To identify the precise location of the motor points of hip adductors in relation to bony landmarks.Nineteen limbs from ten adult cadavers were anatomically dissected. The motor point of each adductor muscle was determined by measuring its distance from the pubic tubercle with reference to a line joining the pubic tubercle and the medial epicondyle of the femur, and this distance was expressed as a percentage. For describing the mediolateral relationship between the motor point of each adductor and bony landmarks, its distance from the pubic tubercle was measured with reference to a line joining the pubic tubercle and the greater trochanter of the femur, and the result was expressed as a percentage.The percent distances along the longitudinal reference line distal to the pubic tubercle were as follows: adductor longus, 26.0% +/- 4.8%; adductor brevis, 21.0% +/- 4.8%; gracilis, 32.1% +/- 2.1%; and adductor magnus, 30.4% +/- 4.1%. Further, the percent distances along the horizontal reference line lateral to the pubic tubercle were as follows: adductor longus, 24.9% +/- 7.8%; adductor brevis, 24.9% +/- 7.4%; and adductor magnus, 33.6% +/- 5.9%.Identification of these motor points facilitates the efficacy and efficiency of a neural blockade and decreases undesirable complications.
To evaluate the effect of selective blocking of the anterior branch of the obturator nerve by using phenol in controlling adductor spasticity in children with cerebral palsy.To study the anatomic location of the anterior branch of the obturator nerve with respect to bony landmarks in the inguinal area, 12 limbs of seven adult cadavers were anatomically dissected. We injected 22 anterior branches of obturator nerves in 11 children with spastic cerebral palsy with 5% aqueous phenol guided by anatomical landmarks and electrical stimulation. The range of motion (ROM) of hip abduction and the modified Ashworth scale (MAS) grade of the hip adductors were measured preinjection, and at 1, 3, 6, and 12 mos after injection.Successful clinical results (range of hip abduction greater than 45 degrees with the knee extended) were achieved in all the children immediately after the injection. The average volume of 5% aqueous phenol injected per nerve was 0.79 +/- 0.20 ml (0.12 +/- 0.02 ml/kg). The effect was maintained for more than 6 mos. No immediate or delayed complications were observed.Selective blocking of the anterior branch of the obturator nerve with 5% aqueous phenol can safely and effectively control adductor spasticity in children with cerebral palsy.
Objective: To establish the degree of modulating influence of the type of surfaces (whether stable or labile) on the dynamic balance responses during the sit-to-stand transfers in both stroke patients and healthy controls. Method: We evaluated sit-to-stand balance by Balance Master (NeuroCom, USA) in 30 hemiparetic patients and 10 healthy controls. All subjects were requested to perform sit-to-stand transfers three times each on the both stable and labile surfaces. Four balance indices (weight transfer time, rising index, COG sway velocity, left/right weight symmetry) were obtained. Results: In hemiparetic patients, decreased rising index, increased COG sway velocity, increasing left/right weight asymmetry were noticed. During sit-to-stand transfers from sitting on labile surfaces to standing, rising index increased and left/right weight asymmetry increased in hemiparetic patients, but not in healthy controls. This implies that the maximum vertical force exerted by legs during the rise phase increased, but the differences of weight borne by each leg during the active rising phase increased in hemiparetic patients. Conclusion: Weight bearing exercise on the affected leg as well as strengthening exercise of legs are considered to be essential to decrease the falls during sit-to-stand transfer in stroke patients.
Kwon J-Y, Hwang JH, Kim J-S: Botulinum toxin A injection into calf muscles for treatment of spastic equinus in cerebral palsy: A controlled trial comparing sonography and electric stimulation-guided injection techniques: A preliminary report. Objective: To compare the clinical outcomes of two different injection techniques, one guided by electric stimulation and the other by sonography, for botulinum toxin A injection into calf muscles for the treatment of spastic equinus in children with cerebral palsy. Design: Thirty-two children with cerebral palsy with spastic equinus gait were enrolled in separate categories according to their level under the Gross Motor Function Classification System and divided into two groups with alternate allocation: sonography-guided group and electric stimulation-guided group. Equal amounts of botulinum toxin A were injected into the gastrocnemius at four to six points in 30 children with cerebral palsy. The injection was guided by electric stimulation in 14 and by ultrasonography in 16 children. Modified Ashworth Scale, Modified Tardieu Scale, Selective Motor Control, and Physician's Rating Scale were measured at baseline, 1 mo, and 3 mos posttreatment. Results: Subscales of the Physician's Rating Scale (gait pattern and hindfoot position-maximum foot/floor contact during stance) significantly improved in the sonography-guided group. No statistical differences were noted in Modified Ashworth Scale, Modified Tardieu Scale, and Selective Motor Control. Conclusions: Visual feedback by ultrasonography could improve the accuracy of selective neuromuscular blocking of the gastrocnemius.
The study employed an open label randomized controlled trial. Participants were 10 children of ages between 6 and 12 years. These subjects were placed in 2 groups : the hippo-therapy group and the medication group. Evaluation tools used in this study include Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version, the Wechsler Intelli-gence Scale for Children-IV, Korean Child Behavior Check List (K-CBCL), ADHD rating scale (ARS), Clinical Global Impression (CGI), and Quantitative electroencephalography (QEEG).Results
This study aimed to determine whether filtering out walking-related actigraphy data improves the reliability and accuracy of real-world upper extremity activity assessment in children with unilateral cerebral palsy. Twenty-two children aged 4–12 years diagnosed with unilateral cerebral palsy were included in this study, which was drawn from a two-phase randomized controlled trial conducted from July 2021 to December 2022. Data were collected from a tertiary hospital in Seoul, Republic of Korea. Participants were monitored using tri-axial accelerometers on both wrists across three time points (namely, T0, T1, and T2) over 3 days; interventions were used between each time point. Concurrently, an in-laboratory study focusing on walking and bimanual tasks was conducted with four participants. Data filtration resulted in a reduction of 8.20% in total data entry. With respect to reliability assessment, the intra-class correlation coefficients indicated enhanced consistency after filtration, with increased values for both the affected and less-affected sides. Before filtration, the magnitude counts for both sides showed varying tendencies, depending on the time points; however, they presented a consistent and stable trend after filtration. The findings of this research underscore the importance of accurately interpreting actigraphy measurements in children with unilateral cerebral palsy for targeted upper limb intervention by filtering walking-induced data.
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