Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Social integration and independence is the ultimate goal of habilitation and social support for patients with cerebral palsy (CP). Having a partner and having children provide support for social integration of adults with or without a disability. We studied 416 participants with CP born between 1965 and 1970 (243 males, 173 females; mean age 32 y 2 mo [SD 2 y]; age range 29-35 y) and compared them with 2247 age-matched comparison individuals. Diagnostic subtypes of the 416 participants were: 31% hemiplegia, 49% diplegia, 11% tetraplegia, and 9% other types. The level of motor impairment, estimated in childhood, with regard to walking ability was 65% able to walk without assistance, 22% with assistance, and 12% not able to walk (for 1% of the participants their walking ability was not known). We found no sign of increased social integration over the past two or three decades in Denmark. Sixty-eight per cent lived independently, 13% lived with their parents, and 16% lived at an accommodation facility arranged by the county (institution). Twenty-eight per cent of the participants were cohabiting and 19% had children. The presence of epilepsy and the severity of physical or cognitive impairment as assessed in childhood predicted independent living and physical and cognitive impairment predicted cohabitation, but parents' socioeconomic position and region of living did not. Fifty-five percent of the participants, compared with 4% of the comparison group, had no competitive employment, cohabiting partner, or biological children. The remaining participants had at least one of these types of social contact, but this more optimally socially integrated half of the participants only combined all three types of social contact half as often as the comparison group. This could be due to cognitive difficulties or premature ageing.
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PMID:Social integration of adults with cerebral palsy. 1683 75

We examined muscle recruitment patterns in children with cerebral palsy (CP) and comparison children without CP under conditions of maximum voluntary contractions. Three groups of children participated in the study: (1) 12 children with diplegic CP (eight males, four females; age range 4-10 y, mean age 7 y [SD 2 y 4 mo]); (2) six children with hemiplegic CP (four males, two females; age range 5-10 y, mean age 7 y 4 mo [SD 2 y]); and (3) 13 comparison children with normal motor function (seven males, six females; age range 4-11 y, mean age 7 y 2 mo, [SD 2 y]). The children with CP were classified according to the Gross Motor Function Classification System: eight were Level I, five were Level II, four were Level III, and one was Level IV. Surface electromyography was recorded from four proximal and distal lower extremity (LE) muscles. Children with CP more frequently activated a muscle other than the intended prime mover first, compared with the comparison children, especially when the prime mover was a distal muscle. For example, during ankle plantar flexion, when the lateral gastrocnemius muscle was the prime mover, children with hemiplegia showed preactivation of the tibialis anterior muscle and children with diplegia showed medial hamstring coactivation. In conclusion, children with CP showed considerable differences to the comparison children in how LE muscles were voluntarily activated. Greater understanding of muscle recruitment patterns under a variety of tasks may provide new directions for motor control retraining or other forms of intervention.
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PMID:Synergistic muscle activation during maximum voluntary contractions in children with and without spastic cerebral palsy. 1697 56

The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p = 0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p = 0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p = 0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.
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PMID:Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: Are separate classifications needed? 1747 Dec 80

We assessed the influence of equinus gait treatments on the vertical displacement of the body's centre of mass (COM) in 21 patients with cerebral palsy (14 males, 7 females; mean age 8 y 9 mo [SD 2 y]; range 3 y 7 mo-17 y) presenting different topographical types (quadriplegia, n = 1; diplegia, n = 6; right hemiplegia, n = 6; and left hemiplegia, n = 8). Vertical COM displacement was computed from ground reaction forces, and lower limb kinematics was recorded simultaneously. Equinus gait was treated with non-operative treatments (i.e. botulinum toxin injections and stretching casts) in 14 patients, and with operative treatments in seven patients. After non-operative treatments, the entire ankle displacement shifted towards dorsiflexion throughout the gait cycle, but the amplitude of the third foot rocker (TR) and vertical COM displacement remained unchanged. However, after operative treatments, the amplitude of TR increased and vertical COM displacement decreased. A negative linear correlation was found between the former variables in all the patients where 53% of the changes in their vertical COM displacement, after equinus gait treatments, were explained by the changes in TR amplitude. In fact, TR remains a main gait determinant, reducing the vertical COM displacement after equinus gait treatment and influencing the general gait pattern.
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PMID:Influence of equinus treatments on the vertical displacement of the body's centre of mass in children with cerebral palsy. 1697 60

The purpose of this study was to investigate the changes in electromyographic (EMG) patterns after multilevel surgical treatment in children with spastic cerebral palsy. Children with diplegia (n=18) and hemiplegia (n=16) aging from 6 to 16 years participated in the study. Twenty healthy children within the same age span are presented as reference. Gait analysis and surface electromyograms of seven major lower limb muscles were assessed before and 1-5 years after the multilevel surgery. The most frequent procedures were equinus correction, distal rectus femoris transfer, femoral derotation osteotomy and hamstrings lengthening. The results showed that the EMG pattern of the soleus, lateral gastrocnemius and tibialis anterior muscles became closer to normal after the surgery, while no differences were detected between diplegic and hemiplegic patients. Furthermore, a subgroup of 10 patients showed an increase in medial hamstrings activation during preswing that decreased postoperatively. These findings indicate that changes in EMG patterns should not be ruled out after surgical treatment, although the extent of these changes is limited compared to changes in the kinematics. Abnormal muscle activation before the operation can be related to a compensatory response in some patients and this can be manipulated after surgery.
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PMID:Electromyographic patterns in children with cerebral palsy: do they change after surgery? 1714 Jul 96

Surface electromyography (sEMG) is part of an instrumented gait assessment, however, the interpretation of the data in a clinically meaningful manner is often limited to the extraction of individual sEMG characteristics. The purpose of this study was to develop an assessment methodology using sEMG time and frequency characteristics extracted using wavelet analyses to provide clinically relevant information in children with cerebral palsy (CP). A retrospective study was conducted with 37 children (16 children with typical development (TD) and 21 children with spastic CP). sEMG signals were examined from selected musculature of the lower extremities during level ground walking. Wavelet analysis techniques, along with functional principal component analyses, were employed to calculate a sEMG index. The data indicated a grouping in the EMG index based on the level of motor impairment and the clinical diagnosis of spastic hemiplegia or diplegia. Further analyses of the index exhibited moderate to high (r=-0.43 to -0.74 and r=0.62-0.65) correlations with the existing gait kinetics, kinematics, and clinical measures of motor impairment, and was sensitive to walking ability according to the Gross Motor Functional Classification Scale (GMFCS). Overall, this methodology may have the potential to provide additional insight into the outcome of a clinical intervention that was not available previously, and may find use as a predictive tool that can be utilized for clinical decision making.
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PMID:A time-frequency based electromyographic analysis technique for use in cerebral palsy. 1716 3

In evaluating energy cost (EC) of walking, referred to as walking efficiency, the use of net measurement protocols (i.e. net=gross-resting) has recently been recommended. However, nothing is known about the comparative reproducibility of net protocols and the commonly used gross protocols. Ten minutes of resting and 5 minutes of walking at a self-selected speed were used to determine gross and net EC in 13 children with spastic cerebral palsy (CP; seven males, six females; mean age 8y 7mo [SD 3y 4mo], range 4y 1mo-13y) and in 10 children (three males, seven females) with typical development. In the former, their Gross Motor Function Classification System levels ranged from Level I to Level III; and seven had hemiplegia and six diplegia. There were four repeated sessions on different days, with periods of 1 week between sessions. Reproducibility was assessed for speed, and gross and net EC, by using the standard error of measurement. The results of this preliminary study showed that EC measurements were more variable for children with CP than for children with typical development. Furthermore, in both groups there was considerably more variability in the net measurements than in the gross measurements. We conclude that, on the basis of the methodology used, the use of gross EC, rather than net EC, seems a more sensitive measure of walking efficiency to detect clinically relevant changes in an individual child with CP.
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PMID:Reproducibility evaluation of gross and net walking efficiency in children with cerebral palsy. 1720 76

This pilot study investigated the feasibility of using functional magnetic resonance imaging (fMRI) as a physiological marker of brain plasticity before and after an intensive body-weight-supported treadmill training (BWSTT) program in children with cerebral palsy (CP). Six ambulatory children (four males, two females; mean age 10y 6mo, age range 6-14y) with spastic CP (four hemiplegia, two asymmetric diplegia, all Gross Motor Function Classification System Level I) received BWSTT twice daily for 2 weeks. All children tolerated therapy; only one therapy session was aborted due to fatigue. With training, over ground mean walking speed increased from 1.47 to 1.66m/s (p=0.035). There was no change in distance walked for 6 minutes (pre-: 451m; post-: 458m;p 0.851). In three children, reliable fMRIs were taken of cortical activation pre- and post-intervention. Post-intervention increases in cortical activation during ankle dorsiflexion were observed in all three children. This study demonstrates that children with CP between 6 and 14 years of age can tolerate intensive locomotor training and, with appropriate modifications, can complete an fMRI series. This study supports further studies designed to investigate training-dependent plasticity in children with CP.
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PMID:Ankle dorsiflexion fMRI in children with cerebral palsy undergoing intensive body-weight-supported treadmill training: a pilot study. 1720 75

This study evaluated the effects of multilevel botulinum toxin type A (BTX-A) treatments on the gait pattern of children with spastic cerebral palsy (Gross Motor Function Classification System Levels I-III). In this nested case-control design, 30 children (mean age 6y 11mo [SD 1y 5mo]; 21 males, nine females; 19 with hemiplegia, 11 with diplegia) were treated according to best practice guidelines in paediatric orthopaedics, including BTX-A injections. A matched control group of 30 children (mean age 7y 8mo [SD 1y 10mo]; 13 males, 17 females; 19 with hemiplegia, 11 with diplegia) were treated identically, but without BTX-A. Motor development status at 5 to 10 years of age was assessed by means of three-dimensional gait analysis at a mean time of 1 year 10 months (SD 10mo) after the last BTX-A treatment. The control group showed a significantly more pronounced pathological gait pattern than the BTX-A group. Major differences were found for pelvic anterior tilt, maximum hip and knee extension, and internal hip rotation. These results provide evidence for a prolonged effect of BTX-A and suggest that BTX-A injections, in combination with common conservative treatment options, result in a gait pattern that is less defined by secondary problems (e.g. bony deformities) at 5 to 10 years of age, minimizing the need for complex surgery at a later age and enhancing quality of life.
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PMID:Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy. 1720 78

This prospective cross-sectional multicenter study assessed the relationships between Gross Motor Function Classification System (GMFCS) level and scores on outcome tools used in pediatric orthopedics. Five hundred and sixty-two participants with cerebral palsy (CP; 339 males, 223 females; age range 4-18y, mean age 11y 1mo [SD 3y 7mo]; 400 with diplegia, 162 with hemiplegia; GMFCS Levels I-III;) completed the study. The Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Quality of Life Inventory (PedsQL), the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Functional Independence Measure (WeeFIM), temporal-spatial gait parameters, and O(2) cost were collected during one session. Descriptive characteristics are reported by GMFCS level clinicians can use for comparison with individual children. Tools with a direct relationship between outcome scores and GMFCS levels were the PODCI Parent and Child Global Function, Transfers & Basic Mobility, and Sports and Physical Function; PODCI Parent Upper Extremity Function; WeeFIM Self-care and Mobility; FAQ Question 1; GMFM Dimensions D and E; GMFM-66; O(2) cost; and temporal-spatial gait parameters. Child report scores differed significantly higher than Parent scores for six of eight PODCI subscales and three of four PedsQL dimensions. Children classified into different GMFCS levels function differently.
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PMID:Outcome assessments in children with cerebral palsy, part I: descriptive characteristics of GMFCS Levels I to III. 1735 69


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