- Email: [email protected]
Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications
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(EMGVARIABLE-X POST + EMGVARIABLE-X PRE ) and compared with an inefficacy theoretical index of 0. Results Comparison involved 1937 pre-toxin strides (mean per child 176 ± 114) vs. 1231 post-toxin strides (mean 112 ± 79). There were no difference in XV1-GSC [XV1-GSC-pre 103◦ (6); or in XV3-GSC [XV3-GSC-pre 89◦ (8); XV1-GSC-post 103◦ (6)] XV3-GSC-post 96◦ (4.5)]. EVGS-global-score was improved (P = 0.007) with better clearance in SW (P = 0.07), increased knee re-extension in terminal SW (P = 0.04) and decreased hindfoot valgus at IC (P = 0.02). The normalised-EMGmax was unchanged for PL [−0.06(0.16)] but increased for GM [0.18(0.20), P = 0.007] and TA [0.28(0.19), P < 0.001]. There were reductions of Cocontraction in PL [P < 0.0001; SW,−0.26(0.14); SW1, −0.22(0.14); SW2, −0.27(0.14); SW3, −0.26(0.18)] and in GM [SW, −0.26(0.14), P = 0.06; SW1, −0.21(0.18), P < 0.001; SW2, −0.25(0.20), P < 0.01; SW3, −0.21(0.25), P = 0.06]. TA recruitment was decreased: SW, −0.08(0.18), P = 0.06; SW1, −0.11(0.20), P < 0.001; SW2, −0.07(0.17) NS; SW3, −0.07(0.24), NS. Conclusion In this retrospective study, PL injections in very young CP children improved foot clearance and decreased hindfoot valgus, which was associated with reductions of PL and GM co-contractions and of TA recruitment. This constitutes an argument supporting that increased TA recruitment in children with hemiparesis may be an attempt by the nervous system to compensate for plantar flexor cocontraction rather than the opposite (increased cocontraction due to increased TA recruitment). We can discuss a central action of abobotulinumtoxin A. Keywords Hemiparesis; Equinus; Peroneus longus Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.722 ISPR8-0545
Correlation between therapeutic intensity of rehabilitation and functional improvement in children with cerebral palsy S.Y. Kim 1,∗ , M.H. Moon 1 , S.C. Huh 1 , S.H. Ko 1 , Y.B. Shin 2 Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine, Yangsan, Republic of Korea 2 Pusan National University Hospital, Department of Rehabilitation Medicine, Pusan, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (S.Y. Kim)
1
Introduction/Background In clinically, rehabilitation therapy is focused on functional improvement in mild to moderate cerebral palsy (CP) patients. In severe cases, postural management is one of the target goals. Therapeutic intensity is various in each patients and optimal intensity is still unclear. The aim of this study is to assess relation between therapeutic intensity of rehabilitation therapy and functional improvement in CP patients. Material and method Participants were 39 children with spastic CP. We divided participants into two groups based on initial Gross Motor Function Classification System (GMFCS) level, as mild to moderate groups with GMFCS 1 to 3, and severe groups with GMFCS 4 and 5. We also divided subjects into three groups based on intensity of therapy. We defined low intensity as less than 7 sessions (30 minutes of therapy per session) per week, intermediate intensity as 7 to 14 sessions per week and high intensity as over 14 sessions per week. Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) (three domains of Self-care, Mobility and Social) were measured at initial and 6 months by qualified investigators. Results Statistically significant improvement was observed in GMFM scores and mobility scores of PEDI in mild to moderate group (P < 0.05), self-care and social function sub-scores of PEDI in severe group (P < 0.05) for 6 months. Rehabilitation therapy with
high intensity showed gross motor function improvement in mild to moderate group. In severe group, high intensity therapy showed improvement of self-care and social function than gross motor function in same duration. Conclusion To our knowledge, high intensity rehabilitation could make more functional and postural improvement in CP patients. However, there are many variables such as age, GMFCS level, type of CP, medical condition, comorbidities, etc. Consideration about optimal intensity of rehabilitation therapy according to severity of disease is needed in further study. Keywords Cerebral palsy; Therapeutic intensity; Functional improvement Disclosure of interest The authors declare that they have no competing interest. Appendix A Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.723. https://doi.org/10.1016/j.rehab.2018.05.723 ISPR8-0615
Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications E. Chaleat-Valayer 1,∗ , R. Bard-Pondarré 2 , J.C. Bernard 3 , F. Roumenoff 4 , A. Lucet 5 1 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Hôpital de Jour, Lyon cedex 05, France 2 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Ergothérapie, Lyon cedex 05, France 3 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Pédiatrie, Lyon cedex 05, France 4 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Hôpital de Jour Pédiatrique, Lyon cedex 05, France 5 CMPRE de Bois-Larris, Pédiatrie, Lamorlaye, France ∗ Corresponding author. E-mail address: [email protected] (E.Chaleat-Valayer) Introduction/Background To describe two classifications, one for the general pattern of the upper limb (Fig. 1) and one for the type of hands (Fig. 2) in Cerebral Palsy (CP), and to provide evidence of its reliability. Material and method Two classifications were developed and 212 videos of CP patients (118 for UL patterns and 94 for hands; median age 14, 3–46 years) were viewed by 19 examiners of 2 different rehabilitation centers, who identified the UL pattern (type Ia, Ib, Ic; type IIa, IIb, IIc; type IIIa, IIIb) or the kind of hand (flex simple,
Fig. 1
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and Modified Ashworth Scale for RF and MH, energy expenditure index and Gross Motor Function Measure. Gait analysis data were speed, cadence, step length, time of stance phase, articular range of motion and articular moment on hip and knee flexion. Gait deviation index (GDI) and gait profile score (GPS) were calculated. All data were collected before surgery, and at last gait analysis followup available for each patient. Results Thirty-four patients were included. The average time assessment after surgery was 33.35 months ± 13.8. There is significant improvement of GDI and GPS, respectively from 74.2 ± 11.6 to 79.7 ± 8.2 (P = 0.010) and from 11.54 ± 4.1 to 9.5 ± 2.5 (P = 0.005). Knee flexion decreased at body weight acceptance phase: 30.8 ± 9.9◦ to 24.7 ± 6.6◦ (P = 0.006). Maximum joint moments were closer toward normality at knee on 55% of gait cycle: 0.2118 ± 0.25 Nm/kg to 0.1119 ± 0.14 Nm/kg (P = 0.003), at hip on 10% of gait cycle: 0.1261 ± 0.39 Nm/kg to 0.4419 ± 0.32 Nm/kg (P = 0.004) and for knee flexion at 95% of gait cycle: 0.1340 ± 0.45 Nm/kg to 0.1883 ± 0.068 Nm/kg (P = 0.005). GMFM (E item) increased from 75.39 ± 30.3% to 78.84 ± 27.8% (P = 0.009). Conclusion There is clinical and functional benefits. GDI and GPS were improved after procedure combining single event multilevel surgery with neurotomy. Moreover, kinematics of gait cycle is improved particularly at the beginning of gait cycle. Keywords Selective neurotomy; Multilevel surgery; Gait analysis Disclosure of interest The authors declare that they have no competing interest. Fig. 2
https://doi.org/10.1016/j.rehab.2018.05.725
total or evolved; punching intrinsic, superficialis or profundus), and twice by 18 examiners at 2 months interval. Results There was a very high intra-rater and inter-raters reliability for types (0.87 < k < 0.92), and a substantial agreement also for subtypes (0.58 < k < 0.68), for both classifications. Some specific errors of quotation could be explained. Examiners involved in the study found both classifications useful and feasible. Conclusion Examiners had been only shortly trained to using classifications, and both novice and experienced raters had good to high agreement, which confirms that these classifications are easy to use reliably. Details of disagreement can be used to improve further both classifications. Keywords Cerebral palsy; Upper limb; Classification Disclosure of interest The authors declare that they have no competing interest.
ISPR8-2029
https://doi.org/10.1016/j.rehab.2018.05.724 ISPR8-0286
Fascicular motor neurotomy associated to single event multilevel surgery in cerebral palsy. A long-term review with gait analysis Z. Bérénice 1,∗ , B. Dohin 2 University Hospital of Saint-Étienne, Physical Medicine and Rehabilitation, Saint-Étienne, France 2 University Hospital of Saint-Étienne, Pediatric Surgery, Saint-Étienne, France ∗ Corresponding author. E-mail address: [email protected] (Z. Bérénice)
1
Introduction/Background The aim of this study is assessment of functional benefits after multilevel surgery associated with selective partial neurotomies, focusing on rectus femoris (RF), semitendinosus and semimembranosus muscles (medial hamstring MH) and the function of hip and knee joints. Material and method This is a series of patients who had multilevel surgery associated with selective neurotomy on RF, MH between 2009 and 2016. Clinical data were knee range of motion
Botulinum toxin type A in the treatment of sialorrhea - Our experience F. de Matos 1,∗ , D. Ascenso 1 , M. Freitas 1 , S. Almeida 2 , C. Duarte 2 Hospital Garcia de Orta, Physical Medicine and Rehabilitation, Almada, Portugal 2 Hospital Garcia de Orta, Center For Child Development Torrado da Silva, Almada, Portugal ∗ Corresponding author. E-mail address: fi[email protected] (F. de Matos)
1
Introduction/Background Sialorrhea consists of an involuntary loss of saliva, and is considered pathological after 4YO. The aim of this study is to describe our methodology and evaluate the efficacy and safety of botulinum toxin type A (BTX-A) in sialorrhea in children and adults with cerebral palsy (CP) or cognitive deficit, referenced to PMR consultation between 2002–2017. Material and method Longitudinal descriptive study with clinical records analysis and consultation of Drooling Rate Scale (DRS) and Teacher Drool Scale (TDS) prior to BTX-A injections and 1-month after. Injection of BTX-A performed with ultrasound and sedation. Results Total of 104 patients, 86 patients selected, 32 female (37.21%), 54 male (62.79%), current ages 7–29YO (mean 18), age of the 1st application 3–22YO (mean 9.76), age of last application 4–23YO (mean 11.83). Fifty patients (58.14%) diagnosed with CP. Two hundred and three total applications (average 2.36), maximum 10 applications. Parotids (55.56%), submandibular (9.09%) or both (35.35%), mean periodicity of 11.81 months. Sedation: 49.38% midazolam, 41.36% nitrogen protoxide, 0.62% chloral-hydrate and 8.64% without. Surveys: mean pre-application-DRS of 33.98 (minimum 19, maximum 58), mean post-application-DRS of 28.46 (min 15, max 54), with P = 6.48–5, average difference 4.28 points in DRS (min −27, max 22). Mean pre-application-TDS of 4.04 (min 2, max 5), mean post-applicantion-TDS of 3.38 (min 1, max 4), with P = 2.80–5, an average difference of 0.69 points in TDS (min −1, max 3). Difference in DRS and TDS of 0.76 and 0.24 respectively in the parotids, 6.33 and 0.83 in the submandibular and 8.52 and 1.43 in both. Improvements were statistically significant. Surgery:
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(EMGVARIABLE-X POST + EMGVARIABLE-X PRE ) and compared with an inefficacy theoretical index of 0. Results Comparison involved 1937 pre-toxin strides (mean per child 176 ± 114) vs. 1231 post-toxin strides (mean 112 ± 79). There were no difference in XV1-GSC [XV1-GSC-pre 103◦ (6); or in XV3-GSC [XV3-GSC-pre 89◦ (8); XV1-GSC-post 103◦ (6)] XV3-GSC-post 96◦ (4.5)]. EVGS-global-score was improved (P = 0.007) with better clearance in SW (P = 0.07), increased knee re-extension in terminal SW (P = 0.04) and decreased hindfoot valgus at IC (P = 0.02). The normalised-EMGmax was unchanged for PL [−0.06(0.16)] but increased for GM [0.18(0.20), P = 0.007] and TA [0.28(0.19), P < 0.001]. There were reductions of Cocontraction in PL [P < 0.0001; SW,−0.26(0.14); SW1, −0.22(0.14); SW2, −0.27(0.14); SW3, −0.26(0.18)] and in GM [SW, −0.26(0.14), P = 0.06; SW1, −0.21(0.18), P < 0.001; SW2, −0.25(0.20), P < 0.01; SW3, −0.21(0.25), P = 0.06]. TA recruitment was decreased: SW, −0.08(0.18), P = 0.06; SW1, −0.11(0.20), P < 0.001; SW2, −0.07(0.17) NS; SW3, −0.07(0.24), NS. Conclusion In this retrospective study, PL injections in very young CP children improved foot clearance and decreased hindfoot valgus, which was associated with reductions of PL and GM co-contractions and of TA recruitment. This constitutes an argument supporting that increased TA recruitment in children with hemiparesis may be an attempt by the nervous system to compensate for plantar flexor cocontraction rather than the opposite (increased cocontraction due to increased TA recruitment). We can discuss a central action of abobotulinumtoxin A. Keywords Hemiparesis; Equinus; Peroneus longus Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.722 ISPR8-0545
Correlation between therapeutic intensity of rehabilitation and functional improvement in children with cerebral palsy S.Y. Kim 1,∗ , M.H. Moon 1 , S.C. Huh 1 , S.H. Ko 1 , Y.B. Shin 2 Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine, Yangsan, Republic of Korea 2 Pusan National University Hospital, Department of Rehabilitation Medicine, Pusan, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (S.Y. Kim)
1
Introduction/Background In clinically, rehabilitation therapy is focused on functional improvement in mild to moderate cerebral palsy (CP) patients. In severe cases, postural management is one of the target goals. Therapeutic intensity is various in each patients and optimal intensity is still unclear. The aim of this study is to assess relation between therapeutic intensity of rehabilitation therapy and functional improvement in CP patients. Material and method Participants were 39 children with spastic CP. We divided participants into two groups based on initial Gross Motor Function Classification System (GMFCS) level, as mild to moderate groups with GMFCS 1 to 3, and severe groups with GMFCS 4 and 5. We also divided subjects into three groups based on intensity of therapy. We defined low intensity as less than 7 sessions (30 minutes of therapy per session) per week, intermediate intensity as 7 to 14 sessions per week and high intensity as over 14 sessions per week. Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) (three domains of Self-care, Mobility and Social) were measured at initial and 6 months by qualified investigators. Results Statistically significant improvement was observed in GMFM scores and mobility scores of PEDI in mild to moderate group (P < 0.05), self-care and social function sub-scores of PEDI in severe group (P < 0.05) for 6 months. Rehabilitation therapy with
high intensity showed gross motor function improvement in mild to moderate group. In severe group, high intensity therapy showed improvement of self-care and social function than gross motor function in same duration. Conclusion To our knowledge, high intensity rehabilitation could make more functional and postural improvement in CP patients. However, there are many variables such as age, GMFCS level, type of CP, medical condition, comorbidities, etc. Consideration about optimal intensity of rehabilitation therapy according to severity of disease is needed in further study. Keywords Cerebral palsy; Therapeutic intensity; Functional improvement Disclosure of interest The authors declare that they have no competing interest. Appendix A Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.723. https://doi.org/10.1016/j.rehab.2018.05.723 ISPR8-0615
Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications E. Chaleat-Valayer 1,∗ , R. Bard-Pondarré 2 , J.C. Bernard 3 , F. Roumenoff 4 , A. Lucet 5 1 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Hôpital de Jour, Lyon cedex 05, France 2 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Ergothérapie, Lyon cedex 05, France 3 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Pédiatrie, Lyon cedex 05, France 4 Centre Médico-Chirurgical de Réadaptation des Massues Croix rouge franc¸aise, Hôpital de Jour Pédiatrique, Lyon cedex 05, France 5 CMPRE de Bois-Larris, Pédiatrie, Lamorlaye, France ∗ Corresponding author. E-mail address: [email protected] (E.Chaleat-Valayer) Introduction/Background To describe two classifications, one for the general pattern of the upper limb (Fig. 1) and one for the type of hands (Fig. 2) in Cerebral Palsy (CP), and to provide evidence of its reliability. Material and method Two classifications were developed and 212 videos of CP patients (118 for UL patterns and 94 for hands; median age 14, 3–46 years) were viewed by 19 examiners of 2 different rehabilitation centers, who identified the UL pattern (type Ia, Ib, Ic; type IIa, IIb, IIc; type IIIa, IIIb) or the kind of hand (flex simple,
Fig. 1
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and Modified Ashworth Scale for RF and MH, energy expenditure index and Gross Motor Function Measure. Gait analysis data were speed, cadence, step length, time of stance phase, articular range of motion and articular moment on hip and knee flexion. Gait deviation index (GDI) and gait profile score (GPS) were calculated. All data were collected before surgery, and at last gait analysis followup available for each patient. Results Thirty-four patients were included. The average time assessment after surgery was 33.35 months ± 13.8. There is significant improvement of GDI and GPS, respectively from 74.2 ± 11.6 to 79.7 ± 8.2 (P = 0.010) and from 11.54 ± 4.1 to 9.5 ± 2.5 (P = 0.005). Knee flexion decreased at body weight acceptance phase: 30.8 ± 9.9◦ to 24.7 ± 6.6◦ (P = 0.006). Maximum joint moments were closer toward normality at knee on 55% of gait cycle: 0.2118 ± 0.25 Nm/kg to 0.1119 ± 0.14 Nm/kg (P = 0.003), at hip on 10% of gait cycle: 0.1261 ± 0.39 Nm/kg to 0.4419 ± 0.32 Nm/kg (P = 0.004) and for knee flexion at 95% of gait cycle: 0.1340 ± 0.45 Nm/kg to 0.1883 ± 0.068 Nm/kg (P = 0.005). GMFM (E item) increased from 75.39 ± 30.3% to 78.84 ± 27.8% (P = 0.009). Conclusion There is clinical and functional benefits. GDI and GPS were improved after procedure combining single event multilevel surgery with neurotomy. Moreover, kinematics of gait cycle is improved particularly at the beginning of gait cycle. Keywords Selective neurotomy; Multilevel surgery; Gait analysis Disclosure of interest The authors declare that they have no competing interest. Fig. 2
https://doi.org/10.1016/j.rehab.2018.05.725
total or evolved; punching intrinsic, superficialis or profundus), and twice by 18 examiners at 2 months interval. Results There was a very high intra-rater and inter-raters reliability for types (0.87 < k < 0.92), and a substantial agreement also for subtypes (0.58 < k < 0.68), for both classifications. Some specific errors of quotation could be explained. Examiners involved in the study found both classifications useful and feasible. Conclusion Examiners had been only shortly trained to using classifications, and both novice and experienced raters had good to high agreement, which confirms that these classifications are easy to use reliably. Details of disagreement can be used to improve further both classifications. Keywords Cerebral palsy; Upper limb; Classification Disclosure of interest The authors declare that they have no competing interest.
ISPR8-2029
https://doi.org/10.1016/j.rehab.2018.05.724 ISPR8-0286
Fascicular motor neurotomy associated to single event multilevel surgery in cerebral palsy. A long-term review with gait analysis Z. Bérénice 1,∗ , B. Dohin 2 University Hospital of Saint-Étienne, Physical Medicine and Rehabilitation, Saint-Étienne, France 2 University Hospital of Saint-Étienne, Pediatric Surgery, Saint-Étienne, France ∗ Corresponding author. E-mail address: [email protected] (Z. Bérénice)
1
Introduction/Background The aim of this study is assessment of functional benefits after multilevel surgery associated with selective partial neurotomies, focusing on rectus femoris (RF), semitendinosus and semimembranosus muscles (medial hamstring MH) and the function of hip and knee joints. Material and method This is a series of patients who had multilevel surgery associated with selective neurotomy on RF, MH between 2009 and 2016. Clinical data were knee range of motion
Botulinum toxin type A in the treatment of sialorrhea - Our experience F. de Matos 1,∗ , D. Ascenso 1 , M. Freitas 1 , S. Almeida 2 , C. Duarte 2 Hospital Garcia de Orta, Physical Medicine and Rehabilitation, Almada, Portugal 2 Hospital Garcia de Orta, Center For Child Development Torrado da Silva, Almada, Portugal ∗ Corresponding author. E-mail address: fi[email protected] (F. de Matos)
1
Introduction/Background Sialorrhea consists of an involuntary loss of saliva, and is considered pathological after 4YO. The aim of this study is to describe our methodology and evaluate the efficacy and safety of botulinum toxin type A (BTX-A) in sialorrhea in children and adults with cerebral palsy (CP) or cognitive deficit, referenced to PMR consultation between 2002–2017. Material and method Longitudinal descriptive study with clinical records analysis and consultation of Drooling Rate Scale (DRS) and Teacher Drool Scale (TDS) prior to BTX-A injections and 1-month after. Injection of BTX-A performed with ultrasound and sedation. Results Total of 104 patients, 86 patients selected, 32 female (37.21%), 54 male (62.79%), current ages 7–29YO (mean 18), age of the 1st application 3–22YO (mean 9.76), age of last application 4–23YO (mean 11.83). Fifty patients (58.14%) diagnosed with CP. Two hundred and three total applications (average 2.36), maximum 10 applications. Parotids (55.56%), submandibular (9.09%) or both (35.35%), mean periodicity of 11.81 months. Sedation: 49.38% midazolam, 41.36% nitrogen protoxide, 0.62% chloral-hydrate and 8.64% without. Surveys: mean pre-application-DRS of 33.98 (minimum 19, maximum 58), mean post-application-DRS of 28.46 (min 15, max 54), with P = 6.48–5, average difference 4.28 points in DRS (min −27, max 22). Mean pre-application-TDS of 4.04 (min 2, max 5), mean post-applicantion-TDS of 3.38 (min 1, max 4), with P = 2.80–5, an average difference of 0.69 points in TDS (min −1, max 3). Difference in DRS and TDS of 0.76 and 0.24 respectively in the parotids, 6.33 and 0.83 in the submandibular and 8.52 and 1.43 in both. Improvements were statistically significant. Surgery: