Clinical Study on Improving Articulation Clarity in Spastic Cerebral Palsy with 120 Cases of Oral-Facial Acupressure Combined with Oral Placement Therapy

Objective:To observe the efficacy of oral-facial acupressure combined with oral placement therapy(OPT)in improving articulation clarity in 120 children with spastic cerebral palsy,and to explore effective therapeutic solutions for speech disorders associated with spastic cerebral palsy.Methods:A total of 120 children with spastic cerebral palsy and speech disorders,meeting the inclusion criteria,were randomly assigned into two groups:60 cases in the treatment group and 60 cases in the control group.The treatment group received orofacial acupressure combined with OPT,while the control group received only OPT.The Oral Motor Function Assessment Scale(OMFAS),developed by the China Rehabilitation Research Centre(CRRC),was used to evaluate the treatment outcomes before and after the intervention.Results:After the treatment,both the treatment and control groups showed improved mobility of the mandible,lips,and tongue.However,the treatment group exhibited significantly better improvement than the control group,with the difference between the two groups being statistically significant(P<0.05).Conclusion:Oral-facial acupressure combined with OPT can effectively improve articulation clarity in children with spastic cerebral palsy.This combined therapy is recommended for clinical promotion and application.

Systematic evaluation of the efficacy and safety of botulinum toxin type A in the treatment of spastic cerebral palsy

Background:Botulinum toxin type A(BTX-A)is a neuromuscular blocking agent.BTX-A inhibits acetylcholine release,causes neuromuscular transmission impairment,and decreases muscle spasms.Objective:To explore the efficacy and safety of BTX-A injection in the treatment of spastic cerebral palsy through systematic evaluation and to provide a reference for the clinical use of BTX-A.Methods:We used“Cerebral palsy”and“BTX-A”as the subject terms and used a combination of subject terms and free words for the search.We searched 7 databases,including CNKI,Wanfang,VIP,Sinomed,PubMed,Embase,and Web of science.Based on the inclusion and exclusion criteria,we screened the articles by reading their titles,abstracts,and full texts and finally included relevant literature for systematic evaluation.Result:A total of 93 papers were systematically evaluated,revealing that BTX-A injection treatment can effectively reduce muscle tone,increase joint mobility,improve gait and motor posture,and enhance gross motor movements in patients with spastic cerebral palsy.The benefits of BTX-A treatment can be sustained for 3–6 months,with motor ability improvement lasting up to 1 year.Combining BTX-A treatment with rehabilitation or external fixation therapy can enhance its efficacy.However,the effectiveness of BTX-A treatment is influenced by several factors,such as the dosage,number of injections,and patient age.Adverse reactions to BTX-A treatment are typically mild and can be relieved within 1–2 weeks.Conclusion:BTX-A injection is relatively safe but reversible.

Establishing a rat model of spastic cerebral palsy by targeted ethanol injection

Spastic cerebral palsy is generally considered to result from cerebral cortical or pyramidal tract damage. Here, we precisely targeted the left pyramidal tract of 2-month-old Sprague-Dawley rats placed on a stereotaxic instrument under intraperitoneal anesthesia. Based on the rat brain stereotaxic map, a 1-mm hole was made 10 mm posterior to bregma and 0.8 mm left of sagittal suture. A microsyringe was inserted perpendicularly to the surface of the brain to a depth of 9.7 mm, and 15 wL of ethanol was slowly injected to establish a rat model of spastic cerebral palsy. After modeling, the rats appeared to have necrotic voids in the pyramidal tract and exhibited typical signs and symptoms of flexion spasms that lasted for a long period of time. These findings indicate that this is an effective and easy method of establishing a rat model of spastic cerebral palsy with good reproducibility. Ethanol as a chemical ablation agent specifically and thoroughly damages the py- ramidal tract, and therefore, the animals display flexion spasms, which are a typical symptom of the disease.

Local injection of bortulinum toxin A at multiple points for decreasing the muscular tension of children with spastic cerebral palsy A comparative observation

More than 70% children with cerebral palsy belong to the spastic one, and the increased muscular tension results in motor dysfunction and posture abnormality. OBJECTIVE： To observe the assistant effect of the local injection of BTX-A at multiple points in the rehabilitative treatment of spastic cerebral palsy. DESIGN： A comparative observation on the clinical efficacy. SETTINGS： Rehabilitation Center, Loufeng Hospital, Suzhou Industrial Park; Gansu Rehabilitation Center Hospital. PARTICIPANTS： Sixty-nine children with cerebral palsy were selected from the outpatients and inpatients who accepted rehabilitative treatments in the Cerebral Palsy Treatment Center of Gansu Rehabilitation Center Hospital from April 2003 and October 2004. Inclusive criteria： ①Having high risk factors for brain injury before birth and within 1 month after birth, mainly manifested as central motor disorder and posture abnormality; ② Accompanied by increase of muscular tension in both lower limbs, appearing as tiptoes and scissors gaits while in standing position or walking; ③ Without fixed contracture of lower limb; ④ Had never been operated for lower limbs; ⑤ Had never been injected with BTX-A; ⑥ Clearly diagnosed to have spastic palsy. The enrolled children were not screened by disease conditions, course, age, etc., and informed consents were obtained from the parents of all the children. The children whose parents agreed to accept BTX-A treatment were taken as BTX-A treated group （n =45）, and the others as control group （n = 24）. METHODS： All the children accepted regular rehabilitative training after admission, 6 times a weeks, besides, those in the BTX-A treated group were given local injection of BTX-A at multiple points of target muscles, including bilateral adductor longus muscles, pectineal muscles, gastrocnemius muscles and soleus muscles. BTX-A was diluted with saline （5 U BTX-A in 0.1 mL）, 3 - 4 U/kg for each piece of muscle. The number of injected sites depended on the size of target muscle, and no more than 0.5 mL for each site. The injection should be followed by manual massage for 1 - 2 minutes, and electromuscular stimulation for 20 minutes, which were continued for 3 days. They participated in the comprehensive rehabilitative training and treatment at 24 hours after injection. MAIN OUTCOME MEASURES： The comprehensive abilities of cerebral palsy were evaluated, the adductor angle and forced area on soles were measured before treatment and at 3 and 6 months after treatment. RESULTS： All the 69 children with spastic cerebral palsy were involved in the analysis of results. ① Efficacy in the BTX-A treated group： BTX-A began to take effect at 48 hours after injection, and the maximal effect was observed in all the cases on the 6th day; 2 weeks later, the scissors gaits and hip adduction were obviously improved in 39 and 11 cases, respectively, and tiptoes gaits were improved in 22 cases; 2 months later, tiptoes gaits were improved in 43 cases. ② Efficacy in the control group： Two months later, certain improvements of scissors gaits were observed in 2 children with mild cerebral palsy; the scissors gaits and tiptoes were obviously improved in 6 cases of moderate cerebral palsy and 3 cases of mild one after 3 months, and there were changes of the parameters after 6 months in 1, 10 and 5 cases of severe, moderate and mild cerebral palsy, respectively. ③ Improvement of adductor angle before and after treatment in both groups： The muscular tension was evaluated according to Komam＇s method. There was no obvious difference in the adductor angle between the two groups before treatment （P 〉 0.05）. The adductor angle had very significant difference （P 〈 0.01） and significant difference （P 〈 0.05） between the two groups at 3 and 6 months after treatment. ④ Changes of forced area on soles before and after treatment in bothgroups： The forced area on soles was assessed referred to the method of foot-print analysis. There was no obvious difference in the forced area on soles between the two groups before treatment （P 〉 0.05）. The forced area on soles had very significant difference （P 〈 0.01） and significant difference （P 〈 0.05） between the two groups at 3 and 6 months after treatment. CONCLUSION： BTX-A local injection is an important assistant therapeutic method for treating spastic cerebral palsy. For the patients with moderate and severe cerebral palsy, BTX-A local injection should be combined with rehabilitative training to obviously shorten the course and improve efficacy.

Research progress of Chinese and Western medicine on spastic cerebral palsy in children in recent ten years

In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatment of children with spastic cerebral palsy in the world.This study summarizes the latest progress of traditional Chinese and Western medicine in the treatment of children with spastic cerebral palsy in recent years,hoping that the whole work can serve as a clinical and theoretical basis and provide certain reference significance.

Comparison of Electroacupuncture and Body Acupuncture on Gastrocnemius Muscle Tone in Children with Spastic Cerebral Palsy: A Single Blinded, Randomized Controlled Pilot Trial

Objective:To compare the immediate effects of electroacupuncture(EA)and body acupuncture(BA)on gastrocnemius muscle tone in children with spastic cerebral palsy(CP).Methods:Children with spastic CP,age from 24 to 60 months,who all received rehabilitation treatment in the Department of Developmental and Behavioral Pediatrics,the First Hospital of Jilin University from April 2016 to May 2017 were enrolled in this trial and assigned to EA group and BA group through a random number table.Both EA and BA therapies were performed on acupoints of Zusanli(ST 36),Shangjuxu(ST 37),Sanyinjiao(SP 6),and Xuanzhong(GB 39)for 30 min once.The root mean square(RMS),integrated electromyogram(iEMG)of the gastrocnemius of surface electromyography(sEMG),and Modified Tardieu Scale(MTS)of the two groups were evaluated before and after treatment.All adverse events were accurately recorded.Results:Thirty-six children with spastic CP completed the study(18 cases and 32 legs in the EA group;18 cases and 31 legs in the BA group).There was no significant difference in RMS,iEMG and MTS between the two groups before treatment(P>0.05).After treatment,compared with before treatment,RMS and iEMG significantly reduced and MTS(R2–R1)significantly increased in both EA and BA groups(P<0.05),and EA was more effective than BA in RMS and MTS(P<0.05).However,the iEMG between the two groups were not statistically significant after treatment(P>0.05).There was no serious adverse event during this clinical trial.Conclusion:Both EA and BA could significantly relieve the gastrocnemius muscle tone in spastic CP,and EA was more effective than BA.

Gait analysis of children with spastic hemiplegic cerebral palsy

An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebra palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.

A Randomised Controlled Study to Investigate Effects of Bobath Based Trunk Control Training on Motor Function of Children with Spastic Bilateral Cerebral Palsy

Purpose: The aim of this study was to investigate the effects of trunk control on motor function, which plays an important role in the daily activities of children with Cerebral Palsy (CP) and is often observed as a deficiency in children with CP. Material and Methods: Forty children with spastic bilateral CP, ages between 3 to 10 years and with Gross Motor Function Classification System (GMFCS) level I, II, and III were included in this study. Children were divided into two groups using randomization and in training group;Bobath Therapy for trunk control in addition to classical physiotherapy programs was performed for 45 minutes, for two days a week, for 6 weeks. In control group, existing physiotherapy program, 45 minutes for two days a week, continued. Any addition was not made into the existing program of the control group. Modified Ashworth Scale (MAS), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), 1 Minute Walking Test (1MWT), Timed Up and Go Test (TUG) were applied to both groups before and after 6 weeks. Moreover, trunk muscle strength of children was evaluated. Results: After therapy, differences were found in results of MAS and PBBS, and trunk extensor strength between the training group and the control group in favor of the training group (p Conclusion: This study shows that adding exercises which aim trunk to conventional physiotherapy and exercise programs of children with CP, affects motor function positively.

Rehabilitative training effects of severe mixed-type cerebral palsy in children One case report

It has often been thought that severe spastic and athetoid cerebral palsy children respond poorly to rehabilitative training effects and have a poor prognosis after school age. The present study included a nine-year-old severe spastic and athetoid cerebral palsy boy, who received 2 years of physical therapy, supplemented with drugs and orthotic devices and who acquired good therapeutic effects. The beneficial rehabilitative effects were as follows： After discharge, primitive reflex disappeared, and both vertical reflex and parachute reflex were found; In the establishment of balance reflex, sitting position was rated as level III, and standing position was rated as level II. The boy could independently walk for 30-50 meters. In the assessment of muscle tone, the level was rated according to the Modified Ashworth Scale and was decreased from three, four to one, two, and the level rated according to the Clonus Scale decreased from V to II. Motor function was noticeably improved. The level was rated according to the Gross Motor Function Classification System and was decreased from V to II. The total score of 88 items of the Gross Motor Function Measure was increased from 6.1% to 72.2%. The Berg Balance Scale score increased from 0 to 42. The Holden Walking Functional Classification level increased from 0 to 3. The score of activities of daily living increased from 9.5 to 70. The symptoms of dysarthria were alleviated from severe to moderate, and those of salivation were alleviated from level V to level I. These results demonstrated that after systemic and scientific treatment and training, the spastic and athetoid cerebral palsy boy had the ability to walk independently and to care for himself.

Anesthesia management in a pediatric patient with complicatedly difficult airway:A case report

BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce.In addition to relatively more difficulties in the technique of endotracheal intubation,the time for manipulation is restricted compared to adults.Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.CASE SUMMARY A 9-year-old boy with spastic cerebral palsy,severe malnutrition,thoracic scoliosis,thoracic and airway malformation,laryngomalacia,pneumonia,and epilepsy faced the risk of anesthesia during palliative surgery.After a thorough preoperative evaluation,a detailed scheme for anesthesia and a series of intu-bation tools were prepared by a team of anesthesiologists.Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways.Given the age and medical condition of the patient,we kept him sedated with spontaneous breathing during endotracheal intubation.The endotracheal intubation was completed on the second attempt after the failure of the first effort.Fortunately,the surgery was successful without postoperative complications.CONCLUSION Dealing with difficult airways in the pediatric population,proper sedation allows time to intubate without interrupting spontaneous breathing.The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.

Occupational therapy with or without combined acupuncture on upper limb pain and hand functions in children with spastic hemiplegic cerebral palsy:A three-arm randomized,placebo-controlled trial

Objective:This study is conducted to investigate the effects of occupational therapy(OT) with or without combined acupuncture for upper limb pain and hand functions among children with spastic hemiplegic cerebral palsy.Methods:A total of 90 patients who met the inclusion criteria were enrolled in a three-arm randomized,placebo-controlled trial,and were allocated to mono-occupational therapy(OT) group(patients=30),OT combined with real-acupuncture(ORA) group(patients=30),and OT combined with placeboacupuncture(OPA) group(patients=30),respectively.In addition to receiving the conventional OT program as the basic treatment for total 8 weeks,patients in ORA and OPA group also received corresponding acupuncture treatment 5 days per week for the first two weeks,3 days per week for the next two weeks,2 days per week for another two weeks,and 1 day per week for the last two weeks.Non-communicating children’s pain checklist-revised scale(NCCPC-R) was used for assessing the upper limb pain among patients.Squeeze dynamometry,modified Ashworth scale(MAS),manual muscle testing(MMT),JebsenTaylor hand function test(JTHFT) and box and block test(BBT) were used for assessing various aspects of upper limb and hand functions among patients.Meanwhile,adverse effects were monitored and recorded.Results:After 8-week treatment,NCCPC-R global scores witnessed a dramatic decline in ORA group(P<0.05),but not in either OPA(P> 0.05) or OT group(P> 0.05).Dramatic increases were identified in both squeeze dynamometry scores and MMT scores in all three groups(all P <0.05).Furthermore,the increases of ORA group were more significant than those of another two groups(both P <0.05).There were no significant changes in MAS global scores in each group(all P> 0.05).The BBT global scores of all three groups significantly increased(all P <0.05) after treatment.Among them,the increase of the ORA group was more than that of the other two groups(P <0.05).The 8-week treatment also had a significant impact on several sub-tests of JTFHT in each group.No significant adverse event was reported.Conclusion:ORA is a potential and promising alternative therapy for mitigating upper limb pain as well as improving both upper limb and hand functions among children with spastic hemiplegic cerebral palsy.

Orthopedic treatment of the lower limbs in spastic paralysis

Spastic paralysis of the limb mainly results from the central lesion,in which spastic cerebral palsy is the common cause.Due to durative muscle spasm in spastic cerebral palsy,it is often accompanied by the formation of secondary musculoskeletal deformities,resulting in limb motor disability.Based on its pathogenesis,surgical treatment is currently applied:selective posterior rhizotomy(SPR)or orthopedic surgery.The primary purpose of early orthopedic surgery was simply to correct limb deformities,which usually led to the recurrence of deformity as a result of the presence of spasticity.With the application of SPR,high muscle tone was successfully relieved,but limb deformity was still present postoperatively.Therefore,this study aimed to elaborate on the management of orthopedic surgery,common deformities of the lower limb,and orthopedic operative methods;discuss the relationship between SPR and orthopedic procedure for limb deformity;and focus on the indications,timing of intervention,and postoperative outcome of different surgical methods.