Desempenho funcional de crianças com mielomeningocele

This study aimed at analysing the impact of level of lesion, locomotion, and neurological changes associated to meningomyelocele clinical framework concerning functional performance. For this prospective cross-sectional study 40 children with meningomyelocele were assessed as to level of lesion, ambulatory ability, Arnold-Chiari malformation, hydrocephalus, hydromyelia, tethered cord, and sphincter incontinence. Functional performance was evaluated by the Pediatric Evaluation of Disability Inventory (PEDI) which quantitatively assesses functional performance and independence in daily activities in the areas of self-care, mobility, and social functioning. Collected data were statistically analysed and the significance level set at pEste trabalho visou analisar o impacto dos níveis de lesão, deambulação e alterações neurológicas associadas ao quadro clínico da mielomeningocele sobre o desempenho funcional de seus portadores. Neste estudo transversal prospectivo foram examinadas 40 crianças com mielomeningocele, avaliando-se nível de lesão, deambulação, malformação de Arnold-Chiari, hidrocefalia, hidromielia, medula ancorada e incontinência esfincteriana. O desempenho funcional foi avaliado pelo Pediatric Evaluation of Disability Inventory (PEDI), para um registro quantitativo da capacidade funcional e autonomia nas atividades cotidianas, nas áreas de autocuidado, mobilidade e função social. Os dados coletados foram analisados estatisticamente, estabelecendo-se o nível de significância em

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial

Background: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. Methods/design A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. Discussion This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. Trial registration ReBEC RBR-9B5DH

Craniopharyngioma: treatment with intratumoral bleomycin

Foram estudados 52 pacientes com craniofaringioma submetidos ao protocolo para tratamento com bleomicina intratumoral. O tratamento foi dividido em tres fases: colocacao do cateter intratumoral, controle radiologico e injecao do farmaco intratumoral. Doze (23 por cento) pacientes foram excluidos na fase 1 e 2 de tratamento. Entre os pacientes que chegaram a fase 3,um (1,9 por cento) foi excluido apos a primeira dose de bleomicina por vazamento do quimioterapico. As exclusoes por vazamento do sistema foram relacionadas a tecnica cirurgica utilizada, 21,4 por cento (3/14) dos pacientes submetidos a cirurgia por estereotaxia; 18,8 por cento (2/11) dos pacientes submetidos a puncao direta; 11,5 por cento (3/26) dos pacientes submetidos a craniotomia. Entre os 39 pacientes tratados com quimioterapia intratumoral, 30 (77 por cento) tiveram as medidas dos tamanhos dos craniofaringiomas aferidas antes do inicio do tratamento e apos o mesmo. Nos pacientes em que o craniofaringioma nao tinha sido tratado previmamente, a resposta no pos-tratamento com diminuicao do tamanho tumor foi significante. Esta variavel tambem foi significante avaliando o grupo com idade maior do que a mediana das idades. A recidiva apos o tratamento foi mais significante nos pacientes do grupo com idade menor ou igual a mediana das idades. Vinte e oito pacientes (71,8 por cento) recidivaram em algum momento do acompanhamento. Destes, 23 (58,9 por cento) foram submetidos a uma abordagem cirurgica para o tratamento do craniofaringioma. Em 16 (41 por cento) pacientes o craniofaringioma foi controlado sem nova cirurgia apos o uso da quimioterapia intratumoral. Dez pacientes (25,6 por cento) necessitaram de um segundo ciclo de bleomicina e 4 (10,2 por cento) receberam um terceiro ciclo de tratamento. A dosagem da desidrogenase latica (DHL) nao mostrou resultados relacionados a meihor ou pior resposta ao tratamento. A funcao visual apos tratamento teve melhora de 100 por cento do papiledema, com melhora tambem da acuidade em 31 por cento e no campo visual, melhora de 14 por cento. Dois pacientes (5,1 por cento) desenvolveram diabetes insipidus apos o tratamento com bleomicina intratumoral. No acompanhamento de 3 ate 13 anos (media = 6 anos), a mortalidade entre os 52 pacientes acompanhados foi de 15 por centoBV UNIFESP: Teses e dissertaçõe

A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial

Objective: Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy.Design: Randomized controlled clinical trial.Setting: Physical therapy clinics.Subjects: Thirty-six children with cerebral palsy (levels I-III of the Gross Motor Functional Classification System) randomly divided into two intervention groups.Interventions: Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up.Results: Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. the experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up (p < 0.05).Conclusion: Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Nine July, São Paulo, BrazilCtr Pediat Neurosurg CENEPE, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Motor Cortex Plasticity in Children With Spastic Cerebral Palsy: A Systematic Review

A review of the literature was performed to answer the following questions: Does motor cortex excitability correlate with motor function? Do motor cortex excitability and cortex activation change after a rehabilitation program that results in improvements in motor outcomes? Can the 10–20 electroencephalography (EEG) system be used to locate the primary motor cortex when employing transcranial direct current stimulation? Is there a bihemispheric imbalance in individuals with cerebral palsy similar to what is observed in stroke survivors? the authors found there is an adaptation in the geometry of motor areas and the cortical representation of movement is variable following a brain lesion. The 10–20 EEG system may not be the best option for locating the primary motor cortex and positioning electrodes for noninvasive brain stimulation in children with cerebral palsy