Clinical and videofluoroscopic evaluation of swallowing inpatients with spastic tetraparetic cerebral palsy and athetosic cerebral palsy

Aim. To evaluate and to compare the findings of oral and pharyngeal phases of swallowing in children with both spastic tetraparetic cerebral palsy (STCP) and with athetosic cerebral palsy (ACP). Patients and methods. 11 children were evaluated, with their ages ranging from 10 months to 8 years old, through both clinical assessment and videofluoroscopic evaluation. Results. The children with STCP were more involved at the neurologic, clinical and speech-language and hearing aspects. At the oral phases all the children had presented some involvement. At the pharyngeal phases the clinical signs of aspiration were identified in 10 children. It was observed aspirations in 80% of children with STCP and in 67% with ACP The changes on swallowing were similar in both cerebral palsy groups, but the performance of the children with STCP was inferior Conclusion. The videofluoroscopy was an important method which makes possible the verification of aspirations, helping the professionals at the therapeutical program for these children.42846246

Developmental language disorder associated with polymicrogyria

Background: Subtle disorders of neuronal migration occur in the brains of some dyslexic patients who presented developmental language disorder (DLD) during early childhood. Objective: To investigate a possible neuroanatomical substrate based on neuroimaging evaluation in children with DLD. Methods: The authors obtained psychological assessment, language evaluation, neurologic examination, and neuroimaging investigation. Inclusion criteria were as follows: children should be at least 4 years of age; primary complaint of language delay; normal hearing; IQ >70; and an informed consent form signed by parents or guardians. Exclusion criteria were severe motor and cognitive handicap. Results: Fifteen children met all inclusion criteria. Ages ranged from 4 to 14 years and 11 were boys. Six patients presented diffuse polymicrogyria (PMG) around the entire extent of the sylvian fissure on MRI, and they had severe clinical manifestation of DLD: they did not speak at all or had mixed phonologic-syntactic deficit syndrome. Six children presented PMG restricted to the posterior aspects of the parietal regions, and they had a milder form of DLD: mainly phonologic programming deficit syndrome. The other three children had different imaging findings. Conclusions: Developmental language disorder can be associated with polymicrogyria and the clinical manifestation varies according to the extension of cortical abnormality. A subtle form of posterior parietal polymicrogyria presenting as developmental language disorder is a mild form of perisylvian syndrome.o TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.59224525

Efeito de um programa de fisioterapia funcional em crianças com paralisia cerebral associado a orientações aos cuidadores: estudo preliminar

O objetivo foi verificar o efeito de um programa de fisioterapia funcional para crianças com paralisia cerebral, associado a orientações aos pais e/ou cuidadores; e verificar a correlação entre as habilidades funcionais e a assistência do cuidador, utilizando o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Participaram quatro crianças entre 24 e 43 meses de idade, hemiplégicas, espásticas e nível I no sistema de classificação da função motora ampla (GMFCS). Foram realizadas quatro avaliações - uma antes do início do programa, as demais aos 30, 60 e 90 dias após a primeira -, empregando-se as partes I (Habilidades funcionais) e II (Assistência do cuidador) do PEDI. As crianças foram submetidas a sessões de uma hora de fisioterapia funcional três vezes por semana, durante três meses: duas vezes a sessão era de fisioterapia com base no conceito neuroevolutivo Bobath e uma vez, treino de atividades da vida diária. Também foram dadas orientações por escrito aos pais e/ou cuidadores quanto à assistência à criança, incentivando-os a praticá-la em casa. A análise dos resultados mostrou que, na última avaliação, as crianças obtiveram escores significativamente maiores que na primeira. Foi verificada correlação altamente significativa (r=1,0; p=0,083) entre as partes I e II. O programa de fisioterapia funcional associado às orientações aos pais e/ou cuidadores foi efetivo em melhorar o desempenho funcional de crianças nível I com hemiplegia espástica.The purpose was to verify the effect of a functional physical therapy program on children with cerebral palsy, associated to guidance to parents and/or caregivers; and to search for correlations between the child's functional abilities and caregivers' assistance, by means of the Pediatric Evaluation Disability Inventory (PEDI). Four hemiplegic, spastic children between 24 and 43 months old, classified at the Gross Motor Function Classification System level I, were submitted to four evaluations, the first prior to program onset, and the others 30, 60, and 90 days after the first one. PEDI parts I (Functional abilities) and II (Caregivers' assistance) were used. Caregivers were provided with written instructions on how to best deliver care at home. The physical therapy program consisted of three weekly 1-hour sessions for three months; two sessions were of physical therapy based on Bobath concept, and one, of daily activities training. The analysis of results showed children obtained a significantly higher score at the last assessment as compared to the first. A high, significant correlation was found between PEDI parts I and II (r=1.0; p=0.083). The functional physical therapy program associated to instructions to caregivers proved thus effective to improve the functional performance of level-I children with spastic hemiplegia

Hemiparetic cerebral palsy: etiological risk factors and neuroimaging Paralisia cerebral hemiparética: fatores de risco etiológico e neuroimagem

The purpose of this paper, which was conducted on 175 children with hemiparetic cerebral palsy (H-CP), was to verify the etiological risk period for this disease. Etiological risk factors (ERF) were detected through anamnesis: 23% in the prenatal period, 18% in the perinatal period and 59% of the patients the period was undefined (ERF in the prenatal and perinatal period was 41% and no ERF was 18% of the cases. The computerized tomographic scan (CT) and MRI were performed on all the patients, who were then classified according to their etiopathogenic data: CT1= normal (18%); CT 2= unilateral ventricular enlargement (25%); CT 3= cortical/ subcortical cavities (28%); CT4= hemispheric atrophy and other findings (14%); CT 5= malformations (15%). CT 5 was associated with physical malformations beyond the central nervous system and with prenatal ERF's , while CT 2 was associated with the perinatal ERF's, mainly in premature births. Magnetic resonance imaging was performed on 57 patients and demonstrated a good degree of concordance with the CT. Etiology remained undefined in only 37% of the cases after neuroimaging was related to ERF. A high perinatal RF frequency (59%) was observed and emphasized the need for special care during this period.<br>Foram estudadas 175 crianças com paralisia cerebral hemiparética (PC-H) para elucidar o período de risco etiológico. Através da anamnese constataram-se fatores de risco para etiologia (FRE) pré-natal em 23%, perinatal em18% e período indefinido em 59% dos pacientes (com FRE pré e perinatal 41% e sem FRE 18%). A tomografia computadorizada (TC) foi realizada em todos os sujeitos e classificada de acordo com dados etiopatogênicos em: TC1= normal (18%); TC2= alargamento ventricular unilateral (25%); TC3= cavidades córtico-subcorticais (28%); TC4= atrofia hemisférica e outros achados (14%); TC5= malformações (15%). A TC5 se associada a malformações físicas fora do sistema nervoso central e aos FRE pré-natais e a TC2 aos perinatais, principalmente, nascer prematuro. A ressonância magnética foi realizada em 57 sujeitos demonstrando boa concordância com a TC. Após associação da neuroimagem e FRE a etiologia ficou indefinida em apenas 37%. Constatou-se alta frequência de FRE perinatais (59%), alertando para melhores cuidados neste período