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SDR yra veiksminga priemonė kovojant su CP sukeltu raumenų spastiškumu, visgi Lietuvoje vis dar trūksta informacijos ir tyrimų šia tema. Tyrimo objektas: SDR poveikis vaikų su CP kojų raumenų spastiškumui ir elektriniam aktyvumui, eisenai. Tyrimo tikslas: įvertinti SDR poveikį vaikų su CP kojų raumenų spastiškumui ir elektriniam aktyvumui, eisenai. Išanalizavus mokslinę literatūrą galima teigti jog raumenų spastiškumas yra klinikinis CP sindromas, atsirandantis dėl viršutinių neuronų pažeidomo, o atlikus EMG tyrimus, pastebima jog po šio pažeidimo sergančiojo eisena primena tipiškai besivystančio vaiko pradinį savarankišką vaikščiojimą, tačiau CP vaikams atlika SDR operaciją užtikrina nuoseklų spazminių pacientų motorinės funkcijos pagerėjimą. Kineziterapija prieš SDR pagerina ankstyvą chirurginę naudą, o po operacijos yra svarbu užtikrinti laispsnišką paciento reabilitaciją. Vaikų po SDR kojų elektrinio aktyvumo rezultatai nesiskyrė, išskyrus dešinės kojos m. tibialis anterior aktyvumas buvo didesnis (p>0,05)., SDR is an effective tool in combating muscle spasticity caused by CP, but there is still a lack of information and research on this topic in Lithuania. Research object. The effect of SDR on lower limb muscle spasticity, electromyographic activity and gait in children with CP. Research aim. To evaluate the effect of SDR on muscle spasticity and electromyographic activity during gait in children with CP. Analyzing the scientific literature, it can be concluded that muscle spasticity is a clinical syndrome of cerebral palsy, resulting from upper motor neuron damage. EMG studies have shown that individuals with this condition exhibit a gait pattern similar to that of typically developing children during initial independent walking. However, performing selective dorsal rhizotomy (SDR) surgery on children with cerebral palsy ensures consistent improvement in motor function for spastic patients.

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p>0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity. Introdução: A espasticidade é uma condição motora presente em 75 a 88 % das crianças com Paralisia Cerebral (PC). Uma forma de tratamento é a chamada oscilação mecânica pontual (OP). Este trabalho teve por objetivo estudar diferentes protocolos de aplicação da OP e a magnitude de seus efeitos. Métodos: Foram incluídas 7 crianças com diagnóstico médico de PC e CID (Classificação Internacional de Doenças). O primeiro protocolo de intervenção (Int1) consistiu na aplicação de OP no tendão do músculo espástico e o segundo protocolo de intervenção (Int2) no ventre muscular do músculo antagonista espástico. Para avaliação, foi utilizada a Escala Modificada de Ashworth (EMA), capturando simultaneamente os sinais da mecanomiografia (MMG). Os dados foram coletados antes da intervenção e 1 (Pós1), 15 (Pós15), 30 (Pós30), 45 (Pós45) e 60 (Pós60) minutos após as intervenções. Resultados: Os valores do MAS (mediana ± intervalo interquartil) pós-intervenção foram estatisticamente menores quando comparados aos pré-valores nos 2 protocolos estudados; no Int1 entre Pré (2 ± 0) e Pós15 (0 ± 1,75), Pós30 (0 ± 1), Pós45 (1 ± 1) e Pós60 (1 ± 1) e no Int2 apenas entre Pré (2 ± 1) e Pós1 (0 ± 1). Os valores encontrados no MMG nos domínios temporal e espectral não seguiram um padrão (p> 0,05). Conclusão: A comparação entre os protocolos não demonstrou diferenças estatísticas em nenhuma característica (EMA, MMGMF, and MMGRMS). No entanto, a OP mostrou-se um recurso terapêutico que modulou a espasticidade por até 60 minutos após a sua aplicação, e a OP poderia contribuir como uma ferramenta para auxiliar o tratamento da espasticidade.

Cerebral palsy (CP) is a non-progressive injury to the developing central nervous system resulting in permanent disorders of the development of movement and posture, causing activity limitation. Therefore physical and rehabilitation medicine has a particular interest in the study of organization and reorganization of the sensorimotor cortex following early brain injury in order to propose new methods for motor rehabilitation. We first showed that motor cortex could be analyzed in functional magnetic resonance imaging (fMRI) using action-observation and passive movement tasks. We then demonstrated in patients with unilateral CP that resting state analysis could study functional connectivity in sensorimotor system. Moreover, our work showed that observing hand movement produced, in CP patients, large bilateral activations in temporo-parieto-fronto-occipital network, comprising most of the nodes of the well described action-observation network. For either side, observing hand movements recruits the primary motor cortex, contralateral to the viewed hand, as would be expected in healthy persons. In addition, we showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation. Finally we present the perinatal stroke as a well suited model to analyze the postlesional neural plasticity notably the "mal-adaptive" plasticity.; La paralysie cérébrale (PC) est définie comme un trouble du mouvement secondaire à une lésion cérébrale précoce non progressive. C'est la première cause de handicap moteur de l'enfant. La médecine physique et de réadaptation a donc un intérêt particulier à l'étude du contrôle centrale de la motricité (motricité-cérébrale) aussi bien en termes d'organisation que de réorganisation après lésion, et ce, afin de proposer de nouvelles méthodes de rééducation motrice. Après avoir montré, chez le sujet sain, que la motricité-cérébrale pouvait être étudiée, en imagerie par résonance magnétique fonctionnelle (IRMf), par l'observation du mouvement et le mouvement passif, nous démontrons que l'IRMf " de repos " peut étudier la connectivité fonctionnelle du réseau sensori-moteur chez l'enfant avec PC. D'autre part, dans cette population, l'observation d'une main parétique active le réseau sensori-moteur comme attendu chez le sujet sain, avec une prédominance d'activation dans le cortex moteur primaire lésé. Aussi, lorsque l'on combine cette tâche d'observation du mouvement à un mouvement passif congruent de la main parétique, on observe une activation plus importante des aires sensori-motrices, notamment des aires de " haut niveau ". Cette tâche de mouvement vidéo-guidé nous semble pouvoir constituer une tâche de rééducation motrice dont l'efficience sera à tester ultérieurement. Enfin, nous exposons l'accident vasculaire néonatal comme modèle d'étude de la plasticité postlésionnelle, notamment pour différencier la plasticité " mal-adaptative " de la plasticité efficiente.

Cerebral palsy (CP) is a non-progressive injury to the developing central nervous system resulting in permanent disorders of the development of movement and posture, causing activity limitation. Therefore physical and rehabilitation medicine has a particular interest in the study of organization and reorganization of the sensorimotor cortex following early brain injury in order to propose new methods for motor rehabilitation. We first showed that motor cortex could be analyzed in functional magnetic resonance imaging (fMRI) using action-observation and passive movement tasks. We then demonstrated in patients with unilateral CP that resting state analysis could study functional connectivity in sensorimotor system. Moreover, our work showed that observing hand movement produced, in CP patients, large bilateral activations in temporo-parieto-fronto-occipital network, comprising most of the nodes of the well described action-observation network. For either side, observing hand movements recruits the primary motor cortex, contralateral to the viewed hand, as would be expected in healthy persons. In addition, we showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation. Finally we present the perinatal stroke as a well suited model to analyze the postlesional neural plasticity notably the "mal-adaptive" plasticity., La paralysie cérébrale (PC) est définie comme un trouble du mouvement secondaire à une lésion cérébrale précoce non progressive. C'est la première cause de handicap moteur de l'enfant. La médecine physique et de réadaptation a donc un intérêt particulier à l'étude du contrôle centrale de la motricité (motricité-cérébrale) aussi bien en termes d'organisation que de réorganisation après lésion, et ce, afin de proposer de nouvelles méthodes de rééducation motrice. Après avoir montré, chez le sujet sain, que la motricité-cérébrale pouvait être étudiée, en imagerie par résonance magnétique fonctionnelle (IRMf), par l'observation du mouvement et le mouvement passif, nous démontrons que l'IRMf " de repos " peut étudier la connectivité fonctionnelle du réseau sensori-moteur chez l'enfant avec PC. D'autre part, dans cette population, l'observation d'une main parétique active le réseau sensori-moteur comme attendu chez le sujet sain, avec une prédominance d'activation dans le cortex moteur primaire lésé. Aussi, lorsque l'on combine cette tâche d'observation du mouvement à un mouvement passif congruent de la main parétique, on observe une activation plus importante des aires sensori-motrices, notamment des aires de " haut niveau ". Cette tâche de mouvement vidéo-guidé nous semble pouvoir constituer une tâche de rééducation motrice dont l'efficience sera à tester ultérieurement. Enfin, nous exposons l'accident vasculaire néonatal comme modèle d'étude de la plasticité postlésionnelle, notamment pour différencier la plasticité " mal-adaptative " de la plasticité efficiente.