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Ann E Van Heest - One of the best experts on this subject based on the ideXlab platform.
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tendon transfers and releases for the forearm wrist and hand in Spastic hemiplegic cerebral palsy
Techniques in Hand & Upper Extremity Surgery, 2010Co-Authors: Carolien P De Roode, Michelle A James, Ann E Van HeestAbstract:Cerebral Palsy (CP) is a static disorder of movement and posture secondary to an insult to the developing central nervous system. The peripheral manifestations and functional impairments of this condition vary in severity from mild-to-profound. In hemiplegic CP, 1 side of the body is affected more than the other. Spastic Hemiplegia is the most common type and that for which upper extremity surgery is most indicated. Treatment options range from physical therapy and splinting to botulinum toxin A injections (Botox) to tendon transfers to arthrodeses. This article will discuss the indications, preoperative evaluation, our preferred surgical technique, and postoperative protocol for the most commonly used tendon transfers in the upper extremity in Spastic Hemiplegia.
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follow up motion laboratory analysis for patients with Spastic Hemiplegia due to cerebral palsy analysis of the flexor carpi ulnaris firing pattern before and after tendon transfer surgery
Journal of Hand Surgery (European Volume), 2010Co-Authors: Ann E Van Heest, Roy Wervey, Jean Stout, Louis GarciaAbstract:Purpose To compare the preoperative and postoperative pattern of firing of the flexor carpi ulnaris (FCU) in a grasp and release functional activity for children treated with an FCU to extensor carpi radialis brevis tendon transfer for wrist flexion deformity associated with Spastic Hemiplegia from cerebral palsy. Methods Seven children, evaluated by a preoperative EMG video analysis and treated with an FCU to extensor carpi radialis brevis transfer, had a follow-up postoperative EMG/video motion laboratory analysis at an average follow-up of 3.5 years (range, 1.0–6.8 years). Each preoperative and postoperative EMG/video was reviewed for the task of lifting heavy cans, as described by Jebson et al. The EMG activity of the FCU was described as active or relaxed during grasp and during release. Results Preoperatively, the most common pattern was to activate the FCU during grasp and to relax the FCU during release (4 patients). Postoperatively, 6 patients activated the FCU during grasp and relaxed the FCU during release; 1 patient activated the FCU during both grasp and release. Conclusions Of the 7 patients studied, the FCU changed phase from preoperative to postoperative in only 1. This study concludes that most commonly the FCU does not predictably change phase when transferred from a position of wrist flexion to wrist extension. Type of study/level of evidence Therapeutic IV.
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quantitative and qualitative functional evaluation of upper extremity tendon transfers in Spastic Hemiplegia caused by cerebral palsy
Journal of Pediatric Orthopaedics, 2008Co-Authors: Ann E Van Heest, Vimala Ramachandran, Jean L Stout, Roy Wervey, Louis GarciaAbstract:Background: The purpose of this study was to determine if upper extremity function and joint positioning improved after tendon transfer surgery in patients with Spastic Hemiplegia caused by cerebral palsy. Methods: Thirteen patients with Spastic Hemiplegia underwent tendon transfer surgery at a mean age of 10.8 years (range, 7-24 years). Before surgery, all patients were evaluated with a standardized motion laboratory analysis protocol. At a mean follow-up of 3.6 years (range, 1-10 years), 13 patients returned for a repeat motion laboratory analysis using the same protocol. The motion laboratory studies were then compared quantitatively, comparing times for completion of the Jebsen-Taylor hand test, and qualitatively for elbow, forearm, wrist, finger, and thumb positions using the validated Shriner's Hospital Upper Extremity Evaluation protocol. Results: In timed testing on the Jebsen-Taylor hand function test, 5 patients improved, 5 patients remained the same, and 3 patients worsened. No statistically significant change in timed testing was noted for any of the 6 subtests. A qualitative assessment of limb position during completion of tasks showed a significant improvement in position for the elbow (P < 0.01), forearm (P < 0.02), wrist (P < 0.02), and fingers (P < 0.02). There was no significant change in thumb position (P < 0.85). Conclusions: Tendon transfers, especially for wrist extension, can be beneficial in improving upper extremity joint positioning in children with Spastic Hemiplegia. However, significant impairment in hand function persists.
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Spastic Hemiplegia of the upper extremity in children
Hand Clinics, 1998Co-Authors: Peter M Waters, Ann E Van HeestAbstract:Care of upper extremity problems in hemiplegic children requires careful evaluation and planning. This article focuses on the evaluation and treatment of Spastic Hemiplegia attributable to cerebral palsy. All treatments must take into consideration the level of static and dynamic motor deformity; levels of discriminatory sensibility, intelligence, and motivation; and overall level of function. The treatments discussed are designed to improve the child's musculoskeletal condition but do not cure the underlying disease.
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sensibility deficiencies in the hands of children with Spastic Hemiplegia
Journal of Hand Surgery (European Volume), 1993Co-Authors: Ann E Van Heest, James H House, Matthew D PutnamAbstract:We evaluated 40 children with Spastic Hemiplegia due to cerebral palsy for sensory function and relative limb size in the affected and unaffected upper extremities. Sensory function of each limb was evaluated with respect to stereognosis (12 objects), two-point discrimination, and proprioception. Four size measurements of each limb were made: arm and forearm circumference and forearm and forearm-hand length. This study showed that 97% of the Spastic limbs had a stereognosis deficit, 90% had a two-point discrimination deficit, and 46% had a proprioception deficit. Thus sensory deficits are the rule rather than the exception in children with Spastic Hemiplegia. Those children with severe stereognosis deficits had significantly smaller limbs in all four measurement parameters than the children with mild or moderate stereognosis deficits. In the preoperative evaluation of children with Spastic Hemiplegia, severe size discrepancy is a physical examination tool that can be used as a predictor of severe sensory deficits. This information is helpful for the hand surgeon in establishing realistic surgical goals.
Jing Ru Gong - One of the best experts on this subject based on the ideXlab platform.
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hindlimb Spasticity after unilateral motor cortex lesion in rats is reduced by contralateral nerve root transfer
Bioscience Reports, 2016Co-Authors: Hai Yang Zong, Lai Yin Zhang, Hui Ping Lu, Jing Ru GongAbstract:The aim was to test the feasibility and effectiveness of contralateral nerve root transfer in reducing post stroke Spasticity of the affected hindlimb muscles in rats. In our study, we for the first time created a novel animal hindlimb Spastic Hemiplegia model in rats with photothrombotic lesion of unilateral motor cortex and we established a novel surgical procedure in reducing motor cortex lesion induced hindlimb Spastic Hemiplegia in rats. Thirty six rats were randomized into three groups. In group A, rats received sham operation. In group B, rats underwent unilateral hindlimb motor cortex lesion. In group C, rats underwent unilateral hindlimb cortex lesion followed by contralateral L4 ventral root transfer to L5 ventral root of the affected side. Foot print analysis, H-reflex, cholera toxin subunit B (CTB) retrograde tracing of gastrocnemius muscle motoneurons and immunofluorescent staining of vesicle glutamate transporter 1 (VGLUT1) on CTB labeled motoneurons were used to assess Spasticity of the affected hindlimb. Sixteen weeks postoperatively, toe spread and stride length recovered significantly in group C compared with group B (P We demonstrated that contralateral L4 ventral root transfer to L5 ventral root of the affected side was effective in relieving unilateral motor cortex lesion induced hindlimb Spasticity in rats. Therefore, contralateral neurotization may exert a potential therapeutic candidate to improve the function of lower extremity in patients with Spastic Hemiplegia.
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hindlimb Spasticity after unilateral motor cortex lesion in rats is reduced by contralateral nerve root transfer
Bioscience Reports, 2016Co-Authors: Hai Yang Zong, Lai Yin Zhang, Jing Ru Gong, Min Cai, Hao Dong Lin, Yizhun Zhun Zhu, Chun Lin HouAbstract:Lower extremity Spasticity is a common sequela among patients with acquired brain injury. The optimum treatment remains controversial. The aim of our study was to test the feasibility and effectiveness of contralateral nerve root transfer in reducing post stroke Spasticity of the affected hindlimb muscles in rats. In our study, we for the first time created a novel animal hindlimb Spastic Hemiplegia model in rats with photothrombotic lesion of unilateral motor cortex and we established a novel surgical procedure in reducing motor cortex lesion-induced hindlimb Spastic Hemiplegia in rats. Thirty six rats were randomized into three groups. In group A, rats received sham operation. In group B, rats underwent unilateral hindlimb motor cortex lesion. In group C, rats underwent unilateral hindlimb cortex lesion followed by contralateral L4 ventral root transfer to L5 ventral root of the affected side. Footprint analysis, Hoffmann reflex (H-reflex), cholera toxin subunit B (CTB) retrograde tracing of gastrocnemius muscle (GM) motoneurons and immunofluorescent staining of vesicle glutamate transporter 1 (VGLUT1) on CTB-labelled motoneurons were used to assess Spasticity of the affected hindlimb. Sixteen weeks postoperatively, toe spread and stride length recovered significantly in group C compared with group B (P<0.001). Hmax (H-wave maximum amplitude)/Mmax (M-wave maximum amplitude) ratio of gastrocnemius and plantaris muscles (PMs) significantly reduced in group C (P<0.01). Average VGLUT1 positive boutons per CTB-labelled motoneurons significantly reduced in group C (P<0.001). We demonstrated for the first time that contralateral L4 ventral root transfer to L5 ventral root of the affected side was effective in relieving unilateral motor cortex lesion-induced hindlimb Spasticity in rats. Our data indicated that this could be an alternative treatment for unilateral lower extremity Spasticity after brain injury. Therefore, contralateral neurotization may exert a potential therapeutic candidate to improve the function of lower extremity in patients with Spastic Hemiplegia.
Hai Yang Zong - One of the best experts on this subject based on the ideXlab platform.
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hindlimb Spasticity after unilateral motor cortex lesion in rats is reduced by contralateral nerve root transfer
Bioscience Reports, 2016Co-Authors: Hai Yang Zong, Lai Yin Zhang, Hui Ping Lu, Jing Ru GongAbstract:The aim was to test the feasibility and effectiveness of contralateral nerve root transfer in reducing post stroke Spasticity of the affected hindlimb muscles in rats. In our study, we for the first time created a novel animal hindlimb Spastic Hemiplegia model in rats with photothrombotic lesion of unilateral motor cortex and we established a novel surgical procedure in reducing motor cortex lesion induced hindlimb Spastic Hemiplegia in rats. Thirty six rats were randomized into three groups. In group A, rats received sham operation. In group B, rats underwent unilateral hindlimb motor cortex lesion. In group C, rats underwent unilateral hindlimb cortex lesion followed by contralateral L4 ventral root transfer to L5 ventral root of the affected side. Foot print analysis, H-reflex, cholera toxin subunit B (CTB) retrograde tracing of gastrocnemius muscle motoneurons and immunofluorescent staining of vesicle glutamate transporter 1 (VGLUT1) on CTB labeled motoneurons were used to assess Spasticity of the affected hindlimb. Sixteen weeks postoperatively, toe spread and stride length recovered significantly in group C compared with group B (P We demonstrated that contralateral L4 ventral root transfer to L5 ventral root of the affected side was effective in relieving unilateral motor cortex lesion induced hindlimb Spasticity in rats. Therefore, contralateral neurotization may exert a potential therapeutic candidate to improve the function of lower extremity in patients with Spastic Hemiplegia.
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hindlimb Spasticity after unilateral motor cortex lesion in rats is reduced by contralateral nerve root transfer
Bioscience Reports, 2016Co-Authors: Hai Yang Zong, Lai Yin Zhang, Jing Ru Gong, Min Cai, Hao Dong Lin, Yizhun Zhun Zhu, Chun Lin HouAbstract:Lower extremity Spasticity is a common sequela among patients with acquired brain injury. The optimum treatment remains controversial. The aim of our study was to test the feasibility and effectiveness of contralateral nerve root transfer in reducing post stroke Spasticity of the affected hindlimb muscles in rats. In our study, we for the first time created a novel animal hindlimb Spastic Hemiplegia model in rats with photothrombotic lesion of unilateral motor cortex and we established a novel surgical procedure in reducing motor cortex lesion-induced hindlimb Spastic Hemiplegia in rats. Thirty six rats were randomized into three groups. In group A, rats received sham operation. In group B, rats underwent unilateral hindlimb motor cortex lesion. In group C, rats underwent unilateral hindlimb cortex lesion followed by contralateral L4 ventral root transfer to L5 ventral root of the affected side. Footprint analysis, Hoffmann reflex (H-reflex), cholera toxin subunit B (CTB) retrograde tracing of gastrocnemius muscle (GM) motoneurons and immunofluorescent staining of vesicle glutamate transporter 1 (VGLUT1) on CTB-labelled motoneurons were used to assess Spasticity of the affected hindlimb. Sixteen weeks postoperatively, toe spread and stride length recovered significantly in group C compared with group B (P<0.001). Hmax (H-wave maximum amplitude)/Mmax (M-wave maximum amplitude) ratio of gastrocnemius and plantaris muscles (PMs) significantly reduced in group C (P<0.01). Average VGLUT1 positive boutons per CTB-labelled motoneurons significantly reduced in group C (P<0.001). We demonstrated for the first time that contralateral L4 ventral root transfer to L5 ventral root of the affected side was effective in relieving unilateral motor cortex lesion-induced hindlimb Spasticity in rats. Our data indicated that this could be an alternative treatment for unilateral lower extremity Spasticity after brain injury. Therefore, contralateral neurotization may exert a potential therapeutic candidate to improve the function of lower extremity in patients with Spastic Hemiplegia.
B C M Smitsengelsman - One of the best experts on this subject based on the ideXlab platform.
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effect of addition of botulinum toxin a to standardized therapy for dynamic manual skills measured with kinematic aiming tasks in children with Spastic Hemiplegia
Journal of Rehabilitation Medicine, 2010Co-Authors: Eugene Rameckers, Jacques Duysens, Lucianne Speth, Hans J S Vles, B C M SmitsengelsmanAbstract:OBJECTIVE: To measure the effect of intensive therapy and the lasting effect of a standardized functional training programme with vs. without the addition of chemodernervation of the muscles of the forearm and hand. PATIENTS AND METHODS: Twenty children with Spastic Hemiplegia, aged 4-16 years, were matched for baseline characteristics and randomized to standardized task-oriented therapy for 6 months with or without botulinum toxin injections. Dynamic kinematic outcome measures were: speed, accuracy, end-point spread and performance. Measurements of active and passive range of motion, stretch-restricted angle of the elbow and wrist, Ashworth scores and Melbourne Assessment of Unilateral Upper Limb Function were made. All measures were performed at baseline, 2 weeks after injection of botulinum toxin and after 6 months (at the end of therapy), and 3 months after end of the therapy. RESULTS: Clinical measures showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Directly after the botulinum toxin injection all kinematic outcome measures showed a decrease, but baseline values were re-established during the therapy period. After botulinum toxin injections a temporarily significant greater increase in speed and performance was found. These results illustrate the need for further quantitative research into the effects of botulinum toxin.
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botulinum toxin a in children with congenital Spastic Hemiplegia does not improve upper extremity motor related function over rehabilitation alone a randomized controlled trial
Neurorehabilitation and Neural Repair, 2009Co-Authors: Eugene Rameckers, Jacques Duysens, Lucianne Speth, J S H Vles, B C M SmitsengelsmanAbstract:BACKGROUND: Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). OBJECTIVE: To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized functional training program versus without the addition of chemodenervation of forearm and hand muscles. METHODS: Twenty children with Spastic Hemiplegia, aged 4 to 16 years, were matched for baseline characteristics and then randomized to standardized functional physical and occupational therapies for 6 months (PT/OT group) or to the same therapies plus multimuscle BTX-A (BTX+ group). MAIN OUTCOME MEASURES: were isometric generated force, overshoot and undershoot (force production error), active and passive range of motion by goniometry (ROM), stretch restricted angle (SRA) of joints, Ashworth scores at the elbow and wrist, and the Melbourne assessment of unilateral upper limb function. All measures were performed at baseline, 2 weeks after BTX-A, 6 months (end of therapy), and then 3 months after termination of the therapy. RESULTS: Clinical measures (muscle tone, active ROM of wrist and elbow) showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Generated force decreased directly after the BTX-A injection but increased during the therapy period. The PT/OT group, however, showed a significantly higher increase in force and accuracy with therapy compared with the BTX+ therapy group. CONCLUSIONS: Functional rehabilitation therapies for the upper extremity increase manual isometric flexor force at the wrist and ROM, but BTX injections cause weakness and do not lead to better outcomes than therapy alone.
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fast responses to target changes are not impaired in children with Spastic Hemiplegia
Neuroreport, 2009Co-Authors: B C M Smitsengelsman, Eugene E A Rameckers, Jacques DuysensAbstract:Humans are able to correct an ongoing movement very quickly in response to a suddenly moving target. Such fast responses possibly bypass the motor cortex and if so, one would expect that damage to the motor cortex would not greatly affect them. A group of children with congenital Spastic Hemiplegia were asked to move to a target, which, in some trials, jumped to a new position. It was found that the congenital Spastic Hemiplegia group was not affected more by the target jumps than the typically developing children. The moving targets made adaptive movements faster instead of slower for the affected hand. It is concluded that fast-adjusting movements do not necessarily rely on the motor cortex in these children.
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kinematic aiming task measuring functional changes in hand and arm movements after botulinum toxin a injections in children with Spastic Hemiplegia
American Journal of Physical Medicine & Rehabilitation, 2007Co-Authors: Eugene Rameckers, Jacques Duysens, Lucianne Speth, J Hans S Vles, B C M SmitsengelsmanAbstract:OBJECTIVE: To describe different aspects of a kinematic aiming task (KAT) as a quantitative way to assess changes in arm movements within 2 wks after botulinum toxin-A (BTX-A) injections in children with Spastic Hemiplegia. DESIGN: Intervention study randomized clinical trial; follow-up within 4 wks after baseline measurement. RESULTS: The KAT gave a high intraclass correlation on movement time, spread of end points (END), and index of performance effective (IP-E). After BTX-A, a significant increase of END and IP-E was shown if precision demand in the KAT was high, whereas the inverse occurred when speed was more important. These functional changes coincided with a significant decrease of the maximum voluntary contraction of the flexor muscles of the forearm. Muscle tone measured with the Ashworth scale did show a nonsignificant decrease of muscle tone, as did the stretch restricted angle and the active and passive ranges of motion of the elbow and wrist. CONCLUSIONS: Muscle force decreased immediately after BTX-A, showing the direct effect of BTX-A. The KAT is an adequate, reproducible way to quantify functional changes after BTX-A in the upper limb. BTX-A has an inverse effect in the precision task when accuracy is important, and it has a positive effect when speed prevails.
Mary Ann Keenan - One of the best experts on this subject based on the ideXlab platform.
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muscle releases to improve passive motion and relieve pain in patients with Spastic Hemiplegia and elbow flexion contractures
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Surena Namdari, Gabe J Horneff, Keith D Baldwin, Mary Ann KeenanAbstract:Introduction Patients with Spastic Hemiplegia after upper motor neuron (UMN) injury can develop elbow contractures. This study evaluated outcomes of elbow releases in treating Spastic elbow flexion contractures in hemiplegic patients. Methods Adults with Spastic Hemiplegia due to UMN injury who underwent elbow releases (brachialis, brachioradialis, and biceps muscles) were included. Nonoperative treatment was unsuccessful in all patients. Patients complained of difficulty with passive functions. Passive range of motion (ROM), pain relief, Modified Ashworth Spasticity score, and complications were evaluated preoperatively and postoperatively. Results There were 8 men and 21 women with an average age of 52.4 years (range, 24.1-81.4 years). Seventeen patients had pain preoperatively. Postoperative follow-up was a mean of 1.7 years (range, 1-4.5 years). Preoperatively, patients lacked a mean of 78° of passive elbow extension compared with 17° postoperatively (P .05). Conclusion Releases of the brachialis, brachioradialis, and biceps muscles can be an effective means of pain relief, improved passive ROM, and decreased Spasticity in patients with elbow flexion deformity after UMN injury.
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shoulder tenotomies to improve passive motion and relieve pain in patients with Spastic Hemiplegia after upper motor neuron injury
Journal of Shoulder and Elbow Surgery, 2011Co-Authors: Surena Namdari, Keith D Baldwin, Hassan Alosh, Samir Mehta, Mary Ann KeenanAbstract:Hypothesis Shoulder adduction and internal rotation contractures commonly develop in patients with Spastic Hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function. Materials and methods A consecutive series of 36 adults (10 men, 26 women) with Spastic Hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively. Results Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P Discussion We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy. Conclusion Shoulder tenotomy to relieve Spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function.