BACKGROUND: During late pregnancy and the puerperium cerebral venous and sinus thrombosis (CVST) is a rare but important cause of stroke. Despite adequate anticoagulation some patients deteriorate, which may warrant the use of more aggressive treatment modalities. CASE REPORT: A 29-year-old pregnant woman (29th week of pregnancy) presented with diffuse headaches and a progressive left hemiparesis. MRI revealed a CVST involving the superior sagittal sinus, the left lateral sinus, and the rectal sinus. Furthermore, it showed a space occupying brain edema and a congestional bleeding within the frontal and parietal lobes on the right side. Despite immediate intravenous anticoagulation and treatment with mannitol the patient developed a progressive loss of consciousness and unilateral third nerve palsy as a result of a beginning transtentorial herniation. Due to the severe course of the CVST an urgent decompressive craniectomy and shortly thereafter a cesarean section were performed. The patient made an excellent recovery. CONCLUSION: While previous reports have demonstrated the feasibility of decompressive hemicraniectomy in selected patients with CVST and beginning herniation due to space occupying brain edema, venous infarction and congestional bleeding with mass effect, our rare case supports the notion that this procedure can also be life-saving in pregnant women.

OBJECTIVE: To probe into an effective therapy for treatment of cerebral palsy of involuntary movement. METHODS: Sixty cases were randomly divided into two groups, the control group was treated with routine rehabilitation method (Bobath + Tuina + scalp acupuncture), while the observation group was treated with plum-blossom needle on Governor Vessel and point Jiaji (EX-B 2) on the basis of routine rehabilitation method. After 3 months of treatment, therapeutic effect, total percentage of Gross Motor Function Measurement (GMFM), incurvation reflex and muscular tension fluctuation were compared. RESULTS: The obvious effective rate of 53.3% (16/30) in the observation group was superior to that of 20.0% (6/30) in the control group (P < 0.05); the total percentage of GMFM increased, incurvation reflex disappeared, muscular tension fluctuation relieved in both groups after treatment (P < 0.05, P < 0.01), but the indices above all improved more significantly in the observation group than those in the control group (P < 0.05, P < 0.01). CONCLUSION: Plum-blossom needle on Governor Vessel and point Jiaji (EX-B 2) on the basis of routine rehabilitation method for treatment of cerebral palsy of involuntary movement can enhance the gross motor function, make the incurvation reflex disappear effectively, relieve the muscular tension fluctuation.

Objective: The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children. Methods: In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training. Results: Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training. Conclusions: The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

INTRODUCTION: Spasticity is an important medical and social problem with a high rate of incidence both in childhood, where it is mainly a result of infantile cerebral palsy, and in adults, where it is frequently brought about by a cerebrovascular accident, traumatic brain injury, spinal cord injury or multiple sclerosis, among other pathologies. It gives rise to important problems that have a significant effect on the quality of life of patients and their caregivers. Clinical practice guidelines (CPG) are instruments that help professionals, administrators and planners to make decisions that can improve clinical outcomes. DEVELOPMENT: Due to the complexity of spasticity, its evaluation and treatment should be carried out by specialised units using a multidisciplinary approach. One of the first-line treatment options is botulinum toxin type A (BTA). For this treatment to be successful and to be able to evaluate the patient’s progress, it is advisable to have a work protocol that includes the knowledge and tools necessary to use BTA in the most suitable way and in agreement with the available scientific evidence. All these factors led the Spasticity Unit to consider the need to draw up a set of CPG. CONCLUSIONS: These CPG have been in use at the Hospital Universitari Mutua de Terrassa for 15 years, and are updated on a regular basis. This has enabled us to carry out a standardised selection of spastic patients and to establish a clear-cut set of treatment goals. It has also allowed us to implement a suitable plan regarding follow-up, the adjuvant therapies needed for each of the patients and an evaluation of results that is as objective as possible.

OBJECTIVES: Information obtained from families is of particular importance in the evaluation of functional mobility skills of children with cerebral palsy (CP) after orthopedic interventions and long-term rehabilitation applications. This study was designed to evaluate the interobserver reliability of the Gillette Functional Assessment Questionnaire (FAQ) which was administered to the mothers and the physiotherapist for children with CP. METHODS: The study included 52 spastic diparetic children with CP (22 girls, 30 boys; mean age 7.8+/-4.4 years; range 4 to 12 years) and their mothers. According to the Gross Motor Function Classification System (GMFCS), all the children were in level 1 to 3. The Gillette FAQ was administered to the mother and physiotherapist to determine the functional walking level of the child and the interobserver reliability of the FAQ was calculated. In addition, gross motor performance was evaluated by the standing and walking-running-jumping dimensions of the Gross Motor Performance Measure (GMPM), and functional independence level was evaluated by the transfer and locomotion dimensions of the Functional Independence Measure for Children (WeeFIM). Correlations were sought between the FAQ results of the physiotherapist and mothers and the GMFCS, GMPM, and WeeFIM. RESULTS: The intraclass correlation coefficient for interobserver reliability of the Gillette FAQ was 0.94 (95% CI 0.898-0.966). A highly significant correlation was found between the responses of the mother and physiotherapist to the Gillette FAQ (r=0.882, p<0.01). The responses of the mother and physiotherapist to the Gillette FAQ showed a negative correlation with the GMFCS level, and positive correlations with the dimensions of the GMPM and WeeFIM studied (p<0.01). CONCLUSION: The Gillette FAQ can be used by the physiotherapists to determine the functional changes in spastic diparetic children with CP and can help clinicians derive important information from the families about functional walking of their children.

BACKGROUND: Morbidity attributable to hypoxic-ischaemic injury (HIE) in the perinatal period remains problematic, and timely and accurate assessment of the degree of injury is required for clinical management and prognosis. Conventional MR sequences typically appear normal in the first 48 h post HIE. While diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps register the injury earlier, perhaps within the first 24 h, it has been suggested that there may be a propensity at that early stage to underestimate the lesion severity or extent. OBJECTIVE: To assess whether MR imaging that included DWI, measured ADC values and T1- and T2-weighted sequences ultimately correlated with either neurodevelopmental outcome or with late MR imaging at 2 years of age. In addition, we wished to compare the performance of MR imaging with cranial US imaging. MATERIALS AND METHODS: All infants presenting with HIE who had an MRI within 10 days of life were eligible for enrollment and subsequently underwent a full neurodevelopmental assessment at 2 years of age. All children underwent repeat MRI at this time. All neonates had at least one cranial US study. The US findings were categorized as normal, abnormalities confined to the cerebral cortex and subcortical white matter, isolated central grey matter hyperechogenicity, and central hyperechogenicity combined with cerebral cortical/subcortical changes. All MRI studies were retrospectively reviewed by three radiologists. The patterns of injury on the early DWI and ADC maps and early T1- and T2-W studies were recorded as diffuse, central, watershed or atypical. The patterns of signal abnormality were assessed using a scoring system that yielded four separate scores [basal ganglia (BG), watershed (W), BG/W and summation (S)] for the three sets of images, a total of 12 scores in all. The appearance of the posterior limb of the internal capsule (PLIC) on T1-W inversion recovery sequences and of the corpus callosum on all sequences was also documented. After detailed neurodevelopmental assessment at 2 years of age, infants were classified into two groups according to whether they had a favourable or unfavourable outcome. RESULTS: Of the 26 infants, 6 infants died before formal assessment at the age of 2 years. A further 5 infants had moderate to severe cerebral palsy in addition to severe cognitive impairment. The remaining 15 infants were categorized in the favourable outcome group. The US appearance performed well in terms of predicting final outcome (P = 0.005). The pattern of ischaemia seen on early MRI was a significant predictor of outcome (P < 0.0001). The BG, BG/W and S scores of the diffusion imaging were significantly associated with outcome (P < 0.0001, P < 0.0001 and P = 0.0005 respectively). DWI was predictive of outcome group (P < 0.0001), as were the early T1- and T2-W sequences (P = 0.002) and cranial US (P = 0.005). Assessment of the PLIC in infants with watershed or atypical patterns of ischaemia was found to be less reliable in predicting outcome. The measured ADC value in the PLIC was significantly reduced in those children who had an unfavourable outcome (P = 0.03). CONCLUSION: While early MRI performed better than cranial US, the sonography findings were useful. The pattern of ischaemia on early MRI was a good predictor of prognosis. All infants with watershed or atypical patterns had a favourable outcome. The majority of infants with central patterns of ischaemia had an unfavourable outcome and all infants with a diffuse pattern had an unfavourable outcome. DWI was predictive of outcome group, as were early T1- and T2-W sequences and cranial US.

Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the 'activity limitation' perspective of International Classification of Functioning, Disability, and Health (ICF) and to investigate the relationship between the two classification systems in different subtypes of cerebral palsy (CP). This prospective cross-sectional study was performed on 448 children with CP ranging from 4 to 15 years of age. Activity limitations were studied with the GMFCS for gross motor function and MACS for manual ability. The Spearman's correlation coefficient, contingency coefficient, and Cramer's V coefficient were used to assess the strength and significance of the association between GMFCS and MACS. The overall agreement between GMFCS and MACS was found to be 41%. The agreement was 42% in spastic children, 40% in dyskinetic children, 50% in ataxic children, and 28% in mixed type children. The overall kappa value was kappa=0.235 (P<0.001). The kappa coefficient was 0.252 in spastic children, 0.245 in dyskinetic children, 0.318 in ataxic children, and 0.023 in mixed type children. All the kappa coefficients except the value for the mixed type were found to be significant. The usage of two different classification systems, GMFCS and MACS, to describe the capacity and performance in children with CP as defined by the ICF provides an easy and quick classification tool for indicating 'activity limitations' of ICF in children with CP. The next step in research should be to highlight the other domains such as participation restrictions in these children.Ziel dieser Studie war die Evaluierung der Leistung und Leistungsfähigkeit laut Definition des GMFCS (System zur Messung und Klassifikation motorischer Funktionen) und des MACS (System der Klassifikation der manuellen Fähigkeiten) aus der Perspektive der 'Einschränkungen der Aktivitäten' der internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) sowie die Untersuchung der Beziehung zwischen beiden Klassifikationssystemen in unterschiedlichen Subtypen der Zerebralparese (CP). An dieser prospektiven Querschnittsstudie nahmen insgesamt 448 Kinder mit CP im Alter von 4 bis 15 Jahren teil. Einschränkungen der Aktivität wurden anhand der Systeme GMFCS für körpermotorische Fähigkeiten und MACS für manuelle Fähigkeiten untersucht. Der Korrelationskoeffizient nach Spearman, der Kontingenzkoeffizient und der Cramer-V-Koeffizient wurden zur Beurteilung der Intensität und Bedeutung der Verbindung zwischen GMFCS und MACS herangezogen. Insgesamt stimmten die Systeme GMFCS und MACS zu 41% überein. Die Ubereinstimmung lag bei Kindern mit spastischer CP bei 42%, bei Kindern mit dyskinetischer CP bei 40%, bei Kindern mit ataktischer CP bei 50% und bei Kindern mit einer Mischform der CP bei 28%. Der Gesamtwert kappa lag bei kappa=0.235 (P<0.001). Der kappa-Koeffizient lag bei Kindern mit spastischer CP bei 0.252, bei Kindern mit dyskinetischer CP bei 0.245, bei Kindern mit ataktischer CP bei 0.318 und bei Kindern mit einer Mischform der CP bei 0.023. Alle kappa-Koeffizienten mit Ausnahme des Wertes für die Mischform der Zerebralparese erwiesen sich als signifikant. Die Verwendung von zwei unterschiedlichen Klassifikationssystemen – GMFCS und MACS – zur Beschreibung der Leistungsfähigkeit und Leistung von Kindern mit CP laut ICF-Definition ist ein Klassifikationstool, mit dem sich Einschränkungen der Aktivitäten" bei Kindern mit CP leicht und schnell aufzeigen lassen. Als nächstes sollte die Forschung andere Domänen wie beispielsweise die Einschränkungen bei der Partizipation (Teilhabe) dieser Kinder am Leben in der Gesellschaft hervorheben.Nuestro propósito en este estudio fue evaluar el rendimiento y la capacidad, según el Sistema de Clasificación de la Función Motora Global (SCFMG) y el Sistema de Clasificación de la Destreza Manual (SCDM), en lo relativo al dominio limitaciones para la ejecución de actividades de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), e investigar la relación entre dichos dos sistemas de clasificación en los distintos subtipos de la parálisis cerebral infantil (PCI). En este estudio transversal prospectivo participaron 448 niños de entre 4 y 15 años de edad con PCI. Para la exploración de las limitaciones para la realización de actividades se utilizaron el SCFMG, en el caso de la función motora global, y el SCDM, en el caso de la destreza manual. Para determinar la magnitud y significación de la asociación entre el SCFMG y el SCDM se utilizaron el coeficiente de correlación de Spearman, el coeficiente de contingencia y el coeficiente V de Cramer. La concordancia general entre los resultados del SCFMG y del SCDM fue del 41%. La concordancia fue del 42% en los niños que padecen espasticidad, del 40% en los niños con discinesias, del 50% en niños con ataxia, y del 28% en niños con cierta combinación de dichas afecciones. El valor general del coeficiente kappa fue de kappa=0.235 (P<0.001). Este coeficiente fue de 0.252 en los niños que padecen espasticidad, de 0.245 en los niños con discinesias, de 0.318 en niños con ataxia, y de 0.023 en niños con cierta combinación de dichas afecciones. Los valores del coeficiente kappa, excepto en el caso de los niños con el tipo mixto de la enfermedad, resultaron significativos. El uso de dos sistemas distintos de clasificación, el SCFMG y el SCDM, para determinar el grado de capacidad y de rendimiento, según se definen en la CIF, en niños con PCI constituye una herramienta de clasificación de uso fácil y rápido para determinar el grado de limitaciones para la ejecución de actividades, según la CIF, en niños con PCI. El siguiente paso en la investigación de estos niños sería explorar los otros dominios de esta clasificación, tales como las restricciones de estos niños para participar en actividades cotidianas.Notre objectif dans cette étude était d'évaluer la performance et la capacité telle qu'elles sont définies par le système de classification GMFCS des fonctions motrices (Gross Motor FunctionClassification System) et le système de classification MACS des capacités manuelles (Manual Ability Classification System) du point de vue de la limitation de l'activité selon la classification internationale ICF des fonctions motrices, du handicap et de la santé, et d'étudier la relation entre les deux systèmes de classification dans les différents sous-types d'infirmité motrice cérébrale. Cette étude prospective transversale a été réalisée sur 448 enfants âgés de 4 à 15 ans souffrant d'infirmité motrice cérébrale. Les limitations de l'activité ont été étudiées avec la classification GMFCS pour la fonction motrice globale et la classification MACS pour l'habileté manuelle. Le coefficient de corrélation de Spearman, le coefficient de contingence et le coefficient V de Cramer ont été utilisés pour évaluer la portée et la signification des associations entre GMFCS et MACS. Le taux de corrélation global entre GMFCS et MACS a été mesuré à 41%. La corrélation était de 42% chez les enfants handicapés moteur, 40% chez les enfants dyskinétiques, 50% chez les enfants ataxiques et 28% chez les enfants de type mixte. La valeur kappa globale était kappa=0.235 (P<0.001). Le coefficient kappa était de 0.252 chez les enfants handicapés moteur, 0.245 chez les enfants dyskinétiques, 0.318 chez les enfants ataxiques et 0.023 chez les enfants de type mixte. Tous les coefficients kappa, à l'exception de la valeur correspondant au type mixte, ont été jugés significatifs. L'utilisation de deux systèmes de classification différents, GMFCS et MACS, pour décrire la capacité et la performance chez les enfants atteints d'infirmité motrice cérébrale telle que définie par l'ICF fournit un outil de classification simple et rapide pour indiquer les limitations de l'activité de l'ICF chez les enfants souffrant d'infirmité motrice cérébrale. L'étape de recherche suivante sera de mettre en évidence les autres domaines, tels que les restrictions à la participation, chez ces enfants.

In departments of neurology, neurosurgery and hospice care there is a group of patients with compete motor function impairment having normal central nervous system function. Victims of spinal cord injury, cerebral palsy, cerebral stroke, loss of extremities, neuromuscular diseases, between others belong to them. Since two decades an intensive studies of use of brain waves to steer peripheral equipments has been performed. Brain Computer Interface and Brain-Machine Interface will allow in the near future for even partial restore of skills in permanently disabled patients. Recently new sets composed of games steered by brain waves have been introduced to the market. Exercises with such equipment will help to control an ability to concentrate and precise steer of the peripheral electronic equipments. The next phase will be use of the new skills to steer the wheelchairs and other computer programs with the brain signals to control own healthy organs or artificial machines.

We studied the effect of botulinum toxin A injections to the lower extremities of spastic cerebral palsy children on upper limb body function and occupational performance. A total of 16 children with spastic cerebral palsy, aged 2 to 8 years, Gross Motor Function Classification System levels I-IV, referred to a child neurology outpatient clinic for botulinum toxin A injections to the lower limbs, underwent 4 assessments: 1 month prior to injection, immediate pre injection, and at 1 and 5 to 6 months post injection. Three tools were used to test everyday function (Canadian Occupational Performance Measure and the Pediatric Evaluation of Disability Inventory) and upper extremity body function (Quality of Upper Extremity Skills Test). Significant improvement was documented between the immediate preinjection and the 2 postinjection assessments, indicating that improvement lasted for at least 6 months. Botulinum toxin A injections to the lower extremities in children with cerebral palsy improve upper limb body function and occupational performance.