Congenital cytomegalovirus is associated with severe forms of cerebral palsy and female sex in a retrospective population-based study

AIM

Congenital cytomegalovirus (cCMV) infection can result in poor outcomes including cerebral palsy (CP). The aim of this study was to describe the incidence and comorbidities of CP reported to the Australian Cerebral Palsy Register (ACPR) as attributed to cCMV infection.

METHOD

This was a retrospective population-based study. Cases were drawn from Australian state CP registers with population level ascertainment, 1993 to 2003 (n=2265; 56.4% males, Gross Motor Function Classification System [GMFCS] ratings available for Victorian cases only: 70% GMFCS levels I to III and 30% GMFCS levels IV to V). Clinical data were extracted and cases with cCMV reported as a known cause were compared with cases where cCMV was not reported.

RESULTS

Children with cCMV (n=34; 12 males, 22 females; mean [SD] gestational age, 36.4 wk [4.4], range 24-41 wk) accounted for 1.5% of CP cases; 2.9 per 100,000 live births, (95% confidence intervals 1.9-3.9). When compared with CP cases where cCMV was not reported, proportionally, more CP cases with cCMV were born to younger mothers (p<0.001), were female (64% vs 43%, p=0.014), had spastic quadriplegia (73% vs 21%, p<0.001), required wheeled mobility i.e. GMFCS IV or V (78% vs 28%, p<0.001), had epilepsy (70% vs 30%, p<0.001), deafness (40% vs 2%, p<0.001), functional blindness (20% vs 5%, p<0.001), and severe communication impairment (71% vs 25%, p<0.001).

INTERPRETATION

cCMV is an important potentially preventable cause of CP and is associated with severe disability and female sex in cases reported to the ACPR. Future studies utilising prospective sample collection for cCMV testing are needed to confirm these findings.

What constitutes cerebral palsy in the twenty-first century?

AIM

Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed.

METHOD

Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993-2003), the Western Australian CP Register (1975-2008), and the Surveillance of CP in Europe (SCPE; 1976-1998). An expert panel used a consensus building technique, which utilized the SCPE 'decision tree' and the original 'What constitutes cerebral palsy?' paper as frameworks.

RESULTS

CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety-seven syndromes/disorders were reviewed and advice on their inclusion/exclusion is provided.

INTERPRETATION

What constitutes CP will continue to evolve as diagnostics improve. Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.

Predicting equipment needs of children with cerebral palsy using the Gross Motor Function Classification System: a cross-sectional study

BACKGROUND

Children with cerebral palsy (CP) routinely use assistive equipment to improve their independence. Specialist equipment is expensive and therefore not always available to the child when needed.

AIM

The aim of this study was to determine whether the assistive equipment needs of children with CP and the associated costs could be predicted.

METHOD

A cross-sectional study using a chart audit was completed. Two hundred forty-two children met eligibility criteria and were included in the study. Data abstracted from files pertained to the child's CP, associated impairments and assistive equipment prescribed. The findings were generated using linear regression modelling.

RESULTS

Gross Motor Function Classification System (GMFCS) level [B = 3.01 (95% CI, 2.36-3.57), p = 0.000] and the presence of epilepsy [B = 2.35 (95% CI, 0.64-4.06), p = 0.008] predicted the prescription of assistive equipment. The more severely affected the gross motor function impairment, the more equipment that was required and the more the equipment cost.

INTERPRETATION

The equipment needs of children with CP can be predicted for the duration of childhood. This information may be useful for families and for budget and service planning.

'Just like you': a disability awareness programme for children that enhanced knowledge, attitudes and acceptance: pilot study findings

PURPOSE

Participation of people with disabilities is influenced by environmental and contextual factors. Disability awareness programmes aim to increase knowledge and acceptance of disability. This study evaluated a disability awareness programme for students aged 9-11 in Australia.

METHOD

Pre-post questionnaires and focus groups evaluated the programme. The intervention took a cognitive-behavioural approach including a person with a disability co-presenting. Students (n = 147) participated in two sessions of discussions, written activities, demonstrations and disability simulation activities.

RESULTS

Significant improvements (p < 0.001) in knowledge, attitudes and acceptance of disability were evident immediately following the intervention. Focus group analyses further demonstrated these findings.

CONCLUSIONS

A brief disability awareness programme for children improved knowledge, attitudes and acceptance of disability in the short-term. Further research is required to identify the potential impact of such programmes on inclusion and social participation of people with disabilities both inside and outside of the school setting.