewandowska, Katarzyna Wasiak

Dariusz Białoszewski, Izabela Korabiewska, Monika Lewandowska, Katarzyna Wasiak – The Usefulness of Hippotherapy in the Rehabilitation of Cerebrally Palsied Children. Pilot Study. Fizjoterapia Polska 2011; 11(2); 175-181

Abstract
Zootherapy has been introduced in recent years as an adjunct approach to traditional physiotherapy in patients with cerebral palsy (CP). Hippotherapy is less popular in Poland compared to other European countries or the USA, with few reports of investigations carried out in accordance with the EBM paradigm. The aim of the present study was to evaluate the usefulness of hippotherapy in comprehensive rehabilitation of children with cerebral palsy.The study involved 40 cerebrally palsied children who were randomly divided into two equal-sized groups (A and B). Both groups received home-based rehabilitation according to the Proprioceptive Neuromuscular Facilitation (PNF) method. Group A additionally received hippotherapy. The children’s motor function was determined using the Gross Motor Function Measure (GMFM).In Group A was 0.02 for ChP=5.226, 1 df. The parameter determined in the study exceeded this critical value, thus allowing the conclusion that the effect of home-based rehabilitation combined with hippotherapy on overall health improvement was statistically significant (p&lt;0.05). In Group B, the right-tailed critical value (p) was 0.429 for Chi2=0.625, 1 df. The parameter determined in the study did not exceed the critical value, thus not allowing the statement that home-based rehabilitation had a significant effect on overall health improvement.1. The study shows significantly better results of rehabilitation in children treated with combination of PNF and hippotherapy. 2. The results indicate the need for randomized prospective studies involving larger test groups.
Key words:
Cerebral Palsy, Rehabilitation, hippotherapy, physiotherapy
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The application of the Balance Trainer parapodium in the therapy of children with cerebral palsy

Agata Michalska, Jolanta Dudek, Mieczysława Bieniek, Anna Tarasow-Zych, Kamila Zawadzka

Agata Michalska, Jolanta Dudek, Mieczysława Bieniek, Anna Tarasow-Zych, Kamila Zawadzka – The application of the Balance Trainer parapodium in the therapy of children with cerebral palsy. Fizjoterapia Polska 2011; 11(3); 273-285

Abstract
Inconstant clinical image and functional state of patients with cerebral palsy as well as difficulties in achievements of intended therapy aims put forward the need for constant searching for new improvement methods by the physiotherapists. The Balance Trainer – static-dynamic parapodium equipped with Balance-Soft computer program – is the device which can be applied in the therapy and diagnostics of persons with cerebral palsy. The aim of the thesis is to estimate the possibilities to apply the Balance Trainer device in the therapy of the children with cerebral palsy. Children and youth (7 subjects) with different forms of ICP, assessed using GMFCS (levels I-IV) scale were qualified for the study. The subjects were initially examined using Balance Trainer parapodium. The tests involved assessment of gravity centre location (balance test), deflection test and the assessment of the ability to perform intended movements in the frontal and sagittal plane. Next, their posture was controlled in standing position and the initially performed tests were repeated. All the results were statistically analysed. In children with lower GMFCS levels (I-II) the treatment brought about better results than in these with higher levels of impairment (III-IV), although a therapeutic success was achieved in each case.Using the Balance Trainer device in the treatment of children with cerebral palsy one can improve both the postural control and movement coordination. The improvement level depends on the form of cerebral palsy and the functional deficiency.
Key words:
Cerebral Palsy, Postural control, static-dynamic parapodium
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