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Examination of Gait in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Nirmal Raj Gopinathan
The description of gait in spastic hemiplegia by Winters et al.10 is the most widely accepted classification and is based mainly on the sagittal plane kinematics (Figure 3.7, Table 3.2).
Neurology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Fenella Kirkham, Adnan Manzur, Stephanie Robb
In a long-standing pyramidal disorder, there is ‘clasp-knife’ rigidity accompanied by increased tendon reflexes and upgoing plantar responses. For further details, see Cerebral palsy (page 225) – spastic hemiplegia and quadriparesis.
The Cerebral Palsies
Published in Michele Kiely, Reproductive and Perinatal Epidemiology, 2019
Spastic hemiplegia is disproportionately represented in postnatal cases, although other types are found, but again these proportions depend on the definitions used and the hazards most common in any given society.
The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis
Published in Disability and Rehabilitation, 2022
Therese Ramström, Lina Bunketorp-Käll, Johanna Wangdell
Between June 2018 and March 2020, a total of 33 individuals underwent spasticity-correcting surgeries in the UL. Of those, 15 individuals were not eligible since no gains as a result of surgery could be expected in terms of uni- or bimanual activities in daily life or increased supportive use of the treated arm. Six were excluded due to cognitive difficulties that hindered reflection upon the intervention’s effect, and four individuals were excluded due to language difficulties. Eight patients were thus eligible and accepted to participate in the study. In six patients, spasticity was due to SCI; three had bilateral UL impairment, and three had incomplete unilateral injuries. The remaining two patients had unilateral spastic hemiplegia due to stroke. The mean age of the patients was 62 years (range 49–78 years). The mean time since injury was eight years (range 1–18 years). In four cases, the goal of surgery was to improve volitional muscle control and thereby enable use of the affected arm in unimanual activities. In the remaining four cases, the goal was to improve use of the affected arm in bimanual UL activities. The type of ambulation reported by patients were wheelchair (n = 4) and walking (n = 4). The participants were geographically dispersed all over Sweden. The interviews took place at a mean of 7.6 months after the surgery (range 6–9 months) (Tables 1 and 2).
Characteristics of the severely impaired hand in survivors of stroke with chronic impairments
Published in Topics in Stroke Rehabilitation, 2022
Alexander J. Barry, Derek G. Kamper, Mary Ellen Stoykov, Kristen Triandafilou, Elliot Roth
Substantial coactivation of antagonist muscles during voluntary task performance was also present. During attempted MCP extension torque production with the paretic hand, participants created an average of 30% MVC activation of FDS, a value almost 4 times as great as that created by neurologically intact individuals during this task.14 The more impaired participants (CMSA-H2 group) created 50% MVC activation of FDS. As with the spasticity measure, FDS coactivation was significantly negatively correlated with voluntary MCP flexion torque generation. Thus, the hypertonicity did not lead to greater voluntary force production. EDC coactivation was also observed during attempted MCP flexion, with numerous subjects creating greater EDC activation during flexion than during extension, potentially contributing to the force deficits in grip and MCP flexion torque. Diminished reciprocal inhibition, specifically in participants with spastic hemiplegia, is thought to contribute to this excessive coactivation.38 In support of the diminished reciprocal inhibition hypothesis, we also observed EDC activation of greater than 10% of maximum activation coincident with an evocation of a spastic FDS reflex.
Virtual reality training improves dynamic balance in children with cerebral palsy
Published in International Journal of Developmental Disabilities, 2021
Morteza Pourazar, Fazlolah Bagherzadeh, Fatemeh Mirakhori
Abnormal body fluctuations are caused by several factors, one of them is cerebral palsy (Miller 2007). Cerebral palsy is a congenital neuromuscular disorder that can occur in the age range of fertilization up to 2 years after birth (Miller 2007). The word ‘cerebral’ means being related to the brain. The word ‘palsy’ means having problems with body movement. Cerebral palsy (CP) points to a group of disorders that affect muscle movement (Miller 2007). One of the most common forms of cerebral palsy is spastic hemiplegia due to one-sided injury to the motor cortex or pyramidal pathway. In this particular type of cerebral palsy, muscles in the opposite side of affected brain region have an eclipse state that are reflected in the increase of sensitivity to normal tensile reflections; as a result, movements of the more damaged limbs are often slow and jerky (Miller 2007). CP is characterized by impaired motor control and delayed motor milestones. Defect in balance control is a restrictive factor in motor growth of children with cerebral palsy. Clinical conditions of cerebral palsy include neuromuscular deficits such as lack of selective motor control and changes in muscle tone, leading to an imbalance between the agonist and antagonist muscles, sensory changes and weaknesses (Shumway-Cook et al. 2003).