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La extensión completa de la rodilla es esencial para la marcha. Los pacientes con parálisis cerebral infantil con frecuencia pueden tener déficit de extensión de distinta magnitud, lo que compromete la marcha e incluso la bipedestación. El tratamiento de la contractura en flexión de rodilla parte por tratar la espasticidad de los músculos comprometidos y con fisioterapia. Cuando el flexo es estructurado, el tratamiento es quirúrgico mediante distintas técnicas, dependiendo de la magnitud de la contractura y de la edad del paciente. Las técnicas sobre partes blandas incluyen alargamientos funcionales de isquiotibiales y transferencias musculares. Cuando la contractura es capsular, es preferible realizar cirugía ósea, la cual extiende el fémur proximal, ya sea en forma progresiva, mediante fisiodesis anterior en pacientes pediátricos, o en forma aguda, mediante osteotomía extensora del fémur distal. Con frecuencia existe una patela alta, la cual hay que corregir en el mismo acto quirúrgico para mantener la eficiencia del aparato extensor

Full knee extension is essential for gait. Patients with cerebral palsy frequently have extension deficits of different magnitudes, which compromise walking and even standing up. The treatment of knee flexion contracture begins by addressing the spasticity of the involved muscles and includes physical therapy. For structured extension deficits, the treatment is surgical, using different techniques depending on the magnitude of the contracture and the patient's age. Soft tissue techniques include functional hamstring lengthening and muscle transfers. For capsular contracture, bone surgery is preferable and extends the proximal femur either progressively, through anterior physiodesis in pediatric patients, or acutely, by extensor distal femoral osteotomy. A high patella is common and requires correction during the same surgical procedure to maintain the efficiency of the extensor apparatus

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Neuropsychiatric disorders associated with coronavirus infections emerged with the coronavirus disease 2019 (COVID-19) pandemic. We describe the clinical, laboratory and radiological features of a patient who presented, after recent COVID-19, two rare neuropsychiatric manifestations: a brief psychotic break followed by severe bilateral peripheral facial palsy.

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BACKGROUND: The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain-Barré syndrome related to  COVID-19 , with sensory and motor compromise in the extremities. CASE PRESENTATION: In this report, we describe a rare case of Guillain-Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves. CONCLUSION: Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system.

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Abstract This case series describes the clinical and paraclinical findings in two young men with bilateral peripheral facial palsy or facial diplegia during the convalescent period of leptospirosis, who recovered neurologically without sequelae. This highlights the role of spirochetes in the development of an atypical and rare variant of Guillain-Barré syndrome. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1947).

Resumen Esta serie de caso describe los hallazgos clínicos y paraclínicos observados en dos hombres jóvenes, con parálisis facial periférica bilateral o diplejía facial durante la fase de convalecencia de la leptospirosis, con recuperación neurológica sin secuela; resaltando así, el papel de la espiroqueta en el desarrollo de una variante atípica y poco frecuente del síndrome de Guillain-Barré. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1947).

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Spastic diplegia, a muscle hypertonia motor syndrome, can occur in conjunction with the characteristic abnormal movement features of Angelman syndrome (AS), a neurodevelopmental disorder with primary features of ataxic gait, happy demeanor, developmental delay, speech impairment, intellectual disability, microcephaly, and seizures. Spastic diplegia is classically associated with cerebral palsy (CP), an umbrella term encompassing developmental delay, abnormal brain magnetic resonance imaging findings, and various types of CP including spastic, ataxic, dyskinetic, and mixed types. We present a 12-year-old Haitian patient of African descent with AS due to a microdeletion involving the entire UBE3A (ubiquitin-protein ligase E3A) gene and spastic diplegia. She was initially given a clinical diagnosis of CP. Cases of AS in patients of African descent have been rarely reported and this case of severe spastic diplegia, unresponsive to medical intervention, reflects a rarely reported presentation of AS in patients of African descent and possibly the first reported case of a Haitian patient with this clinical presentation. Given that deletions are the most common mechanism resulting in AS, this case report provides supportive evidence that chromosome 15q11 deletion-type AS is most frequently associated with spastic diplegia, a more severe motor impairment phenotype in AS.

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Abstract Introduction: Diplegic children have difficulties in gait and therefore ramps are used as strategies of accessibility. Objective: The present study investigated the influence of an inclined surface (ascending and descending) on the kinematic characteristics during gait of the diplegic group (DG) when compared to typically developing children of the control group (CG). Methods: Study participants included 20 children (10 with DG and 10 CG) matched by age, which were evaluated in three experimental conditions (horizontal and inclined ascending and inclined descending surfaces of 7º) through an optoelectronic imaging system. Results: Among the linear kinematic variables, only step width differed among groups, however, without influence of the surface. The foot height differed among the groups only in the descending phase, where DG had greater difficulty in raising the foot. The 3-dimensional gait analyses could not provide more evidences of differences in kinematics variables, especially in transverse plane, between DG and CG, but provide some evidence to support that hip range of motion (ROM) during the gait cycle, hip flexion-extension in initial contact, knee ROM and the 2nd anterior-posterior trunk peak amplitude of the DG were influenced on descent by their flexor pattern. Conclusion: The DG was most affected by the inclination plane than CG especially on descent. Although a hip and knee flexor pattern is evident for DG on inclination of 7º, this angle is accessible since it allows independent gait functional activity.

Resumo Introdução: Crianças com diplegia apresentam dificuldades na marcha e rampas são utilizadas como estratégia de acessibilidade. Objetivo: O presente estudo investigou a influência da superfície inclinada (subida e descida) sobre as variáveis cinemáticas durante a marcha no grupo com diplegia (GD) comparado ao grupo de crianças com desenvolvimento típico no grupo controle (GC). Métodos: Participaram do estudo 20 crianças (10 GD e 10 GC) pareadas por idade, as quais foram avaliadas em 3 condições experimentais (horizontal, subida e descida de 7º) por meio de um sistema de imagem optoeletrônico. Resultados: Nas variáveis cinemáticas lineares apenas o comprimento do passo diferiu entre os grupos sem influência da inclinação do plano. A altura do pé diferiu entre os grupos na descida, com maior dificuldade do GD em elevar o pé. A análise tridimensional da marcha não permitiu identificar diferenças cinemáticas no plano transverso entre GD e GC, mas identificou que a ADM de quadril durante o ciclo de marcha, flexo-extensão de joelho no contato inicial, ADM de joelho e o 2º pico de amplitude de movimento (ADM) ântero-posterior de tronco do GD foram influenciadas na descida devido ao padrão flexor desse grupo. Conclusão: O GD foi mais afetado que o GC, especialmente na descida. Embora sejam evidenciados padrões de flexão de quadril e joelhos do GD na inclinação de 7º, essa angulação é acessível ao permitir marcha funcional independente.

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ABSTRACT Objective Facial diplegia (FD) is a rare neurological manifestation with diverse causes. This article aims to systematically evaluate the etiology, diagnostic evaluation and treatment of FD. Method The study was performed retrospectively and included 17 patients with a diagnosis of FD. Results Patients were diagnosed with Guillain-Barré syndrome (GBS) (11), Bickerstaff’s brainstem encephalitis (1), neurosarcoidosis (1), non-Hodgkin’s Lymphoma (1), tuberculous meningitis (1) herpes simplex reactivation (1) and idiopathic (1). In addition, two patients had developed FD during pregnancy. Conclusion Facial diplegia is an ominous symptom with widely varying causes that requires careful investigation.

RESUMO Objetivo Diplegia facial (DF) é uma manifestação neurológica rara proveniente de diferentes causas. Este artigo visa avaliar sistematicamente a etiologia, avaliação diagnóstica e tratamento de DF. Método O estudo foi retrospectivo e incluiu 17 pacientes com diagnóstico de FD. Resultados Os pacientes foram diagnosticados como casos de síndrome de Guillain-Barré (SGB) (11), encefalite de tronco de Bickerstaff (1), neurosarcoidose (1), linfoma não-Hodgkin’s (1), meningite tuberculosa (1) reativação de herpes simplex (1) e causa idiopática (1). Além disto, duas pacientes haviam desenvolvido DF durante a gestação. Conclusão Diplegia facial é uma manifestação com diversas causas que requer investigação cuidadosa.

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The single event multilevel surgery (SEMLS) is a procedure preferably for patients with cerebral palsy (CP), including several orthopedic surgeries in one surgical time, and involves at least two levels joints of lower extremities, seeking to optimize gait. It is based on biomechanical principles provided by the gait lab (GL). Objective: To evaluate the impact of SEMLS in the gait of patients with CP spastic diplegia, one year after surgery. Patients and Methods: Retrospective study with review of medical records of 61 patients undergoing SEMLS. 23 out of 61 subjects accomplished the inclusion criteria. GL data before and after surgery was summarized in Gait deviation index (GDI), cadence and velocity, as well as functional mobility scale (FMS). Patients were categorized in two groups according to the Gross motor function classification system (GMFCS) as “A” for I-II GMFCS and “B” for III GMFCS. Statistical comparison was performed using Wilcoxon test. Results: The average SEMLS include 6.19 procedures per patient. Overall, significant variations in GDI (p < 0.0001) and cadence (p < 0.007) were found. In the subgroup A, there were significant changes in all GL variables (p < 0.009). In subgroup B, a significant effect was only found for GDI. Although FMS showed improvement, it was not statistically significant for 50 m and 500 m, in both subgroups and the total population (14 patients). Conclusion: Significant improvement was seen in CP spastic diplegic patients, for both cadence and GDI after one year SEMLS, particularly in the subgroup with independent walking...

La cirugía multinivel (CMN), es un procedimiento usado preferentemente en pacientes con parálisis cerebral (PC) que reúne varias cirugías ortopédicas en un tiempo quirúrgico involucrando como mínimo dos niveles articulares de extremidades inferiores, buscando optimizar la marcha. Se basa en principios biomecánicos aportados por el laboratorio de marcha (LM). Objetivo: Evaluar el impacto de CMN en la marcha de pacientes con PC tipo diplejía espástica, a un año postcirugía. Pacientes y Método: Estudio de cohorte única, retrospectivo. Se revisaron fichas de 61 pacientes intervenidos con CMN, 23 cumplieron los criterios de inclusión. Se obtuvo datos de LM pre y a un año postoperatorio, resumidos en cadencia del paso, velocidad, Gait Deviation Index (GDI), y Functional Mobility Scale (FMS); los sujetos se dividieron en subgrupos: “A” con Gross Motor Function Clasification System (GMFCS) I-II y “B” con GMFCS III. Se realizó comparación estadística mediante test de Wilcoxon con p < 0,05. Resultados: En promedio se realizaron 6,19 procedimientos quirúrgicos por paciente. En el grupo total se obtuvo variaciones significativas en GDI (p < 0,0001) y cadencia (p < 0,007). En el subgrupo A hay variaciones significativas en todas las variables de marcha (p < 0,009). En subgrupo B hay variaciones significativas sólo en GDI. Para la escala FMS existió mejoría, sin significancia estadística en 50 m y 500 m, en los 14 pacientes examinados y en los subgrupos. Conclusión: Se observa mejoría en la marcha de pacientes PC tipo diplejía espástica, en cadencia y GDI, tras un año post CMN, particularmente en el subgrupo A, con marcha independiente...

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El síndrome de Guillain-Barré (SGB) es la causa más común de parálisis generalizada aguda. El SGB es una polirradiculoneuropatia aguda inflamatoria desmielinizante que generalmente se presenta como una parálisis que inicia en miembros inferiores y luego progresa de forma ascendente y simétrica. El presente trabajo, tiene como objetivo, informar un caso de diplejía facial como manifestación inicial de SGB. Paciente masculino, 37 años de edad, diabético tipo 2, que luego de ocho días de haber padecido una sinusitis aguda, presentó de forma gradual, cefalea hemicraneana derecha, derramamiento salival y disartria. En la exploración neurológica se observó ausencia bilateral de los pliegues frontales, lagoftalmos bilateral acompañado de epífora, signo de Bell bilateral y derramamiento salival a través de ambas comisuras labiales. A las 48 horas de su ingreso hospitalario, presentó paresia en ambos miembros superiores. El estudio del líquido cefalorraquídeo reportó 1,1 células/mm³ representadas en su totalidad por linfocitos de aspecto normal, y proteínas totales 196,9mg/dL. La electromiografía fue compatible con polineuropatía desmielinizante aguda de predominio motor con mayor afectación facial. Con los hallazgos clínicos y paraclínicos se realizó el diagnóstico de SGB. Se inició tratamiento a base de plasmaféresis e inmunoglobulina endovenosa, con posterior mejoría de la clínica. La diplejía facial forma parte de las variantes regionales del SGB. A pesar que cerca del 60% de los pacientes con SGB presentan debilidad facial en el curso del trastorno, ésta habitualmente es precedida por debilidad en extremidades. El presente caso permite evidenciar que el SGB puede debutar clínicamente como una diplejía facial.

The Guillain-Barré syndrome (GBS) is the most common cause of acute generalized paralysis. GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It usually presents as a paralysis that starts in the lower limbs and then progresses symmetrically upward. The present study reports a case of bilateral facial palsy as the initial manifestation of GBS. This is a report of a case of a 37-year-old male, diabetic, that eight days after having suffered acute sinusitis, gradually presented with right hemicranial headache, dysarthria and sialorrhea. The neurological examination disclosed the absence of the bilateral frontal folds, accompanied by epiphora, bilateral lagophthalmos, bilateral Bell sign and salivary drooling through both commissures of lips. At 48 hours after hospital admission the patient showed paresis in both upper limbs. The cerebrospinal fluid analysis reported 1.1cells/mm³, fully represented by lymphocytes of normal aspect and total proteins were 196.9 mg/dL. The electromyography was consistent with acute demyelinating polyneuropathy, with a predominant motor component and a major facial involvement. With the clinical and laboratory findings, a diagnosis of GBS was established. Treatment was started with plasmapheresis and intravenous immunoglobulin, with the subsequent improvement of the clinic. The facial diplegia is part of the regional variants of GBS. Although about 60% of GBS patients present with facial weakness, it is usually preceded by weakness in the limbs. This case makes evident that GBS may present clinically as a facial diplegia.

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The analysis of the movement patterns of children with spastic diplegia (SD) during the process of standing up can contribute to a better understanding of postural control. The purpose of this study was to describe the movement patterns during this task in children with SD and typical development and to analyze the differences according to their age group. Participated 40 children (38-154 months), 20 children with SD and 20 children with typical development. The participants were instructed to lie down in a supine position and quickly stand up (10 trials). Motor task sessions were videotaped and subsequently analyzed. Children with SD had more asymmetrical and less efficient movement patterns in the Upper Limbs (UL), Axial Region (AR) and Lower Limbs (LL). The oldest group of children with SD did not have more mature and efficient movement patterns, and the oldest children with typical development have more mature and efficient movement patterns in the UL and AR.

A análise dos padrões de movimento de crianças com diplegia espástica (DE) durante o movimento de levantar pode contribuir para uma melhor compreensão do controle postural. O objetivo do estudo foi descrever os padrões de movimento durante esta tarefa em crianças com DE e com desenvolvimento típico e analisar as diferenças de acordo com a idade. Participaram 40 crianças (38-154 meses), 20 crianças com DE e 20 crianças com desenvolvimento típico. Os participantes foram instruídos para se deitarem em posição de decúbito dorsal e levantarem-se rapidamente (10 tentativas). As sessões foram gravadas e analisadas posteriormente. As crianças com DE apresentaram padrões de movimentos mais assimétricos e menos eficientes nos Membros Superiores (MS), Região Axial (RA) e Membros Inferiores (MI). As crianças mais velhas com DE não apresentaram padrões de movimento mais maduros e eficientes, e as mais velhas com desenvolvimento típico apresentaram padrões movimentos mais eficientes e maduros nos MS e RA.

El análisis de los patrones de movimiento de los niños con diplejía espástica (DE) durante el movimiento de levantar puede contribuir para una mejor comprensión del control postural. El objetivo del estudio fue describir los patrones de movimiento durante esta tarea en niños con DE y con desarrollo típico y analizar las diferencias en función de la edad. Participaron 40 niños (38-154 meses), 20 niños con DE y 20 niños con desarrollo típico. Los participantes fueron instruidos para que se echaran en decúbito dorsal y se levantaran rápidamente (10 intentos). Las sesiones fueron gravadas y analizadas posteriormente. Los niños con DE presentaron patrones de movimientos más asimétricos y menos eficientes en los miembros superiores (MS), región axial (RA) y miembros inferiores (MI). Los niños más viejos con DE no mostraron patrones de movimiento más eficientes y maduros, y los más viejos con desarrollo típico mostraron patrones de movimientos más eficientes y maduros en los MS y RA.

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El Síndrome de Guillain Barre es una polineuropatía autoinmune que causa desmielinización motora y sensitiva, frecuentemente con antecedente de una infección. El diagnóstico se realiza mediante sospecha clínica, aunque el líquido cefalorraquídeo y estudios electrodiagnósticos ayudan a soportarlo. El Médico debe estar familiarizado con las variantes clínicas tales como la diplejía facial para hacer un diagnóstico preciso. La inmunoglobulina intravenosa y la plasmaferesis son tratamientos eficaces. El cuidado de soporte durante y después de la hospitalización es crucial.

Guillain Barre Syndrome is an autoimmune polyneuropathy that causes motor and sensory demyelination, often with a history of infection. The diagnosis is made by clinical suspicion, although the cerebrospinal fluid and electrodiagnostic studies help support it. The Physician should be familiar with the clinical variants such as facial diplegia and make an accurate diagnosis. IVIG and plasmapheresis are effective treatments. Supportive care during and after hospitalization is crucial.

A síndrome de Guillain Barre é uma polineuropatia autoimune que provoca desmielinização motora e sensitiva, frequentemente com antecedentes de infecção. O diagnostico é realizado através de suspeita clinica, embora o líquido cefalorraquidiano e estudos eletrodiagnósticos ajudam a apoiá-lo. O médico deve estar familiarizado com as variantes clínicas tais como a diplegia facial para estabelecer um diagnóstico preciso. A imunoglobulina intravenosa e a plasmaférese são tratamentos eficazes. O tratamento de suporte durante e após a hospitalização é crucial.

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Guillain-Barré syndrome is an acute demyelinating disease which presents in a classic form with muscular weakness and the lack of reflexes. There are multiple variations and atypical forms of the disease, being facial diplegia with paresthesia one of them. Also, the absence of reflexes in this syndrome is typical but not constant, since 10% of patients present reflexes. We describe a case of atypical presentation with bilateral facial palsy, paresthesia, brisk reflexes and weakness in the lower limbs in a 33 year old woman.

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El síndrome de Guillain-Barré es una enfermedad desmielinizante aguda con una forma clásica que se presenta con debilidad muscular y ausencia de reflejos. Existen múltiples variantes y formas atípicas de la enfermedad, entre otras la diplejía facial con parestesias. Asimismo, la ausencia de reflejos en este síndrome es característico pero no constante, ya que en un 10% de los pacientes los reflejos están presentes. Se presenta aquí el caso de una mujer de 33 años con paresia facial bilateral, parestesias y debilidad de miembros inferiores e hiperreflexia, una forma de presentación infrecuente de este síndrome.(AU)

Guillain-Barré syndrome is an acute demyelinating disease which presents in a classic form with muscular weakness and the lack of reflexes. There are multiple variations and atypical forms of the disease, being facial diplegia with paresthesia one of them. Also, the absence of reflexes in this syndrome is typical but not constant, since 10% of patients present reflexes. We describe a case of atypical presentation with bilateral facial palsy, paresthesia, brisk reflexes and weakness in the lower limbs in a 33 year old woman.(AU)

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El síndrome de Guillain-Barré es una enfermedad desmielinizante aguda con una forma clásica que se presenta con debilidad muscular y ausencia de reflejos. Existen múltiples variantes y formas atípicas de la enfermedad, entre otras la diplejía facial con parestesias. Asimismo, la ausencia de reflejos en este síndrome es característico pero no constante, ya que en un 10% de los pacientes los reflejos están presentes. Se presenta aquí el caso de una mujer de 33 años con paresia facial bilateral, parestesias y debilidad de miembros inferiores e hiperreflexia, una forma de presentación infrecuente de este síndrome.

Guillain-Barré syndrome is an acute demyelinating disease which presents in a classic form with muscular weakness and the lack of reflexes. There are multiple variations and atypical forms of the disease, being facial diplegia with paresthesia one of them. Also, the absence of reflexes in this syndrome is typical but not constant, since 10% of patients present reflexes. We describe a case of atypical presentation with bilateral facial palsy, paresthesia, brisk reflexes and weakness in the lower limbs in a 33 year old woman.

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Objective The aims of this study were to evaluate the reliability of three range of motion tests (Straight Leg Raise, Modified Thomas, and Duncan-Ely) using photographic measurements in children with spastic diplegic cerebral palsy (SD) and with typical development (TD). Methods A cross-sectional test-retest design was applied to compare muscle-tendon unit shortening tests between groups. Results The tests showed reliability that ranged from good to excellent (ICC > 0.8), except for the Thomas Test for the bi-articular hip flexor muscle-tendon unit of the TD group (ICC = 0.7). Differences between groups were found in all tests (p < 0.05), except when the range of motion of the bi-articular hip flexor muscles was assessed using the Thomas test (p > 0.05). Conclusion Children with SD presents a smaller range of motion than the TD group. However, the Thomas Test for the bi-articular hip flexor muscles was unable to determine differences between children with spastic diplegic cerebral palsy from that with typical development. .

Objetivo O objetivo do estudo foi avaliar a repetibilidade de três testes de amplitude de movimento (Elevação da perna reta, Thomas Modificado e Duncan-Ely) usando medidas realizadas por fotografia em crianças com paralisia cerebral do tipo diparesia espástica (SD) e com desenvolvimento típico (TD). Métodos O estudo teve design transversal do tipo teste-reteste para comparar o comprimento musculotendíneo entre os grupos. Resultados Os testes mostraram repetibilidade de boa a excelente (ICC > 0,8), com exceção do teste de Thomas para os flexores biarticulares do quadril para o grupo TD (ICC = 0,7). Diferenças entre os grupos foram encontradas em todos os testes (p < 0,05), à exceção da amplitude de movimento dos flexores biarticulares do quadril ao se utilizar o teste de Thomas (p > 0,05). Crianças com SD apresentam menores amplitudes de movimento que as crianças do grupo TD. Entretanto, o teste de Thomas para os flexores biarticulares do quadril não foi capaz de determinar diferenças entre as crianças com diparesia espástica e as crianças com desenvolvimento típico. .

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INTRODUCTION: Neurological involvement of Human T-lymphotropic virus type 1 (HTLV-1) mainly results in myelopathy (tropical spastic paraparesis). However, cranial nerve impairment, including facial nerve damage, is rare in patients with HTLV-1 infection. OBSERVATION: We report the case of a patient, originally from Caribbean islands, who developed recurrent bilateral facial palsy (six recurrences during the 7-year follow-up). Both blood and cerebrospinal fluid serologies were positive for HTLV-1. The diagnosis of recurring bilateral facial palsy revealing HTLV-1 infection was made. CONCLUSION: Our case report underscores that HTLV-1 infection should be considered in patients, coming from endemic areas (Caribbean islands, South America, Japan and Africa), who exhibit recurrent bilateral facial palsy. Our data therefore indicate that HTLV-1 serology should be routinely performed in these patients.

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Identificar padrões de marcha em um grande grupo de crian-ças com paralisia cerebral (PC) tipo diplegia espástica e caracterizarcada grupo de acordo com a idade, nível do Gross Motor FunctionClassification System (GMFCS) e Gait Deviation Index (GDI) e cirurgiasprévias. Métodos: Foram divididos em sete grupos 1805 pacientescom base nos padrões de marcha observados: joelho saltitante, agachamento,recurvatum, joelho rígido, assimétrico, misto, e não classificável.Resultados: O grupo assimétrico foi o mais prevalente (48,8%).Os grupos joelho saltitante (9,6 anos) e recurvatum (9,4 anos) exibiramidade média menor que os demais grupos. O GDI mais baixo (43,58)foi observado no grupo agachamento. Notaram-se mais pacientesclassificados como nível III do GMFCS nos grupos agachamento emisto. Cirurgias prévias no tríceps sural foram mais frequentes nosgrupos joelho rígido e misto. O grupo joelho saltitante recebeu menornúmero de procedimentos cirúrgicos prévios nos isquiotibais, enquantoque o grupo com joelho rígido recebeu maior número, quandocomparado aos demais. Conclusões: Os casos assimétricos forammais frequentes, mesmo em grupo de pacientes diplégicos. Pacientescom padrão em agachamento foram caracterizados pelo GDI maisbaixo e prevalência do nível III no GMFCS, enquanto que o grupojoelho rígido exibiu uma porcentagem maior de alongamento préviodos isquiotibiais em comparação com os demais grupos. Nível deEvidência III, Estudo Retrospectivo Comparativo...

To identify gait patterns in a large group of childrenwith diplegic cerebral palsy and to characterize each groupaccording to age, Gross Motor Function Classification System(GMFCS) level, Gait Deviation Index (GDI) and previous surgicalprocedures. Methods: One thousand eight hundred and fivepatients were divided in seven groups regarding observed gaitpatterns: jump knee, crouch knee, recurvatum knee, stiff knee,asymmetric, mixed and non-classified. Results: The asymmetricgroup was the most prevalent (48.8%). The jump knee (9.6 yearsold) and recurvatum (9.4 years) groups had mean age lowerthan the other groups. The lowest GDI (43.58) was found in thecrouch group. There were more children classified within GMFCSlevel III in the crouch and mixed groups. Previous surgical procedureson the triceps surae were more frequent in stiff kneeand mixed groups. The jump knee group received less and thestiff-knee group more surgical procedures at hamstrings thanothers. Conclusions: The asymmetrical cases were the most frequentwithin a group of diplegic patients. Individuals with crouchgait pattern were characterized by the lowest GDI and the highestprevalence of GMFCS III, while patients with stiff knee exhibited ahigher percentage of previous hamstring lengthening in comparisonto the other groups. Level of Evidence III, RetrospectiveComparative Study...

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Maintaining standing postural balance is important for walking and handling abilities in patients with cerebral palsy. This study included 23 patients with cerebral palsy (seven with spastic diplegia and 16 with spastic hemiplegia), aged from 7 to 16 years of age. Standing posture balance measurements were performed using an AMTI model OR6-7 force platform with the eyes open and closed. Patients with diplegic cerebral palsy exhibited greater center of pressure displacement areas with the eyes open and greater center of pressure sway in the medial-lateral direction with the eyes open and closed compared with hemiplegic patients. Thus, diplegic patients exhibited weaker postural balance control ability and less standing stability compared with hemiplegic cerebral palsy patients.

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Cerebral Palsy presents itself in a clinical form of spastic diplegia, where neurological sequels are predominant in the lower limbs and substantially affects the capacity to walk. Traditional methods of physiotherapy intervention emphasize the techniques of neurological rehabilitation at the expense of progressive resistance exercises.The goal of the present research is to fulfill a bibliographic review concerning the period of 1985 to 2012 about studies that investigated the effect of resistance exercises applied to cerebral palsy children carrying spastics’ diplegia. The Scielo, MEDLINE, PubMed, EMBASE, CINAHL, Sports Discus, DARE, PsychInfo, ERIC, Ausport-Med, AMI, Cochrane and PEDro databases were used to conduct a literature search using keywords without restrictions. In this systematization, a search was conducted using the keywords: cerebral palsy, progressive resistance exercise, diplegia, gross motor function measure (GMFM). Literature have shown that the restrict capacity to generate force is as debilitating or more than it is the muscle spasticity, potentially causing more restriction to the movement than the spasticity itself. Children with normal motor development, as well as carrying spastic diplegia increase their capacity to generate strength when submitted to a resistive training, not only on lower limbs, but also on upper limbs. Furthermore, several studies have shown that diplegic cerebral palsy children improve their motor ability due to strength training, thought it still remains to be proved that strength training leads to a substantial change for the better allowing that there is ascension of category for functional capacity.

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RESUMO

El síndrome de Moebius conocido también como diplejia facial congénita o agenesia nuclear, es una enfermedad neurológica congénita poco frecuente en la que se ven afectados los núcleos de origen de los pares craneales VI y VII, impidiendo su total desarrollo. Aunque su etiología es idiopática se asocia al uso de sustancias teratógenas, tales como cocaína, talidomida, misoprostol, etc. Se describe el caso clínico de un paciente de 11 meses de edad cuya madre usó tabletas de misoprostol por vía vaginal (400 mcg),durante el primer trimestre de gestación, con fines abortivos, presentando al nacimiento defectos congénitos. El misoprostol es un análogo de la prostaglandina E1 y fue creado para el tratamiento de la úlcera gástrica, pero, además posee acción uterotónica y tiene capacidad de maduración del cuello uterino. Si se lo usa al final de la gestación colabora como buen inductor del parto, no siendo así en el primer trimestre de gestación, donde los efectos son devastadores provocando un aborto, o en su defecto, genera déficit en la irrigación sanguínea, afectando el desarrollo embriológico del nuevo ser. En países donde el aborto no es legal, el misoprostol se emplea para la interrupción del embarazo, sin embargo la infrecuente supervisión profesional, llevan a que algunos de los embarazos continúen produciendo exposición prenatal al misoprostol, lo cual está asociado con la ocurrencia de anomalías congénitas. El presente trabajo demuestra la injerencia del misoprostol como agente teratógeno durante el primer trimestre de embarazo y posible inductor al desarrollo del síndrome de Moebius.

The Moebius syndrome, also known as congenital facial diplegia or nuclear agenesis, is a rare congenital neurological disorder which affects the nuclei of origin of cranial nerves VI and VII, preventing their full development. Although etiology is idiopathic, it is associated with the use of teratogenic substances such as cocaine, thalidomide, misoprostol, etc. The clinical case of an 11-month old patient is described, whose mother used misoprostol tablets vaginally (400 mcg) during the first trimester of pregnancy with abortive purposes, presenting birth defects. Misoprostol is a prostalglandin E1 analogue and was created for the treatment of gastric ulcer, but also has an uterotonic action and the capacity to ripen the cervix. If it is used at the end of the pregnancy, it works as a good inducer of birth, not so in the first trimester of pregnancy, where the effects are devastating causing an abortion, or otherwise, creating deficits in blood supply, affecting the embryological development of the new being. In countries where abortion is illegal, misoprostol is used for the termination of pregnancy, but the lack of professional supervision causes some of the pregnancies to continue, producing prenatal exposure to misoprostol, which is associated with the occurrence of congenital anomalies. This study demonstrates the interference of misoprostol as a teratogen in the first trimester of pregnancy and as thepossible inducer of the development of the Moebius syndrome

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