No abstract

Introduction: Cerebral palsy (CP) is a group of disorders that affect muscle movement, tone and coordination. The reduction of spastic muscular paralysis can be obtained by intramuscular injection of botulinum neurotoxin type A (BTX-A).Objectives: This study aimed to evaluate the antispastic effect of BTX-A in children with spastic CP and to estimate the parents' opinion about the effectiveness of BTX-A therapy. Material and methods: A group of 40 children was divided into the study (n = 24, BTX-A + rehabilitation) and the control group (n = 16, rehabilitation). The modified Ashworth scale (MAS) was used to assess the level of muscle tone. A survey method was used to determine the subjective opinion of the children's parents regarding the effectiveness of BTX-A. Results: The BTX-A injections significantly reduced the level of muscle spasticity in children with CP (5.5 points in the study vs. 2.8 points in control; p = 0.008). The analysis from the univariate linear regression model showed children from the study group (B = 1.38, p = 0.005) and older children (B = -0.30, p = = 0.046) influence the difference in obtained MAS scores. The best effect was obtained by combining the BTX-A injection with rehabilitation. Parents positively opinionated the use of BTX-A injections to improve functioning, decrease hypertonia, and facilitate carrying. 83% of parents noticed an improvement in their child's functioning after the first injection of BTX-A and 92% would recommend BTX-A injections for CP. Conclusions: BTX-A injections lead to a reduction in spasticity in children with CP. The effects of therapy are particularly noticeable at the beginning of the treatment, and the most effective in the youngest patients. BTX-A injections combined with intensive rehabilitation contribute to an improved functional level for children with spastic CP.

Spinal epidural hematoma (SEH) is a very rare condition associated with trauma or occurring as a complication of lumbar puncture and can appear spontaneously. It manifests with acute pain and neurological deficits, leading to severe and permanent complications. This study aimed to assess changes in health-related quality of life and functional status following long-term intensive neurorehabilitation in a patient after severe sport-related head injury with a related SEH. The 60-year-old male patient experienced bilateral weakness of lower limbs, loss of sensation, and sphincter dysfunction. A laminectomy was performed, followed by a slight superficial and deep sensation improvement. The patient underwent intensive neurological rehabilitation treatment. The proprioceptive neuromuscular facilitation (PNF) method, PRAGMA device exercises, and water rehabilitation were provided. The study outcomes were assessed using the validated questionaries World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and Health-Related Quality of Life (HRQOL-14) for health-related quality of life as well as the Functional Independence Measure (FIM) and Health Assessment Questionnaire (HAQ) for functional status. A beneficial clinical improvement was observed following the intensive rehabilitation using PNF techniques, training with a PRAGMA device, and water exercises in the case of SEH. The patient’s physical condition significantly improved, with an increase in the FIM score from 66 to 122 pts. (by 56 pts.) and in the HAQ score from 43 to 16 pts. (by 27 pts.). Additionally, the QOL level increased after rehabilitation, with an increase in the WHOQOL-BREF from 37 to 74 pts. (by 37 pts.) and a decrease in unhealthy or limited days, as assessed using the HRQOL-14, from 210 to 168 (by 42 days). In conclusion, the improvement in QOL and functional level in the SEH patient were associated with high-intensity rehabilitation, simultaneous integration of three therapeutic modalities, and committed patient cooperation.

Background: Pain maps provide reliable information on pain location in various conditions. This study explored the feasibility of pain maps as a screening tools for serious underlying conditions. The pain symmetry was evaluated as the possible distinguishing feature. Methods: A Web-based survey on the correlation of pain-related disability and pain pattern was developed. Respondents with lower back pain were asked to mark the exact location of their pain over the pain chart. The symmetry index was calculated and used to divide subjects into two groups that were then compared in terms of the prevalence of red flags for serious pathologies, as well as the pain-related disability measured with COMI and ODI instruments. Results: Of the 4213 respondents who completed the survey, 1018 were included in the study. The pain related disability was greater in respondents with asymmetrical pain patterns, as shown with all instruments. The distribution of red flags was also dependent on pain symmetry. The history of weight loss (6.70 vs. 1.76 p < 0.001) and fever (4.91 vs. 2.14 p < 0.001) were more prevalent with symmetrical pain patterns, and the history of trauma was more frequent with asymmetrical pain (21.41 vs. 10.71 p < 0.001). Conclusions: It was shown that the symmetry of pain is correlated to the prevalence of red flags and pain-related disability.