Search

BackgroundCerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors.MethodsThis international, multicentric study will include 50 pre-school children with CP from 12 to 60months of age, comparing the effect of 50h (2weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, neuroimaging and kinematics.DiscussionThe results of this study should highlight the impact of a motor, intensive, goal-directed therapy (HABIT-ILE) in pre-school children at a functional, neuroplastic and biomechanical level. In addition, this changes could demonstrated the impact of this intervention in the developmental curve of each child, improving functional ability, activity and participation in short-, mid- and long-term.Name of the registryEvaluation of Functional, Neuroplastic and Biomechanical Changes Induced by an Intensive, Playful Early-morning Treatment Including Lower Limbs (EARLY-HABIT-ILE) in Preschool Children With Uni and Bilateral Cerebral Palsy (HABIT-ILE).Trial registrationNCT04017871Registration dateJuly 12, 2019., This protocol and trial is funded by La Fondation Paralysie Cerebrale (https://www.fondationparalysiecerebrale.org/).The funding body has reviewed this protocol during the selection process, but after this initial point, the Fondation Paralysie Cerebrale has not participated in the design study and will not participate in data collection, analysis, interpretation data or in writing the manuscript.

Background Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters. Methods This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures. Discussion We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impact the whole developmental curve of each child, improving functional ability, activity and participation in the short-, mid- and long-term. Name of the registry: Changes Induced by Early HABIT-ILE in Pre-school Children With Uni- and Bilateral Cerebral Palsy (EarlyHABIT-ILE)., This protocol and trial is funded by La Fondation Paralysie Cerebrale (https://www.fondationparalysiecerebrale.org/). The funding body has reviewed this protocol during the selection process, but after this initial point, the Fondation Paralysie Cerebrale has not participated in the design study and will not participate in data collection, analysis, interpretation data or in writing the manuscript.

RESUMEN La metrorragia posparto es una de las complicaciones mas graves de la obstetricia con importante morbi-mortalidad materna. La ligadura de las arterias uterinas forma parte de la cadena de procedimientos tera-peuticos. Esta comunicacion muestra una paciente con hemorragia posparto tratada con ligadura vaginal de arterias uterinas, con cese del sangrado y recuperacion de la paciente sin complicaciones. PALABRAS CLAVE: Hemorragia posparto, ligadura de arterias uterinas, mortalidad materna SUMMARY Postpartum hemorrhage is one of the most serious obstetrics complications with significant maternal morbi-dity and mortality. Uterine arteries ligature is part of the chain of therapeutic procedures. This communication presents a patient with postpartum hemorrhage treated with vaginal uterine arteries ligature with cessation of bleeding after the intervention and recovery without complications.KEY WORDS: Postpartum hemorrhage, vaginal uterine arteries ligature, maternal mortality INTRODUCCION

La metrorragia posparto es una de las complicaciones más graves de la obstetricia con importante morbi-mortalidad materna. La ligadura de las arterias uterinas forma parte de la cadena de procedimientos terapéuticos. Esta comunicación muestra una paciente con hemorragia posparto tratada con ligadura vaginal de arterias uterinas, con cese del sangrado y recuperación de la paciente sin complicaciones. Postpartum hemorrhage is one of the most serious obstetrics complications with significant maternal morbidity and mortality. Uterine arteries ligature is part of the chain of therapeutic procedures. This communication presents a patient with postpartum hemorrhage treated with vaginal uterine arteries ligature with cessation of bleeding after the intervention and recovery without complications.

Tesis (Magíster en Psicología Clínica) Este seminario se formula la siguiente pregunta: ¿Es el vínculo temprano inseguro, un potencial patrón de un modo relacional violento? Se plantea que la raíz y/o el sostenimiento de dinámicas familiares violentas, muchas veces surgen en base a eventos que sucedieron en la temprana infancia, específicamente en el vínculo primario entre madre e hijo, apego. Este vínculo se constituye como modelo interacciona}, que se repite y se reedita en distintos momentos y relaciones de la vida del ser humano. Estudios plantean la existencia de una "transmisión transgeneracional del apego", vale decir, cuidadores que han tenido un cierto estilo de apego con sus propios padres tienden a transmitir el mismo a sus hijos. En cuanto a la violencia, este patrón funciona de igual manera, lo que indica que estos modelos "disfuncionales" permiten el sostenimiento de relaciones basadas en agresión, la que es vivida activa o pasivamente. Este seminario constará de una revisión bibliográfica actualizada, por lo que está basado en autores contemporáneos con respecto a las temáticas antes mencionadas. En vista que trata de un recorrido teórico, se intentara sistematizar los conceptos más relevantes en cuanto al apego y al fenómeno de la violencia, así como su transmisión transgeneracional. En la última parte se expondrá el estudio de un caso que escenificará este hilo teórico conductor.