Tsui-Fen Yang

Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing.

Liao S-F, Yang T-F, Hsu T-C, Chan R-C, Wei T-S: Differences in seated postural control in children with spastic cerebral palsy and children who are typically developing. Am J Phys Med Rehabil 2003;82:622–626. ObjectiveTo quantitatively evaluate the difference of posture control in sitting position between children with spastic cerebral palsy and normal subjects. DesignTwenty children with spastic cerebral palsy who could sit independently and 20 age- and sex-matched normal children were enrolled. The Chatteex Balance System was used to evaluate static and dynamic posture control as the subjects were sitting on a bench. The sway distance in sagittal and lateral directions, sway ratio, and sway index in both the static and dynamic sitting positions were recorded by the Chatteex Balance System. ResultsThere was a significantly lower static and dynamic sway ratio and a greater static sway index and dynamic lateral sway distance in the study group. The dynamic sway index in the study group was greater than the index in the control group, although it did not reach statistical significance. ConclusionsChildren with diplegic cerebral palsy did perform significantly worse in sitting posture control compared with normal subjects of similar chronological age. The sway index and sway ratio proved to be the objective and sensitive indicators that can be used to distinguish children with cerebral palsy from normal peer groups.

Pediatric Aquatic Therapy on Motor Function and Enjoyment in Children Diagnosed With Cerebral Palsy of Various Motor Severities

This study investigates the effects of pediatric aquatic therapy on motor function, enjoyment, activities of daily living, and health-related quality of life for children with spastic cerebral palsy of various motor severities. Children with spastic cerebral palsy were assigned to a pediatric aquatic therapy group (n = 11; mean age = 85.0 ± 33.1 months; male : female = 4 : 7) or a control group (n = 13; mean age = 87.6 ± 34.0 months; male : female = 9 : 4). The statistic results indicate that the pediatric aquatic therapy group had greater average 66-item Gross Motor Function Measure following intervention than the control group (η2 = 0.308, P = .007), even for children with Gross Motor Function Classification System level IV (5.0 vs 1.3). The pediatric aquatic therapy group had higher Physical Activity Enjoyment Scale scores than the control group at post-treatment (P = .015). These findings demonstrate that pediatric aquatic therapy can be an effective and alternative therapy for children with cerebral palsy even with poor Gross Motor Function Classification System level.

Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy

Severe muscular spasticity encountered frequently in patients with spastic cerebral palsy not only affects patient locomotor function but also causes musculoskeletal complications. Significant reduction of spasticity over pelvis and lower limbs after selective posterior rhizotomy (SPR) results in improvement of trunk stability, locomotor function, and function of upper limbs also. The purpose of this study was to investigate the difference of sitting balance before and after SPR using a quantitative measurement in sitting stability represented as dispersion index provided by the Chattecx Balance System. Seventeen children with spastic cerebral palsy, ten boys and seven girls, with a mean age of 5.06 yr, underwent SPR. Their sitting stability under static and dynamic, visual and nonvisual testing conditions was assessed before SPR and three mo after SPR. Their sitting balance showed significant improvement at postoperative evaluation except for the static-nonvisual testing condition. Dispersion index under the dynamic testing condition was significantly higher than under the static testing condition, which implies that dynamic sitting balance was worse than static sitting balance in these patients. There was no statistical difference of sitting performance between visual and nonvisual condition both preoperatively and postoperatively. Quantitative measurement of dispersion index provided by the Chattecx Balance System offers an objective evidence of improvement in sitting balance for children after SPR.

Neuropsychological functions and quality of life in survived patients with intracranial germ cell tumors after treatment

BACKGROUND The notable survival chances of intracranial germ cell tumors (icGCTs) lead to a rising concern over long-term neurocognitive outcome. Yet, prior evidence related to this issue fails to provide a comprehensive examination of the effects of tumor location and radiotherapy. We attempt to explore their impacts on the neuropsychological functions and life quality in children with icGCT after multimodality treatments. METHODS A retrospective review of 56 patients diagnosed with icGCTs at age <20 and treated at the Taipei Veterans General Hospital was provided. Intelligence, memory, visual organization, attention, and executive function were assessed by neurocognitive tests; adaptation to life, emotional and behavioral changes, interpersonal relationships, and impact on the family were evaluated by parent-report instruments. Effects of tumor locations (germinomas and nongerminomatous malignant germ cell tumors in the pineal, suprasellar, and basal ganglia) and irradiation on these measurements were examined. RESULTS Patients with tumors in the basal ganglia region had lower full-scale IQs than those with tumors in the pineal or suprasellar regions. Subscores of intelligence scale and short-term retention of verbal and visual stimuli showed evident group differences, as did the quality of life and adaptive skills, particularly in psychosocial domains. Patients treated with whole-ventricular irradiation had better outcomes. Extensive irradiation field and high irradiation dosage influenced intellectual functions, concept crystallization, executive function, and memory. CONCLUSIONS Tumor location and irradiation field/dosage appear to be the crucial factors related to certain neuropsychological, emotional, and behavioral dysfunctions that in turn alter the quality of life in children with icGCTs who survive after treatment.

Brainstem auditory evoked potential monitoring and neuro-endoscopy: Two tools to ensure hearing preservation and surgical success during microvascular decompression

Background: The effectiveness of microvascular decompression (MVD) has made trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia, and other cranial nerve rhizopathy diseases treatable by surgery. To ensure hearing preservation and surgical success, we have presented our experience in the application of brainstem auditory evoked potential (BAEP) monitoring and neuro‐endoscopy during MVD. Methods: From July 2007 to October 2012, a total of 93 patients in our institution received MVD for cranial nerve rhizopathies. Among these patients, 43 had both BAEP monitoring and endoscope‐assisted microsurgery for their MVD. None of the patients had undergone previous surgical treatment. Postoperative outcomes were assessed based on the medical records and clinical follow‐up. Results: This study included 32 women and 11 men. There were 36 HFS cases and seven TN cases, and the median patient age at the time of MVD was 48 years. The median duration of symptoms before MVD was 4.2 years, and the median follow‐up duration was 3.5 years (range 1.5 months–5 years). All of the patients had either immediate or delayed complete relief from the symptoms after MVD. One TN patient underwent gamma knife radiosurgery 3 years after MVD, and two HFS cases had recurrent slight spasms, which warranted no further treatment. There was no surgical mortality. The major complications included one HFS patient with delayed and permanent hearing loss and facial palsy, which occurred 1 week after MVD. The surgical success rate was 100%, and the hearing complication rate was 2%. Conclusion: The results of this retrospective study emphasized the importance of BAEP monitoring and neuro‐endoscopy during MVD. It is well known that BAEP monitoring can preserve hearing function, and the endoscope offers neurosurgeons a second look to identify the nerve root entry zone and confirms the position of the Teflon felt. These two tools are especially useful in difficult cases.

Spinal Dysraphism: A Cross-sectional and Retrospective Multidisciplinary Clinic-based Study

Background: Spinal dysraphism is a common birth defect that causes different kinds of secondary impairments, including joint deformities, reduced mobility, and bowel/bladder dysfunction. Due to the diversity in terminology, cultural/ethnic differences, and medical policies, prior study results cannot be generalized to all populations. Therefore, we performed this study to define the characteristics of patients in Taiwan with spinal dysraphism. Methods: Patients diagnosed with a myelomeningocele or lipomyelomeningocele were identified from the database of our spinal dysraphism multidisciplinary clinic. A cross‐sectional study was conducted by telephone interview and retrospective chart review. Clinical characteristics, such as neurologic level, orthopedic deformities, assistive device use, and level of ambulation, were collected. Spearmans correlation (r) tests were performed between ambulation or neurologic level and other variables. Results: Seventy‐eight subjects were included in the current study. Subjects with myelomeningoceles had more severe neurologic involvement, poorer ambulation outcome, and higher rates of orthopedic deformities, assistive device use, lower hand function, and bowel/bladder dysfunction. The correlation test revealed that the level of ambulation was negatively influenced by a higher neurologic level, a history of shunt placement, and various orthopedic deformities. Neurologic level also had widespread influence on history of shunt placement, orthopedic deformities, assistive device use, the need for additional assistive devices, aggressiveness of assistive devices, and bowel/bladder dysfunction. Conclusions: For patients with spinal dysraphism, the neurologic level is the most important prognostic factor for many other clinical characteristics, including ambulation status.

EMG changes during graded isometric exercise in pianists: comparison with non-musicians.

Background: Long‐term piano training might induce some biochemical and structural adaptations in the intrinsic muscles of the hand or change the motor strategy of the nervous system. The main purpose of this study was to analyze whether the intrinsic muscles of the hands of pianists and sedentary controls differ in electromyographic characteristics at different strengths. Methods: Fifteen college piano students and 15 sedentary controls were asked to sit on an examination bench and perform first dorsal interosseous muscle contractions for 1 minute. The motor unit potentials were recorded during various percentages of maximal voluntary muscle contraction (MVC) by automatic decomposition electromyography. Results: The pianists demonstrated a significantly higher firing rate, shorter duration, and higher amplitude of motor unit potentials during minimal muscle contractions than the sedentary controls. But when comparing all the parameters at other degrees of contractions, the pianists were found to have significantly higher firing rate only at 25% and 50% of MVC, and higher amplitude at maximal contraction than the control group. The amplitude at maximal control contraction was higher in pianists than in controls. Conclusion: These results imply that high‐frequency and highly efficient muscle fibers are recruited in pianists when minimal muscle contractions are performed, which also indicate that by using smaller motor units, pianists may delicately control their fine motor performance.

Fluorescence-assisted visualization of facial nerve during mastoidectomy: A novel technique for preventing iatrogenic facial paralysis

OBJECTIVE Mastoidectomy can be risky due to the chance of iatrogenic facial nerve dysfunction. Avoiding injuries to the mastoid segment of the facial nerve is mandatory when drilling the bone. With advancements in intraoperative near-infrared indocyanine green (ICG) video angiography, we describe the application of a novel fluorescent guidance technique during mastoidectomies to identify the facial canal with safety. METHODS Mastoidectomies were performed as the key step in the presigmoid, petrosal or translabyrinthine approaches in 16 patients with different pathologies located at the cerebellopontine angle or petroclival region. After the facial canal was drilled to paper thin, ICG was injected via the central venous catheter. Compared with the dark bony portion, the vessels inside the vasa nervorum were highlighted as a result. The fluorescence guides the operator through the course of the facial nerve and facilitates opening of the internal auditory canal and the dissection of tumors. RESULTS All 16 facial nerves were recognized during mastoidectomies under fluorescence guidance for varied periods of enhancing time (range, 23-50s). In all, one to four attempts after repeated drilling works to enhance the facial nerve were required before these nerves could be clearly seen. The tumor resection procedure yielded the following results: grossly total removal in seven patients, near total removal in five, and subtotal removal in three. Complete obliteration of a giant vertebral artery aneurysm in one patient was seen in the follow-up angiogram. The post-mastoidectomy facial nerve function, examined by triggered EMG, was preserved in all 16 patients, and no patients had postoperative facial palsy worse than House-Brackmann grade IV after 6 months of follow-up. CONCLUSION With this novel technique, the course of the facial nerve can be confirmed during mastoidectomy, which reduces the possibility of iatrogenic facial nerve dysfunction. This fluorescence technique is especially helpful in establishing confidence and shortening the learning curve for beginners at mastoidectomies.

Delayed Onset of Peroneal Neuropathy After Minor Ankle Torsion in a 9-Year-Old Boy

Ankle sprain is only rarely reported as the cause of peroneal nerve palsy and occurs predominantly in adults. Peroneal nerve palsy following an ankle sprain is extremely rare in children. Furthermore, peroneal nerve palsy most commonly results from a severe ankle sprain with considerable pain and edema. Peroneal nerve palsy after minor ankle torsion without major clinical symptoms of ankle sprain is uncommon. Here, we report the case of a 9-year-old boy who developed right peroneal neuropathy, leading to foot drop, following minor ankle plantar flexion/inversion torsion. Electrophysiological findings confirmed a focal neuropathy around the fibular head. The neurologic symptoms resolved completely 4 months after the injury. This case emphasizes that peroneal neuropathy can occur after minor ankle torsion without evident ankle sprain symptoms. Moreover, electrophysiological evaluation is very helpful to confirm the diagnosis and is important for prognostic evaluation.

Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

OBJECTIVE To compare the effectiveness of local steroid injection plus splinting with that of local steroid injection alone using clinical and electrophysiological parameters in patients with carpal tunnel syndrome (CTS). DESIGN Randomized controlled study with 12 weeks of follow-up. SETTING Tertiary care center. PARTICIPANTS Volunteer sample of patients (N=52) diagnosed with CTS. INTERVENTIONS Participants were randomly assigned to the steroid injection group (n=26) or the steroid injection-plus-splinting group (n=26). Patients of both groups received ultrasound-guided steroid injection with 1mL of 10mg (10mg/mL) triamcinolone acetonide (Shincort) and 1mL of 2% lidocaine hydrochloride (Xylocaine). Participants in the second group also wore a volar splint in the neutral position while sleeping and also during daytime whenever possible for the 12-week intervention period. MAIN OUTCOME MEASURES Participants were evaluated before the treatment and at 6 and 12 weeks after the onset of treatment. The primary outcome measure was Boston Carpal Tunnel Questionnaire scores. The secondary outcome measures were as follows: scores on the visual analog scale for pain; electrophysiological parameters, including median nerve distal motor latency, sensory nerve conduction velocity (SNCV), and compound muscle action potential and sensory nerve action potential (SNAP) amplitudes; and patients subjective impression of improvement. RESULTS At 12-week follow-up, improvements in symptom severity and functional status scores on the Boston Carpal Tunnel Questionnaire as well as SNCV and SNAP amplitudes were greater in the group that received steroid injection combined with splinting than in the group that received steroid injection alone. The between-group difference was .48 points (95% confidence interval [CI], .09-.88 points; P=.032) in the Symptom Severity Scale score, .37 points (95% CI, .06-.67 points; P=.019) in the Functional Status Scale score, 3.38m/s (95% CI, 0.54-6.22m/s; P=.015) in the SNCV amplitude, and 3.21μV (95% CI, 0.00-6.46μV; P=.025) in the SNAP amplitude. CONCLUSIONS In people with CTS, steroid injection combined with splinting resulted in modestly greater reduction of symptoms, superior functional recovery, and greater improvement in nerve function at 12-week follow-up as compared with steroid injection alone. However, these small differences are of unclear clinical significance.