101
|
Abstract
Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention.
Collapse
Affiliation(s)
- Eve Blair
- Division of Population Sciences, Centre for Child Health Research, University of Western Australia at The Telethon Institute for Child Health Research, West Perth, WA 6872, Australia.
| |
Collapse
|
102
|
Deon LL, Gaebler-Spira D. Assessment and treatment of movement disorders in children with cerebral palsy. Orthop Clin North Am 2010; 41:507-17. [PMID: 20868881 DOI: 10.1016/j.ocl.2010.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cerebral palsy is the most common motor disability in childhood. Orthopedic care depends on the appreciation and the identification of muscle tone abnormalities and how they affect growth and development of the child. Abnormal muscle tone is a common diagnostic feature of cerebral palsy and can include hypotonia or hypertonia. Hypertonia is the most frequent tone abnormality in children with cerebral palsy. This article reviews hypertonia and provides information on discriminating between spasticity, dystonia, and rigidity. Medication and neurosurgical options for the management of hypertonia are presented and compared.
Collapse
Affiliation(s)
- Laura L Deon
- Pediatric Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago at Northwestern University, Chicago, IL 60611, USA
| | | |
Collapse
|
103
|
Carrillo-Ruiz JD, Andrade P, Godínez-Cubillos N, Montes-Castillo ML, Jiménez F, Velasco AL, Castro G, Velasco F. Coupled obturator neurotomies and lidocaine intrathecal infusion to treat bilateral adductor spasticity and drug-refractory pain. J Neurosurg 2010; 113:528-31. [DOI: 10.3171/2009.11.jns09607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spastic diplegia is present in three-fourths of children with cerebral palsy, interfering with gait and frequently accompanied by severe pain. The authors report the case of a 28-year-old woman with history of perinatal hypoxia, who presented with cerebral palsy and severe spastic diplegia (Ashworth Scale Score 4, Tardieu Scale Score 5) and was confined to a wheelchair. She complained of pain in the left hip and knee with mixed neuropathic and somatic components. She consistently rated pain intensity as 10 of 10 on a visual analog scale, and her symptoms were resistant to multiple treatments. The patient underwent selective bilateral adductor myotomies and the implantation of an infusion pump for intrathecal lidocaine application. Postoperative control of pain and spasticity was dramatic (scores of 0 on the Ashworth, Tardieu, and visual analog scales) and persisted throughout a follow-up period of 36 months. This is the first report in the literature of combined selective neurotomies for the treatment of spasticity and chronic lidocaine subarachnoid infusion to treat associated pain. This therapy could represent an alternative to treat spasticity associated with neuropathic and somatic pain.
Collapse
Affiliation(s)
- José D. Carrillo-Ruiz
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
- 2Anáhuac University, School of Medicine and Psychology
| | - Pablo Andrade
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
- 2Anáhuac University, School of Medicine and Psychology
| | | | | | - Fiacro Jiménez
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
- 2Anáhuac University, School of Medicine and Psychology
| | - Ana L. Velasco
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
| | - Guillermo Castro
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
| | - Francisco Velasco
- 1Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital
| |
Collapse
|
104
|
Hoare BJ, Imms C, Rawicki HB, Carey L. Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper. BMC Neurol 2010; 10:58. [PMID: 20602795 PMCID: PMC2909943 DOI: 10.1186/1471-2377-10-58] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 07/05/2010] [Indexed: 11/16/2022] Open
Abstract
Background Use of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A. Methods/Design A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale. Discussion The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided. Trial Registration ACTRN12605000002684
Collapse
|
105
|
van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:615-23. [PMID: 20382296 DOI: 10.1016/j.apmr.2009.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity. DESIGN Cross-sectional study. SETTING A special school for children with physical disabilities. PARTICIPANTS Children with CP (N=20; age range, 5-14y; mean weight +/- SD, 35+/-14kg; mean length +/- SD, 139+/-19cm). INTERVENTIONS Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners. MAIN OUTCOME MEASURES Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity ("burst"). The average rectified value (ARV) of the EMG signal was calculated for each test. RESULTS The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower. CONCLUSIONS The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.
Collapse
Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, Vrije Universiteit University Medical Center, 1007 MB Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
106
|
Hoare BJ, Wallen MA, Imms C, Villanueva E, Rawicki HB, Carey L. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE). Cochrane Database Syst Rev 2010; 2010:CD003469. [PMID: 20091546 PMCID: PMC7154577 DOI: 10.1002/14651858.cd003469.pub4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is "a group of permanent disorders of the development of movement and posture causing activity limitation(s) that are attributed to non-progressive disturbance that occurred in the developing fetal or infant brain" (Rosenbaum 2007, p.9). The spastic motor type is the most common form of CP. Therapeutic management may include splinting/casting, passive stretching, facilitation of posture/movement, spasticity-reducing medication and surgery. Botulinum toxin-A (BoNT-A) is now used as an adjunct to these techniques in an attempt to reduce spasticity, improve range of movement and function. OBJECTIVES To assess the effectiveness of injections of BoNT-A or BoNT-A and occupational therapy in the treatment of the upper limb in children with CP. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register/CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (1966 to August Week 1 2008), EMBASE (1980 to 2008 Week 28) and CINAHL (1982 to August Week 1 2008). SELECTION CRITERIA All randomised controlled trials (RCTs) comparing BoNT-A injection or BoNT-A injection and occupational therapy in the upper limb(s) with other types of treatment (including no treatment or placebo) in children with CP. DATA COLLECTION AND ANALYSIS Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity and rated for quality using the PEDro scale. Data were extracted and entered into RevMan 5.0.15. MAIN RESULTS Ten trials met the inclusion criteria. PEDro quality ratings ranged from 6/10 to 10/10. Concentration of BoNT-A ranged from 50U/1.0ml to 200U/1.0ml saline with doses of 0.5U to 16U/kg body weight and total doses of 220 to 410 Units (Botox(R)).A combination of BoNT-A and occupational therapy is more effective than occupational therapy alone in reducing impairment, improving activity level outcomes and goal achievement, but not for improving quality of life or perceived self-competence. When compared with placebo or no treatment, there is moderate evidence that BoNT-A alone is not effective. AUTHORS' CONCLUSIONS This systematic review found high level evidence supporting the use of BoNT-A as an adjunct to managing the upper limb in children with spastic CP. BoNT-A should not be used in isolation but should be accompanied by planned occupational therapy.Further research is essential to identify children most likely to respond to BoNT-A injections, monitor longitudinal outcomes, determine timing and effect of repeated injections and the most effective dosage, dilution and volume schedules. The most effective adjunct therapies including frequency and intensity of delivery also requires investigation.
Collapse
Affiliation(s)
- Brian J Hoare
- La Trobe University, Victorian Paediatric Rehabilitation Service, Monash Medical CentreSchool of Occupational Therapy246 Clayton RoadClaytonVictoriaAustralia3086
| | - Margaret A Wallen
- The Children's Hospital at WestmeadOccupational TherapyLocked Bag 4001WestmeadNSWAustralia2145
| | - Christine Imms
- LaTrobe University, Murdoch Children's Research Institute, Royal Children's HosptialSchool of Occupational TherapyLa Trobe UniversityMelbourneVictoriaAustralia3086
| | - Elmer Villanueva
- Monash UniversityGippsland Medical SchoolNorthways RoadChurchillVictoriaAustralia3842
| | - Hyam Barry Rawicki
- Monash Medical CentreVictorian Paediatric Rehabilitation Service246 Clayton RoadClaytonVictoriaAustralia3168
| | - Leeanne Carey
- School of Occupational Therapy, LaTrobe UniversityDivision of Neurorehabilitation and Recovery, National Stroke Research Institute, Florey Neuroscience Institutes andLevel 2, Neurosciences Bldg, Austin Health, Repatriation Campus300 Waterdale Road, Heidleberg HeightsMelbourneVictoriaAustralia3081
| | | |
Collapse
|
107
|
The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
Collapse
|
108
|
Gorter JW, Verschuren O, van Riel L, Ketelaar M. The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development. BMC Musculoskelet Disord 2009; 10:108. [PMID: 19728891 PMCID: PMC2751738 DOI: 10.1186/1471-2474-10-108] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 09/04/2009] [Indexed: 11/10/2022] Open
Abstract
Background It is thought that spasticity has an influence on the development of functional motor abilities among children with cerebral palsy (CP). The extent to which spasticity is associated with the change in motor abilities in young children with CP has not been established. The objective of this study is to evaluate the relationship of initial spasticity in young children with CP and their gross motor function development over one year. Methods Fifty children with CP aged 18 months, GMFCS-levels I-V participated in a longitudinal observational study. Change in gross motor functioning (GMFM-66) was measured over one year. The level of spasticity measured at the first assessment was determined with the Modified Tardieu Scale in three muscle groups of the lower extremity (adductor muscles, the hamstrings and the m. gastrocnemius). The Spasticity Total Score per child was calculated with a maximum score of 12 points. Results Spearman's Rho Correlation (-0.28) revealed a statistically significant relationship (p < 0.05) of small strength between the Spasticity Total Score and the change score of the GMFM-66. Conclusion Our findings indicate that when measured over one year, spasticity is marginally related to gross motor function development in infants with CP. The initial level of spasticity is only one of the many child, environmental and family factors that determines gross motor development of a young child with CP.
Collapse
Affiliation(s)
- Jan Willem Gorter
- Canchild, Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | |
Collapse
|
109
|
van den Noort JC, Scholtes VA, Harlaar J. Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors. Gait Posture 2009; 30:138-43. [PMID: 19525113 DOI: 10.1016/j.gaitpost.2009.05.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 04/28/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
Abstract
Spasticity is clinically assessed using goniometry to measure the joint angle of the catch (AOC) during fast passive muscle stretch. The precision and accuracy of the goniometric AOC measurements are questionable, because of the inevitable joint repositioning after occurrence of the catch. This study aims to evaluate the use of goniometry in estimating the AOC in spasticity assessment of the medial hamstrings, soleus and gastrocnemius in twenty children with Cerebral palsy (CP), using inertial sensors (IS) as reference system. The IS were initially validated with an optoelectronic system to measure 3d-orientation and proved to be accurate within 1 degree. To evaluate the precision and accuracy of the goniometry, the joint angle measured with the goniometer after repositioning was compared to the joint angle measured simultaneously with the IS, and to the true AOC, detected and measured with the IS during the fast muscle stretch. Results showed that goniometry is an imprecise method to measure the true AOC in spasticity assessment. The error is mainly due to joint repositioning after the fast muscle stretch. For spasticity assessment, it is advised to apply inertial sensors when a precise measurement of the angle of catch is required.
Collapse
Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | |
Collapse
|
110
|
Venture G, Yamane K, Nakamura Y, Yamamoto T. Identification of Human Limb Viscoelasticity using Robotics Methods to Support the Diagnosis of Neuromuscular Diseases. Int J Rob Res 2009. [DOI: 10.1177/0278364909103786] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper we present an original method to estimate in vivo the joint dynamics of the human limbs. The method is based on a non-invasive and painless technology making use of an optical motion capture system and an associated skeletal model to record the human motion and compute its kinematics and its dynamics. The formalism that is used for the identification is commonly used in robotics. The passive limb joints properties are modeled by enhanced spring-damper systems. The inverse dynamics is sampled along a movement to give an over-determined system. The obtained system is solved by the linear least-squares method. To perform the estimation, we place emphasis on giving indicators and requirements to interpret the obtained results, and on using painless, passive constraint-free movements that are usually performed during the clinical diagnosis of neuromuscular diseases. Finally the method is experimentally applied to two healthy subjects and five patients of neuromuscular diseases in order to estimate the upper-limb viscoelastic properties. The obtained results are discussed.
Collapse
Affiliation(s)
- Gentiane Venture
- University of Tokyo, Department of Mechano-Informatics, 7-3-1 Hongo Bunkyo-ku, 113-8656 Tokyo, Japan,
| | - Katsu Yamane
- University of Tokyo, Department of Mechano-Informatics, 7-3-1 Hongo Bunkyo-ku, 113-8656 Tokyo, Japan
| | - Yoshihiko Nakamura
- University of Tokyo, Department of Mechano-Informatics, 7-3-1 Hongo Bunkyo-ku, 113-8656 Tokyo, Japan
| | - Tomotaka Yamamoto
- University of Tokyo Hospital, Department of Neurology, 7-3-1 Hongo Bunkyo-ku, 113-8656 Tokyo, Japan
| |
Collapse
|
111
|
Spijker M, Strijers RLM, van Ouwerkerk WJR, Becher JG. Disappearance of spasticity after selective dorsal rhizotomy does not prevent muscle shortening in children with cerebral palsy: a case report. J Child Neurol 2009; 24:625-7. [PMID: 19151363 DOI: 10.1177/0883073808325652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selective dorsal rhizotomy is an effective treatment for spasticity in children with cerebral palsy who have a spastic motor disorder. It is hypothesized that muscle shortening is related to spasticity; the lack of stretch of a muscle is thought to be the cause of muscle shortening. If this is true, the treatment for spasticity should prevent the occurrence of muscle shortening during growth. We present the case of 1 child with cerebral palsy and spastic diplegia, for whom the treatment with selective dorsal rhizotomy was successful in improving the walking abilities. She did, however, develop muscle shortening during growth. In conclusion, the development of muscle shortening during growth in children with cerebral palsy and spastic paresis cannot be prevented by treatment for the spasticity alone.
Collapse
Affiliation(s)
- Margje Spijker
- Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands.
| | | | | | | |
Collapse
|
112
|
Rameckers EAA, Speth LAWM, Duysens J, Vles JSH, Smits-Engelsman BCM. Botulinum toxin-a in children with congenital spastic hemiplegia does not improve upper extremity motor-related function over rehabilitation alone: a randomized controlled trial. Neurorehabil Neural Repair 2008; 23:218-25. [PMID: 19106252 DOI: 10.1177/1545968308326629] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). OBJECTIVE To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized functional training program versus without the addition of chemodenervation of forearm and hand muscles. METHODS Twenty children with spastic hemiplegia, aged 4 to 16 years, were matched for baseline characteristics and then randomized to standardized functional physical and occupational therapies for 6 months (PT/OT group) or to the same therapies plus multimuscle BTX-A (BTX+ group). MAIN OUTCOME MEASURES were isometric generated force, overshoot and undershoot (force production error), active and passive range of motion by goniometry (ROM), stretch restricted angle (SRA) of joints, Ashworth scores at the elbow and wrist, and the Melbourne assessment of unilateral upper limb function. All measures were performed at baseline, 2 weeks after BTX-A, 6 months (end of therapy), and then 3 months after termination of the therapy. RESULTS Clinical measures (muscle tone, active ROM of wrist and elbow) showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Generated force decreased directly after the BTX-A injection but increased during the therapy period. The PT/OT group, however, showed a significantly higher increase in force and accuracy with therapy compared with the BTX+ therapy group. CONCLUSIONS Functional rehabilitation therapies for the upper extremity increase manual isometric flexor force at the wrist and ROM, but BTX injections cause weakness and do not lead to better outcomes than therapy alone.
Collapse
Affiliation(s)
- E A A Rameckers
- Avans+, University for Professionals, Breda The Netherlands.
| | | | | | | | | |
Collapse
|
113
|
Ansari NN, Naghdi S, Hasson S, Azarsa MH, Azarnia S. The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia. Brain Inj 2008; 22:1007-12. [PMID: 19117179 DOI: 10.1080/02699050802530557] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PRIMARY OBJECTIVE To investigate the inter-rater reliability of the Modified Tardieu Scale (MTS) in the measurement of elbow flexor muscle spasticity in patients with adult hemiplegia. RESEARCH DESIGN A cross-sectional study to examine the agreement between two raters on elbow flexor muscle spasticity using Modified Tardieu Scale. INTERVENTIONS Not applicable. METHODS AND PROCEDURES Thirty patients (21 men, nine women) with an age range of 21-79 years (mean = 54.9; SD = 15.7) were tested. Two inexperienced raters assessed the elbow flexor muscle spasticity in the affected side during the same session. The order of assessments by the two raters was randomized. The main outcome measure was dynamic component of spasticity (R2-R1). Reliability was also calculated for MTS scores, angle of muscle reaction (R1), and passive range of motion (R2). MAIN OUTCOMES AND RESULTS The ICC for R2-R1 was 0.72. The ICC for MTS scores, R1 and R2 were 0.74, 0.74 and 0.56, respectively. CONCLUSIONS The Modified Tardieu Scale did not provide acceptable high inter-rater reliability in the measurement of muscle spasticity in patients with hemiplegia when used by raters of limited experience.
Collapse
|
114
|
Hägglund G, Wagner P. Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord 2008; 9:150. [PMID: 18990204 PMCID: PMC2644696 DOI: 10.1186/1471-2474-9-150] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 11/06/2008] [Indexed: 01/09/2023] Open
Abstract
Background The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy. Methods All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995–2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0–1 were gathered in one category and levels 2–4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion. Results In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2–4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15. Conclusion In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.
Collapse
Affiliation(s)
- Gunnar Hägglund
- Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden.
| | | |
Collapse
|
115
|
Naghdi S, Ansari NN, Azarnia S, Kazemnejad A. Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity. Physiother Theory Pract 2008; 24:372-9. [PMID: 18821443 DOI: 10.1080/09593980802278959] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The measurement of spasticity is part of the neurological examination of patients with disorders of the central nervous system. Recently, the Modified Modified Ashworth Scale (MMAS) was developed for the characterization of muscle spasticity. The purpose of this study was to determine the interrater reliability of the MMAS in the assessment of wrist flexor muscle spasticity in adult patients after upper motoneuron lesions resulted in hemiplegia. Thirty hemiplegic patients (17 males and 13 females) with a mean age of 55.6+/-7.8 years participated in this study. The wrist flexor spasticity was assessed according to MMAS by two female physiotherapists. The raters gave 23 patients the same spasticity score (weighted percentage agreement=97.4%). The most agreement occurred for scores 3 (46.7%) and 0 (16.7%), respectively. The agreement between raters was very good (weighted kappa=0.92, SE=0.03, p<0.0001). In conclusion, the MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity.
Collapse
Affiliation(s)
- Soofia Naghdi
- Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | | |
Collapse
|
116
|
Ansari NN, Naghdi S, Younesian P, Shayeghan M. Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract 2008; 24:205-13. [PMID: 18569857 DOI: 10.1080/09593980701523802] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.
Collapse
|
117
|
Faber IR, Nienhuis B, Rijs NPAM, Geurts ACH, Duysens J. Is the modified Tardieu scale in semi-standing position better associated with knee extension and hamstring activity in terminal swing than the supine Tardieu? Dev Med Child Neurol 2008; 50:382-7. [PMID: 18384387 DOI: 10.1111/j.1469-8749.2008.02056.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate whether the modified Tardieu scale (MTS) in a semi-standing position, used for the assessment of hamstrings spasticity, was better associated with knee extension and hamstrings activity in terminal swing than the MTS in a supine position in children with cerebral palsy (CP). Seven children diagnosed with spastic CP (Gross Motor Function Classification System Levels I-II) and seven healthy comparison children participated in the study. An instrumented MTS in supine and semi-standing position and an instrumented gait assessment were conducted. Results showed that spasticity-related outcomes of the semi-standing MTS do not show better associations with terminal swing characteristics of gait than the same outcomes of the supine MTS in children with spastic CP. Only the passive restricted knee angle from the supine MTS was strongly associated with the maximum knee extension during gait (r(s)=0.99; p <0.001), suggesting that hamstrings length is more important for terminal swing behaviour than hamstrings spasticity.
Collapse
Affiliation(s)
- Irene R Faber
- Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
118
|
Vles GF, de Louw AJA, Speth LA, van Rhijn LW, Janssen-Potten YJM, Hendriksen JG, Vles JSH. Visual Analogue Scale to score the effects of Botulinum Toxin A treatment in children with cerebral palsy in daily clinical practice. Eur J Paediatr Neurol 2008; 12:231-8. [PMID: 17933567 DOI: 10.1016/j.ejpn.2007.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 08/08/2007] [Accepted: 08/21/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined the reliability and efficiacy of the Visual Analogue Scale (VAS) in evaluating spasticity treatment in an outpatient setting. PATIENTS AND METHODS We used a parent-reported VAS device for evaluating the effects of Botulinum Toxin A (BTX-A). Data were collected on 55 children with cerebral palsy. Individual goals of treatment were formulated in close consultation with the caregivers. The categories of treatment options were improvement of pain, problems with nursing, sitting position, standing and walking. RESULTS Seventy-four interventions were performed in 55 children. A statistically significant effect was found for improvement of nursing, standing and walking. No statistically significant effect for pain was found, probably because of small numbers. In seven children there was no effect at all. Side effects were observed in five children. CONCLUSION In using a VAS instrument, beneficial effects were found for nursing, standing and walking after BTX-A treatment. A positive (not significant) correlation was found between the VAS and the Modified Tardieu for those children who also underwent a gait analysis. Evaluating spasticity treatment with the use of the VAS has an important advantage because it is a quick and easy method for evaluating individually defined treatment goals in an outpatient setting, in which time-consuming evaluations are not an option.
Collapse
Affiliation(s)
- Georges F Vles
- Department of Child Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
119
|
Abstract
Extreme prematurity confers about a 100-fold increase in the risk of cerebral palsy (CP), relative to birth at term gestation. Although CP is primarily a disorder of movement, many children with this disorder have other impairments which may affect their quality of life and life expectancy. Epidemiologic and clinical studies of cerebral palsy have benefited from recent efforts to develop greater uniformity of definition and classification. Particularly noteworthy is the development of the Gross Motor Function Classification System, which is a reliable and valid measure used with increasing frequency in observational and experimental studies. Also of great importance are efforts to quantify reliably the quality of life for children with cerebral palsy, thereby providing a target for medical and community interventions that aim to increase participation and well-being among affected children. During the late 1970s and early 1980s, the rate of CP actually rose, presumably as a result of increased survival of especially vulnerable infants who otherwise would have died. In developed countries over the past two decades (late 1980s to present), CP rates have been either stable or decreasing. Although considerable effort is being directed at prevention, the only perinatal interventions for which there is strong evidence of a beneficial effect on both mortality and the risk of CP is antenatal treatment of the mother with glucocorticoid.
Collapse
Affiliation(s)
- Michael O'Shea
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| |
Collapse
|
120
|
Verhoog J, Fuijkschot J, Willemsen M, Ketelaar M, Rotteveel J, Gorter JW. Sjögren-Larsson syndrome: motor performance and everyday functioning in 17 patients. Dev Med Child Neurol 2008; 50:38-43. [PMID: 18173629 DOI: 10.1111/j.1469-8749.2007.02013.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sjögren-Larsson syndrome (SLS) is an autosomal recessive neurometabolic disorder characterized by spasticity, learning disability, and ichthyosis. To our knowledge, there is no detailed report in the literature concerning the functional consequences of SLS. Therefore, we performed a cross-sectional study of motor performance and everyday functioning in 17 patients with this rare disorder. Nine female and eight male patients with SLS (age range 1-35y) were investigated. Data were obtained by structured interview with parents and patients with SLS, a telephone-conducted questionnaire, and physical examination. Motor performance was measured by the Gross Motor Function Measure; everyday functioning was assessed using the Pediatric Evaluation of Disability Inventory and the Vineland Adaptive Behavior Scale. In most patients, spasticity was bilaterally present in hamstrings, hip adductors, and gastrocnemic muscles. All participants above 7 years had contractures in the lower extremities. Limitations were present in all gross motor dimensions, except for lying and rolling. Participants had developmental ages far below their chronological age. This study revealed that patients with SLS have limitations in gross motor performance. Although some patients can reach a certain level of independence, most have activity limitations and restrictions in their participation in society.
Collapse
|
121
|
|
122
|
Abstract
OBJECTIVE To describe different aspects of a kinematic aiming task (KAT) as a quantitative way to assess changes in arm movements within 2 wks after botulinum toxin-A (BTX-A) injections in children with spastic hemiplegia. DESIGN Intervention study randomized clinical trial; follow-up within 4 wks after baseline measurement. RESULTS The KAT gave a high intraclass correlation on movement time, spread of end points (END), and index of performance effective (IP-E). After BTX-A, a significant increase of END and IP-E was shown if precision demand in the KAT was high, whereas the inverse occurred when speed was more important. These functional changes coincided with a significant decrease of the maximum voluntary contraction of the flexor muscles of the forearm. Muscle tone measured with the Ashworth scale did show a nonsignificant decrease of muscle tone, as did the stretch restricted angle and the active and passive ranges of motion of the elbow and wrist. CONCLUSIONS Muscle force decreased immediately after BTX-A, showing the direct effect of BTX-A. The KAT is an adequate, reproducible way to quantify functional changes after BTX-A in the upper limb. BTX-A has an inverse effect in the precision task when accuracy is important, and it has a positive effect when speed prevails.
Collapse
|
123
|
Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Bilateral spastic cerebral palsy--prevalence through four decades, motor function and growth. Eur J Paediatr Neurol 2007; 11:215-22. [PMID: 17306577 DOI: 10.1016/j.ejpn.2006.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 12/21/2006] [Accepted: 12/24/2006] [Indexed: 11/22/2022]
Abstract
UNLABELLED The aim was to depict changes in the prevalence and severity of bilateral spastic cerebral palsy (CP) over a 40-year period. Another objective was to characterise the group born in 1991-1998 with respect to gross motor function, spasticity and growth. Data were obtained from the CP register of western Sweden and rehabilitation records. RESULTS After a rise to 1.27 per 1000 live births in 1983-1986, the prevalence decreased significantly, in children born both preterm and at term, to 0.69 in 1995-1998. After 1975, more children were born preterm than at term. There was a significant decrease in severe bilateral spastic CP during the same period, mainly in children born at term. In all, 46% of the children born at term and 33% of those born preterm had a severe motor impairment, i.e. no walking ability. In the 167 children born in 1991-1998, the gross motor function classification system (GMFCS) level was I in 14%, II in 34%, III in 10%, IV in 25% and V in 17%. The GMFCS level correlated with the gross motor function measure (GMFM) and the Ashworth spasticity scores, as well as with the deviation in postnatal weight and height. We conclude that the prevalence of bilateral spastic CP has decreased since the mid-1980s, parallel to a reduction in the severity of the motor impairment. Children born preterm have predominated since the mid-1970s. The severity of the motor impairment correlated with the degree of spasticity, GMFM and growth. The percentage of children who were underweight was substantial.
Collapse
Affiliation(s)
- Kate Himmelmann
- The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | | | |
Collapse
|
124
|
Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy. Pediatr Neurol 2007; 36:30-9. [PMID: 17162194 DOI: 10.1016/j.pediatrneurol.2006.09.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/28/2006] [Accepted: 09/15/2006] [Indexed: 11/16/2022]
Abstract
To evaluate the effect of multilevel botulinum toxin A and comprehensive rehabilitation on gait pattern, muscle length, and spasticity, a multicenter randomized trial was performed in 46 children with spastic cerebral palsy who walk with flexed knees. Their mean age was 8.0 years (range 4 to 11 years). They were randomly allocated to the intervention group (multilevel botulinum toxin A and comprehensive rehabilitation) or the control group (usual care). After 6 weeks, a significant treatment effect in the intervention group was observed on: improved knee extension during midstance and terminal swing (7 degrees and 5 degrees , P < 0.01, respectively); hip rotation during terminal swing (4 degrees , P = 0.02); gait score (1.7, P < 0.01); decreased spasticity in hamstrings (11 degrees , P < 0.01), gastrocnemius (6 degrees , P = 0.01), and soleus (5 degrees , P = 0.02); and increased muscle length in hamstrings (9 degrees , P < 0.01) and gastrocnemius (5 degrees , P < 0.01). The improved muscle length was maintained up to 24 weeks. This study demonstrated that multilevel botulinum toxin A and comprehensive rehabilitation improves knee extension during gait, increases muscle length, and decreases spasticity in injected muscles after 6 weeks in children who walk with flexed knees. Although the effect on muscle length was maintained after 24 weeks, the effect on gait and spasticity had disappeared.
Collapse
|