The frequency of obstetric palsy ranges from 0.5 to 3.0 cases per 1000 live births. The functional outcome disorders are determined by the nature of the damage and the number of damaged roots of the ...brachial plexus. There are 50 % of patients have complete recovery, 15 % have severe functional disorders of the upper limb, and 35 % have some limitation of the shoulder joint function. There are 3 variants of residual phenomena in children with obstetric palsy: paresis, paralysis, and co‑contraction. The article describes the mechanisms of nerve regeneration in children and adults, the pathogenesis of contractions and motor disorders in general in children with obstetric palsy, and modern methods of treatment of co‑contraction. This article will be useful for neurologists, rehabilitation specialists, and orthopedists.
Abstract The frequency of obstetric palsy ranges from 0.5 to 3.0 cases per 1000 live births. The functional outcome disorders are determined by the nature of the damage and the number of damaged ...roots of the brachial plexus. There are 50 % of patients have complete recovery, 15 % have severe functional disorders of the upper limb, and 35 % have some limitation of the shoulder joint function. There are 3 variants of residual phenomena in children with obstetric palsy: paresis, paralysis, and co‑contraction. The article describes the mechanisms of nerve regeneration in children and adults, the pathogenesis of contractions and motor disorders in general in children with obstetric palsy, and modern methods of treatment of co‑contraction. This article will be useful for neurologists, rehabilitation specialists, and orthopedists.
The incidence of plexus brachial birth injuries consists 0.12 % of births (0.04–0.20 %). Although the possibility of complete recovery is relatively high, 10–30 % patients have secondary deformity ...and limitation of upper limb function due to muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities and joint contracture. Botulinum toxin type A injections into targeted muscles in combination with occupation therapy, physiotherapy or operative treatment reduce the abnormal cocontraction of the antagonist muscles and help to restore muscles balance and prevent secondary deformities. The article discuses indications for botulinum injection therapy, target muscles, doses of botulinum toxin A, optimal patient’s age and results of treatment.
Learning new movement skills is a critical factor in the treatment of certain motor disorders. Thus, the treatment of children with congenital atrophy of the biceps (arthrogryposis) uses an ...innovative technique involving autotransplantation of donor muscles, which begin to take over the role of the non-functioning biceps. After the operation, these patients are faced with a unique situation – it becomes possible to perform movement patterns that had never been performed before surgery. Execution of new movements may not always be associated solely with the effects of the surgical procedure, but may also be linked with the neuroplastic rearrangements required in the central nervous system. The present study addressed changes in the most marked neurodynamic component of cerebral activity – the α rhythm – in the context of learning new motor patterns in children after this surgery. The study showed that in some patients, significant progress in motor skills correlates with an abrupt increase in power in the EEG α range. This may indicate that the α rhythm may also be a biomarker and predictor of the efficacy of muscle autotransplant surgery in the treatment of arthrogryposis.
Arthrogryposis is one of the most severe congenital orthopedic diseases, characterized by multiple joint contractures, hypoplasia or aplasia of the skeletal muscles of the extremities, as well as ...severe motor disorders. The use of compensatory strategies allows patients to improve the ability to self-care.
To study the compensatory strategies in children with arthrogryposis with absent of active flexion in the elbow joint and estimate their dynamic after surgical treatment.
We performed a clinical examination of 236 patients with arthrogryposis with deformities of the upper extremities due to arthrogryposis at the age of 10 months to 16 years. The examination was carried out before the operation, as well as at various times (from 1 month to 8 years) after. In 87 cases (67 patients), restoration of active elbow flexion was performed by transposition of latissimus dorsii or pectoralis major to the biceps position. The activity of the muscles involved that most commonly used in compensatory strategies (synergy of m. biceps brachii and m. deltoideus or m.biceps brachii and m. quadriceps femoris) in 10 patients (from 3 to 10 y.o.), was evaluated before and after (from 2 months to 2 years) surgery by surface electromyography.
It was found that children's compensatory strategies are formed at the age of 6 months to 1 y.o.6 months after surgery, the using of compensatory strategies becomes more rare, and 12-18 months after surgery, when the strength of the forearm muscles was 4 points, they were not used at all.
Compensatory strategies in children with the absence of active and preservation of passive flexion in the elbow joint are diverse. They depend on the amplitude of passive and active movements in the shoulder, the function of the hand and deformities of the lower extremities. These strategies in children with arthrogryposis are unstable and completely disappear when active movements in the elbow joint are restored in the functional range.
Many studies demonstrating the effects of noninvasive stimulation on various brain functions have been reported. The main methods used for such stimulation are transcranial electrical stimulation ...(TES) and transcranial magnetic (TMS) stimulation. A number of stimulation protocols are already being implemented in the clinic, though the reliability of the effects of these approaches raises a number of questions. This review examines the effects of TES and TMS on the development and correction of motor skills and cognitive functions and how they are interconnected. Particular emphasis is placed on the effects associated with correction of motor skills, as the movement-associated corticospinal system (the main target of stimulation) can be assessed objectively using a variety of neuroimaging and neurostimulation methods, providing more accurate assessment of the mechanisms of action of noninvasive brain stimulation (NBS). In addition, studies using NBS show a relationship between cognitive and motor functions, which indicates the need for comprehensive studies in these areas in the context of seeking to improve the effectiveness of motor skills. Both the individual effects of TES and TMS and the effects of their combined use are considered here. The authors believe that there is no unequivocal answer to the question of whether noninvasive stimulation provides a route to the reliable correction of the development of motor and cognitive skills. The data presented in this review suggest that such correction is possible. This aspect is important both for clinical medicine (patients with motor disorders) and for other areas – sports medicine, educational technologies, etc.
The term “acute flaccid myelitis” is used to describe a condition characterized by acute flaccid paralysis of the limb, as well as damage to the motor neurons of the spinal cord. The absence of ...specific treatment, severe neurological deficit that persists in 75–95 % of patients in the long term indicates its severity. The aim of the work is to describe acute flaccid myelitis in children, modern methods of treatment, and estimate the effectiveness of nerve transfers for restoration of the upper limb function. The search for publications was carried out in the PubMed/MEDLINE, Google Scholar databases from 2003 to 2022, and data from the US Centers for Disease Control and Prevention (https://www.cdc.gov) were used. There were analyzed surgical treatments of 57 children with paresis of the upper extremities due to AFM (105 nerve transfers). Restoration of shoulder function (neurotization of n. axillaris, n. suprascapularis ) was performed in 57 (54.3 %) patients, elbow flexion (neurotization of n. musculocutaneus ) in 37 (35.2 %), elbow extension in 9 (8.5 %) (neurotization of the branch of n. radialis to m. triceps brachii ), fingers flexion in 1 (1 %) (neurotization of the n. interosseus anterior branch), fingers extension in 1 (1 %) (neurotization of n. interosseus posterior ). The review demonstrated the effectiveness of nerve transfers in children with paresis of the upper extremities due to acute flaccid myelitis who were operated up to 1 year from the onset of the disease.
Quantitative analysis of skeletal muscles in cerebral palsy is an important but unsolved problem. Ultrasound elastography is a group of diagnostic methods that allow visualizing tissue stiffness, ...measuring and displaying biomechanical properties of tissues. The aim of our study was to conduct a systematic analysis of literature on ultrasound elastography of skeletal muscles in children with cerebral palsy.A literary search for keywords in the databases PubMed, Google Scholar, eLIBRARY was carried out. The inclusion criteria were nosology (cerebral palsy), age (up to 18 years) and the study design (original study in ultrasound elastography of the skeletal muscler), as well as the availability of detailed information about the technical issues, demographic and clinical data.The final analysis included 20 publications. Patients with hemiplegic cerebral palsy were most often studied, with the healthy side used as a control, shear wave elastography was used more often, in which both share wave velocity and shear modulus were assessed, and linear probes were used more often. The most frequent anatomical objects were the calf muscles. Most often, elastography was used to assess the results of botulinum therapy, and demonstrated an increase in muscle elasticity after treatment.Ultrasound elastography as a method od assessment of the mechanical properties of skeletal muscles in children with cerebral palsy cannot be considered suitable as a routine study at the moment. But the method showed promising results for the research purposes: all the publications we analyzed demonstrated significant difference in elastography indicators both when comparing with unaffected limb or with healthy controls. Positive changes were also detected after various therapeutic interventions aimed to reducing muscle tone and retraction e. g. botulinum toxin injections.The absence of a unified approach to muscle elastography in children with cerebral palsy was demonstrated, both for data obtaining and interpretation. In general, ultrasound elastography of the skeletal muscles in children with cerebral palsy is a promising method for qualitative and quantitative assessment of muscle tissue that requires further development. Improvement of technology, standardization of technique and measurements will further expand the usage of this method.
Lower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable ...seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient’s greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.
Частота интранатальной травмы плечевого сплетения составляет 0,12 % (0,04–0,20 %) всех новорожденных. Хотя вероятность полного выздоровления относительно высока, у 10–30 % пациентов наблюдаются ...вторичная деформация и ограничение функции верхней конечности вследствие дисбаланса мышц плечевого пояса, плеча, коконтракции, что приводит к двигательным нарушениям, возникновению контрактур суставов, а также деформации костей. Инъекции ботулинического токсина типа А в мышцы-мишени в сочетании с лечебной физкультурой, физиотерапией или оперативным лечением помогают восстановить мышечный баланс, устранить коконтракцию мышц-антагонистов, предотвратить вторичные деформации. В статье рассматриваются показания к ботулинотерапии, мышцы-мишени, дозы ботулинического токсина А, оптимальный возраст пациента и результаты лечения.
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