Therapeutic effect of the new multilevel brace orthosis on cerebral palsy gait: a case report

Background

Infantile spastic bilateral cerebral palsy (CP) is the most common form of CP. Diplegia (with ambulatory ability) is mostly a chronic condition that impairs the ability to walk. Standard orthotic management includes hip-knee-ankle-foot orthosis (HKAFO) as a pri-mary conservative treatment option to contrast spasticity and stabilise gait through partial immobilisation of the body structure. Multilevel brace orthosis (MLB) (Registered Trademark) is a specific type of light HKAFO designed to improve functional alignment and dynamic gait stability without limb immobilisation. Aim of the case report is to verify the effects of the MLB on the diplegic gait cycle.

Case

A child with a bilateral spastic gait due to CP diplegia is described. Gait analyses were performed to investigate the therapeutic effects of the MLB on walking.

Discussion

The MLB improved the gross motor function measure of walking and gait temporal parameters (velocity), compared with barefoot condition. During the swing phase, we observed a reduction in plantar and knee flexion, and the orthosis increased the width and length of the step.

Conclusion

Use of this specific type of HKAFO in children with diplegia improved gait symmetry and stability.

West Nile Virus Surveillance in the Lombardy Region, Northern Italy

In 2013, the circulation of West Nile virus (WNV) was detected in the Lombardy region and the following year a surveillance programme was activated with the aim of early identification of the viral distribution in mosquitoes and wild birds. A total of 50 959 Culex spp. mosquitoes grouped in six hundred and forty-seven pools as well as 1400 birds were screened by RT-PCR for the presence of West Nile virus leading to the identification of the viral genome in 32 mosquito pools and 13 wild birds. The surveillance was able to detect the WNV circulation on an average of 42 days (CI 95% 29.98-53.86; Student's t-distribution) before the occurrence of human West Nile disease (WND) cases in the same area. These results demonstrate the presence of WNV in the Lombardy region and confirm entomological and wild birds surveillance as an effective measure for the early identification of WNV circulation in infected areas, thus providing a useful and cost-effective tool for the public health authorities in the application of measures to prevent human infection.

Co-circulation of distinct genetic lineages of astroviruses in turkeys and guinea fowl

Viruses belonging to the genus Astrovirus have been increasingly associated with enteritis in mammalian and avian species, including turkeys. More recently, astroviruses have also been detected in diseased guinea fowl. In turkeys, two genetically distinct types of astrovirus have been reported, namely turkey astrovirus 1 and 2 (TAstV1 and TAstV2). The prevalence and the pathogenesis of astrovirus infections in this species is currently unknown, with the exception of data generated in the USA. In the present report, we have demonstrated the co-circulation of distinct genetic lineages of astroviruses infecting turkeys and guinea fowl. The predominant lineage infecting turkeys is genetically related to the American TAstV2, but genetic variability within this lineage was demonstrated. Other isolates appeared to be either TastV1-related or unrelated to any other known isolate. Astroviruses infecting guinea fowl were more closely related to TAstV2, and interspecies transmissions between turkeys and guinea fowl is suggested as a possible mechanism by which these viruses may have evolved, based on the genetic data available. This investigation provides genetic and epidemiological information contributing to a better understanding of enteric viral infections in turkeys and guinea fowl.

Tactile extinction in childhood hemiplegia

Tactile extinction was investigated by the Quality Extinction Test (QET) of Schwartz in 39 patients, 34 of whom had congenital hemiplegia and five early-acquired hemiplegia. Extinction values were significantly higher in hemiplegia patients than in controls and usually contralateral to the side of brain damage, except for four cases with right hemiplegia. Values were also higher in males than in females. There were no significant differences between patients with left and right hemiplegia, and no correlations between extinction and IQ or the presence of epilepsy. There was a correlation between QET scores and neuroradiologically proven cerebral atrophy. The meaning of extinction in hemiplegic patients and the principal theories regarding the pathogenesis of neglect are discussed.

High prevalence of Rett syndrome in a small area

Five cases of Rett syndrome were revealed in a population of 2,269 girls 4-14 years of age and born in 1973-83. This gives a prevalence of 22.03 per 10,000 girls in this small rural area situated around the city of Crema in northern Italy. Family history of these families did not reveal any inbreeding among these families. This unusual concentration of patients with this syndrome is apparently the first example of a strong geographical concentration of Rett syndrome.