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   Table of Contents - Current issue
July-December 2016
Volume 2 | Issue 2
Page Nos. 69-125

Online since Wednesday, April 12, 2017

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Interventions on hyperexcited motor circuits: Science or bias and confusion – what can be done? p. 69
Aniruddh Kumar Purohit
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Neuronal apoptosis of the developing brain: Influence of anesthetics p. 71
Padmaja Durga
Surgeries and multiple procedures are undertaken on millions of children all over the world which involves exposure of these children to anesthetics during the stage of brain development. There is an increasing concern regarding the risk of anaesthetic neurotoxicity in children. Evidence has shown that exposure to all commonly used anaesthetics and sedatives can cause neurodegeneration in the developing brain with the possible exception of α2-adrenergic agonists. Anaesthetic effects on the brain during its growth spurt can initiate a cascade of alterations in neurodevelopment which have been detected structurally or functionally in preclinical experiments. The studies are ongoing to gather clinical evidence.
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Testicular characteristics of children with cerebral palsy: Our experience p. 79
Ibrahim Aliyu, Abdulsalam Mohammed, Raymond Belonwu, Zainab Fumilayo Ibrahim, Umar Isah Umar
Introduction: Cerebral palsy (CP) is a chronic neurologic disorder. The hallmark of CP is the abnormality of movement and posture, but there may be other associated abnormalities; however, association with absent testis is an area poorly studied. Materials and Methods: This was a case–control study. Pretested questionnaire was administered by the researchers, and testicular size was determined using an orchidometer. Results: Thirty-six (65.5%) of the caregivers in the cerebral palsy group had examined the testes of their wards while only 17 (30.9%) of those in the noncerebral palsy group had examined the testes of their wards. Absent testes were reported in 5 (13.9%) of the children in the cerebral palsy group while none was reported in the non-CP group. Three (60%) left testes were reported absent in the CP group, and two (40%) had both testes absent. Most caregivers (80%) could not remember the exact age at which the testes became nonpalpable, but one (20%) was reported at <1-year of life and none at birth. Only one caregiver (20%) complained of absent testes in the cerebral palsy group. A total of 8 (7.3%) testes were absent from the 110 testes (55 pairs); on the right side, 3 (5.5%) absent testes and 2 small testes were recorded among the CP group while only a single small testis was reported in the non-CP group. Conclusion: Absent testes were more common among the CP group; routine check of its presence and size should be a part of their evaluation.
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Does Q angle change in spastic diplegia children? p. 85
TU Jimshad, Sanam Mainali, KS Swethankh, Anil T John
Background: Spastic diplegia is a form of cerebral palsy that is a chronic neuromuscular condition of hypertonia and spasticity manifested as an especially high and constant tightness or stiffness in the muscles of the lower extremities of the human body, usually those of the legs, hips, and pelvis. Q angle is an angle formed by two imaginary lines, first line extending from anterior superior iliac spine to center point of patella and second line extending from tibial tuberosity to center point of patella. The abnormal twisting of patella is known as tibial torsion. Objectives: To find Q angle value in male children with spastic diplegia aged between 7 and 12 years and to compare the degree of Q angle between children with internal and external tibial torsion. Methodology and Procedure: A total of thirty male children aged between 7 and 12 years were divided into two groups based on their tibial torsion, and Q angle was assessed using standard goniometer. Results: Results were statistically analyzed. There was a significant change in Q angle of children with spastic cerebral palsy, and children with spastic diplegia with internal tibial torsion have decreased Q angle and children with external tibial torsion have a significant increase in their Q angle (P = 0.001). Conclusion: This study concludes that Q angle is a good outcome variable for assessing musculoskeletal problem related to lower limb and can be used as a major tool for prognosis during rehabilitation. This study also proves that children with spastic diplegia with internal tibial torsion have decreased Q angle and children with external tibial torsion have a significant increase in their Q angle.
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Comorbidities and their relationship to subtype of cerebral palsy in a tertiary care hospital in South India p. 90
Raghavendraswami Amoghimath, Vykuntaraju K Gowda, Asha Benakappa
Introduction: Comorbid conditions such as intellectual disability (ID), visual disability, epilepsy, and hearing impairment are associated with cerebral palsy (CP). For many children with cerebral palsy, it is these cooccurring conditions that may often have the greatest impact on the child and family from varying perspective. Aims: The aim of the current study was to provide data on the frequency and type of comorbidities in children with cerebral palsy and the burden of comorbidities among each motor subtypes of CP. In addition, we evaluated the causative agent of motor subtypes of CP. Methods: Two hundred consecutive children with cerebral palsy attending the pediatric neurology outpatient department with an age group from 3 months to 18 years were enrolled in the study. Information on neurologic subtype classified according to the topographic distribution of the motor impairment on neurologic examination and the presence of comorbidities: ID, visual impairment, hearing impairment, and coexisting afebrile seizures, was obtained. Demographic factors were also noted. Results: The mean age of the children was 55 months, with 120 boys and 80 girls. ID was seen in 91% (182/200) of children. Active afebrile seizure disorder was noted in 40% (80/200), severe auditory impairment was noted in 4% (8/200), and cortical visual impairment was noted in 19.5% (39/200) of children. Comorbidities were most frequent in children with spastic and dyskinetic cerebral palsy. The most common type of seizures was focal seizures in 47 individuals (23.5% of all the individuals), followed by generalized seizures in 23 individuals (11.5% of all the individuals) and myoclonic seizures in 11 individuals (5.5% of all the individuals). Conclusion: ID and seizures are more frequently associated comorbidities with CP. Bilateral spastic and dyskinetic CP are more likely to be associated with comorbidities.
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Efficacy of task-oriented training on balance in children with cerebral palsy p. 94
Arjun Dutt, BN Prem Kumar
Background and Objective: Cerebral palsy (CP) is a well-recognized group of motor and postural neurodevelopmental disorders beginning in early childhood and persisting through the life span.[1] Prevalence estimates of CP ranged from 1.5 to more than 4 per 1000 live births. This single-group interventional study was conducted to know the effectiveness of task-oriented training on balance in children with cerebral palsy. Materials and Methods: Patients included for the study were children with spastic diplegic cerebral palsy, 6–14 years of age, both male and female children, Gross Motor Functional Classification Scale levels I, II and III, Motor Assessment Scale (sitting to standing item), and Modified Modified Ashworth Scale (MMAS) grade 1 and 2. Pediatric Balance Scale (PBS), Functional Reach Test (FRT), Five Times Sit to Stand Test (5STS), and Modified Modified Ashworth Scale (MMAS) were used as the tools of assessment. Task consisting included sitting reach outs activities, sit to stand activity, squatting, step up, stepping on one leg, and step on a small ball. Descriptive and inferential statistical analyses have been carried out in the present study, Student's t-test (two-tailed, independent) has been used for intergroup analysis, and Student's t-test (two-tailed, dependent) has been used to find the significance of study parameters on continuous scale within each group. Duration of the study lasted for 12 months and frequency was 1 h per session, 5 days a week. Results: Statistical analysis was performed using Student's t-test and significant improvement was observed in balance with task-oriented training with the mean improvement of 3.667 in PBS, 0.250 in 5STS, 0.25 in FRT, and 63% in MMAS. Conclusion: This study suggests that the task-oriented training is effective in improving the balance of children with cerebral palsy assessed using PBS, FRT, 5STS, and MMAS.
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Individuals having cerebral palsy with tertiary structural dissociation: A preliminary report p. 100
Hong Wang Fung
Cerebral palsy (CP) is one of the most common childhood physical disabilities and often requires various treatments. The experience of living with CP and receiving early-life medical treatments could be psychologically traumatic and stressful. Previous studies found that psychological problems are not uncommon among individuals with cerebral palsy. However, the comorbidity of CP and tertiary structural dissociation of the personality (TSDP) is an unaddressed topic in the field and has just been brought into the literature recently. TSDP is the extreme form of posttraumatic psychopathology, and its typical clinical example is the DSM-5 dissociative identity disorder. This paper provides a preliminary report of four patients with comorbidity of cerebral palsy and TSDP. This complicated comorbidity might be a new challenge in the field and more attention to it is needed. Further investigations of this comorbidity are necessary. Some implications for research and practice are discussed.
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Abstracts p. 105
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