Canine cerebral leishmaniasis: Potential role of matrix metalloproteinase-2 in the development of neurological disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: Study protocol for prospective, randomized, controlled trial

Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.

Effect of posture-control insoles on function in children with cerebral palsy: Randomized controlled clinical trial

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Lesões intestinais decorrentes de isquemia e reperfusão: Fisiopatologia e modelos experimentais

The intestinal ischemia is unusual in vascular surgery emergency. Its main causes are embolisms and arterial thrombosis. In addition to severe ischemia, reperfusion of the ischemic tissues can lead to several complications that may worsen the ischemic lesion and produce a life threatening situation caused by systemic alterations. Intestinal tissue injuries due to ischemia and reperfusion have been demonstrated in clinical and experimental studies, in which pathophysiology and adequate treatment were also studied. The great variety of experimental models used and results achieved reflect the need for an intestinal ischemia and reperfusion experimental model that is simple, reproducible and consistent, in order to search for treatments that can reduce the damage caused by this situation. In this review, the main pathophysiologic aspects and the most used experimental models will be reviewed. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.

Prevalence of dental trauma in patients with cerebral palsy

This study presents the findings of a record review that evaluated the prevalence of dental trauma in patients with cerebral palsy and evaluated its possible relationship with age, type of palsy, and epilepsy. The dental records of 2,200 patients with special needs admitted to the special care clinic of the School of Dentistry of Araçatuba/UNESP, Brazil, between 1998 and 2003 were reviewed. Of the records that were analyzed, 500 patients who had cerebral palsy were selected for this study. Information regarding age, gender, type of palsy and dental trauma was collected and statistically analyzed. It was observed that 10.6% of the subjects (n = 53) had sustained dental trauma. The number of traumatized teeth was 84. Enamel or enamel/dentin fractures were the most frequent types of traumatic injury (84.9%). The permanent maxillary central incisors were the most commonly affected teeth (50%). The frequency of traumatic injuries showed no significant correlation (p>.05) with the type of cerebral palsy or gender and they were more frequent in subjects between the ages of 0 and 12 years. Having epilepsy was not a statistically significant risk factor (p>.05) for dental trauma. © 2008 Special Care Dentistry.

Desenvolvimento motor de criança com paralisia cerebral: Avaliação e intervenção

The objective of this study was to analyze the motor development of a ten year old child with ataxic cerebral palsy and the effects of a motor activities program in the swimming pool. Motor development was measured according to the motor assessment and the intervention program of motor activities in the swimming pool conducted at Sesi/Londrina, twice a week, during 45 minute sessions over a 2 month period, with an attendance rate of 87%. Data was analyzed descriptively comparing the results with before and after tests. Generally, the motor quotient regarding all items was classified as very low, characterizing motor deficit, with exception of temporal organization, presented as normal low. After intervention, the only area that showed positive change was balance; this result showed that the child gained 12 months in motor age, without corresponding alterations in the other areas.

Assistência Odontológica em Crianças com Paralisia Cerebral e Perspectivas Tecnológicas de Reabilitação

The improvement of oral health and quality of life is closely related to transdisciplinary dialogue, technological development and social responsibility. In patients with cerebral palsy, the lesion of motor areas of the brain compromises the development and function of the craniofacial complex. Considering all the ethiopathogenic conditions, the treatment of such patients involves great difficulties. The dentist and other professionals related to their rehabilitation need to deal with difficulty in chewing, respiration, phonation, besides the poor oral hygiene resulted from abnormal involuntary movements of facial and masticatory musculature, tongue, and upper limb. It is also relevant the lack of understanding about the importance of oral health care due to mental deficits of these individuals. This study aims to review some aspects of oral health in patients with cerebral palsy proposing rehabilitation associated to technology. Few studies concerned about the effectiveness of therapies for oral rehabilitation in patients with cerebral palsy. Laser therapy, electromyography, electrostimulation and LED therapy should be analyzed as options for treatment of patients with cerebral palsy. Following research projects should focus more attention on the dynamic and oral function of these patients to achieve positive repercussions in their overall health. © ArquiMed, 2010.

Perfusão cerebral e análise individual automatizada utilizando SPECT em uma população com transtorno obsessivo-compulsivo

Objective: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. Methods: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. results: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07%. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8% of the sample. Conclusion: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

Estudio sobre la amplitud del movimiento articular de la rodilla en el proceso de marcha de niños con parálisis cerebral espástica

Introduction: To analyze the contribution of knee range of motion in walking of hemiplegic and diplegic children, considering their asymmetries. Material and method: Twelve children, 6 hemiplegics and 6 diplegics, from 7 to 12 years of age (9.5 ± 1.93) participated. Spasticity was assessed with the Ashworth's Modified Scale and the passive knee range of motion using an electrogoniometer. The task was to walk on an 8 m long walkway, using their preferred speed. Six attempts were made, three of which were on the right and three on the left sagittal planes. Results: The Mann-Whitney's U test found differences in the type of cerebral palsy for knee extension/hyperextension, for the relative angle of the knee at the load acceptance phase and for the knee range of motion during stride. The Wilcoxon's test revealed differences in hemibody for hemiplegics in the relative angle of the knee in acceptance of the load. Conclusions: Children with spastic cerebral palsy use compensation strategies between the lower limbs during walking. These strategies differed according to the type of cerebral palsy. The knee joint has an important function in those strategies, especially in the load acceptance and propulsion phases. © 2010 Elsevier España, S.L. y SERMEF. Todos los derechos reservados.

The influence of the flexibility of the chair seat on pressure peak and distribution of the contact area in individuals with cerebral palsy during the execution of a task

This study aimed to determine the influence of flexibility of the chair seat surface on the pressure peak and on the contact area during the execution of a task of handling an object on the seated position by individuals with spastic cerebral palsy. Ten individuals of both genders with diagnosis of spastic cerebral palsy, who had some control to voluntarily move the body and the upper limbs, participated in this study. Quantification of data was carried out in two experimental situations: (1) execution of a task of fitting with upper limbs, and with the individual placed on an adapted canvas seat; (2) execution of a task of fitting with the participant positioned on an adapted wooden seat. Data obtained were submitted to a non-parametric and descriptive statistical analysis using the Wilcoxon test. Results indicated that the use of canvas seat increased the contact area and decreased the pressure peak and the medio-lateral displacement of centre pressure on the seated posture. © 2011 Informa UK, Ltd.