RESUMO
Movement disorders comprise a heterogeneous and complex group of neurological disorders that increase (hyperkinetic) or decrease (hypokinetic) the speed or amplitude of movements, or disrupt their coordinated sequencing. In this article, we describe three instructive cases, exemplifying classic movement disorders, namely dystonia, chorea, and ataxia. We highlight the diagnostic approach based on clinical clues, syndromic reasoning, evaluation, and management recommendations. Each case ends with key messages for the clinicians.
Assuntos
Coreia , Distonia , Distúrbios Distônicos , Transtornos dos Movimentos , Humanos , Coreia/diagnóstico , Coreia/terapia , Distonia/diagnóstico , Distonia/terapia , Transtornos dos Movimentos/diagnóstico , Ataxia/diagnóstico , Ataxia/terapiaRESUMO
OBJECTIVES: To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). STUDY DESIGN: Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. RESULTS: Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. CONCLUSIONS: Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.
Assuntos
Ataxia/terapia , Incontinência Fecal/terapia , Distúrbios do Assoalho Pélvico/terapia , Criança , Feminino , Humanos , Masculino , Diafragma da Pelve , Modalidades de Fisioterapia , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim of the present study was to analyze the use of anodal tDCS of the cerebellar region combined with treadmill training to improve balance and functional performance in children with ataxic cerebral palsy. DESIGN: Single-blind, sham-controlled, crossover, pilot study. SETTING: Rehabilitation center and research motion analysis laboratory. PARTICIPANTS: Children (N = 6) with ataxic cerebral palsy and balance deficit. MAIN OUTCOME MEASURES: Static balance (oscillations of the center of pressure), functional balance (Pediatric Balance Scale) and functional performance (Pediatric Evaluation of Disability Inventory) were evaluated. RESULTS: Significant reductions occurred in oscillations of the center of pressure with eyes closed after active anodal tDCS only. The effects of treadmill training on functional balance and functional performance in mobility were maintained in the active tDCS group only. CONCLUSION: These preliminary data support the notion that anodal tDCS of the cerebellar region combined with treadmill training improves balance in children with ataxic cerebral palsy.
Assuntos
Ataxia/terapia , Cerebelo/fisiopatologia , Paralisia Cerebral/terapia , Terapia por Exercício/métodos , Doenças Genéticas Inatas/terapia , Avaliação de Resultados em Cuidados de Saúde , Estimulação Transcraniana por Corrente Contínua/métodos , Criança , Pré-Escolar , Terapia Combinada , Estudos Cross-Over , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-CegoAssuntos
Ataxia/terapia , Estimulação Encefálica Profunda/métodos , Síndrome do Cromossomo X Frágil/terapia , Núcleos Posteriores do Tálamo , Tremor/terapia , Zona Incerta , Idoso , Ataxia/genética , Proteína do X Frágil da Deficiência Intelectual/genética , Síndrome do Cromossomo X Frágil/genética , Humanos , Masculino , Resultado do Tratamento , Tremor/genéticaAssuntos
Neoplasias das Glândulas Suprarrenais/complicações , Ataxia/terapia , Ganglioneuroblastoma/complicações , Imunoglobulina G/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Transtornos da Motilidade Ocular/terapia , Tremor/terapia , Ataxia/etiologia , Feminino , Humanos , Lactente , Transtornos da Motilidade Ocular/etiologia , Tremor/etiologiaAssuntos
Humanos , Masculino , Feminino , Ataxia/patologia , Ataxia/terapia , Coreia/patologia , Coreia/terapia , Hemiplegia/terapia , Hemiplegia/patologiaRESUMO
La Corea de Huntington (CH) puede asociarse a otros procesos; sin embargo la asociación con las ataxias cerebelosas es poco frecuente. se presenta un caso juvenil de ataxia, con signos piramidales y degeneración retiniana en una descendiente directa de CH. La administración de isoniacida a dosis de 300 mgrs. diarios mejoró la ataxia notablemente. Se intenta establecer una correlación bioquímica entre ataxia y corea en relación con el ácido gamma-aminobutírico