Search results for: cranial nerve palsy

Authors: Morteza Pourazar, Fatemeh Mirakhori, Fazlolah Bagherzadeh, Rasool Hemayattalab

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The purpose of study was to examine the effects of external and internal focus of attention in the motor learning of children with cerebral palsy. The study involved 30 boys (7 to 12 years old) with CP type 1 who practiced throwing beanbags. The participants were randomly assigned to the internal focus, external focus, and control groups, and performed six blocks of 10-trial with attentional focus reminders during a practice phase and no reminders during retention and transfer tests. Analysis of variance (ANOVA) with repeated measures on the last factor was used. The results show that significant main effects were found for time and group. However, the interaction of time and group was not significant. Retention scores were significantly higher for the external focus group. The external focus group performed better than other groups; however, the internal focus and control groups’ performance did not differ. The study concluded that motor skills in Spastic Hemiparetic Cerebral Palsy (SHCP) children could be enhanced by external attention.

Keywords: cerebral palsy, external attention, internal attention, throwing task

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Authors: Michael Zaidman, Naum Simanovsky

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The most of brachial birth palsies are transient. Children with incomplete recovery almost always develop an internal rotation and adduction contracture. The muscle imbalance around the shoulder results in glenohumeral joint deformity and functional limitations. Natural history of glenohumeral deformity is it’s progression with worsening of function. Anteversion glenoid osteotomy with latissimus dorsi and teres major tendon transfers could be an alternative procedure of proximal humeral external rotation osteotomy for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy. We will discuss pre-operative planning and stepped operative technique of the procedure on clinical example.

Keywords: obstetric brachial plexus palsy, glenoid anteversion osteotomy, tendon transfer, operative technique

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Authors: M. Zaïgouche, A. Kouvahe, F. Stefanelli

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IMPERTIO is a high technology based project aiming at offering efficient assistance help in communication for persons affected by Cerebral Palsy. The systems currently available are hardly used by these patients who are not satisfied by ergonomics and response time. The project rests upon the concept that, opposite to usual master-slave communication giving power to the entity with larger range of possibilities, providing conversely the mastery to the entity with smaller range of possibilities will allow a better understanding ground for both parties. Entirely customizable, the application developed from this idea gives full freedom to the user. Through pictograms (one button linked to a word or a sentence) and adapted keyboard, noticeable improvements are brought to the response time and ease to use ergonomics.

Keywords: cerebral palsy, master-slave relation, communication interface, virtual keyboard, word construction algorithm

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Bara Yousef

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The development of independency and functional participation is an important therapeutic goal for many children with cerebral palsy,They was many therapeutic approach have been used for treatment those children like neurodevelopment treatment, balance training strengthening and stretching exercise. More recently, therapy for children with cerebral palsy has focused on achieving functional goals using task-oriented interventions and summer camping model, which focus on activities that relevant and meaningful to the child, to learn more efficient and effective motor skills. We explore the effectiveness of using functional rehabilitation comparing with regular rehabilitation among 40 Saudi children with cerebral palsy in pediatric unit at Sultan Bin Abdul Aziz Humanitarian City-Ksa ,where 20 children randomly assign in control group who received rehabilitation based on regular therapy approach and other 20 children assign on experiment group who received rehabilitation based on functional therapy approach with an average of 45min OT treatment and 45 min PT treatment- daily within a period of 6 week. Our finding reported that children in experiment group has improved in gross motor function with an average from 49.4 to 57.6 based on GMFM 66 as primary outcome measure and improved in WeeFIM with an average from 52 to 62 while children in control group has improved with an average from 48.4 to 53.7 in GMFM and from 53 to and 58 in WeeFIM. Consequently, there has been growing interest in determining the effects of functional training programs as promising approach for these children.

Keywords: Cerebral Palsy (CP), gross motor function measure (GMFM66), pediatric Functional Independent Measure (WeeFIM), rehabilitation, disability

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Authors: A. Gagat-Matuła

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The aim of this article is to present a relation between family relationships and styles of approach to coping with stress among young people from migrant families with cerebral palsy. The study involved 70 persons (with cerebral palsy in the standard intellectual capacity) from families, in which at least one of parents is a migrant. To measure the level of communication in the family, the Family Relationships Questionnaire (FRQ) was employed, while the styles of coping with stress was investigated with the CISS Questionnaire. The relation between family relationships and styles of coping with stressful situations of the respondents was investigated. It was shown that there is an affiliation between the emotion-oriented style of coping with the stress and the variable of “communication in my family”. Moreover, it was demonstrated that there is a linkage between the task-oriented style of coping with the stress and the variable of “maternal control in mother-child relationship”. Young people with CP subjected to overprotection and control from their mothers in problem situations tend to focus on their own emotions instead of trying to undertake constructive actions. Excessive control in daily life by mothers results in passivity and a lack of motivation to cope with difficult situations.

Keywords: young people with cerebral palsy, family relationships, styles of coping with stress, migration

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Authors: Wei-Chia Huang, Jane Wang

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Damage to nerves is considered one of the most irreversible injuries. The regeneration of nerves has always been an important topic in regenerative medicine. In general, damage to human tissue will naturally repair overtime. However, when the nerves are damaged, healed flesh wound cannot guarantee full restoration to its original function, as truncated nerves are often irreversible. Therefore, the development of treatment methods to successfully guide and accelerate the regeneration of nerves has been highly sought after. In order to induce nerve tissue growth, nerve conduits are commonly used to help reconnect broken nerve bundles to provide protection to the location of the fracture while guiding the growth of the nerve bundles. To prevent the protected tissue from becoming necrotic and to ensure the growth rate, the conduits used are often modified with microstructures or blended with neuron growth factors that may facilitate nerve regeneration. Electrical stimulation is another attempted treatment for medical rehabilitation. With appropriate range of voltages and stimulation frequencies, it has been demonstrated to promote cell proliferation and migration. Biodegradability are critical for medical devices like nerve conduits, while conductive polymers pose great potential toward the differentiation and growth of nerve cells. In this work, biodegradability and conductivity were combined into a novel biodegradable, photocurable, conductive polymer composite materials by embedding conductive nanoparticles in poly(glycerol sebacate) acrylate (PGSA) and 3D-printed into nerve conduits. Rat pheochromocytoma cells and rat neuronal Schwann cells were chosen for the in vitro tests of the conduits and had demonstrate selective growth upon culture in the conductive conduits with built-in microchannels and electrical stimulation.

Keywords: biodegradable polymer, 3d printing, neural regeneration, electrical stimulation

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Authors: Priyanka Tiwari, Uma Devi Ranjit, Ritesh Thapa

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Background and Significance: Cerebral Palsy (CP) influences not only the child's everyday functioning but also the functioning of whole family. Application of study findings can be used in clinical or community setting to screen the parents of children with cerebral palsy in order to identify the compromised domain of stress which in turn will help to improve the interaction between parent and child with disability and thus ultimately affect the progress that a child makes in his or her therapeutic or educational programs. Objective: The objective of the study was to assess the level of stress in mothers of children with CP by adopting mixed method design. Methodology: Cross-sectional descriptive design was adopted in the quantitative design where Parental Stress Scale (PSS) was utilized to collect data from a convenient sample of 40 mothers of children with CP who were under regular follow-up by home visitor of Self-help Group for Cerebral Palsy while embedded qualitative design was used to explore the stress of mothers of CP affected children. From the parent population of quantitative sample 4 mothers were chosen for in-depth exploration, regarding their stress by means of case study method. Descriptive statistics like frequency, percentage, mean, median, standard deviation, correlation and inferential statistics like Mann-Whitney U test and Kruskal-Wallis H test were used to describe and assess relationship between variables. Findings: The mean stress experienced by mothers of children with cerebral palsy was 53.62±9.53 with 15% percent of the mothers experiencing severe stress. There was significant association between age group of mother and total stress score and negative themes of stress. Similarly, signification association was found between educational status of the mother and positive themes of stress which was convergent with the qualitative finding as well, where literate mothers had more positive view of their child's disability which could be attributed to their educational level as education provides us with a broad perspective to look at a situation. Conclusions: Still one-sixth of the mothers experienced severe stress so if we want to ensure the well-being of the children affected by cerebral palsy, then parents caring for them need to be looked after as well.

Keywords: stress, cerebral palsy, mothers, mixed method

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Authors: Guy Rubin, Ravit Shay, Nimrod Rozen

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The accuracy of a diagnostic test used to classify a patient as having disease or being disease-free is a valuable piece of information to be used by the physician when making treatment decisions. Finger laceration, suspected to have nerve injury is a challenging decision for the treating surgeon. The purpose of this study was to evaluate the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of digital nerve injury. The six clinical tests included light touch, pin prick, static and dynamic 2-point discrimination, Semmes Weinstein monofilament and wrinkle test. Data comparing pre-surgery examination with post-surgery results of 42 patients with 52 digital nerve injury was evaluated. The subjective examinations, light touch, pin prick, static and dynamic 2-point discrimination and Semmes-Weinstein monofilament were not sensitive (57.6, 69.7, 42.4, 40 and 66.8% respectively) and specific (36.8, 36.8, 47.4, 42.1 and 31.6% respectively). Wrinkle test, the only objective examination, was the most sensitive (78.1%) and specific (55.6%). This result gives no pre-operative examination the ability to predict the result of explorative surgery.

Keywords: digital nerve, injury, nerve examination, Semmes-Weinstein monofilamen, sensitivity, specificity, two point discrimination, wrinkle test

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Authors: Emmanuel Kamal Aziz Saba

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Aim of the work: This study proposed to assess the role of the median versus ulnar medial thenar motor (MTM) recording in supporting the diagnosis of carpal tunnel syndrome (CTS). Patients and methods: The present study included 130 hands (70 CTS and 60 controls). Clinical examination was done for all patients. The following tests were done (using surface electrodes recording) for patients and control: (1) sensory nerve conduction studies: median nerve, ulnar nerve and median versus ulnar digit four sensory study; (2) motor nerve conduction studies: median nerve, ulnar nerve, median (second lumbrical) versus ulnar (interosseous) (2-LINT) motor study and median versus ulnar (MTM) study. Results: The tests with higher sensitivity in diagnosing CTS were median versus ulnar (2-LINT) motor latency difference (87.1%), median versus ulnar (MTM) motor latency difference (80%) and median versus ulnar digit four sensory latency differences (91.4%). There was no statistically significant difference between median versus ulnar (MTM) motor latency difference with both median versus ulnar (2-LINT) motor latency difference and median versus ulnar digit four sensory latency difference (P > 0.05) as regards the confirmation of CTS. Conclusions: Median versus ulnar (MTM) motor latency difference has high sensitivity and specificity for the diagnosis of CTS as for both median versus ulnar (2-LINT) motor latency difference and median versus ulnar digit four sensory latency differences. It can be considered a useful neurophysiological test to be used in combination with another median versus ulnar comparative tests for confirming the diagnosis of CTS beside other well-known electrophysiological tests.

Keywords: carpal tunnel syndrome, medial thenar motor, median nerve, ulnar nerve

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Authors: Trad Khodja Rafik, Mahtout Amine, Ghoul Rachid, Benbouali Amine, Boulahlib Amine, Hariza Abdelmalik

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Cranioplasty with custom implant realized using 3D printing technology. Cranioplasty is a surgical act that aims restoring cranial bone losses in order to protect the brain from external aggressions and to improve the patient aesthetic appearance. This objective can be achieved with taking advantage of the current technological development in computer science and biomechanics. The objective of this paper it to present an approach for the realization of high precision biocompatible cranial implants using new 3D printing technologies at the lowest cost. The proposed method is to reproduce the missing part of the skull by referring to its healthy contralateral part. Once the model is validated by the neurosurgeons, a mold is 3D printed for the production of a biocompatible implant in Poly-Methyl-Methacrylate (PMMA) acrylic cement. Using this procedure four patients underwent this procedure with excellent aesthetic results.

Keywords: cranioplasty, cranial bone loss, 3D printing technology, custom-made implants, PMMA

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Authors: Zengmin Tian, Bin Lv, Rui Hui, Yupeng Liu, Chuan Wang, Qing Liu, Hongyu Li, Yan Qi, Li Song

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Objective Robot was used for replacement of the frame in recent years. The paper is to investigate the safety and effectiveness of frameless stereotactic surgery in the treatment of children with cerebral palsy. Methods Clinical data of 425 children with spastic cerebral palsy were retrospectively analyzed. The patients were treated with robot-assistant frameless stereotactic surgery of nuclear mass destruction. The motor function was evaluated by gross motor function measure-88 (GMFM-88) before the operation, 1 week and 3 months after the operation respectively. The statistical analysis was performed. Results The postoperative CT showed that the destruction area covered the predetermined target in all the patients. Minimal bleeding of puncture channel occurred in 2 patient, and mild fever in 3 cases. Otherwise, there was no severe surgical complication occurred. The GMFM-88 scores were 49.1±22.5 before the operation, 52.8±24.2 and 64.2±21.4 at the time of 1 week and 3 months after the operation, respectively. There was statistical difference between before and after the operation (P<0.01). After 3 months, the total effective rate was 98.1%, and the average improvement rate of motor function was 24.3% . Conclusion Replaced the traditional frame, the robot-assistant frameless stereotactic surgery is safe and reliable for children with spastic cerebral palsy, which has positive significance in improving patients’ motor function.

Keywords: cerebral palsy, robotics, stereotactic techniques, frameless operation

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Authors: Sedef Şahin, Meral Huri

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Cerebral Palsy (CP) represents the most frequent cause of physical disability in children with a rate of 2,9 per 1000 live births. The activity-focused intervention is known to improve function and reduce activity limitations and barriers to participation of children with disabilities. The aim of the study was to assess the effects of occupational therapy on level of fatigue, activity performance and satisfaction in children with Unilateral Cerebral Palsy. Twenty-two children with hemiparetic cerebral palsy (mean age: 9,3 ± 2.1years; Gross Motor Function Classification System ( GMFCS) level from I to V (I = 54%, II = 23%, III = 14%, IV= 9%, V= 0%), Manual Ability Classification System (MACS) level from I to V (I = 40%, II = 32%, III = 14%, IV= 10%, V= 4%), were assigned to occupational therapy program for 6 weeks.Visual Analogue Scale (VAS) was used for intensity of the fatigue they experienced at the time on a 10 point Likert scale (1-10).Activity performance and satisfaction were measured with Canadian Occupational Performance Measure (COPM).A client-centered occupational therapy intervention was designed according to results of COPM. The results were compared with nonparametric Wilcoxon test before and after the intervention. Thirteen of the children were right-handed, whereas nine of the children were left handed.Six weeks of intervention showed statistically significant differences in level of fatigue, compared to first assessment(p<0,05). The mean score of first and the second activity performance scores were 4.51 ± 1.70 and 7.35 ± 2.51 respectively. Statistically significant difference between performance scores were found (p<0.01). The mean scores of first and second activity satisfaction scores were of 2.30± 1.05 and 5.51 ± 2.26 respectively. Statistically significant difference between satisfaction assessments were found (p<0.01). Occupational therapy is an evidence-based approach and occupational therapy interventions implemented by therapists were clinically effective on severity of fatigue, activity performance and satisfaction if implemented individually during 6 weeks.

Keywords: activity performance, cerebral palsy, fatigue, occupational therapy

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Authors: Khaja Moiduddin, Sherif Mohammed Elseufy, Hisham Alkhalefah

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Recent advances in three-dimensional (3D) printing, medical imaging, and implant design may alter how craniomaxillofacial surgeons construct individualized treatments using patient data. By utilizing medical image data, medical professionals can obtain detailed information about a patient's injuries, enabling them to conduct a thorough preoperative assessment while ensuring the implant's accuracy. However, selecting the right implant material requires careful consideration of various mechanical properties. This study aims to compare the two commonly used implant material for cranial reconstruction which includes titanium (Ti6Al4V) and Polyetheretherketone (PEEK). Biomechanical analysis was performed to study the implant behavior, by keeping the implant design and fixation constant in both cases. A finite element model was created and analyzed under loading conditions. The finite element analysis proves that although Ti6Al4V is stronger than PEEK but, its mechanical strength is adequate to bear the loads of the adjacent bone tissue.

Keywords: cranial reconstruction, titanium implants, PEEK, finite element model

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Authors: Deepthinath Reghunathan, Satheesha Nayak, Sudarshan S., Prasad Alathady Maloor, Prakash Shetty

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Lumbar plexus is formed by the union of ventral rami of T12, L1, L2, L3 spinal nerves and the larger upper division of L4 lumbar spinal nerves. Variations in the normal anatomy of the lumbar and sacral plexus might be seen in some cases and are reported in the literature, but finding such an unusual case comprising of multiple variations which is normally not expected in a clinical setup, proves to be a vital piece of information for clinicians and medical practitioners. During the dissection of the abdomen and pelvis of an approximately 70 year old cadaver, we observed the following variations in the formation of the lumbar and sacral nerves. 1. The genitofemoral nerve bifurcated at a higher level; genital branch of genitofemoral nerve gave branches to the anterior abdominal wall muscles, 2. A communicating branch was given from the lateral cutaneous nerve of thigh to the medial cutaneous nerve of thigh, 3. A muscular branch was given from femoral nerve to psoas major, 4. There was absence of contribution of L4 spinal nerve in the formation of the lumbosacral trunk and 5. Lumbosacral trunk gave communicating branches to the femoral and obturator nerves. Most of the variations found were rare and finding all the above said variations in a single cadaver is even rare. Documentation of such rare cases with multiple variations in the formation of nerves from the lumbar plexus provides vital information on such occurrences. This information would in turn improve the knowledge of clinicians and surgeons dealing with this region. Emphasizing such knowledge of this region would prevent accidental damage to the structures with a variant anatomy.

Keywords: femoral nerve, genitofemoral nerve, lumbar plexus, lumbosacral trunk

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Authors: Hazha Hidayat, Shayma Ibrahim

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Folate metabolism plays a crucial role in the normal development of the neonatal central nervous system. It is regulated by MTHFR gene polymorphism. Any factors, which will affect this metabolism either by hereditary or gene mutation will lead to many mental disorders. The purpose of this study was to investigate whether MTHFR gene mutation contributes to the development of mental retardation and CP combined with mental retardation in Erbil city. DNA was isolated from the peripheral blood samples of 40 cases suffering from mental retardation (MR) and CP combined with MR were recruited, sequence the 4, 6, 7, 8 exons of the MTHFR gene were done to identify the variants. Exons were amplified by PCR technique and then sequenced according to Sanger method to show the differences with MTHFR reference sequences. We observed (14) mutations in 4, 6, 7, 8 exons in the MTHFR gene associated with Cerebral Palsy combined with mental retardation included deletion, insertion, Substitution. The current study provides additional evidence that multiple variations in the MTHFR gene are associated with mental retardation and Cerebral Palsy.

Keywords: methylenetetrahydrofolate reductase (MTHFR) gene, SNPs, homocysteine, sequencing

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Authors: Harold Mauricio Díaz-Vargas, Cristian Alfonso Jimenez-Castaño, David Augusto Cárdenas-Peña, Guillermo Alberto Ortiz-Gómez, Alvaro Angel Orozco-Gutierrez

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Precise identification of the nerves is a crucial task performed by anesthesiologists for an effective Peripheral Nerve Blocking (PNB). Now, anesthesiologists use ultrasound imaging equipment to guide the PNB and detect nervous structures. However, visual identification of the nerves from ultrasound images is difficult, even for trained specialists, due to artifacts and low contrast. The recent advances in deep learning make neural networks a potential tool for accurate nerve segmentation systems, so addressing the above issues from raw data. The most widely spread U-Net network yields pixel-by-pixel segmentation by encoding the input image and decoding the attained feature vector into a semantic image. This work proposes a conditioning approach and encoder pre-training to enhance the nerve segmentation of traditional U-Nets. Conditioning is achieved by the one-hot encoding of the kind of target nerve a the network input, while the pre-training considers five well-known deep networks for image classification. The proposed approach is tested in a collection of 619 US images, where the best C-UNet architecture yields an 81% Dice coefficient, outperforming the 74% of the best traditional U-Net. Results prove that pre-trained models with the conditional approach outperform their equivalent baseline by supporting learning new features and enriching the discriminant capability of the tested networks.

Keywords: nerve segmentation, U-Net, deep learning, ultrasound imaging, peripheral nerve blocking

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Authors: Ashwin Rai, Rajalakshmi Rai, Rajanigandha Vadgoankar

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Lingual artery is the chief artery of the tongue and the neighboring structures pertaining to the oral cavity. At the carotid triangle, this artery arises from the external carotid artery opposite to the tip of greater cornua of hyoid bone, undergoes a tortuous course with its first part being crossed by the hypoglossal nerve and runs beneath the digastric muscle. Then it continues to supply the tongue as the deep lingual artery. The aim of this study is to draw surgeon's attention to the course of lingual artery in this area since it can be accidentally lesioned causing an extensive hemorrhage in certain surgical or dental procedures. The study was conducted on 44 formalin fixed head and neck specimens focusing on the anatomic relations of lingual artery. In this study, we found that the lingual artery is located inferior to the digastric muscle and the hypoglossal nerve contradictory to the classical description. This data would be useful during ligation of lingual artery to avoid injury to the hypoglossal nerve in surgeries related to the anterior triangle of neck.

Keywords: anterior triangle, digastric muscle, hypoglossal nerve, lingual artery

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Authors: Krizette Ladera

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Fathers are there not only to provide the financial stability of a family but a father is also there to provide the love and support that usually people would see as the mother’s responsibility. To describe the lived experiences and how fathers make sense of their lived experiences with their children who have cerebral palsy is the main objective of the study. A qualitative research using a thematic analysis was used for the study. The qualitative research focused on the personal narratives, self-report and expression of the participant’s memory in terms of how they tell their stories. The interpretative phenomenological analysis was used to focus on the experience of the participants on how they will describe their experiences, and to also add on that the IPA will also attempt to describe and explain the meaning of human experiences using interview, specifically on the father who have a child that suffers from cerebral palsy. For the sampling technique, the snowball technique was used to gather participants from the referral of other participants. The five non-randomly selected fathers will be served as the participants for the research. A self-made interview with an open-ended question was used as the research instrument; it includes profiling of the respondent as well as their experiences in taking care of their child that suffers from cerebral palsy. In analyzing a data, the researcher used the thematic analysis where in the interview was made into a transcript, then it was organized and divided themes. After that, the relations of each themes, was identified and it was later documented and translated into written text format using thematic grouping. Finally, the researcher analyzed each data according to its themes and put it in a table to be presented in the result section of the study And as for the result of the study, the researcher was able to come up with the four (4) main themes that most of the participants experienced and those are: The experiences in finding out about the condition of the Child, disclosing the condition of the child to the family and its emotional effect, The experiences of living the day of day realities in providing the physical, financial, emotional and a well balanced environment to the child, and the religious perspectives of the fathers. Along with those four (4) themes comes the subtheme which explains the themes in a more detailed explanation.

Keywords: cerebral palsy, children, fathers, lived experiences

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Authors: J. Sagouis, A. Chamel, E. Carre, C. Casasreales, G. Rudnik, M. Cerdan

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Robotics provides answers to amputees. The most expensive solutions surgically connect the prosthesis to nerve endings. There are also several types of non-invasive technologies that recover nerve messages passing through the muscles. After analyzing these messages, myoelectric prostheses perform the desired movement. The main goal is to avoid all surgeries, which can be heavy and offer cheaper alternatives. For an amputee, we use valid muscles to recover the electrical signal involved in a muscle movement. EMG sensors placed on the muscle allows us to measure a potential difference, which our program transforms into control for a robotic arm with two degrees of freedom. We have shown the feasibility of non-invasive prostheses with two degrees of freedom. Signal analysis and an increase in degrees of freedom is still being improved.

Keywords: prosthesis, electromyography (EMG), robotic arm, nerve message

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Authors: Freddy Patricio Moncayo-Matute, Pablo Gerardo Peña-Tapia, Vázquez-Silva Efrén, Paúl Bolívar Torres-Jara, Diana Patricia Moya-Loaiza, Gabriela Abad-Farfán

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This study describes a clinical case and the results on the application of additive manufacturing for the surgical planning in the removal of a cranial spheno-orbital meningioma. It is verified that the use of personalized anatomical models and cutting guides helps to manage the cranial anomalies approach. The application of additive manufacturing technology: Fused Deposition Modeling (FDM), as a low-cost alternative, enables the printing of the test anatomical model, which in turn favors the reduction of surgery time, as well the morbidity rate reduction too. And the printing of the personalized cutting guide, which constitutes a valuable aid to the surgeon in terms of improving the intervention precision and reducing the invasive effect during the craniotomy. As part of the results, post-surgical follow-up is included as an instrument to verify the patient's recovery and the validity of the procedure.

Keywords: surgical planning, additive manufacturing, rapid prototyping, fused deposition modeling, custom anatomical model

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Authors: Mihir Kothari, Heena Khan, Vivek Rathod

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Assessment of binocular single vision field (BSVF) is traditionally done using a Goldmann perimeter. The measurement of BSVF is important for the management of incomitant strabismus, viz. orbital fractures, thyroid orbitopathy, oculomotor cranial nerve palsies, Duane syndrome etc. In this paper, we describe a new technique for measuring BSVF using a CROM device. Goldmann perimeter is very bulky and expensive (Euro 5000.00 or more) instrument which is 'almost' obsolete from the contemporary ophthalmology practice. Whereas, CROM can be easily made in the DIY (do it yourself) manner for the fraction of the price of the perimeter (only Euro 15.00). Moreover, CROM is useful for the accurate measurement of ocular torticollis vis. nystagmus, paralytic or incomitant squint etc, and it is highly portable.

Keywords: binocular single vision, perimetry, cervical rgen of motion, visual field, binocular single vision field

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Authors: A. Gagat-Matuła

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There is a definite lack – in Poland, as well as around the world – of empirical studies of families raising handicapped child, in which one parent migrates. In diagnostics of the functioning of such families emphasis should be placed not only on the difficulties, but most of all it should be indicated what possibilities are there for the family and how it overcomes the difficulties. Migration of a parent on the one hand is a chance to improve the family’s material situation. In certain circumstances this may only be an “escape” into work from the issues associated with the upbringing and rehabilitation of a handicapped child. The aim of the study was to learn the functioning of a temporarily single parent family system as a result of migration of a parent from the perspective of adolescents with cerebral palsy. The study was conducted in the year 2013 in the area of Eastern Poland. It involved an analysis of 70 persons (with cerebral palsy in an intellectual capacity) from families in which at least one of the parents migrates. The study incorporated the diagnostic survey method. These tools were used: Family Evaluation Scales (SOR) adapted for Poland by Andrzej Margasiński. The explorations in this study indicate, that 47% of studied temporarily single parent families are balanced models. This is evidence of the resources at the disposal of the family which, despite the disability of the child and temporary separation, is able to function properly. The conducted studies show, that 37% of temporarily single parent families are imbalanced models in the perception of adolescents with cerebral palsy. These families experience functional difficulties and require psychological and pedagogical support. There is a need for building skills related to effective coping with family stress. Especially considering, that families of an imbalanced type do not use the internal and external resources of the family system. Such a situation may deepen the disarrangement of family life. In intermediate families (16%) there are also temporary difficulties in functioning. Separation anxiety experienced by mothers may disrupt relations and introduce additional stress factors. For that reason it is important to provide support for women with difficulties coping with the emotions associated with raising handicapped adolescents and migratory separation.

Keywords: child with cerebral palsy, family, migration, parents

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Authors: Mostafa Sarabzadeh, Masoumeh Helalizadeh, Seyyed Mahmoud Hejazi

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Multiple Sclerosis is considered as diseases related to central nerve system, the chronic and progressive disease impress on sensory and motor function of people. Due to equilibrium problems in this patients that related to disorder of nerve conduction transmission from central nerve system to organs and the nature of elastic bands that can make changes in neuromuscular junctions and momentary actions, the aim of this research is evaluate elastic training effect by reactionary ropes on nerve conduction velocity (in lower and upper limb) and functional balance in female patients with Multiple Sclerosis. The study was a semi-experimental study that was performed based on pre and post-test method, The statistical community consisted of 16 women with MS in the age mean 25-40yrs, at low and intermediate levels of disease EDSS 1-4 (Expanded Disability Status Scale) that were divided randomly into elastic and control groups, so the training program of experimental group lasted six weeks, 3 sessions per week of elastic exercises with reactionary ropes. Electroneurography parameters (nerve conduction velocity- latency) of Upper and lower nerves (Median, Tibial, Sural, Peroneal) along with balance were investigated respectively by the Electroneurography system (ENG) and Timed up and go (TUG) functional test two times in before and after the training period. After that, To analyze the data were used of Dependent and Independent T-test (with sig level p<0.05). The results showed significant increase in nerve conduction velocity of Sural (p=0.001), Peroneal (p=0.01), Median (p=0.03) except Tibial and also development Latency Time of Tibial (p= 0), Peroneal (p=0), Median (p=0) except Sural. The TUG test showed significant decreases in execution time too (p=0.001). Generally, based on what the obtained data can indicate, modern training with elastic bands can contribute to enhanced nerve conduction velocity and balance in neurosis patients (MS) so lead to reduce problems, promotion of mobility and finally more life expectancy in these patients.

Keywords: balance, elastic bands, multiple sclerosis, nerve conduction, velocity

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Authors: Conor Mccartney, Mark Lee

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Background: An essential component in ambulatory breast augmentation surgery is good analgesia. The demographic undergoing this operation is usually fit, low risk with few comorbidities. These patients do not require long-term hospitalization and do not want to spend excessive time in the hospital for financial reasons. Opiate analgesia can have significant side effects such as nausea, vomiting and sedation. Reducing volumes of postoperative opiates allows faster ambulation and discharge from day surgery. We have developed two targeted nerve blocks that can be applied by the operating surgeon in a matter of seconds under direct vision, not requiring imaging. Anecdotally we found that these targeted nerve blocks reduced opiate requirements and allowed accelerated discharge and faster return to normal activities. This was then tested in a prospective randomized, double-blind trial. Methods: 20 patients were randomized into saline (n = 10) or Ropivicaine adrenaline solution (n = 10). The operating surgeon and anesthetist were blinded to the solution. All patients were closely followed up and morphine equivalents were accurately recorded. Follow-up pain scores were recorded using the Overall Benefit of Analgesia pain questionnaire. Findings: The Ropivicaine nerve blocks significantly reduced opiate requirements postoperatively (p<0.05). Pain scores were significantly decreased in the study group (p<0.05). There were no side effects attributable to the nerve blocks. Conclusions: Intraoperative targeted nerve blocks significantly reduce postoperative opiate requirements in breast augmentation surgery. This results in faster recovery and higher patient satisfaction.

Keywords: breast augmentation, nerve block, postoperative recovery, opiate analgesia, inter pectoral block, sub serratus block

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Authors: Pymaneh Bairami Rad

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The present work was planned with the aim to study the histological changes that might occur in the sciatic nerve of adult male albino rat following antimony trioxide exposure and to throw more light on the protective role of vitamin "E" on the peripheral neurotoxicity induced by this environmental toxin Sixty adult male albino rats, weighing 183 - 235 grams, were utilized in this work. The animals were divided into 3 groups; each of 20 rats: animals of group I served as control, animals of group II received antimony trioxide daily for 12 successive weeks , animals of group III received antimony trioxide and vitamin "E" daily for the same duration. Antimony trioxide was given in a daily dose of 500 mg/ kg body weight which represents 1/40 of the known LD50 and vitamin "E" was administered in a daily dose of 300 mg/kg body weight. Both antimony trioxide and vitamin "E" were given to the animals by gastric intubation. This research revealed many histological changes in the sciatic nerve, following exposure to antimony trioxide, including Wallerian degeneration in most myelinated nerve fibers with pleomorphic destruction, fragmentation, loss of normal lamination and rupture of myelin sheaths. The axoplasms of these nerve fibers were irregular, degenerated and contained myelin fragments with loss of neurofibrils. Obvious increase in endoneurium was also observed. Concomitant administration of vitamin "E" with antimony trioxide resulted in marked improvement in the histological changes observed in the sciatic nerve.

Keywords: neurotoxicity, antimony, vitamin e, anatomy, histology

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Authors: Aamna Tufail, Catherine Anyanwu

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Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

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Authors: Shyamani Hettiarachchi, Gopi Kitnasamy

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Background: The potentially high level of physical need and dependency experienced by children with cerebral palsy could affect the quality of life (QOL) of the child, the caregiver and his/her family. Poor QOL in children with cerebral palsy is associated with the parent-child relationship, limited opportunities for social participation, limited access to healthcare services, psychological well-being and the child's physical functioning. Given that children experiencing disabilities have little access to remedial support with an inequitable service across districts in Sri Lanka, and given the impact of culture and societal stigma, there may be differing viewpoints across respondents. Objectives: The aim of this study was to evaluate the psychometric properties of the Tamil version of the Cerebral Palsy Quality of Life for Children (CPQOL-Child) Questionnaire. Design: An instrument development and validation study. Methods: Forward and backward translations of the CPQOL-Child were undertaken by a team comprised of a physiotherapist, speech and language therapist and two linguists for the primary caregiver form and the child self-report form. As part of a pilot phase, the Tamil version of the CPQOL was completed by 45 primary caregivers with children with cerebral palsy and 15 children with cerebral palsy (GMFCS level 3-4). In addition, the primary caregivers commented on the process of filling in the questionnaire. The psychometric properties of test-retest reliability, internal consistency and construct validity were undertaken. Results: The test-retest reliability and internal consistency were high. A significant association (p < 0.001) was found between limited motor skills and poor QOL. The Cronbach's alpha for the whole questionnaire was at 0.95.Similarities and divergences were found between the two groups of respondents. The child respondents identified limited motor skills as associated with physical well-being and autonomy. Akin to this, the primary caregivers associated the severity of motor function with limitations of physical well-being and autonomy. The trend observed was that QOL was not related to the level of impairment but connected to environmental factors by the child respondents. In addition to this, the main concern among primary caregivers about the child's future and on the child's lack of independence was not fully captured by the QOL questionnaire employed. Conclusions: Although the initial results of the CPQOL questionnaire show high test-retest reliability and internal consistency of the instrument, it does not fully reflect the socio-cultural realities and primary concerns of the caregivers. The current findings highlight the need to take child and caregiver perceptions of QOL into account in clinical practice and research. It strongly indicates the need for culture-specific measures of QOL.

Keywords: cerebral palsy, CPQOL, culture, quality of life

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Authors: Krupali Mukeshkumar, Jinesh Shah

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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

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Authors: Kayla Belanger, Pascale Vigneron, Guy Schlatter, Bernard Devauchelle, Christophe Egles

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A severe injury to a peripheral nerve leads to its degeneration and the loss of sensory and motor function. To this day, there still lacks a more effective alternative to the autograft which has long been considered the gold standard for nerve repair. In order to overcome the numerous drawbacks of the autograft, tissue engineered biomaterials may be effective alternatives. Silk fibroin is a favorable biomaterial due to its many advantageous properties such as its biocompatibility, its biodegradability, and its robust mechanical properties. In this study, bio-mimicking multi-channeled nerve guidance conduits made of aligned nanofibers achieved by electrospinning were functionalized with signaling biomolecules and were tested in vitro and in vivo for nerve regeneration support. Silk fibroin (SF) extracted directly from silkworm cocoons was put in solution at a concentration of 10wt%. Poly(ethylene oxide) (PEO) was added to the resulting SF solution to increase solution viscosity and the following three electrospinning solutions were made: (1) SF/PEO solution, (2) SF/PEO solution with nerve growth factor and ciliary neurotrophic factor, and (3) SF/PEO solution with nerve growth factor and neurotrophin-3. Each of these solutions was electrospun into a multi-layer architecture to obtain mechanically optimized aligned nanofibrous mats. For in vitro studies, aligned fibers were treated to induce β-sheet formation and thoroughly rinsed to eliminate presence of PEO. Each material was tested using rat embryo neuron cultures to evaluate neurite extension and the interaction with bio-functionalized or non-functionalized aligned fibers. For in vivo studies, the mats were rolled into 5mm long multi-, micro-channeled conduits then treated and thoroughly rinsed. The conduits were each subsequently implanted between a severed rat sciatic nerve. The effectiveness of nerve repair over a period of 8 months was extensively evaluated by cross-referencing electrophysiological, histological, and movement analysis results to comprehensively evaluate the progression of nerve repair. In vitro results show a more favorable interaction between growing neurons and bio-functionalized silk fibers compared to pure silk fibers. Neurites can also be seen having extended unidirectionally along the alignment of the nanofibers which confirms a guidance factor for the electrospun material. The in vivo study has produced positive results for the regeneration of the sciatic nerve over the length of the study, showing contrasts between the bio-functionalized material and the non-functionalized material along with comparisons to the experimental control. Nerve regeneration has been evaluated not only by histological analysis, but also by electrophysiological assessment and motion analysis of two separate natural movements. By studying these three components in parallel, the most comprehensive evaluation of nerve repair for the conduit designs can be made which can, therefore, more accurately depict their overall effectiveness. This work was supported by La Région Picardie and FEDER.

Keywords: electrospinning, nerve guidance conduit, peripheral nerve regeneration, silk fibroin

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