DOCSLIB.ORG

Influence of Gestational Age on the Type of Brain Injury and Neuromotor Outcome in High-Risk Neonates

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Influence of Gestational Age on the Type of Brain Injury and Neuromotor Outcome in High-Risk Neonates Eur J Pediatr DOI 10.1007/s00431-007-0629-2 ORIGINAL PAPER Influence of gestational age on the type of brain injury and neuromotor outcome in high-risk neonates Christine Van den Broeck & Eveline Himpens & Piet Vanhaesebrouck & Patrick Calders & Ann Oostra Received: 16 July 2007 /Accepted: 4 October 2007 # Springer-Verlag 2007 Abstract This study was an investigation of a possible periventricular leukomalacia, 24% intraventricular hemor- correlation between either the gestational age (GA) and rhage and 18% persistent flares. There was a significant type of brain injury or between the gestational age and type, correlation between the GA and type of brain injury (P< distribution and severity of cerebral palsy (CP). Four 0.001; Cramer’s V=0.76) and between the GA and type (P= hundred sixty-one children with a birthweight ≥1250 g 0.004; Cramer’s V=0.47) and distribution (P<0.001; and GA ≥30 weeks with a complicated neonatal period and/ Cramer’s V=0.55) of CP. There was no significant correla- or brain injury on serial cerebral ultrasound were selectively tion between the GA and severity of CP. The type of brain followed at the regional Center for Developmental Disor- injury detected by serial ultrasound during the neonatal ders. The children were divided into a preterm and term period, as well as the type and location of CP detected group. There were 40 children with cerebral palsy in the during later childhood, are all GA-dependent in at-risk preterm group and 38 children with cerebral palsy in the newborn infants with a birthweight of ≥1,250 g and term group. Various types of brain injury diagnosed by GA ≥30 weeks. echography were nosologically classified. The type, distri- bution and severity of cerebral palsy were also registered. Keywords Cerebral palsy. Gestational age . Type of brain The type of brain injury most frequently occurring in the injury . Distribution of cerebral palsy. Type of cerebral palsy term group was hypoxic-ischemic injury to the basal ganglia (39%), focal ischemia (18%), subcortical hemor- Abbreviations rhage (13%) and parasagittal cerebral injury (10%). In the CP cerebral palsy preterm group 39% of the children with cerebral palsy had GA gestational age PVL periventricular leukomalacia IVH intraventricular hemorrhage Christine Van den Broeck and Eveline Himpens equally contributed to this article. : * : C. Van den Broeck E. Himpens ( ) P. Calders Introduction Rehabilitation Sciences and Physiotherapy Ghent, University College Arteveldehogeschool-Ghent University, Campus Heymans (UZ) 1B3, De Pintelaan 185, Cerebral palsy (CP) is one of the most common causes of 9000 Ghent, Belgium motor disability in childhood. CP describes a group of dis- e-mail: [email protected] orders of movement and posture causing activity limitation A. Oostra that are attributed to non-progressive disturbances occurring Center for Developmental Disorders, in the developing fetal or infant brain. Abnormal motor Ghent, Belgium behavior is the core feature of CP [3]. Barkovich [2] has shown that the brain region most sus- P. Vanhaesebrouck Department of Neonatology, University Hospital Ghent, ceptible to hypoxic/ischemic damage changes as the infant Ghent, Belgium matures. Preterm and full-term infants may thus experience Eur J Pediatr ischemia in different regions of the brain. Vohr [23] found spastic cerebral palsy if they had at least two of the following that the prevalence of any type of cerebral palsy and the criteria: abnormal posture or movement, increased tone or degree of severity of CP differed significantly for two groups hyperreflexia. An abnormal pattern of posture and/or move- of different gestational age. Therefore, probable relation- ments with involuntary, uncontrolled, recurring, occassion- ships between either the gestational age (GA) and type of ally stereotyped movements was defined as dyskinetic brain injury or between the GA and major characteristics cerebral palsy. Two types of dyskinetic cerebral palsy were of CP (i.e., type, distribution and severity) are described discerned, i.e., dystonic and choreo-athetotic cerebral palsy. [6, 10–14, 21]. Dystonic CP is described as hypokinesia (reduced activity Registers of childhood impairments and large population- and stiff movements) and hypertonia. Hyperkinesia (in- based studies monitor trends in the rates of cerebral palsy creased activity with stormy movements) and hypotonia are according to gestational age, but focus particularly on the classified as the choreo-athetotic form of dyskinetic CP. Two prevalence of CP as an assessor of the quality of perinatal mixed forms of CP are also identified, i.e., dystonia with care [6, 9, 21]. Other studies focus on the type, distribution spasticity and athetosis with spasticity. Lastly, ataxia is a and severity of cerebral palsy of term and pretem infants [1, primary disorder of coordination. Children with ataxia show 3, 6, 7, 9, 12, 21, 26]. The aim of this study was to an abnormal pattern of posture and/or movements with loss investigate a possible relationship either between the GA of muscular coordination so that movements are performed and type of brain injury, defined by serial echography, or with abnormal force, rhythm and accuracy. between GA and characteristics of CP. Different types of distribution of CP were nosologically defined. Hemiparesis is a unilateral impairment. Limbs on one side of the body are involved. Diparesis, triparesis and Patients and methods quadriparesis are bilateral motor involvements. When only the lower limbs are affected, CP is classified as diparetic. During an 8-year period (January 1995 to December 2002), When four limbs are affected CP is classified as a quadri- 461 children with a birthweight ≥1,250 g and a GA ≥30 paresis. Triparesis is used when one arm is not or only who had completed weeks with a complicated neonatal period minimally affected in a quadriparetic child [25]. and/or brain injury consulted the regional Center for Devel- The degree of severity of CP was classified as mild, opmental Disorders. The children were assessed at the moderate and severe. A child with a mild cerebral palsy corrected age of 4, 7, 12, 18 and 24 months. In the Department performs gross motor skills independently, but speed, bal- of Neonatology of the University Hospital of Ghent, an ance and coordination are reduced. CP was defined as echography was performed on day 1, 3, 7, 14 and 90 (or at the moderate if the child reached a form of independent walking time of discharge). For children with GA ≥35 weeks major with or without walking aids. When the child had no basic ultrasound findings were usually confirmed by MRI. antigravity postural control and/or could not walk, CP was The children were divided into two groups: a preterm group classified as severe. Nowadays it is common practice to use (276 children) with a gestational age (GA) between 30 and the GMFCS for the degree of severity of CP. Bax et al. [4] 37 weeks and a term group (185 children) with GA ≥37 weeks. describe a strong correspondence (K=0.583; P<0.001) be- Each child was subjected to a detailed physical and neu- tween the classification of mild-moderate-severe and the rological examination. Children were classified conforming GMFCS. to the definition proposed by the Surveillance of Cerebral Different types of brain injury detected by cerebral Palsy in Europe [3, 20]. Children were classified as having echography were identified. Fig. 1 Relative frequency of term preterm type of brain injury in the term and preterm group (PVL= 40 periventricular leukomalacia; 35 IVH=intraventricular hemor- rhage; bas=injury to basal gan- 30 glia; para=parasagittal cerebral 25 injury; focal=focal ischemia; haemor=subcortical 20 hemorrhage) 15 10 relative frequency (%) 5 0 PVL flares IVH bas para focal haemor Eur J Pediatr Fig. 2 Relative frequency of term preterm type of cerebral palsy in the term and preterm group (spast= 80 spastic; dyst=dystonic; ath=choreo-athetosis; dyst+ spast=dystonia with spasticity; 60 ath+spast=athetosis with spasticity) 40 20 relative frequency (%) 0 spast dyst ath dyst + spast ath + spast ataxia Periventricular leukomalacia (PVL) is defined as peri- For the children with CP a highly significant (P<0.001) ventricular areas of increased echogenicity evolving into correlation between the GA and the type of brain injury was small or extensive periventricular cystic lesions involving found (Cramer’s V=0.76). The most common brain injury occipital and fronto-parietal white matter. Flares are defined in the term group with CP was an injury to the basal ganglia as diffuse periventricular echodensities persistent beyond (39%), followed by focal ischemia (18%), subcortical hem- 7 days of age. Deep grey matter injury involves the thal- orrhage (13%) and parasagittal injury (10%). The diagnosis amus and basal ganglia. Parasagittal cerebral injury refers to for all four children with parasagittal injury was confirmed a lesion of the cerebral cortex and subcortical white matter by MRI. In the preterm group 39% had periventricular with a characteristic distribution. Although the injury is usually leukomalacia, 24% had an intraventricular hemorrhage and symmetrical, it may be more striking in one hemisphere as 18% of these prematurely born children had persistent flares well. Focal ischemia refers to necrosis in the territory of one or on neonatal ultrasound scans. For two preterm infants we more large cerebral blood vessels. Hemorrhage can be sub- had no neonatal ultrasound scan (Fig. 1). cortical or intraventricular. Intraventricular hemorrhage (IVH) A significant correlation (P<0.01; Cramer’s V=0.47) is a hemorrhage into the germinal matrix and the ventricles. was also found between the GA and type of CP. In the term The subcortical hemorrhages are situated in the vascular group 31% of the children had a spastic type of CP, 29% boundery (watershed) zones. For term infants these are the had dystonia, and 24% had the mixed form of dystonia with regions between the anterior and middle cerebral arteries and spasticity.
Load more

Recommended publications
  • WCN19 Journal Posters Part 2 Revised V1
    JNS-0000116542; No. of Pages 131 ARTICLE IN PRESS Journal of the Neurological Sciences (2019) xxx–xxx Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns WCN19 Journal Posters Part 2 revised_V1 WCN19-2260 WCN19-2269 Poster shift 01 - Channelopathies /neuroethics /neurooncology / Poster shift 01 - Channelopathies /neuroethics /neurooncology / pain - Part I /sleep disorders - Part I /stem cells and gene therapy - pain - Part I /sleep disorders - Part I /stem cells and gene therapy - Part I /stroke /training in neurology - Part I and traumatic brain Part I /stroke /training in neurology - Part I and traumatic brain injury injury Numb chin syndrome- The first finding in metastatic malignancy Results of surgical treatment in patients with moyamoya disease considering CT-perfusion imaging study N. Mustafayev, A. Bayrakoglu, F. Ilgen Uslu, M. Kolukısa Bezmialem University, Neurology, Istanbul, Turkey O. Harmatinaa, V. Morozb, I. Skorokhodab, I. Tyshb, N. Shahinb,R. Hanemb, U. Maliarb a Numb chin syndrome (NCS) is a sensory neuropathy of the SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», mental nerve, which is accompanied by hypoesthesia and paresthe- Neuroradiology Department, Kyiv, Ukraine b sia of the jaw and lower lip. Although being well known in neurology SI «Romodanov Institute of Neurosurgery of NAMS of Ukraine», practice, most of the physicians who have not experienced this Emergency Department of Vascular Neurosurgery, Kyiv, Ukraine phenomenon are unaware of this phenomenon since it is rare and can be confused with somatic complaints. This case report aims to Aim point out that NCS may be the first sign and symptom of metastatic To improve the results of surgical treatment of patients with cancers in patients who are not diagnosed.
    [Show full text]
  • Hepatic Myelopathy: Case Report And
    LIVER RESEARCH ISSN 2379-4038 http://dx.doi.org/10.17140/LROJ-1-108 Open Journal Case Report Hepatic Myelopathy: Case Report and *Corresponding author Review of the Literature Hua Hong Department of Neurology First Affiliated Hospital Huanquan Liao1#, Zhichao Yan2#, Wei Peng3# and Hua Hong1* Sun Yat-Sen University No. 58 Zhongshan Road 2 #These authors contributed equally. Guangzhou 510080, P.R. China Tel. +008615920500906 1 Fax: +00862087331989 Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou E-mail: [email protected] 510080, P.R. China 2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen Univer- Volume 1 : Issue 2 sity, Guangzhou 510060, Guangdong, P.R. China 3 Article Ref. #: 1000LROJ1108 Department of Stomatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, P.R. China Article History Received: August 5th, 2015 ABSTRACT Accepted: August 12th, 2015 Published: August 12th, 2015 Background: Hepatic Myelopathy (HM) is a rare complication of chronic liver disease usually associated with extensive portosystemic shunt of blood, which has been created surgically or has occurred spontaneously, causing progressive spastic paraparesis. Some single cases or short Citation clinical reports describing patients suffering from HM have been published worldwide, but are Liao H, Yan Z, Peng W, Hong H. He- patic myelopathy: case report and re- often scattered. view of the literature. Liver Res Open Material and method: One additional case of HM with typical symptoms was presented, and J. 2015; 1(2): 45-55. doi: 10.17140/ a retrospective survey of the literature in a manner of comprehensive review was undertaken.
    [Show full text]
  • A Dictionary of Neurological Signs
    FM.qxd 9/28/05 11:10 PM Page i A DICTIONARY OF NEUROLOGICAL SIGNS SECOND EDITION FM.qxd 9/28/05 11:10 PM Page iii A DICTIONARY OF NEUROLOGICAL SIGNS SECOND EDITION A.J. LARNER MA, MD, MRCP(UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. FM.qxd 9/28/05 11:10 PM Page iv A.J. Larner, MA, MD, MRCP(UK), DHMSA Walton Centre for Neurology and Neurosurgery Liverpool, UK Library of Congress Control Number: 2005927413 ISBN-10: 0-387-26214-8 ISBN-13: 978-0387-26214-7 Printed on acid-free paper. © 2006, 2001 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dis- similar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to propri- etary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omis- sions that may be made.
    [Show full text]
  • Spectrum of Nontraumatic Myelopathies in Ethiopian Patients: Hospital-Based Retrospective Study
    Spinal Cord (2016) 54, 604–608 & 2016 International Spinal Cord Society All rights reserved 1362-4393/16 www.nature.com/sc ORIGINAL ARTICLE Spectrum of nontraumatic myelopathies in Ethiopian patients: hospital-based retrospective study NJ Fidèle1 and A Amanuel2 Study design: This is a retrospective hospital-based study. Objectives: The study aimed at a better understanding of the etiology, clinical presentation and treatment outcome of nontraumatic myelopathies in Ethiopian patients. Setting: Etiologies of nontraumatic myelopathies have not been evaluated extensively in most sub-Saharan African countries. The available studies in this region were conducted before the widespread clinical use of modern neuroimaging modalities. This study was conducted in Addis Abba, Ethiopia. Methods: We retrospectively analyzed medical files of patients with a diagnosis of myelopathy (age ⩾ 13 years) admitted or followed up at Tikur Anbesa Hospital between 1 January 2010 and 30 June 2013. Results: Records of 105 patients were analyzed. The male to female ratio was 1.7. The mean age was 38.5 years. Weakness, sensory symptoms (including sensory level), back pain and sphincter dysfunction were the dominant features. Etiologies were dominated by spinal tuberculosis (23.8%) followed by spinal cord neoplastic lesions (primary (10.5%) and secondary neoplasms 8.6%). Other important etiological causes were transverse myelitis (16.2%), degenerative cervical spondylotic myelopathy (15.2%), amyotrophic lateral sclerosis (4.8%) and neuromyelitis optica/multiple sclerosis (3.8%). The mortality rate was 9.5%. Among the patients who died, 40% had chest infection as a complication and 70% presented with complete weakness. Conclusion: Infections remain a major cause of spinal cord disease, and tuberculosis constitutes public health target for reducing the incidence of myelopathies.
    [Show full text]
  • A Dictionary of Neurological Signs.Pdf
    A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A.J. LARNER MA, MD, MRCP (UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. 123 Andrew J. Larner MA MD MRCP (UK) DHMSA Walton Centre for Neurology & Neurosurgery Lower Lane L9 7LJ Liverpool, UK ISBN 978-1-4419-7094-7 e-ISBN 978-1-4419-7095-4 DOI 10.1007/978-1-4419-7095-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010937226 © Springer Science+Business Media, LLC 2001, 2006, 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Cerebral-Palsy-Feeding Executive
    Comparative Effectiveness Review Number 94 Effective Health Care Program Interventions for Feeding and Nutrition in Cerebral Palsy Executive Summary Background Effective Health Care Program Cerebral palsy (CP) is a “group of disorders of the development of The Effective Health Care Program movement and posture, causing was initiated in 2005 to provide activity limitation, that is attributed to valid evidence about the comparative non-progressive disturbances that effectiveness of different medical occurred in the developing fetal or interventions. The object is to help infant brain. The motor disorders of consumers, health care providers, cerebral palsy are often accompanied and others in making informed by disturbances of sensation, cognition, choices among treatment alternatives. communication, perception, and/or Through its Comparative Effectiveness behaviour, and/or by a seizure disorder.”1 Reviews, the program supports This group of syndromes ranges in systematic appraisals of existing severity and is the result of a variety scientific evidence regarding of etiologies occurring in the prenatal, treatments for high-priority health perinatal, or postnatal period. Though conditions. It also promotes and the disorder is nonprogressive, the generates new scientific evidence by clinical manifestations may change over identifying gaps in existing scientific time as the brain develops, with other evidence and supporting new research. neurologic impairments frequently The program puts special emphasis co-occurring.1,2 on translating findings into a variety of useful formats for different More than 100,000 children are estimated stakeholders, including consumers. to be affected with CP in the United States. Due to advances in supportive The full report and this summary are medical care, approximately 90 percent available at www.effectivehealthcare.
    [Show full text]
  • Pediatric Orthopedics in Practice, DOI 10.1007/978-3-662-46810-4, © Springer-Verlag Berlin Heidelberg 2015 880 Backmatter
    879 Backmatter Subject Index – 880 F. Hefti, Pediatric Orthopedics in Practice, DOI 10.1007/978-3-662-46810-4, © Springer-Verlag Berlin Heidelberg 2015 880 Backmatter Subject index Bold letters: Principal article Italics: Illustrations A Acetylsalicylic acid 303, 335 Adolescent scoliosis Amyloidosis 663 Acheiropodia 804 7 Scoliosis Amyoplasia 813–814 Abducent nerve paresis 752, Achievement by proxy 10, 11 AFO 7 Ankle Foot Orthosis Anaerobes 649, 652, 657 816 Achilles tendon Aggrecan 336, 367, 762 ANA 7 antinuclear antibodies Abducted pes planovalgus – lengthening 371, 426, 431, aggressive osteomyelitis Analysis, gait 488, 490–497 433, 434, 436, 439, 443, 464, 7 osteomyelitis, aggressive 7 Gait analysis Abduction contracture 468, 475, 485, 487–490, 493, Agonist 281, 487, 492, 493, Anchor 169, 312, 550, 734 7 contracture 496, 816, 838, 840 495, 498, 664, 832, 835, 840, Andersen classification abduction pants 219–221 – shortening 358, 418, 431, 868 7 classification, Andersen Abduction splint 212, 218–221, 433, 464, 465, 467, 468, 475, Ahn classification 366 Andry, Nicolas 21, 22 248, 850 489, 496, 838 Aitken classification (congenital Anesthesia 26, 38, 135, 154, Abduction Achondrogenesis 750, 751, femoral deficiency ) 7 classi- 162, 174, 221, 243, 247, 248, – hip 195, 198, 199, 212, 213, 756, 758–760, 769 fication, femoral deficiency 255, 281, 303, 385, 386, 400, 214, 218, 219, 220, 221, Achondroplasia 56, 163, 166, Akin osteotomy 477, 479 500, 506, 559, 568, 582–585, 241–245, 247, 248, 251, 255, 242, 270, 271, 353, 409, 628, Albers-Schönberg
    [Show full text]
  • Brainstem and Multiple Cranial Nerve Syndromes
    CHAPTER 21 Brainstem and Multiple Cranial Nerve Syndromes he brainstem is a compact structure, with cra- the lower motor neurons of the CN nuclei. With a nial nerve (CN) nuclei, nerve fascicles, and few exceptions, CNs innervate structures of the head T long ascending and descending tracts all and neck ipsilaterally. A process affecting the brain- closely juxtaposed. Structures and centers in the reticu- stem long tracts on one side causes clinical abnormal- lar formation control many vital functions. Brainstem ities on the opposite side of the body. For this reason, diseases are serious and often life threatening. focal brainstem lesions are characterized by “crossed” Involvement of the intricate network of neural struc- syndromes of ipsilateral CN dysfunction and contra- tures often causes a plethora of clinical findings. lateral long motor or sensory tract dysfunction. For Brainstem syndromes typically involve dysfunction of instance, in the right side of the pons, the nuclei for one or more CNs. Deficits due to dysfunction of indi- CNs VI and VII lie in proximity to the right corti- vidual nerves are covered in the preceding chapters. cospinal tract, which is destined to decussate in the This chapter discusses conditions that cause dysfunc- medulla to innervate the left side of the body. The tion beyond the distribution of a single CN, involving patient with a lesion in the right pons will have CN more than one CN, or conditions that involve brain- findings on the right, such as a sixth or seventh nerve stem structures in addition to the CN nucleus or fasci- palsy, and a hemiparesis on the left.
    [Show full text]
  • Module 2 Neurology and Instrumentation Motor Paralysis The
    Module 2 Neurology and Instrumentation Motor paralysis The term paralysis is derived from the Greek words para, “beside,off, amiss,” and lysis, a “loosening” or “breaking up.” In medicine it has come to refer to an abolition of function, either sensory or motor. When applied to motor function, paralysis means loss of voluntary movement due to interruption of one of the motor pathways at any point from the cerebrum to the muscle fiber. Patterns of paralysis and their diagnosis: The following subdivision, based on the location and distribution of the muscle weakness: 1. Monoplegia : refers to weakness or paralysis of all the muscles of one leg or arm. This term should not be applied to paralysis of isolated muscles or groups of muscles supplied by a single nerve or motor root. 2. Hemiplegia: It is the commonest form of paralysis, involves the arm, the leg, and sometimes the face on one side of the body. With rare exceptions, mentioned further on, hemiplegia is attributable to a lesion of the corticospinal system on the side opposite to the paralysis. 3. Paraplegia: indicates weakness or paralysis of both legs. It is most often the result of diseases of the thoracic spinal cord, caudal equina, or peripheral nerves, and rarely, both medial frontal cortices. 4. Quadriplegia (tetraplegia) :denotes weakness or paralysis of all four extremities. It may result from disease of the peripheral nerves, muscles, or myoneural junctions; gray matter of the spinal cord; or the upper motor neurons bilaterally in the cervical cord, brainstem, or cerebrum. Diplegia is a special form of quadriplegia in which the legs are affected more than the arms.
    [Show full text]
  • Rehabilitation Principles for Motor Dysfunctions According to the Kozyavkin Method
    Kozyavkin V. I. Sak N. N. Kachmar O. O. Babadahly M. O. Rehabilitation principles for motor dysfunctions according to the Kozyavkin Method International Clinic of Rehabilitation www.reha.lviv.ua 2009 1 Universal Decimal classification УДК 616.831 - 009.11 - 053.2 - 085.838 Library and descriptive classifier ББК 57.336.1 Kozyavkin V. I., Sak N. N., Kachmar O. O., Babadagly M. A. Principles of rehabilitation of motor dysfunctions according to Kozyavkin Method. – Lviv: scientific production company ”Ukrayinska tekhnolohiya” (Ukrainian technology), 2007.- 192p. The proposed book is devoted to theoretical principles of motor dysfunction rehabilitation according to Prof. Kozyavkin’s Method and reflects 17 years of experience by the staff at the Institute of Medical Rehabilitation and the International Clinic of Rehabilitation. Readers will be informed about fundamentals related to the organization of human movement systems and rehabilitation principles for disorders of function caused by brain lesions and, in particular, cerebral palsy. They will come to understand how this idea evolved into a fundamentally new tendency in medical treatments and will learn about the effectiveness and application of the given system of rehabilitation. The book will be useful to child neurologists, pediatricians, specialists in medical and physical rehabilitation and students attending related academic institutions. ISBN 978-966-345-118-3 © International Clinic of Rehabilitation 2 Introduction Introduction Motor dysfunctions are one of the main causes of child disabilities and rank the problem of cerebral palsies together with the most important tasks which social pediatrics, child neurology and medical rehabilitation face. For many years, the history of the development of medical treatments for CP was based on attempts to eliminate the most obvious disorders of movement and posture.
    [Show full text]
  • Medical Assistance Eligibility Policy Manual (Archive) - Part 3 of 3
    THIS DOCUMENT IS FOR ARCHIVE PURPOSES ONLY AND MAY NOT REFLECT CURRENT POLICY. Medical Assistance Eligibility Policy Manual (Archive) - Part 3 of 3 Effective until 2021-08-06 THIS DOCUMENT IS FOR ARCHIVE PURPOSES ONLY AND MAY NOT REFLECT CURRENT POLICY. Table of Contents Introduction ................................................................................................................... 11 Getting Started .......................................................................................................... 12 Getting Started ....................................................................................................... 12 Cash Assistance and Nutrition Assistance Policy ...................................................... 18 Example ........................................................................................................................ 19 Examples ................................................................................................................... 19 Introduction ................................................................................................................ 20 E508 Community Spouse Example ........................................................................... 21 E602 Budget Group Examples .................................................................................. 22 E602 Budget Group Examples ............................................................................... 22 A MAGI Budget Group Examples ..........................................................................
    [Show full text]
  • A Dictionary of Neurological Signs
    A Dictionary of Neurological Signs A.J. Larner A Dictionary of Neurological Signs Fourth Edition A.J. Larner, MA, MD, MRCP(UK), DHMSA, PhD Walton Centre for Neurology and Neurosurgery Liverpool UK ISBN 978-3-319-29819-1 ISBN 978-3-319-29821-4 (eBook) DOI 10.1007/978-3-319-29821-4 Library of Congress Control Number: 2016938226 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To Sue Nil satis nisi optimum The dictionary is the only place where success comes before work Arthur Brisbane Foreword to the First Edition (2001) Neurology has always been a discipline in which careful physical examination is paramount.
    [Show full text]