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A Critical Review of Constraint-Induced Movement Therapy and Forced Use in Children With Hemiplegia  [PDF]
Jeanne Charles,Andrew M. Gordon
Neural Plasticity , 2005, DOI: 10.1155/np.2005.245
Abstract: Hemiplegia is a physical impairment that can occur in childhood following head trauma, cerebral vascular accident or transient ischemic attack (stroke), brain tumor, or congenital or perinatal injury. One of the most disabling symptoms of hemiplegia is unilaterally impaired hand and arm function. Sensory and motor impairments in children with hemiplegia compromise movement efficiency. Such children often tend not to use the affected extremity, which may further exacerbate the impairments, resulting in a developmentally learned non-use of the involved upper extremity, termed ‘developmental disuse’. Recent studies suggest that children with hemiplegia benefit from intensive practice. Forced use and Constraint-lnduced Movement Therapy (CI therapy) are recent therapeutic interventions involving the restraint of the non-involved upper extremity and intensive practice with the involved upper extremity. These approaches were designed for adults with hemiplegia, and increasing evidence suggests that they are efficacious in this population. Recently, forced use and constraint-induced therapy have been applied to children with hemiplegia. In this review, we provide a brief description of forced use and CI therapy and their historical basis, provide a summary of studies of these interventions in children, and discuss a number of important theoretical considerations, as well as implications for postural control. We will show that whereas the studies to date suggest that both forced use and CI therapy appear to be promising for improving hand function in children with hemiplegia, the data are limited. Substantially more work must be performed before this approach can be advocated for general clinical use.
INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia
Roslyn Boyd, Leanne Sakzewski, Jenny Ziviani, David F Abbott, Radwa Badawy, Rose Gilmore, Kerry Provan, Jacques-Donald Tournier, Richard AL Macdonell, Graeme D Jackson
BMC Neurology , 2010, DOI: 10.1186/1471-2377-10-4
Abstract: A matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs) will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days). A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking), cortical excitability using Transcranial Magnetic Stimulation (TMS), functional use of the hand in everyday tasks (Manual Ability Classification System) and Gross Motor Function Classification System (GMFCS). Outcomes will address neurovascular changes (functional MRI, functional connectivity), and brain (re)organisation (TMS), body structure and function (range of motion, spasticity, strength and sensation), activity limitations (upper limb unimanual capacity and bimanual motor coordination), participation restrictions (in home, school and recreation), environmental (barriers and facilitators to participation) and quality of life.This paper outlines the theoretical basis, study hypotheses and outcome measures for a matched pairs randomised trial comparing CIMT and BIM training to improve outcomes across the ICF.ACTRN12609000912280Cerebral palsy (CP) is the leading cause of childhood disability with an incidence of 1 in 500 live births[1]. Hemiplegia accounts for 35% (1 in 1300) of these children and upper limb (UL) involvement is usually more pronounced than the lower limb[2]. Management of long-term disability and the burden of care on both the health care system and families are substantial. Rece
Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study
Brand?o, Marina B.;Mancini, Marisa C.;Vaz, Daniela V.;Bueno, ?ngela M.;Furtado, Sheyla R. C.;Coelho, Zélia A. C.;
Brazilian Journal of Physical Therapy , 2009, DOI: 10.1590/S1413-35552009005000064
Abstract: objective: to investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (cimt). methods: a single-subject design (aba) was replicated in three children aged 8 to 11 years old. baseline phases (a1) and (a2) and the intervention phase (b) lasted 2 weeks each. during the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. hand function was classified according to the manual ability classification system (macs). children were assessed four times every week with the toddler arm use test (taut) and three adapted tasks from the jebsen-taylor hand function test (jthf), and once a week with the pediatric motor activity log (pmal) and self-care scales of the pediatric evaluation of disability inventory (pedi). celeration line, two-standard deviation band and visual analysis methods were used for data analyses. results: significant improvements in the amount and quality of upper extremity use (pmal), taut quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete jthf tasks for children 2 and 3 were observed. no changes were observed in the pedi self-care scales. conclusion: cimt effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia.
Whose Raoul Wallenberg is it? The Man and the Myth: Between Memory, History and Popularity  [cached]
Tanja Schult
Culture Unbound : Journal of Current Cultural Research , 2010,
Abstract: Raoul Wallenberg is widely remembered for his humanitarian activity on behalf of the Hungarian Jews in Budapest at the end of World War II, and is known as the Swedish diplomat who disappeared into the Soviet Gulag in 1945. While he successfully combated Nazi racial extermination politics, he fell victim to Stalinist communism – yet another barbaric, totalitarian regime of the 20th century. Given Wallenberg’s biography, his mission and his unresolved fate it is no wonder that Wallenberg became a figure of mythic dimensions. It is the mixture of heroics and victimhood, as well as the seemingly endless potential of possible adaptations that secures this historic figure and his mythic after-narratives its lon-gevity. While it is without doubt the man behind the myth who deserves credit – first the man’s realness gives the myth credibility – it is the myth that secures the man’s popularity. The man and his myth depend on each other. In this article, I will give an overview of how Wallenberg was perceived and described by survivors, in popular scholarly literature, how he has been re-searched by historians, and how he has been presented in different media. It will become apparent that the narrators have sought to satisfy different needs, e.g. psy-chological, political, and commercial ones. The narrators’ intention and attitude towards the historic person and the myth which surrounds him is of primary im-portance. I will show how different approaches to, and uses of, the myth exist side by side and nourish one another. And yet they can all simultaneously claim exis-tence in their own right. By providing examples from different times and places, I like to illustrate that the popular images of Wallenberg are far less one-sided, ste-reotypical and homogeneous than they are often portrayed and hope to draw atten-tion to the great potential that the Wallenberg narrative has today, as his 100th anniversary approaches in 2012.
Pontine infarction with pure motor hemiparesis or hemiplegia: A prospective study
Li Ling, Liangfu Zhu, Jinsheng Zeng, Songjie Liao, Suping Zhang, Jian Yu, Zhiyun Yang
BMC Neurology , 2009, DOI: 10.1186/1471-2377-9-25
Abstract: In 118 consecutive selected patients with the first-ever ischemic stroke within 6 hours after onset, fifty of them presented with PMH or hemiplegia and had negative acute computed tomography (CT) scans, then magnetic resonance imaging (MRI) confirmed the corresponding infarcts in pons or cerebrum. The clinical and neuroimaging features of the pontine infarctions were compared with those of cerebral infarctions.The pontine infarction with PMH or hemiplegia accounted for 10.2% (12/118) of all first-ever ischemic stroke patients and 24% (12/50) of the patients with both PMH or hemiplegia and acute negative CT scans. Compared to the patients with cerebral infarction, the patients with pontine infarction had more frequency of diabetes mellitus (50.0% vs 5.3%, P = 0.001), nonvertiginous dizziness at onset (58.3% vs 21.1%, P = 0.036) and a progressive course (33.3% vs 2.6%, P = 0.011).The pontine infarction may present as PMH or hemiplegia with more frequency of nonvertiginous dizziness, a progressive course and diabetes mellitus. MRI can confirm the infarct location in the basal pons at early stage after stroke onset.Pontine infarction is usually manifested by classical crossed syndromes such as Millard-Gubler syndrome, Foville syndrome, Raymond-Cestan syndrome [1]. These classical crossed pontine syndromes consist of ipsilateral peripheral cranial nerve palsies and contralateral movement disorders or sensory disturbances to the pontine lesions. However, some clinical observations have mentioned that pure motor hemiparesis (PMH) or hemiplegia can also be caused by pontine infarctions [2-8]. In 1965, Fisher [3] firstly described the lacunar syndrome of PMH associated with the pontine lacunar infarction. Later, Kim and colleagues [6] studied 37 patients with unilateral pontine base infarctions, and found 17 of them had PMH. Nighoghossian et al [8] reported pontine infarction represented 28.5% (6/21) in all patients with PMH in an 1-year study. The majority of pontine infarc
Two-dimensional analysis of gait asymmetry in spastic hemiplegia
Marise Bueno Zonta,Amancio Ramalho Júnior,Regina Maria Ribeiro Camargo,Fabiano Hessel Dias
Einstein (S?o Paulo) , 2010,
Abstract: Objective: Simple measures of gait for routine clinical use could be useful when the complex gait analysis systems are not available. The aim of this study was to quantify asymmetry in children with spastic hemiplegia using a two-dimensional gait analysis by videography and to relate the asymmetry to motor function. Methods: Twenty-four children with spastic hemiplegia (19 males, 5 females; mean age 49 months [SD 5 months], range from 39 to 60 months) were assessed with a two-dimensional gait analysis by videography and the analyzed parameters were compared with normal values and with clinical and functional data. Results: There were significant differences in swing time (p = 0.002), stance time (p = 0.01) and stance/swing time ratio (p < 0.001). The comparison with the normal values described by Sutherland also demonstrated gait asymmetry. There was no direct relationship between the motor function and asymmetry but a score analysis for specific Gross Motor Function Measure items could quantify it in terms of age of gait acquisition. Children with more adequate muscle tone presented longer stance time in the involved limb than those with more spasticity (p = 0.03). Conclusions: These results suggest that the best performance is associated with the smallest asymmetry in this sample. Although two-dimensional gait analysis does not provide as much data as three dimensional gait analyses, we believe it can contribute significantly to the gait assessment of children with cerebral palsy.
Effects of constraint-induced movement therapy in children with hemiplegia: a single case experimental study Efeitos da terapia de restri o por movimento induzido em crian as com hemiplegia: desenho experimental de caso único  [cached]
Marina B. Brand?o,Marisa C. Mancini,Daniela V. Vaz,?ngela M. Bueno
Brazilian Journal of Physical Therapy , 2009,
Abstract: OBJECTIVE: To investigate the profile of changes in the use of the upper extremity in three children with hemiplegia submitted to an adapted protocol of constraint-induced movement therapy (CIMT). METHODS: A single-subject design (ABA) was replicated in three children aged 8 to 11 years old. Baseline phases (A1) and (A2) and the intervention phase (B) lasted 2 weeks each. During the intervention period, children wore a splint on the non-affected extremity for 10 hours a day and were submitted to 3 hours of therapy a day during 10 days. Training consisted of activities with the affected upper extremity, with gradually increasing complexity and verbal feedback. Hand function was classified according to the Manual Ability Classification System (MACS). Children were assessed four times every week with the Toddler Arm Use Test (TAUT) and three adapted tasks from the Jebsen-Taylor Hand Function test (JTHF), and once a week with the Pediatric Motor Activity Log (PMAL) and self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI). Celeration Line, Two-Standard Deviation Band and visual analysis methods were used for data analyses. RESULTS: Significant improvements in the amount and quality of upper extremity use (PMAL), TAUT quality of use for children 2 and 3, and participation for child 1, as well as decreased time to complete JTHF tasks for children 2 and 3 were observed. No changes were observed in the PEDI self-care scales. CONCLUSION: CIMT effects were associated with improvements in manual dexterity, amount and quality of use of the affected upper extremity in children with hemiplegia. OBJETIVO: Investigar mudan as longitudinais no uso da extremidade superior em três crian as com hemiplegia submetidas a um protocolo adaptado de terapia de movimento induzido por restri o (CIMT). MéTODOS: Um desenho experimental de caso único (ABA) foi replicado em três crian as entre 8 e 11 anos de idade. Fases de baseline (A1) e (A2) e fase de interven o (B) duraram duas semanas cada. Durante a fase de interven o, as crian as usaram um splint na extremidade n o afetada por dez horas por dia e foram submetidas a três horas de terapia diária por dez dias. O treinamento consistiu em atividades para a extremidade superior acometida, com aumento gradual da complexidade da tarefa e refor o verbal. A fun o manual foi classificada de acordo com o Manual Ability Classification System (MACS). As crian as foram avaliadas quatro vezes por semana com o Toddler Arm Use Test (TAUT) e três provas adaptadas do Teste Jebsen-Taylor de Fun o Manual (JTHF) e uma vez po
Brain Reorganization following Intervention in Children with Congenital Hemiplegia: A Systematic Review  [PDF]
E. Inguaggiato,G. Sgandurra,S. Perazza,A. Guzzetta,G. Cioni
Neural Plasticity , 2013, DOI: 10.1155/2013/356275
Abstract: Noninvasive rehabilitation strategies for children with unilateral cerebral palsy are routinely used to improve hand motor function, activity, and participation. Nevertheless, the studies exploring their effects on brain structure and function are very scarce. Recently, structural neuroplasticity was demonstrated in adult poststroke patients, in response to neurorehabilitation. Our purpose is to review current evidence on the effects of noninvasive intervention strategies on brain structure or function, in children with unilateral cerebral palsy. The main literature databases were searched up to October 2013. We included studies where the effects of upper limb training were evaluated at neurofunctional and/or neurostructural levels. Only seven studies met our selection criteria; selected studies were case series, six using the intervention of the constraint-induced movement therapy (CIMT) and one used virtual reality therapy (VR). CIMT and VR seem to produce measurable neuroplastic changes in sensorimotor cortex associated with enhancement of motor skills in the affected limb. However, the level of evidence is limited, due to methodological weaknesses and small sample sizes of available studies. Well-designed and larger experimental studies, in particular RCTs, are needed to strengthen the generalizability of the findings and to better understand the mechanism of intervention-related brain plasticity in children with brain injury. 1. Introduction Unilateral cerebral palsy (U-CP) is the most common type of cerebral palsy (CP), with an incidence of 1 in 1000 live-births [1]. Typically, the upper limb (UL) is more involved than the lower, with impairments of spasticity, sensation, and reduced strength. Effective use of the arm and hand to reach, grasp, release, and manipulate objects is often compromised. Children with hemiplegia usually have the intellectual capacity to attend regular school; however, impaired arm function restricts their participation in educational, leisure, and later vocational roles [2]. U-CP can result from a wide variety of brain lesions, with respect to the timing of insults (acquired during the pre-, peri- or postnatal period), and the type of structural pathology (brain malformations, periventricular lesions, and corticosubcortical lesions) [3]. U-CP often leads to delays in motor development or deconditioning of the affected limb, as individuals are inclined to functional compensation with the intact limb rather than attempting to use the involved limb [4]; this may result in suppression of development of cortical representation
Extrapyramidal syndromes caused by antipsychotics
Pozni?-Je?i? Milana,Je?i? Aleksandar,Babovi?-Filipovi? Jasmina,?ivanovi? Olga
Medicinski Pregled , 2012, DOI: 10.2298/mpns1212521p
Abstract: Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic receptors. Parkinsonism. The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. Tardive dyskinesia. Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. Conclusion. Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment.
Extrapyramidal side effects as a consequence of treatment with neuroleptics
Wanessa Alves Frederico,Seizi Oga,Maria de Lourdes Rabelo Pequeno,Shirley Fumi Taniguchi
Einstein (S?o Paulo) , 2008,
Abstract: Objective: To check the occurrence of extrapyramidal side effects inpatients receiving neuroleptic drugs, how these effects are treated,and to observe the occurrence of hallucinations caused by treatmentof extrapyramidal symptoms. Methods: The present study analyzedmedical records and interviewed 39 schizophrenic patients beingtreated in a public primary care clinic located in the southern partof the city of S o Paulo, who had previously agreed to participatein the project. Results: Among 39 patients studied, 85% presentedextrapyramidal symptoms. Of these, 69.7% were treated for theside effects, 73.9% were treated with biperiden and 26.09% hadtheir neuroleptic drug reduced. Out of those patients treated withbiperiden, 70.5% had side effects, such as hallucination and delusion,blurred vision, somnolence and verbal memory deficit. Conclusions:The majority of patients (85%) undergoing treatment with neurolepticdrugs developed motor side effects. When these extrapyramidalsymptoms were treated with central action anticholinergic drugs(biperiden), hallucination and/or delusion occurred in 52.94% ofpatients – probably because of increased dopaminergic activity asa consequence of cholinergic activity reduction caused by biperidenin the mesocortical and mesolimbic pathways.
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