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Brown A, Tornberg ÅB, Kristensson Hallström I. Parents' lived experience of early risk assessment for cerebral palsy in their young child using a mobile application after discharge from hospital in the newborn period. Ann Med 2024; 56:2309606. [PMID: 38300887 PMCID: PMC10836479 DOI: 10.1080/07853890.2024.2309606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore parents' lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period. METHODS An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans' lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents' lived experience. RESULTS The overall understanding of the parents' experience was 'Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future. CONCLUSIONS The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.
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Affiliation(s)
- Annemette Brown
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Pediatrics and Adolescence Medicine, Nordsjælland University Hospital, Capital Region of Denmark, Denmark
- Department of Neurology and Physiotherapy, Nordsjællands Hospital, Capital Region of Denmark, Denmark
| | - Åsa B. Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Aravamuthan BR, Fehlings DL, Novak I, Gross P, Alyasiry N, Tilton AH, Shevell MI, Fahey MC, Kruer MC. Uncertainties Regarding Cerebral Palsy Diagnosis: Opportunities to Clarify the Consensus Definition. Neurol Clin Pract 2024; 14:e200353. [PMID: 39193394 PMCID: PMC11347036 DOI: 10.1212/cpj.0000000000200353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/10/2024] [Indexed: 08/29/2024]
Abstract
Background and Objectives We have established that physicians, including neurologists, variably diagnose cerebral palsy (CP) when using the most recent CP definition from 2006. We also know that child neurologists and neurodevelopmentalists view themselves to be optimally suited to diagnose CP based on their training backgrounds. Therefore, to reduce variability in CP diagnosis, our objective was to elucidate uncertainties child neurologists and neurodevelopmentalists may have regarding practical application of the 2006 definition. Methods We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists built into a discussion seminar at the 2022 Child Neurology Society (CNS) Annual Meeting, the largest professional meeting of these specialists in North America. Seminar attendees were provided the 2006 definition and asked whether they had any uncertainties about the practical application of the definition across 4 hypothetical clinical vignettes. A group of national and international CP leaders then processed these data through iterative discussions to develop recommendations for clarifying the 2006 definition. Results The seminar was attended by 50% of all conference attendees claiming CME (202/401). Of the 164 closing survey respondents, 145 (88%) expressed uncertainty regarding the clinical application of the 2006 definition. These uncertainties focused on 1) age, both regarding the minimum and maximum ages of brain disturbance or motor symptom onset (67/164, 41%), and 2) interpretation of the term "nonprogressive" (48/164, 29%). Almost all respondents (157/164, 96%) felt that we should revise the 2006 consensus definition of CP. Discussion To address the most common CP diagnostic uncertainties we identified, we collectively propose 4 points of clarification to the 2006 definition: 1) motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible; 3) the clinical motor disability phenotype should be nonprogressive through 5 years old; and 4) a CP diagnosis should be re-evaluated if motor disability is progressive or absent by 5 years old. We anticipate that clarifying the 2006 definition of CP in this manner could address the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.
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Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Darcy L Fehlings
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Iona Novak
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Paul Gross
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Noor Alyasiry
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Ann H Tilton
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael I Shevell
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael C Fahey
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
| | - Michael C Kruer
- Division of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine
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Prentice RE, Hunt RW, Spittle AJ, Ditchfield M, Chen J, Burns M, Flanagan EK, Wright E, Ross AL, Goldberg R, Bell SJ. Well controlled maternal inflammatory bowel disease does not increase the risk of abnormal neurocognitive outcome screening in offspring. Brain Behav Immun Health 2024; 40:100827. [PMID: 39149622 PMCID: PMC11326492 DOI: 10.1016/j.bbih.2024.100827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/26/2024] [Accepted: 07/20/2024] [Indexed: 08/17/2024] Open
Abstract
Background Exposure to maternal inflammation is associated with an increased risk of neurocognitive and developmental disorders in offspring. Early diagnosis and intervention improves childhood motor and cognitive functioning. Neonatal cerebral MRI and remote app-based generalised movement assessments (GMAs) are both predictive of adverse neurocognitive outcomes but have only been used in infants at significantly increased risk for these outcomes, rather than following in utero exposure to maternal inflammatory disorders. Methods Pregnant women with inflammatory bowel disease were assessed clinically and biochemically in each trimester of pregnancy in this single centre prospective study. Neonatal cerebral MRIs were performed at 6-12 weeks post-corrected term. Two GMA videos were filmed using the 'BabyMoves' app from 12 to 16 weeks of age. MRIs and GMAs were assessed by a blinded highly qualified practitioner using validated scoring systems. Results 40/53 of invited maternal-infant dyads were recruited. C-reactive protein was elevated antenatally in less than 13%. 5/37 neonatal MRIs had incidental or obstetric trauma related gross anatomical abnormalities, with none abnormal on validated gross abnormality scoring. 3/35 GMAs were abnormal, with one GMA abnormality being clinically significant. Of those with abnormal GMAs, 2/3 were in exposed to severely active IBD in-utero. Conclusion Neonatal cerebral MRI and GMA for neurocognitive screening is feasible in the setting of maternal inflammatory bowel disease, where the risk of cerebral palsy is poorly defined and thus burdensome screening interventions are less appealing to parents. Larger studies are required to stratify adverse neurocognitive outcome risk in infants born to women with maternal inflammatory disorders, but these data are reassuring for women with IBD in remission antenatally.
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Affiliation(s)
- Ralley E Prentice
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Rod W Hunt
- Department of Neonatal Medicine, Monash Health, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Cerebral Palsy Alliance, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Ditchfield
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Department of Medical Imaging, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Jeff Chen
- Department of Medical Imaging, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Megan Burns
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
| | - Emma K Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Alyson L Ross
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Rimma Goldberg
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Sally J Bell
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
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Ayupe KMA, Lima ALO, de Alcântara Gomes GC, de Sousa DS, Camargos ACR, de Carvalho Chagas PS, Leite HR, Longo E, de Toledo AM. Functional classification systems in Brazilian children with cerebral palsy: Reliability and associations between functional levels. Dev Neurorehabil 2024; 27:243-250. [PMID: 39311709 DOI: 10.1080/17518423.2024.2398158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 07/06/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
Children with Cerebral palsy (CP) present movement and posture disorders. The Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Visual Function Classification System (VFCS) enhance the understanding of their performance. We verified inter-rater reliability and associations between the classification levels. Physical therapists classified 100 Brazilian children with CP (3-17 years) according to GMFCS, MACS, CFCS, EDACS, and VFCS. To evaluate inter-rater reliability (Intraclass Correlation Coefficient-ICC) two independent examiners concurrently assessed a subset of 60 participants. According to Spearman's correlation coefficients, there were associations between GMFCS/MACS (r = 0.81), GMFCS/CFCS (r = 0.70), MACS/CFCS (r = 0.73), GMFCS/VFCS (r = 0.61), MACS/VFCS (r = 0.61), CFCS/EDACS (r = 0.58), CFCS/VFCS (r = 0.50), and EDACS/VFCS (r = 0.45) (p < .05). The inter-rater reliability ranged from excellent (ICC = 0.93-0.99) to good (ICC = 0.89), p < .05. The classification systems are reliable, and the levels associated with each other in Brazilian children, especially the GMFCS, MACS, and CFCS.
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Affiliation(s)
| | | | | | | | | | - Paula Silva de Carvalho Chagas
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, School of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Hércules Ribeiro Leite
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Egmar Longo
- Graduate Program in Physical Therapy and Models of Decision and Health, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Aline Martins de Toledo
- Graduate Program in Rehabilitation Sciences, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
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Hernández-Suárez Á, Marin-Castañeda LA, Rubio C, Romo-Parra H. Effect of cannabidiol as a neuroprotective agent on neurodevelopmental impairment in rats with neonatal hypoxia. Brain Dev 2024; 46:294-301. [PMID: 39068045 DOI: 10.1016/j.braindev.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE This study aims to investigate the neuroprotective effects of cannabidiol (CBD) on neurodevelopmental impairments in rats subjected to neonatal hypoxia, specifically examining its potential to mitigate motor and sensory deficits without the confounding effects of ischemia. METHODS Neonatal Sprague-Dawley rats were allocated to one of four groups: Control, Control-CBD, Hypoxia, and Hypoxia-CBD. Hypoxia was induced on postnatal days 0 and 1. CBD (50 mg/kg) was administered orally for 14 days starting at postnatal day 0. Neurodevelopmental outcomes were assessed using the Neurodevelopmental Reflex Testing in Neonatal Rat Pups scale and the Revised Neurobehavioral Severity Scale for rodents. Statistical analyses were conducted using two-way and one-way ANOVA, with Tukey's post-hoc tests for group comparisons. RESULTS Pup weights were recorded on specified postnatal days, with no significant differences observed across the groups (p = 0.1834). Significant neurological impairments due to hypoxia were noted in the Control group compared to the Hypoxia group, particularly in hindlimb grasping on postnatal day 3 (p = 0.0025), posture on postnatal day 12 (p = 0.0073), and in general balance and sound reflex on postnatal day 20 (p = 0.0016 and p = 0.0068, respectively). Additionally, a statistically significant improvement in posture was observed in the Hypoxia-CBD group compared to the Hypoxia group alone (p = 0.0024). CONCLUSION Our findings indicate that CBD possesses neuroprotective properties that significantly counteract the neurodevelopmental impairments induced by neonatal hypoxia in rats. This study not only supports the therapeutic potential of CBD in managing conditions characterized by neurodevelopmental challenges due to hypoxia but also underscores the necessity for further investigation into the specific molecular mechanisms driving CBD's neuroprotective effects. Further research is essential to explore CBD's clinical applications and its potential role in treating human neurodevelopmental disorders.
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Affiliation(s)
- Ángela Hernández-Suárez
- Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac, Mexico City, Mexico
| | - Luis A Marin-Castañeda
- Neurophysiology Department, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, Mexico
| | - Carmen Rubio
- Neurophysiology Department, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, Mexico.
| | - Héctor Romo-Parra
- Neurophysiology Department, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Mexico City, Mexico; Centro Anáhuac de Investigación en Psicología, Facultad de Psicología, Universidad Anáhuac, Mexico City, Mexico.
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Brien M, Krishna D, Ponnusamy R, Cameron C, Moineddin R, Coutinho F. Motor development trajectories of children with cerebral palsy in a community-based early intervention program in rural South India. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 154:104829. [PMID: 39321692 DOI: 10.1016/j.ridd.2024.104829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/02/2024] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Developmental trajectories are crucial for evidence-based prognostication, planning interventions, and monitoring progress in children with cerebral palsy (CP). AIMS To describe gross motor development patterns of children with CP in rural South India for the five Gross Motor Function Classification System (GMFCS) levels. METHODS Longitudinal cohort study of 302 children (176 males, 126 females) with CP aged 0 to 10 years, followed by a community-based early intervention program. GMFCS levels were 5.4 % level 1, 16.5 % level II, 22.8 % level III, 26.8 % level IV, and 28.5 % level V. Assessments were undertaken using the Gross Motor Function Measure (GMFM-66) at 6-month intervals between April 2017 and August 2020. Longitudinal analyses were performed using mixed-effects linear regression models. OUTCOMES AND RESULTS Five distinct motor development curves were created for ages 0 to 10 years by GMFCS levels as a function of age and GMFM-66 with a stable limit model, variation in estimated limits and rates of development. CONCLUSIONS AND IMPLICATIONS Motor development trajectories for CP in an LMIC differ from those reported in HICs. Consideration of how social determinants of health, environmental and personal factors impact motor development in low-resource contexts is crucial. Further work is needed to describe developmental trajectories of children for CP in LMICs.
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Affiliation(s)
- Marie Brien
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, India; International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.
| | - Dinesh Krishna
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, India; International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.
| | - Ramasubramanian Ponnusamy
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, India; International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada.
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Franzina Coutinho
- Enabling Inclusion Program, Amar Seva Sangam, Ayikudi, India; International Centre for Disability and Rehabilitation, University of Toronto, Toronto, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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Mumford L, Guerriere D, House SC, Chau T. The usability of a wireless vocal fold vibration switch for individuals with complex communication needs: a caregiver-inclusive iterative home-based evaluation. Disabil Rehabil Assist Technol 2024:1-9. [PMID: 39316457 DOI: 10.1080/17483107.2024.2405893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/21/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Abstract
Purpose: A vocal fold vibration switch is a type of access technology that detects voluntary vibrations of the vocal cords. In two sequential usability studies, we evaluated successive prototypes of a novel wireless vocal fold vibration switch. Methods: Each usability study enroled 7 dyads consisting of individuals with complex communication needs and their caregivers. Each study entailed a 2-week period of independent home use flanked by initial and final usability tests. Each usability test comprised nine tasks including donning and configuration of the switch, connecting it to other devices, and actual activation of the switch. Perceived task difficulty was measured via nine 21-point scales, while caregiver impressions were captured through open-ended questions, both encapsulated within a usability questionnaire. Caregivers described their experience in an open-ended interview in the second usability study. Results: Perceived task difficulty was uniformly low with both prototypes. The vast majority of tasks could be completed either independently or with hints. A small number of contraindications for use were identified with the second prototype, which included episodes of dystonia and heavy breathing, and some aspects of the physical design and robustness were flagged as needing further improvement. Conclusions: The overall qualitative feedback was overwhelmingly positive with caregivers generally desiring to keep and eager to recommend the device to others. Additionally, caregivers expressed that the vocal fold vibration switch expanded the switch user's capabilities, and they foresaw applications beyond the study setting. Overall, our findings suggest that the wireless vocal fold vibration switch is useable in the home setting.
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Affiliation(s)
- Leslie Mumford
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah C House
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tom Chau
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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8
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Fjørtoft T, Brandal M, Adde L, Osland S, Rygh H, Ustad T, Evensen KAI. Neurodevelopmental outcome at two years of age and predictive value of General Movement Assessment in infants exposed to alcohol and/or drugs during pregnancy: a prospective cohort study. BMC Pediatr 2024; 24:598. [PMID: 39304852 DOI: 10.1186/s12887-024-05046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Exposure to alcohol and/or other addictive drugs in pregnancy is a documented risk factor for neurological impairment. We aimed to assess neurodevelopmental outcome at two years of age in infants exposed to prenatal alcohol and/or other addictive drugs and to examine the predictive value of early motor assessment. METHODS This was a follow-up at two years of age in the prospective cohort study Children Exposed to Alcohol and/or Drugs in Intrauterine Life (CEADIL). The exposed group comprised 73 infants recruited from primary health care and included in a hospital follow-up programme at St. Olavs Hospital, Trondheim University Hospital, Norway. The control group comprised 93 healthy, unexposed infants recruited from the maternity ward at the same hospital. All children had been assessed by physiotherapists using the General Movement Assessment (GMA) at three months of age. Presence of fidgety movements, movement character and the Motor Optimality Score - Revised (MOS-R) were used. At two years of age, the children were assessed by trained examiners using the Bayley Scales of Infant and Toddler Development - Third Edition (BSID-III), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) and the Hollingshead Two-Factor Index of Social Position (SES). RESULTS The cognitive, language and motor composite scores of BSID-III were considerably lower in the exposed group than in the control group. Mean differences adjusted for age and parental SES ranged from - 13.3 (95% confidence interval, CI: -18.6 to -8.0) to -17.7 (95% CI: -23.3 to -12.2). Suboptimal fidgety movements and monotonous movement character had high sensitivity (0.94 to 0.74), but low specificity (0.10 to 0.32), while sensitivity and specificity of the MOS-R was around 50 and 60%, respectively. CONCLUSIONS Neurodevelopmental outcome at two years of age was poorer in a group of children exposed to alcohol and/or drugs in pregnancy compared with a control group of healthy, unexposed children. Sensitivity of suboptimal fidgety movements and monotonous movement character at three months of age for later neurodevelopmental outcome was high to acceptable, but the MOS-R had limited sensitivity.
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Affiliation(s)
- Toril Fjørtoft
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Merethe Brandal
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lars Adde
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siril Osland
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hilde Rygh
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tordis Ustad
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
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9
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Plotas P, Papadopoulos A, Apostolelli EM, Vlachou E, Gazou F, Zogopoulou I, Katsaidoni I, Panagiotopoulou I, Paparouna SP, Silavou N, Fragkiadaki K, Tsiamaki E, Fouzas S, Sinopidis X, Trimmis N. Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review study. Ital J Pediatr 2024; 50:188. [PMID: 39300490 DOI: 10.1186/s13052-024-01715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 07/25/2024] [Indexed: 09/22/2024] Open
Abstract
Cerebral palsy includes a spectrum of neurodevelopmental disorders caused by brain damage, leading to impairment of movement, posture, and balance for a lifetime. There are many therapeutic interventions for cerebral palsy. One of them is hippotherapy, an alternative physical therapy. It is a type of equine-assisted activity and therapy where children with cerebral palsy and motor function skills interact with a horse. We aimed to study the effects of hippotherapy, as an alternative therapy, on the motor function of children with cerebral palsy. We performed a review of the latest literature on hippotherapy and cerebral palsy. The criteria we used were specific keywords, publication date, age of the subjects/studied population, and article type. The outcome of our research resulted in ten relevant studies. The findings demonstrate improvements in various aspects of motor function - more specifically in gross motor function skills, balance, coordination, gait parameters, and muscle strength. Two of ten studies used the Horse-Riding Simulator with significant improvements in postural control in sitting, motor function, and hip abduction range of motion. Hippotherapy can improve motor function skills of children between 2 and 14 years of age with cerebral palsy, affecting their well-being and overall quality of life. It can have a positive effect either as a standalone treatment or as a part of other traditional therapies. Extended research is needed to assess whether hippotherapy may present significant long-term changes in motor skills in children with cerebral palsy.
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Affiliation(s)
- Panagiotis Plotas
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece.
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece.
| | - Angelos Papadopoulos
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
- General Children's Hospital of Patras "Karamandaneio", Patras, 26331, Greece
| | - Evangelia-Maria Apostolelli
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Eleni Vlachou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Foteini Gazou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Ioanna Zogopoulou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Ioanna Katsaidoni
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Ioanna Panagiotopoulou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Sofia Paraskevi Paparouna
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Nikolina Silavou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Katerina Fragkiadaki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
| | - Eirini Tsiamaki
- Department of Neurology, School of Medicine, University of Patras, Patras, 26504, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, School of Medicine, University of Patras, Patras, 26504, Greece
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, School of Medicine, University of Patras, Patras, 26504, Greece.
| | - Nikolaos Trimmis
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, 26504, Greece
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10
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Ariyoshi Y, Iriyama T, Seyama T, Sayama S, Yano E, Suzuki K, Samejima T, Ichinose M, Toshimitsu M, Sone K, Ito A, Shitara Y, Kumasawa K, Kashima K, Kakiuchi S, Hirota Y, Takahashi N, Osuga Y. Neurological outcomes and associated perinatal factors in infants born between 22 and 25 weeks with active care. J Perinatol 2024:10.1038/s41372-024-02093-0. [PMID: 39294298 DOI: 10.1038/s41372-024-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVES To elucidate the outcomes of periviable infants receiving active care (AC) and explore perinatal factors associated with neurodevelopmental outcomes. METHODS This is a single-center retrospective study on infants born at 22-25 weeks of gestation, all of whom received AC. A developmental quotient (DQ) ≥ 85 at corrected 18 months was judged as normal. RESULTS Fifty-seven infants were included in the study. The survival rates at discharge were 83%, 86%, 93%, and 93% at 22, 23, 24, and 25 gestational weeks, respectively. The overall percentage of normal DQ was 26/47 (55%). Acidemia in the arterial blood gas measured within 6 h after birth was identified as a factor significantly associated with subnormal DQ. CONCLUSIONS Not only high survival rates, but also favorable neurodevelopmental outcomes may be achieved by AC in periviable infants. Moreover, impaired neurodevelopmental outcomes may be associated with early postnatal acidemia following initial resuscitation.
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Affiliation(s)
- Yu Ariyoshi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eriko Yano
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kensuke Suzuki
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taiki Samejima
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mari Ichinose
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masatake Toshimitsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsushi Ito
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshihiko Shitara
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kohei Kashima
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satsuki Kakiuchi
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoto Takahashi
- Department of Pediatrics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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11
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Letzkus L, Conaway M, Daugherty R, Hook M, Zanelli S. A randomized-controlled trial of parent-administered interventions to improve short-term motor outcomes in hospitalized very low birthweight infants. J Neonatal Perinatal Med 2024:NPM230206. [PMID: 39302384 DOI: 10.3233/npm-230206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Premature infants are at increased risk for cerebral palsy (CP). Early interventions with a motor focus and administered by parents may improve motor outcomes. AIMS Secondary study evaluating the short-term motor outcomes and risk for CP in very low birthweight (VLBW) infants randomized to multimodal interventions with a motor focus provided by parents versus usual care. STUDY DESIGN Randomized controlled trial (intervention vs. usual care (control group)). SUBJECTS Infants (<32 weeks' gestational age (GA) and/or <1500 grams birthweight) born between March 2019 and October 2020. OUTCOME MEASURES Short-term motor outcomes and risk for CP was evaluated using the Hammersmith Infant Neurological Evaluation (HINE, primary motor outcome), the General Movement Assessment (GMA) and the Test of Infant Motor Performance (TIMP) at 3 months' postmenstrual age (PMA). RESULTS 70 participants were enrolled (GA 28.3±2.7 weeks, birthweight 1139.2±376.6 grams, 64.3% male). The in-person follow-up rate was 73%, lower than expected, in part due to COVID-19 restrictions, resulting in 25 infants (intervention) and 26 infants (control) with outcome data available for analysis. There was not a significant difference in the HINE, GMA or TIMP at 3 months' PMA between groups. CONCLUSION Multimodal interventions with a motor focus and provided by parents need further investigation to determine if they can improve short-term motor outcomes in VLBW infants. These interventions are evidence-based and the evaluation of broader implementation into routine care is also needed.
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Affiliation(s)
- L Letzkus
- Department of Pediatrics, Division of Developmental Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - M Conaway
- Public Health Sciences, University of Virginia, Charlottesville VA, USA
| | - R Daugherty
- Department of Radiology, Division of Pediatric Radiology, University of Virginia, Charlottesville VA, USA
| | - M Hook
- Department of Radiology, Division of Pediatric Radiology, University of Virginia, Charlottesville VA, USA
| | - S Zanelli
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
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12
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Hussein HM, Alshammari AA, Alshammari HZM, Aldhahi MI, Suwaidi YAH, Ibrahim AA. Association Between Calf Muscle Tone, Plantar Surface Area, and Gross Motor Function in Children with Spastic Diplegic Cerebral Palsy. Int J Gen Med 2024; 17:4037-4044. [PMID: 39295857 PMCID: PMC11409928 DOI: 10.2147/ijgm.s479557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 09/06/2024] [Indexed: 09/21/2024] Open
Abstract
Background Children diagnosed with spastic diplegic Cerebral Palsy (CP) usually demonstrate hypertonicity of the lower limb muscles which affects the normal alignments and weight reception by the feet. These impairments could be correlated to the limitations in gross motor function such as standing and walking abilities. Understanding these relationships can contribute to developing more effective rehabilitation strategies and improving overall motor outcomes for affected children. Objective The current study was designed to explore the relationship between plantar surface area, weight distribution on the plantar surface, and gross motor function (namely, standing and walking abilities) in spastic diplegic CP children. Methods Seventy-one spastic diplegic CP children aged 8-14 years joined this cross-sectional study. The Person's correlation coefficient and regression tests were used to assess the correlation between variables, namely, Gross Motor Function (GMFM), Calf Muscle Tone, Plantar surface area (PSA), and Peak pressure on mid and hind feet (PPMF, PPHF, respectively). These variables were assessed using the GMFM-88 scale, Modified Ashworth scale, and foot scan plantar pressure detection system, respectively. Results The correlation analysis demonstrated a strong to moderate positive correlation between PSA, PPMF, PPHF, and GMFM-D and GMFM-E. Additionally, regression model showed prediction levels equal to 0.791 for the GMFM-D and 0.720 for the GMFM-E categories, respectively. Conclusion Standing and walking abilities were positively correlated (r ≥.6) with the increased plantar surface area and higher peak pressure on mid and hind feet in spastic diplegic CP. Future longitudinal studies should investigate changes in gross motor function in relation to improvement in plantar surface area and peak pressure values.
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Affiliation(s)
- Hisham Mohamed Hussein
- Department of Physical Therapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
- Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amsha Alhumaidi Alshammari
- Medical Rehabilitation Department of Physical Therapy in Maternity and Children Hospital in Hail in the Kingdom of Saudi Arabia, Ha'il, Saudi Arabia
| | | | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh, 11671 Saudi Arabia
| | - Yahya Ali Hamad Suwaidi
- Department of Physical Therapy, Home Health Care, Jazan General Hospital, Jazan, Saudi Arabia
| | - Ahmed Abdelmoniem Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
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13
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Sutter EN, Legare JM, Villegas MA, Collins KM, Eickhoff J, Gillick BT. Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting. J Child Neurol 2024:8830738241279690. [PMID: 39262331 DOI: 10.1177/08830738241279690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Evidence-based assessment pathways inform early detection of cerebral palsy and access to intervention. This study investigated the relationships between early evidence-based assessments, diagnosis timeline, and rehabilitation intervention access in a population of children with cerebral palsy who were seen between 2010 and 2022 at the University of Wisconsin Waisman Center Newborn Follow Up Clinic. Cerebral palsy-specific assessments were increasingly integrated after the publication of early detection guidelines by Novak et al. in 2017. Age at cerebral palsy first mention (high risk for cerebral palsy) decreased over time, although age at diagnosis remained similar. Infants who received multiple evidence-based assessments were diagnosed at a younger age. Ninety-nine percent of children were referred to rehabilitation therapies before diagnosis. Infant age at referral to outpatient therapies decreased over time. This study provides novel clinical data on diagnosis timelines and identifies remaining gaps related to implementation feasibility toward improved early diagnosis and intervention access.
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Affiliation(s)
- Ellen N Sutter
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, USA
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - Janet M Legare
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, USA
| | - Melissa A Villegas
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, USA
| | - Kellie M Collins
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, USA
| | - Jens Eickhoff
- Department of Biostatistics and Informatics, University of Wisconsin-Madison, Madison, USA
| | - Bernadette T Gillick
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, USA
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14
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Kim F, Maitre N. Grand Rounds: How Do We Detect Cerebral Palsy Earlier in Neonates ? J Pediatr 2024:114299. [PMID: 39277080 DOI: 10.1016/j.jpeds.2024.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/27/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Irving Medical Center/New York-Presbyterian Children's Hospital of New York, New York, NY.
| | - Nathalie Maitre
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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15
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Danks MT, Gray PH, Hurrion EM. Diagnostic accuracy of Ages and Stages Questionnaire, Third Edition to identify abnormal or delayed gross motor development in high-risk infants. J Paediatr Child Health 2024. [PMID: 39262286 DOI: 10.1111/jpc.16665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 08/30/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
AIM To investigate the diagnostic accuracy of parent-completed Ages and Stages Questionnaire, Third Edition (ASQ-3) to identify abnormal or delayed gross motor development in infants born less than 1000 g or less than 28 weeks gestation. METHODS Prospective cohort study of high-risk infants comparing ASQ-3 as the index test with concurrent score on Alberta Infant Motor Scale (AIMS) as the reference standard, at 4-, 8- and 12-month corrected (post-term) age. Reference standard positivity cut-offs were 'Abnormal motor development' (AIMS Clinical Range) and 'Motor delay' (AIMS score >1 SD below mean, not captured in Clinical Range). RESULTS Participating infants (n = 191) had mean gestational age (95% confidence interval (CI)) 26.8 weeks (26.6-27.1) and mean birthweight (95% CI) 870 g (844-896). AIMS rated 51%, 31% and 23% of infants as having 'Abnormal motor development' and 12%, 28% and 13% with 'Motor delay', at 4, 8 and 12 months, respectively. Diagnostic accuracy of ASQ-3 to identify abnormal motor development was acceptable for older infants only if 'Monitor' cut-off was used: sensitivity (95% CI) 33% (23-44), 86% (73-95) and 80% (63-92) and specificity (95% CI) 84% (74-92), 76% (66-84), and 76% (67-83) at 4, 8 and 12 months, respectively. ASQ-3 sensitivity to identify motor delay was low. CONCLUSIONS ASQ-3 has poor sensitivity to identify abnormal or delayed motor development at 4 months. Using the 'Monitor' cut-off improves the diagnostic accuracy of ASQ-3 for identification of older infants with abnormal motor development who are at high risk of motor disability. However, ASQ-3 has poor sensitivity to identify motor delay. Clinical motor assessment of high-risk infants is recommended, particularly in early infancy.
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Affiliation(s)
- Marcella T Danks
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - Peter H Gray
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth M Hurrion
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia
- Department of Newborn Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia
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16
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Elvrum AKG, Kårstad SB, Hansen G, Bjørkøy IR, Lydersen S, Grunewaldt KH, Eliasson AC. The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research Design Study. J Clin Med 2024; 13:5287. [PMID: 39274500 PMCID: PMC11396191 DOI: 10.3390/jcm13175287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.
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Affiliation(s)
- Ann-Kristin G Elvrum
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Clinic of Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Silja Berg Kårstad
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Child and Adolescent Mental Health Services, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Gry Hansen
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ingrid Randby Bjørkøy
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kristine Hermansen Grunewaldt
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Children and Youth Clinic, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, 17671 Stockholm, Sweden
- Neuropediatric Research Unit, Astrid Lindgren Children's Hospital, 17176 Stockholm, Sweden
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17
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Berja ED, Kwon H, Walsh KG, Bates SV, Kramer MA, Chu CJ. Infant sleep spindle measures from EEG improve prediction of cerebral palsy. Clin Neurophysiol 2024; 167:51-60. [PMID: 39278086 DOI: 10.1016/j.clinph.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/25/2024] [Accepted: 08/26/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Early identification of infants at risk of cerebral palsy (CP) enables interventions to optimize outcomes. Central sleep spindles reflect thalamocortical sensorimotor circuit function. We hypothesized that abnormal infant central spindle activity would predict later contralateral CP. METHODS We trained and validated an automated detector to measure spindle rate, duration, and percentage from central electroencephalogram (EEG) channels in high-risk infants (n = 35) and age-matched controls (n = 42). Neonatal magnetic resonance imaging (MRI) findings, infant motor exam, and CP outcomes were obtained from chart review. Using univariable and multivariable logistic regression models, we examined whether spindle activity, MRI abnormalities, and/or motor exam predicted future contralateral CP. RESULTS The detector had excellent performance (F1 = 0.50). Spindle rate (p = 0.005, p = 0.0004), duration (p < 0.001, p < 0.001), and percentage (p < 0.001, p < 0.001) were decreased in hemispheres corresponding to future CP compared to those without. In this cohort, PLIC abnormality (p = 0.004) and any MRI abnormality (p = 0.004) also predicted subsequent CP. After controlling for MRI findings, spindle features remained significant predictors and improved model fit (p < 0.001, all tests). Using both spindle duration and MRI findings had highest accuracy to classify hemispheres corresponding to future CP (F1 = 0.98, AUC 0.999). CONCLUSION Decreased central spindle activity improves the prediction of future CP in high-risk infants beyond early MRI or clinical exam alone. SIGNIFICANCE Decreased central spindle activity provides an early biomarker for CP.
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Affiliation(s)
- Erin D Berja
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Hunki Kwon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Katherine G Walsh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sara V Bates
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mark A Kramer
- Department of Mathematics and Statistics and Center for Systems Neuroscience, Boston University, Boston, MA, United States
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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18
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Lucas BR, Bowen J, Morgan C, Novak I, Badawi N, Elliott E, Dwyer G, Venkatesha V, Harvey LA. The Best Start Trial: A randomised controlled trial of ultra-early parent-administered physiotherapy for infants at high risk of cerebral palsy or motor delay. Early Hum Dev 2024; 198:106111. [PMID: 39244966 DOI: 10.1016/j.earlhumdev.2024.106111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/26/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND It is unknown whether ultra-early physiotherapy commenced during neonatal intensive care unit admission is of value for optimising developmental outcomes in preterm/term infants at high-risk of cerebral palsy or motor-delay. AIMS To determine whether ultra-early parent-administered physiotherapy to preterm/term high- risk infants commenced at earliest from 34-weeks post menstrual age, improves motor outcomes at 16-weeks corrected age (CA) compared to usual care. METHODS Single-blind randomised controlled pilot study with 30 infant participants. The primary outcome was the Alberta Infant Motor Scale (AIMS) total score at 16-weeks CA. Secondary outcomes included (i) parent Depression Anxiety and Stress Score and Parent Perceptions Survey at 16-weeks CA; and (ii) Bayley Scales of Infant Development at 12-months CA. RESULTS There were no clinically worthwhile effects at 16-weeks CA on the AIMS (mean between-group difference, 95% CI: -0.2, -2.4 to 2.0) or most secondary outcomes. However, the parents' "perception of treatment effectiveness" and "perception of change" favoured the experimental group. CONCLUSIONS In this pilot trial, there was no clinically worthwhile effect of ultra-early parent-administered physiotherapy over usual care on the AIMS. However, the intervention was feasible for infants, acceptable to parents and parents perceived a benefit of treatment. Whilst this trial did not demonstrate treatment effectiveness using the AIMS, these findings should be interpreted cautiously because of the small sample size, the low responsivity of the AIMS to change in motor performance and the heterogeneity of the participants. Therefore, the intervention should not be abandoned on the basis of this trial, but rather further evaluated in a larger trial that addresses some of the learnings from this one.
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Affiliation(s)
- Barbara R Lucas
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
| | - Jenny Bowen
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia; Department of Neonatology, Royal North Shore Hospital, Sydney, Australia..
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia..
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia..
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia..
| | - Elizabeth Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Kids Research, Sydney Childrens Hospitals Network, Westmead, Sydney, Australia.
| | - Genevieve Dwyer
- Western Sydney University, School of Health Sciences, Sydney, Australia.
| | | | - Lisa A Harvey
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
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19
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Wu X, Liu R, Zhang Z, Yang J, Liu X, Jiang L, Fang M, Wang S, Lai L, Song Y, Li Z. The RhoB p.S73F mutation leads to cerebral palsy through dysregulation of lipid homeostasis. EMBO Mol Med 2024; 16:2002-2023. [PMID: 39080495 PMCID: PMC11393352 DOI: 10.1038/s44321-024-00113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 09/14/2024] Open
Abstract
Cerebral palsy (CP) is a prevalent neurological disorder that imposes a significant burden on children, families, and society worldwide. Recently, the RhoB p.S73F mutation was identified as a de novo mutation associated with CP. However, the mechanism by which the RhoB p.S73F mutation causes CP is currently unclear. In this study, rabbit models were generated to mimic the human RhoB p.S73F mutation using the SpG-BE4max system, and exhibited the typical symptoms of human CP, such as periventricular leukomalacia and spastic-dystonic diplegia. Further investigation revealed that the RhoB p.S73F mutation could activate ACAT1 through the LYN pathway, and the subsequently altered lipid levels may lead to neuronal and white matter damage resulting in the development of CP. This study presented the first mammalian model of genetic CP that accurately replicates the RhoB p.S73F mutation in humans, provided further insights between RhoB and lipid metabolism, and novel therapeutic targets for human CP.
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Affiliation(s)
- Xinyu Wu
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Ruonan Liu
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Zhongtian Zhang
- CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
- Sanya Institute of Swine Resource, Hainan Provincial Research Centre of Laboratory Animals, Sanya, 572000, China
- Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, China
- Jilin Provincial Key Laboratory of Animal Embryo Engineering, Key Laboratory of Zoonosis Research, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, 130062, China
- Institute of Stem Cells and Regeneration, Chinese Academy of Sciences, Beijing, 100039, China
- Research Unit of Generation of Large Animal Disease Models, Chinese Academy of Medical Sciences, Guangzhou, 510530, China
| | - Jie Yang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Xin Liu
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Liqiang Jiang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Mengmeng Fang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China
| | - Shoutang Wang
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Liangxue Lai
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
- CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
- Sanya Institute of Swine Resource, Hainan Provincial Research Centre of Laboratory Animals, Sanya, 572000, China.
- Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, Wuyi University, Jiangmen, 529020, China.
- Jilin Provincial Key Laboratory of Animal Embryo Engineering, Key Laboratory of Zoonosis Research, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
- Institute of Stem Cells and Regeneration, Chinese Academy of Sciences, Beijing, 100039, China.
- Research Unit of Generation of Large Animal Disease Models, Chinese Academy of Medical Sciences, Guangzhou, 510530, China.
| | - Yuning Song
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
| | - Zhanjun Li
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, and College of Veterinary Medicine, Jilin University, Changchun, 130062, China.
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20
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Chalak LF, Slaughter JL, King WC, Sepulveda P, Wisniewski SR. A New Horizon for Understanding the Comparative Effectiveness for Cooling Prospectively Infants with Mild Encephalopathy. Clin Perinatol 2024; 51:605-616. [PMID: 39095099 DOI: 10.1016/j.clp.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The authors summarize the methodology for a new pragmatic comparative effectiveness research investigation, Cooling Prospectively Infants with Mild Encephalopathy (COOLPRIME), which uses sites' existing mild hypoxic-ischemic encephalopathy (HIE) treatment preference (hypothermia or normothermia) to assess hypothermia effectiveness and safety. COOLPRIME's primary aim is to determine the safety and effectiveness of hypothermia compared to normothermia in mild HIE. Engagement of Families and Community Affected by Hypoxic-Ischemic Encephalopathy strongly favored Effectiveness over Efficacy Trials leading to COOL PRIME design.
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Affiliation(s)
- Lina F Chalak
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
| | - Jonathan L Slaughter
- Department of Pediatrics and Epidemiology, Center for Perinatal Research, Nationwide Children's Hospital, Colleges of Medicine and Public Health, The Ohio State University, 575 Children's Crossroad, Columbus, OH 43215, USA
| | - Wendy C King
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Pollieanna Sepulveda
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA
| | - Stephen R Wisniewski
- Department of Epidemiology, School of Public Health, Vice Provost for Budget and Analytics, University of Pittsburgh, Pittsburgh, PA 15260, USA
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21
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Hewawitharana G, Phillips J. Predicting cerebral palsy: The importance of evidence-based screening programs appropriate for low- and middle-income countries. Dev Med Child Neurol 2024; 66:1117-1118. [PMID: 38451743 DOI: 10.1111/dmcn.15902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
This commentary is on the original articles by Romeo et al. and Tian et al. on pages 1173–1180 and 1181–1189 of this issue.
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Affiliation(s)
| | - John Phillips
- University of New Mexico Health Sciences Center, Family and Community Medicine, Albuquerque, NM, USA
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22
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Romeo DM, Velli C, Sini F, Pede E, Cicala G, Cowan FM, Ricci D, Brogna C, Mercuri E. Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination. Dev Med Child Neurol 2024; 66:1173-1180. [PMID: 38287208 DOI: 10.1111/dmcn.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024]
Abstract
AIM To develop a short version of the original Hammersmith Infant Neurological Examination (HINE) to be used as a screening tool (Brief-HINE) and to establish if the short examination maintains good accuracy and predictive power for detecting infants with cerebral palsy (CP). METHOD Eleven items were selected from the original HINE ('visual response'; 'trunk posture'; 'movement quantity'; 'movement quality'; 'scarf sign'; 'hip adductor angles'; 'popliteal angle'; 'pull to sit'; 'lateral tilting'; 'forward parachute reaction'; 'tendon reflexes') identifying those items previously found to be more predictive of CP in both low- and high-risk infants. In order to establish the sensitivity of the new module, the selected items were applied to existing data, previously obtained using the full HINE at 3, 6, 9, and 12 months, in 228 infants with typical development at 2 years and in 82 infants who developed CP. RESULTS Brief-HINE scores showed good sensitivity and specificity, at each age of assessment, for detecting infants with CP. At 3 months, a score of less than 22 was associated with CP with a sensitivity of 0.88 and a specificity of 0.92; at 6, 9, and 12 months, the cut-off scores were less than 25 (sensitivity 0.93; specificity 0.87), less than 27 (sensitivity 0.95; specificity 0.81), and less than 27 (sensitivity 1; specificity 0.86) respectively. The presence of more than one warning sign, or items that are not optimal for the age of assessment, imply the need for a full examination reassessment. INTERPRETATION These findings support the validity of the Brief-HINE as a routine screening method and the possibility of its use in clinical practice.
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Affiliation(s)
- Domenico M Romeo
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Chiara Velli
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Sini
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Pede
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Graziamaria Cicala
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Daniela Ricci
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, Rome, Italy
| | - Claudia Brogna
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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23
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Fehlings D, Makino A, Church P, Banihani R, Thomas K, Luther M, Lam-Damji S, Vollmer B, Haataja L, Cowan F, Romeo DM, George J, Kumar S. The Hammersmith Infant Neurological Exam Scoring Aid supports early detection for infants with high probability of cerebral palsy. Dev Med Child Neurol 2024; 66:1255-1257. [PMID: 38818710 DOI: 10.1111/dmcn.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
This letter to the editor is in response to the original articles by Romeo et al. and Tian et al. on pages 1173–1180 and 1181–1189 of this issue.
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Affiliation(s)
- Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital - Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amber Makino
- Holland Bloorview Kids Rehabilitation Hospital - Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paige Church
- Boston Children's Hospital, Neonatology & Developmental Behavioral Pediatrics, Boston, Massachusetts, USA
| | - Rudaina Banihani
- Sunnybrook Health Sciences Centre - Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Thomas
- McMaster University, Department of Pediatrics, Hamilton, Ontario, Canada
| | - Maureen Luther
- Sunnybrook Health Sciences Centre - Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Lam-Damji
- Holland Bloorview Kids Rehabilitation Hospital - Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Brigitte Vollmer
- University of Southampton, Clinical Neurosciences, Southampton, UK
| | - Leena Haataja
- University of Helsinki, Helsinki University Hospital, Department of Paediatric Neurology, Helsinki, Finland
| | - Frances Cowan
- Imperial College London, Department of Paediatrics, London, UK
| | - Domenico M Romeo
- Pediatric Neurology Unit, Fondazaione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Joanne George
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Swetlana Kumar
- Holland Bloorview Kids Rehabilitation Hospital - Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Hamamie-Chaar A, Renaud M, Gençpinar P, Bruel AL, Philippe C, Maraval J, Racine C, Hadouiri N, Lambert L, Schmitt E, Banneau G, Hocquel A, Thauvin-Robinet C, Faivre L, Thomas Q. Patients with complex and very-early-onset ATL1-related spastic paraplegia offer insights on genotype/phenotype correlations and support for autosomal recessive forms of SPG3A. J Neurol 2024; 271:6343-6348. [PMID: 39003427 PMCID: PMC11377504 DOI: 10.1007/s00415-024-12565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
Spastic paraplegia type 3A (SPG3A) is the second most common form of hereditary spastic paraplegia (HSP). This autosomal-dominant-inherited motor disorder is caused by heterozygous variants in the ATL1 gene which usually presents as a pure childhood-onset spastic paraplegia. Affected individuals present muscle weakness and spasticity in the lower limbs, with symptom onset in the first decade of life. Individuals with SPG3A typically present a slow progression and remain ambulatory throughout their life. Here we report three unrelated individuals presenting with very-early-onset (before 7 months) complex, and severe HSP phenotypes (axial hypotonia, spastic quadriplegia, dystonia, seizures and intellectual disability). For 2 of the 3 patients, these phenotypes led to the initial diagnosis of cerebral palsy (CP). These individuals carried novel ATL1 pathogenic variants (a de novo ATL1 missense p.(Lys406Glu), a homozygous frameshift p.(Arg403Glufs*3) and a homozygous missense variant (p.Tyr367His)). The parents carrying the heterozygous frameshift and missense variants were asymptomatic. Through these observations, we increase the knowledge on genotype-phenotype correlations in SPG3A and offer additional proof for possible autosomal recessive forms of SPG3A, while raising awareness on these exceptional phenotypes. Their ability to mimic CP also implies that genetic testing should be considered for patients with atypical forms of CP, given the implications for genetic counseling.
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Affiliation(s)
| | - Mathilde Renaud
- Department of Clinical Genetics, CHRU Nancy, Nancy, France
- INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | - Pinar Gençpinar
- Department of Pediatric Neurology, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ange-Line Bruel
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France
| | - Christophe Philippe
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France
| | - Julien Maraval
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France
| | - Caroline Racine
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France
| | - Nawale Hadouiri
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France
| | - Laetitia Lambert
- Department of Clinical Genetics, CHRU Nancy, Nancy, France
- INSERM-U1256 NGERE, Université de Lorraine, Nancy, France
| | | | - Guillaume Banneau
- Department of Clinical Genetics, CHU Toulouse, Toulouse, France
- Pitié-Salpêtrière, Department of Genetics, Sorbonne Université, AP-HP, Paris, France
| | - Armand Hocquel
- Department of Clinical Genetics, CHRU Nancy, Nancy, France
| | - Christel Thauvin-Robinet
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France
| | - Laurence Faivre
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France
| | - Quentin Thomas
- Department of Clinical Genetics, Dijon University Hospital, Dijon, France.
- Inserm UMR1231 Team GAD, University of Burgundy and Franche-Comté, Dijon, France.
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25
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Forli F, Capobianco S, Berrettini S, Bruschini L, Lorenzoni F, Fiori S, Lazzerini F. Long-term outcomes of congenital cytomegalovirus infection in children early identified by extended hearing-targeted screening. Int J Pediatr Otorhinolaryngol 2024; 184:112070. [PMID: 39191004 DOI: 10.1016/j.ijporl.2024.112070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES Congenital Cytomegalovirus (cCMV) has been associated with hearing, vision, and neurodevelopmental long-term sequelae. Despite the social burden associated with the disease, a universally accepted consensus on screening, diagnostic, therapeutic and follow-up approaches has not been reached. The present observational retrospective study aims at describing long-term sequelae and radiological abnormalities associated with cCMV in children early identified by extended hearing-targeted screening and evaluated by audiological follow-up in a single III Level Audiological Referral Center for at least 2 years. METHODS Audiological neonatal and follow-up data were available for all subjects. Data collection included clinical neonatal and virological assessment at birth. Ophthalmological, neurodevelopmental and neuroradiological follow-up abnormalities compatible with cCMV sequelae were collected by clinical reports. Spearman's rank correlation coefficient (rho-ρ) was used to evaluate possible correlations among the considered parameters. RESULTS 61 newborns were identified by extended hearing-targeted cCMV screening and diagnosed mostly (83.6 %) by PCR viral DNA extraction in urine collected within the 15° day of life. Seventeen babies were born preterm, with a mean gestational age of 33.5 weeks. Sixteen patients (26.2 %) were admitted to an Intensive or sub-Intensive Neonatal Care Unit. At birth, 35 newborns were symptomatic (57.3 %), and 19 of them received antiviral treatment by valganciclovir or ganciclovir. Overall, 20 children (32.7 %) were diagnosed with sensorineural hearing loss (SNHL), among them 17 (85 %) were refer at the newborn hearing screening while 3 (15 %) were Pass. 5/20 children (25 %) presented isolated SNHL, while in 15/20 (75 %) children SNHL was associated to other long-term sequelae. In 5 patients (25 %) a progression of the hearing threshold was observed, with a mean age of progression of 26 months of age. Risk factors for progression were a worse final hearing threshold (Spearman's ρ = 0.434; p = 0.0001) and a worse hearing threshold at birth (Spearman's ρ = 0.298; p = 0.020). Thirteen children were fitted with hearing aids, 8 of whom subsequently underwent cochlear implantation. Concerning long term impairments, 10/61 children (17 %) presented a variety of ophthalmological sequelae, while 16/40 cCMV patients (40 %) were diagnosed with neurodevelopmental abnormalities. Language delays were significantly associated with a worse hearing threshold (ρ = 0.582; p = 0.0001) and with other neurocognitive abnormalities (ρ = 0.677, p = 0.0001). 30 children underwent radiological brain evaluation by Magnetic Resonance Imaging, and 63.3 % of them presented abnormalities compatible with cCMV. Mean viral load at birth did not show significant associations with long-term sequelae. CONCLUSIONS The study highlights the diverse and significant long-term sequelae of cCMV infection detected through early screening. With a significant proportion of cCMV children developing sensorineural hearing loss, ophthalmological and neurodevelopmental issues, the results emphasize the importance of continuous, multidisciplinary follow-up. Early identification and tailored interventions are crucial for improving the long-term health and quality of life of children affected by cCMV.
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Affiliation(s)
- Francesca Forli
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy.
| | - Silvia Capobianco
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Francesca Lorenzoni
- Neonatal Unit and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Lazzerini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
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26
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Wingrat J, Price C, Wright T. Facilitators of and Barriers to Caregiver Adherence to Home Therapy Recommendations for Infants and Children With Neuromotor and Neuromuscular Diagnoses: A Scoping Review. Am J Occup Ther 2024; 78:7805205070. [PMID: 39083636 DOI: 10.5014/ajot.2024.050567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
IMPORTANCE Caregiver-performed home therapy programs are essential to occupational therapy intervention for infants and children with neuromotor and neuromuscular diagnoses. Factors that facilitate or are barriers to caregiver adherence when making home therapy recommendations should be considered. OBJECTIVE To identify facilitators of and barriers to caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular disorders. METHOD The review followed the five-step methodological framework developed by Arksey and O'Malley (2005) and was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES Searches with no language or date range limits were performed in MEDLINE, CINAHL Plus with Full Text, PsycINFO, and SocINDEX on the EBSCO platform, and Scopus on the Elsevier platform from database inception through January 24, 2023. STUDY SELECTION AND DATA COLLECTION Study inclusion criteria included caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular diagnoses. Eight hundred seventy-five articles underwent title and abstract screening; 64 articles met the criteria for full review. FINDINGS Twelve articles met the inclusion criteria. Four used qualitative measures, 7 used quantitative measures, and 1 used mixed methods. Qualitative thematic analysis revealed four facilitators: routine, efficacy of caregiver education, positive relationship with therapist, and perceived benefit of treatment. The analysis revealed three barriers: lack of time, lack of confidence, and caregiver stress. CONCLUSIONS AND RELEVANCE The facilitators and barriers identified are central to best-practice occupational therapy. Therapists can use expertise in analyzing routines and context to maximize the fit between family needs and home therapy recommendations. Plain-Language Summary: Home therapy for children with a neuromotor and neuromuscular diagnosis is common and uses some form of caregiver-performed movement activities or techniques. To support caregivers, occupational therapists need to understand what factors facilitate or serve as barriers to following home therapy recommendations. The review found three barriers: lack of time, lack of confidence, and caregiver stress. The review provides strategies to support home therapy based on core principles of occupational therapy practice. It also identifies the need for more research to support home therapy recommendations that fit within the child's and family's routine, that can be taught in a way that meets the child's and family's learning needs, that facilitate self-efficacy and confidence, and that reflect the values and motivators of all participants.
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Affiliation(s)
- Jennifer Wingrat
- Jennifer Wingrat, ScD, OTR/L, is Assistant Professor, Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD;
| | - Carrie Price
- Carrie Price, MLS, is Research Impact and Health Professions Librarian, Albert S. Cook Library, Towson University, Towson, MD
| | - Tess Wright
- Tess Wright, BS, is MSOT Student, Department of Occupational Therapy and Occupational Science, Towson, University, Towson, MD
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Nel M, Feucht U, Mulol H, Eksteen CA. Neurological examination of healthy term infants at ages 6 and 10 weeks in Tshwane District. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:2072. [PMID: 39229291 PMCID: PMC11369843 DOI: 10.4102/sajp.v80i1.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 09/05/2024] Open
Abstract
Background Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress. Objectives Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE). Method A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks' postnatal age in the Tshwane district. The statuses of infants' neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points. Results Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively. Conclusion This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages. Clinical Implications The findings support the viewpoint to identify important milestone characteristics during early screening.
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Affiliation(s)
- Marna Nel
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Ute Feucht
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Carina A. Eksteen
- Department of Physiotherapy, School of Health Care Sciences, Sefako Makgatho Health Science University, Pretoria, South Africa
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Rapuc S, Stres B, Verdenik I, Lučovnik M, Osredkar D. Uncovering early predictors of cerebral palsy through the application of machine learning: a case-control study. BMJ Paediatr Open 2024; 8:e002800. [PMID: 39214549 PMCID: PMC11367350 DOI: 10.1136/bmjpo-2024-002800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Cerebral palsy (CP) is a group of neurological disorders with profound implications for children's development. The identification of perinatal risk factors for CP may lead to improved preventive and therapeutic strategies. This study aimed to identify the early predictors of CP using machine learning (ML). DESIGN This is a retrospective case-control study, using data from the two population-based databases, the Slovenian National Perinatal Information System and the Slovenian Registry of Cerebral Palsy. Multiple ML algorithms were evaluated to identify the best model for predicting CP. SETTING This is a population-based study of CP and control subjects born into one of Slovenia's 14 maternity wards. PARTICIPANTS A total of 382 CP cases, born between 2002 and 2017, were identified. Controls were selected at a control-to-case ratio of 3:1, with matched gestational age and birth multiplicity. CP cases with congenital anomalies (n=44) were excluded from the analysis. A total of 338 CP cases and 1014 controls were included in the study. EXPOSURE 135 variables relating to perinatal and maternal factors. MAIN OUTCOME MEASURES Receiver operating characteristic (ROC), sensitivity and specificity. RESULTS The stochastic gradient boosting ML model (271 cases and 812 controls) demonstrated the highest mean ROC value of 0.81 (mean sensitivity=0.46 and mean specificity=0.95). Using this model with the validation dataset (67 cases and 202 controls) resulted in an area under the ROC curve of 0.77 (mean sensitivity=0.27 and mean specificity=0.94). CONCLUSIONS Our final ML model using early perinatal factors could not reliably predict CP in our cohort. Future studies should evaluate models with additional factors, such as genetic and neuroimaging data.
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Affiliation(s)
- Sara Rapuc
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Blaž Stres
- Department of Catalysis and Chemical Reaction Engineering, National Institute of Chemistry, Ljubljana, Slovenia
- Institute of Sanitary Engineering, Faculty of Civil and Geodetic Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Pediatric Neurology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Leite HR, de Sousa Junior RR, Souto DO, Medeiros E Silva JM, de Lima AFB, de Miranda Drumond C, Policiano EBC, Marques AC, de Carvalho Chagas PS, Longo E. Identificação de ingredientes de intervenções não invasivas para crianças deambuladoras com paralisia cerebral usando as minhas palavras favoritas: uma revisão de escopo. Dev Med Child Neurol 2024. [PMID: 39208157 DOI: 10.1111/dmcn.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
ResumoObjetivoMapear os ingredientes das intervenções não invasivas fornecidas às crianças deambuladoras com Paralisia Cerebral (PC).MétodoOs artigos foram selecionados e as características dos estudos extraídas. Os ingredientes das intervenções foram descritos em termos do Sistema de Especificação de Taxonomia de Reabilitação (RTSS) e vinculados às minhas palavras favoritas. Os resultados foram interpretados e validados por meio da abordagem de Envolvimento de pacientes e do Publico em Pesquisa (EPP).ResultadosSessenta e um artigos foram incluídos, dos quais 55,5% foram classificados como ensaios clínicos randomizados. Os estudos selecionados incluíram um total de 2187 crianças (a idade média variou de 3 meses a 5,9 anos), a maioria de países desenvolvidos. Os estudos incluídos investigaram um total de 27 intervenções, que juntas apresentaram ingredientes representando todas as minhas palavras favoritas, na seguinte ordem de frequência: “Saúde” (ex., treinamento de força e resistência), “Funcionalidade” (ex., prática ativa e repetitiva de uma tarefa), “Família” (ex., terapia focada no contexto), “Diversão” (ex., inclusão de atividades amistosas para crianças), “Amigos” (ex., atividades em grupo) e “Futuro” (ex., compartilhamento de informações didáticas). Assim, os ingredientes relacionados à palavra “Futuro” foram os relatados com menos frequência.InterpretaçãoTerapeutas e famílias precisam estar cientes da correspondência mais apropriada entre as metas elencadas por meio das minhas palavras favoritas e os objetivos, ingredientes e alvos das intervenções. Finalmente, “Diversão”, “Amigos” e “Futuro” devem ser abordadas como desfechos potenciais em estudos futuros.
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Ng NS, Razak A, Chandrasekharan P, McLean G, Sackett V, Zhou L, Pharande P, Malhotra A. Early neurodevelopmental outcomes of preterm infants with intraventricular haemorrhage and periventricular leukomalacia. J Paediatr Child Health 2024. [PMID: 39183581 DOI: 10.1111/jpc.16654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
AIM Intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) in preterm infants are associated with an increased risk of long-term neurodevelopmental impairments (NDI) and cerebral palsy (CP). However, little is known about their impact on early neurodevelopmental outcomes despite increasing evidence highlighting the feasibility and importance of early NDI/CP diagnosis. We aimed to determine the early neurodevelopmental outcomes of preterm infants with IVH and PVL. METHODS This was a retrospective single-centre cohort study of preterm infants born at <29 weeks gestation or <1000 g birth weight who attended an Early Neurodevelopment Clinic at 3 to 4 months of corrected age. Primary outcomes of early NDI and CP/high-risk CP diagnoses based on Prechtl's General Movements Assessment and the Hammersmith Infant Neurological Examination were compared between infants without IVH and infants with mild IVH (grades I-II), severe IVH (grades III-IV), and severe brain injury (SBI; severe IVH or cystic PVL). RESULTS Of 313 infants, 52.1% (n = 163), 41.2% (n = 129), 6.7% (n = 21) and 8.6% (n = 27) had no IVH, mild IVH, severe IVH and SBI, respectively. The adjusted odds of early CP/high-risk CP diagnosis were significantly higher in infants with severe IVH (aOR 6.07, 95% CI 1.50-24.50) and SBI (aOR 15.28, 95% CI 3.70-63), but not in those with mild IVH (aOR 1.24, 95% CI 0.49-3.10). However, the adjusted odds of any early NDI were similar across groups. CONCLUSION Preterm infants with severe IVH and SBI are at increased risk of early CP/high-risk of CP diagnosis at 3 to 4 months of corrected age.
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Affiliation(s)
- Nicole Sc Ng
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Abdul Razak
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | | | - Glenda McLean
- Diagnostic Imaging, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Vathana Sackett
- Allied Health Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Lindsay Zhou
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Pramod Pharande
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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Leite HR, de Sousa Junior RR, Souto DO, Medeiros E Silva JM, de Lima AFB, de Miranda Drumond C, Policiano EBC, Marques AC, de Carvalho Chagas PS, Longo E. F-words ingredients of non-invasive interventions for young ambulant children with cerebral palsy: A scoping review. Dev Med Child Neurol 2024. [PMID: 39187986 DOI: 10.1111/dmcn.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/25/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024]
Abstract
AIM To map the ingredients of non-invasive interventions provided to young ambulant children with cerebral palsy. METHOD Articles were screened and each study's characteristics extracted. The intervention ingredients were described in terms of the Rehabilitation Treatment Specification System and linked to the 'F-words'. Results were interpreted and validated by a patient and public involvement group. RESULTS Sixty-one papers were included, of which 55.5% were classified as randomized controlled trial design studies. The selected studies included a total of 2187 children (mean age range 3 months to 5 years 11 months), most from high-income countries. The included studies investigated a total of 27 interventions, which together presented ingredients representing all F-words, in the following order of frequency: 'fitness' (e.g. strength and endurance training), 'functioning' (e.g. active and repetitive practice of a task), 'family' (e.g. context-focused therapy), 'fun' (e.g. inclusion of child-friendly activities), 'friends' (e.g. group activities), and 'future' (e.g. didactic information sharing). Thus, ingredients related to the F-word 'future' were the most infrequently reported. INTERPRETATION Therapists and families need to be aware of the most appropriate match between the F-word goals, ingredients, and targets. Finally, 'fun', 'friends', and 'future' should be addressed as potential outcomes in future studies.
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Affiliation(s)
- Hércules Ribeiro Leite
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Rodrigues de Sousa Junior
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deisiane Oliveira Souto
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Arthur Felipe Barroso de Lima
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolyne de Miranda Drumond
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | | | - Ariane Cristina Marques
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula Silva de Carvalho Chagas
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Egmar Longo
- Graduate Program in Decision Models and Health, Universidade Federal da Paraíba, Paraíba, Brazil
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Lambert G, Husein N, Fehlings D, Andersen J, Oskoui M, Shevell M. Early Biomarkers in the Prediction of Later Functional Impairment in Preterm Children With Cerebral Palsy. Pediatr Neurol 2024; 161:55-60. [PMID: 39276578 DOI: 10.1016/j.pediatrneurol.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/17/2024] [Accepted: 08/19/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND To identify early biomarkers that could predict later functional capabilities in preterm children with later cerebral palsy (CP). METHODS Data from 968 preterm children with later CP were extracted from the Canadian Cerebral Palsy Registry. One hundred eighty-two infants were born before 27 weeks of gestation, 461 infants were born between 27 and 33 weeks, and 325 infants were born between 34 and 37 weeks. Univariate and chi-square analyses were conducted to measure the association between early objective biomarkers and later mobility status defined as Gross Motor Function Classification System (GMFCS) levels IV and V as well as tube feeding dependence. RESULTS Univariate analysis suggested no significant association between GMFCS levels IV and V or impaired feeding status and bilateral white matter injury on magnetic resonance imaging, high-grade intraventricular hemorrhage on head ultrasound, chorioamnionitis, a birth weight of 1000 to 1500 g or <1000 g, as well as an Apgar score of ≤5 at five minutes of life. Similar results were found for gestational age <28 weeks at birth. Only a significant association between GMFCS levels IV and V and a cord or first hour of life pH of ≤7 was reported (mobility status: odds ratio [OR] 1.95, 95% confidence interval [CI] 1.09 to 3.57) and feeding status: OR 2.23, CI 0.97 to 4.65)]. CONCLUSIONS Prediction of functional outcomes based on specific early biomarkers appears hard to obtain in children with CP born preterm in contrast to those born at term. The complications and causal pathways inherent to prematurity may contribute to making prognostication less determinant.
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Affiliation(s)
- Gabrielle Lambert
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Nafisa Husein
- Canadian Cerebral Palsy Registry, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Oskoui
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Dhillon SK, Davidson JO, Dean JM, Bennet L, Gunn AJ. Can or should we try to predict preterm white matter injury? Pediatr Res 2024:10.1038/s41390-024-03524-6. [PMID: 39169226 DOI: 10.1038/s41390-024-03524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Affiliation(s)
| | - Joanne O Davidson
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Justin M Dean
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand.
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Mazzarella J, Richie D, Chaudhari AMW, Pan X, Tudella E, Spees CK, Heathcock JC. Object Weight and Hand Dominance Impact Kinematics in a Functional Reach-to-Drink Task in School-Aged Children. SENSORS (BASEL, SWITZERLAND) 2024; 24:5421. [PMID: 39205115 PMCID: PMC11360325 DOI: 10.3390/s24165421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/06/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
This study evaluates the effects of object weight and hand dominance on the end-point kinematics of the hand-to-mouth (withdrawal) movement in a functional reach-to-drink task for typically developing school-aged children. Using 3D motion capture, speed (average velocity and peak velocity), straightness (ratio), and smoothness (number of velocity peaks and log dimensionless jerk) of hand movements were calculated for the withdrawal motion with three different bottle weights (empty, half-filled, and full). Average velocity (550.4 ± 142.0 versus 512.1 ± 145.6 mm/s) and peak velocity (916.3 ± 234 versus 842.7 ± 198.4 mm/s) were significantly higher with the empty versus half-filled bottle and with the non-dominant (average: 543.5 ± 145.2 mm/s; peak: 896.5 ± 207 mm/s) versus dominant (average: 525.2 ± 40.7 mm/s; peak: 864.2 ± 209.2 mm/s) hand. There were no differences in straightness or smoothness. These findings indicate that increasing weight in reach-to-drink task puts greater constraints on the task. The slower movements with the dominant hand might denote better precision control than the non-dominant hand. The quantitative motion capture results show average values for the kinematic variables for a functional reach-to-drink task in a typically developing population of school-aged children with changing weights of the bottles that are relevant to a real-life scenario. These results could inform the design of individualized therapeutic interventions to improve functional upper-extremity use in children with neurodevelopmental motor disorders.
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Affiliation(s)
- Julia Mazzarella
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel Richie
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ajit M. W. Chaudhari
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Xueliang Pan
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Eloisa Tudella
- Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos 13565-905, SP, Brazil
| | - Colleen K. Spees
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Jill C. Heathcock
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Ventura PA, Carvalho ALD, Nascimento-Carvalho CM. Assessment and Prognostic Resources for Gross Motor Development in a Child with Cerebral Palsy Related to Congenital Zika Syndrome. Neuropediatrics 2024. [PMID: 39151908 DOI: 10.1055/s-0044-1788983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
This article describes how the Gross Motor Ability Estimator (GMAE) software can provide important information based on the Gross Motor Function Measure (GMFM)-66 score of a child with congenital Zika syndrome.A child was assessed at 9, 17, and 25 months of age through the GMFM-66. At 2 years, the child's gross motor ability was estimated and classified according to the Gross Motor Function Classification System (GMFCS).At 2 years of age, the child in this case required assistance to roll and was unable to maintain antigravity trunk posture in sitting position, typical abilities of GMFCS level V.GMAE can be useful to guide health professionals that care for children with lifelong physical and developmental care needs. This is the first study that demonstrated how to use the GMAE in this specific population.
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Affiliation(s)
- Paloma A Ventura
- Post-Graduation Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
- SARAH Network of Rehabilitation Hospital, Salvador, Brazil
| | | | - Cristiana M Nascimento-Carvalho
- Post-Graduation Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
- Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil
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36
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Malak R, Kaczmarek A, Fechner B, Samborski W, Kwiatkowski J, Komisarek O, Tuczyńska M, Tuczyńska M, Mojs E. The Importance of Follow-Up Visits for Children at Risk of Developmental Delay-A Review. Diagnostics (Basel) 2024; 14:1764. [PMID: 39202251 PMCID: PMC11354016 DOI: 10.3390/diagnostics14161764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/26/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Structured follow-up visits should be accessible for children at risk for developmental delay. Follow-up visits should include a serial neuromotor assessment in the first two years of life (e.g., 3-6, 12, 24 months corrected age), which are repeated during the transition to school. The diagnosis of neuromotor development may be prognostic for important skills later in life. The early diagnosis of a child's general movements can be helpful in planning appropriately for proper treatment and intervention. These diagnostic assessments should be conducted by qualified healthcare professionals. The evaluation of neuromotor developmental health is specified in the national guidelines and funded by either a national government or public or private healthcare insurance and based on standardized assessment scales. The aim of this study is to show what elements of follow-up visits are recommended. OBJECTIVES The group of patients for whom the structured follow-up systems are intended were children born very preterm (<32 weeks gestation) or full-term born children with severe neonatal complications. MATERIAL AND METHODS The methods for monitoring neurodevelopment include the following: The General Movements Assessment (GMA), the Ages and Stages Questionnaire (ASQ-3), the Bayley Scales of Infant and Toddler Development (BSID-4), and the Parent Report of Children's Abilities-Revised (PARCA-R). RESULTS The results of follow-up visits should be registered. CONCLUSIONS The benefits of follow-up neuromotor development assessments can be observed at school age and even in adulthood.
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Affiliation(s)
- Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (B.F.); (W.S.)
| | - Ada Kaczmarek
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (A.K.); (E.M.)
| | - Brittany Fechner
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (B.F.); (W.S.)
| | - Włodzimierz Samborski
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (B.F.); (W.S.)
| | - Jacek Kwiatkowski
- SSC of Maxillofacial Orthopaedics and Orthodontics, University of Medical Sciences, 60-812 Poznań, Poland;
| | - Oskar Komisarek
- Department of Plastic, Reconstructive and Aesthetic Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland;
| | - Maria Tuczyńska
- SSC of Clinical Physiotherapy, Poznań University of Medical Sciences, 61-701 Poznań, Poland;
| | - Magdalena Tuczyńska
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Ewa Mojs
- Department of Clinical Psychology, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (A.K.); (E.M.)
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Batista Freire E, Maia Peixoto H, Almeida Ayupe KM, Nunes da Silva E, Luiz Carregaro R, Martins de Toledo A. DIRECT HEALTHCARE COSTS for PEOPLE with CEREBRAL PALSY in the BRAZILIAN UNIFIED HEALTH SYSTEM BETWEEN 2015 and 2019. Expert Rev Pharmacoecon Outcomes Res 2024. [PMID: 39115979 DOI: 10.1080/14737167.2024.2390043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS Health records of people with CP in the Hospital and Outpatient Information's Systems of Brazil between 2015 to 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU and the types of CP are related to increased cost. CONCLUSIONS Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assists in better resource allocation for more effective healthcare provision.
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Affiliation(s)
- Emilie Batista Freire
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Henry Maia Peixoto
- Núcleo em Medicina Tropical, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | | | - Everton Nunes da Silva
- Programa de Ciências e Tecnologias em Saúde, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Rodrigo Luiz Carregaro
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Aline Martins de Toledo
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
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Sudati IP, Damiano D, Rovai G, de Campos AC. Neural Correlates of Mobility in Children with Cerebral Palsy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1039. [PMID: 39200649 PMCID: PMC11354175 DOI: 10.3390/ijerph21081039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/02/2024]
Abstract
Recent advances in brain mapping tools have enabled the study of brain activity during functional tasks, revealing neuroplasticity after early brain injuries and resulting from rehabilitation. Understanding the neural correlates of mobility limitations is crucial for treating individuals with cerebral palsy (CP). The aim is to summarize the neural correlates of mobility in children with CP and to describe the brain mapping methods that have been utilized in the existing literature. This systematic review was conducted based on PRISMA guidelines and was registered on PROSPERO (n° CRD42021240296). The literature search was conducted in the PubMed and Embase databases. Observational studies involving participants with CP, with a mean age of up to 18 years, that utilized brain mapping techniques and correlated these with mobility outcomes were included. The results were analyzed in terms of sample characteristics, brain mapping methods, mobility measures, and main results. The risk of bias was evaluated using a checklist previously created by our research group, based on STROBE guidelines, the Cochrane Handbook, and the Critical Appraisal Skills Programme (CASP). A total of 15 studies comprising 313 children with CP and 229 with typical development using both static and mobile techniques met the inclusion criteria. The studies indicate that children"with'CP have increased cerebral activity and higher variability in brain reorganization during mobility activities, such as gait, quiet standing, cycling, and gross motor tasks when compared with children with typical development. Altered brain activity and reorganization underline the importance of conducting more studies to investigate the neural correlates during mobility activities in children with CP. Such information could guide neurorehabilitation strategies targeting brain neuroplasticity for functional gains.
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Affiliation(s)
- Isabella Pessóta Sudati
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| | - Diane Damiano
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health (NIH), Bethesda, MD 20892, USA;
| | - Gabriela Rovai
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
| | - Ana Carolina de Campos
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos 13565-905, SP, Brazil;
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Xiao J, Liu L, Tang N, Yi C. Effects of exercise intervention on balance function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. BMC Sports Sci Med Rehabil 2024; 16:164. [PMID: 39113106 PMCID: PMC11305018 DOI: 10.1186/s13102-024-00922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To determine the effectiveness of exercise intervention on postural balance, gait parameters, and muscle strength in children with cerebral palsy by quantifying the information from randomized controlled trials (RCTs). METHODS We conducted a systematical search for RCTs from the databases, including PubMed, ISI Web of Science, and Scopus using a between-group design involving children with cerebral palsy and assessing the effect of exercise intervention on postural balance, gait parameters, and muscle strength. The specified inclusion criteria were determined by the PICOS tool. The outcomes of included studies were evaluated by meta-analysis, and subgroup and sensitivity analyses were conducted to analyze the observed heterogeneities using Review Manager 5.4 and Stata version 18.0. The revised Cochrane risk of bias tool for randomized trials (RoB 2) was used to evaluate the risk of bias and quality of the included studies. RESULTS Twenty-four studies were included in this meta-analysis, with 579 children with cerebral palsy. Exercise intervention showed a statistically significant favorable effect on gross motor function (SMD = 0.32; 95%CI [0.03 to 0.61]; I2 = 16%), anteroposterior stability index (SMD = -0.93; 95%CI [-1.69 to -0.18]; I2 = 80%), and mediolateral stability index (SMD = -0.60; 95%CI [-1.16 to -0.03]; I2 = 73%) compared to control group among children with cerebral palsy. None of the above meta-analyses exhibited publication bias, as indicated by Egger's test with p-values greater than 0.05 for all. CONCLUSIONS Exercise is effective in improving gross motor function and balance in children with cerebral palsy. Due to the lack of studies examining the efficacy of each exercise type, we are unable to provide definitive training recommendations.
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Affiliation(s)
- Junjian Xiao
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Linghong Liu
- Institute of Physical Education, Jiangsu Normal University, Xuzhou, China
| | - Nan Tang
- Sports Department, Sanjiang University, Nanjing, China
| | - Chao Yi
- School of Sports Science, Qufu Normal University, Qufu, China.
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Bertoncelli N, Corso L, Bedetti L, Della Casa EM, Roversi MF, Toni G, Pugliese M, Guidotti I, Miselli F, Lucaccioni L, Rossi C, Berardi A, Lugli L. The Motor Optimality Score-Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke. CHILDREN (BASEL, SWITZERLAND) 2024; 11:940. [PMID: 39201875 PMCID: PMC11352565 DOI: 10.3390/children11080940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Neonatal cerebral stroke includes a range of focal and multifocal ischemic and hemorrhagic brain lesions, occurring in about one of 3000 live births. More than 50% of children with neonatal stroke develop adverse outcomes, mainly unilateral cerebral palsy. Asymmetries in segmental movements at three months have been proven to be an early sign of CP in infants with unilateral brain damage. Recognition of additional early signs could enhance prognostic assessment and enable an early and targeted intervention. AIM The aim of the study was to assess early signs of CP in infants with arterial cerebral stroke through the General Movements Assessment and the Motor Optimality Score-Revised (MOS-R). METHOD Twenty-four infants born at term (12 females and 12 males) diagnosed with ACS, and 24 healthy infants (16 females and 8 males) were assessed. The GMs (fidgety movements) and MOS-R were assessed from videos recorded at 11-14 weeks of post-term age. Cognitive and motor outcomes were assessed at 24 months using the Griffiths III developmental quotient and Amiel-Tison neurological examination. The gross motor function classification system expanded and revised (GMFCS-E&R) was adopted to categorize CP. RESULTS Among infants with ACS, 21 (87.5%) developed unilateral CP. Most of them showed non-disabling CP (14 had GMFCS-E&R grade 1 [66.6%], 6 grade 2 [28.6%], and 1 grade 5 [4.8%]). Fidgety movements (FMs) were absent in 17 (70.8%), sporadic in 4 (16.7%) infants, and normal in 3 (12.5%). Segmental movement asymmetry was found in 22/24 (91.7%). According to the MOS-R, motor items (kicking, mouth movements), postural patterns (midline centered head, finger posture variability), and movement character (monotonous and stiff) were statistically different among infants with ACS and healthy infants. The MOS-R median global score was lower in the group with ACS compared to the control group (6 vs 26; p < 0.01). FMs, segmental movement asymmetry, and MOS-R global score were significantly correlated with abnormal outcome. MOS-R global scores less than or equal to 13 had 100% specificity and sensitivity in predicting GMFCS-E&R grade ≥ 2 CP in infants with ACS. CONCLUSIONS The rate of CP was high among infants with ACS, but in most cases it showed low GMFCS-E&R grades. The study highlighted a significant correlation between MOS-R, together with absent FMs and unilateral CP in infants with ACS. Moreover, the MOS-R showed high sensitivity and specificity in the prediction of CP. Combined assessment of FMs and MOS-R could help to better identify infants at high risk of developing UCP in a population of infants with ACS. Early identification of precocious signs of unilateral CP is fundamental to providing an early individualized intervention.
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Affiliation(s)
- Natascia Bertoncelli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Lucia Corso
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Postgraduate School of Paediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Luca Bedetti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Elisa Muttini Della Casa
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Maria Federica Roversi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | | | - Marisa Pugliese
- Psychology Unit, University Hospital of Modena, 41125 Modena, Italy;
| | - Isotta Guidotti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Francesca Miselli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Laura Lucaccioni
- Pediatric Department, University Hospital of Modena, 41125 Modena, Italy;
| | - Cecilia Rossi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Alberto Berardi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
| | - Licia Lugli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy; (N.B.); (A.B.)
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Williams SA, Nakarada-Kordic I, Mackey AH, Reay S, Stott NS. Prioritized strategies to improve diagnosis and early management of cerebral palsy for both Māori and non-Māori families. Dev Med Child Neurol 2024; 66:1074-1083. [PMID: 38236645 DOI: 10.1111/dmcn.15847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 07/05/2024]
Abstract
AIM To identify prioritized strategies to support improvements in early health service delivery around the diagnosis and management of cerebral palsy (CP) for both Māori and non-Māori individuals. METHOD Using a participatory approach, health care professionals and the parents of children with CP attended co-design workshops on the topic of early diagnosis and management of CP. Health design researchers facilitated two 'discovery' (sharing experiences and ideas) and two 'prototyping' (solution-focused) workshops in Aotearoa, New Zealand. A Māori health service worker co-facilitated workshops for Māori families. RESULTS Between 7 and 13 participants (14 health care professionals, 12 parents of children with CP across all functional levels) attended each workshop. The discovery workshops revealed powerful stories about early experiences and needs within clinician-family communication and service provision. The prototyping workshops revealed priorities around communication, and when, what, and how information is provided to families; recommendations were co-created around what should be prioritized within a resource to aid health care navigation. INTERPRETATION There is a critical need for improved communication, support, and guidance, as well as education, for families navigating their child with CP through the health care system. Further input from families and health care professionals partnering together will continue to guide strategies to improve health care service delivery using experiences as a mechanism for change.
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Affiliation(s)
- Sian A Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Anna H Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Stephen Reay
- Good Health Design, Auckland University of Technology, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Lewis SA, Ruttenberg A, Iyiyol T, Kong N, Jin SC, Kruer MC. Potential clinical applications of advanced genomic analysis in cerebral palsy. EBioMedicine 2024; 106:105229. [PMID: 38970919 PMCID: PMC11282942 DOI: 10.1016/j.ebiom.2024.105229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/26/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024] Open
Abstract
Cerebral palsy (CP) has historically been attributed to acquired insults, but emerging research suggests that genetic variations are also important causes of CP. While microarray and whole-exome sequencing based studies have been the primary methods for establishing new CP-gene relationships and providing a genetic etiology for individual patients, the cause of their condition remains unknown for many patients with CP. Recent advancements in genomic technologies offer additional opportunities to uncover variations in human genomes, transcriptomes, and epigenomes that have previously escaped detection. In this review, we outline the use of these state-of-the-art technologies to address the molecular diagnostic challenges experienced by individuals with CP. We also explore the importance of identifying a molecular etiology whenever possible, given the potential for genomic medicine to provide opportunities to treat patients with CP in new and more precise ways.
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Affiliation(s)
- Sara A Lewis
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States; Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Andrew Ruttenberg
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Tuğçe Iyiyol
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Nahyun Kong
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, United States; Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, United States; Programs in Neuroscience and Molecular & Cellular Biology, School of Life Sciences, Arizona State University, Tempe, AZ, United States.
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Christovão IS, de Almeida Rodrigues L, de Paula Machado ACC, de Souza Pascoal AF, Fontes DE, Mendonça KTD, de Castro Magalhães L, Camargos ACR. Hybrid developmental follow-up for preterm infants in Brazil: A feasibility study. Early Hum Dev 2024; 195:106069. [PMID: 38924944 DOI: 10.1016/j.earlhumdev.2024.106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The low attendance of families in child developmental follow-up programs for at-risk preterm children is a challenge in Brazil. OBJECTIVE This study evaluates the feasibility of implementing a developmental follow-up program for Brazilian preterm infants in a hybrid format. METHODS This is an observational, prospective cohort study, involving preterm infants. Longitudinal developmental test results, the participation frequency in the program, and the number of referrals to early intervention programs were used to assess feasibility. The General Movements (GMs) assessment, Alberta Infant Motor Scale (AIMS) and, Survey of Wellbeing of Young Children (SWYC) Milestones were administered via telehealth. The Bayley-III was administered in-person. RESULTS Thirty-four preterm infants attended the follow-up until 12 months of corrected age and 18 (52.9 %) concluded all follow-up assessments. Twenty-six (76.5 %) attended all assessments via telehealth, and 26 (76.5 %) attended the in-person assessment. Eighteen (52.9 %) infants showed at least one altered result in development tests. Infants exhibiting abnormal results in the GMs assessment, motor developmental delay according to the AIMS, or developmental delay based on Balley-III were promptly referred to early intervention services. CONCLUSION This study demonstrated high participation rate and low dropout in a developmental follow-up program employing a hybrid format. The substantial number of identified infants with developmental delay emphasizes the importance of timely detection of motor delays to referral to early intervention services.
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Affiliation(s)
- Isabella Saraiva Christovão
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lara de Almeida Rodrigues
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ana Flávia de Souza Pascoal
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Déborah Ebert Fontes
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karoline Tury de Mendonça
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia de Castro Magalhães
- Graduate Program in Occupation Studies, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Resende Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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van Noort L, Van Crey N, Rouse EJ, Martínez-Caballero I, van Asseldonk EHF, Bayón C. A usability study on the inGAIT-VSO: effects of a variable-stiffness ankle-foot orthosis on the walking performance of children with cerebral palsy. J Neuroeng Rehabil 2024; 21:132. [PMID: 39090725 PMCID: PMC11293312 DOI: 10.1186/s12984-024-01433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are commonly used by children with cerebral palsy (CP), but traditional solutions are unable to address the heterogeneity and evolving needs amongst children with CP. One key limitation lies in the inability of current passive devices to customize the torque-angle relationship, which is essential to adapt the support to the specific individual needs. Powered alternatives can provide customized behavior, but often face challenges with reliability, weight, and cost. Overall, clinicians find certain barriers that hinder their prescription. In recent work, the Variable Stiffness Orthosis (VSO) was developed, enabling stiffness customization without the need for motors or sophisticated control. METHODS This work evaluates a pediatric version of the VSO (inGAIT-VSO) by investigating its impact on the walking performance of children with CP and its potential to be used as a tool for assessing the effect of variable stiffness on pathological gait. Data was collected for three typical developing (TD) children and six pediatric participants with CP over two sessions involving walking/balance tasks and questionnaires. RESULTS The sensors of the inGAIT-VSO provided useful information to assess the impact of the device. Increasing the stiffness of the inGAIT-VSO significantly reduced participants' dorsiflexion and plantarflexion. Despite reduced range of motion, the peak restoring torque increased with stiffness. Overall the participants' gait pattern was altered by reducing crouch gait, preventing drop-foot and supporting body weight. Participants with CP exhibited significantly lower (p < 0.05) physiological cost when walking with the inGAIT-VSO compared to normal condition (own AFO or shoes only). Generally, the device did not impair walking and balance of the participants compared to normal conditions. According to the questionnaire results, the inGAIT-VSO was easy to use and participants reported positive experiences. CONCLUSION The inGAIT-VSO stiffnesses significantly affected participants' plantarflexion and dorsiflexion and yielded objective data regarding walking performance in pathological gait (e.g. ankle angle, exerted torque and restored assistive energy). These effects were captured by the sensors integrated in the device without using external equipment. The inGAIT-VSO shows promise for customizing AFO stiffness and aiding clinicians in selecting a personalized stiffness based on objective metrics.
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Affiliation(s)
- Luc van Noort
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, CAR-CSIC-UPM, Madrid, Spain
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Nikko Van Crey
- Department of Robotics, University of Michigan, Michigan, United States
| | - Elliott J Rouse
- Department of Robotics, University of Michigan, Michigan, United States
- Department of Mechanical Engineering, University of Michigan, Michigan, United States
| | | | | | - Cristina Bayón
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, CAR-CSIC-UPM, Madrid, Spain.
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
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Jonsson H, Gaily E, Stjerna S, Joensuu T, Johari M, Lehesjoki A, Linnankivi T. Epilepsies with onset during the first year of life: A prospective study on syndromes, etiologies, and outcomes. Epilepsia Open 2024; 9:1393-1405. [PMID: 38785332 PMCID: PMC11296082 DOI: 10.1002/epi4.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/06/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Infantile seizures cause great concern for both doctors and parents. In addition to modern neuroimaging and genetics, clinical tools helpful in predicting the course of the disease are needed. We prospectively studied the incidence, electroclinical characteristics and etiologies of epilepsy syndromes with onset before the age of 12 months and looked for prognostic determinants of outcome by age 24 months. METHODS From February 2017 through May 2019, we recruited all eligible infants diagnosed with epilepsy at our unit. Data on electroclinical studies, genetic investigations and drug response were gathered prospectively. The infants were given a structured neurological examination (Hammersmith Infantile Neurological examination [HINE] and Griffiths scales) at predetermined intervals until age 24 months at which age neurocognitive evaluation with Bayley scales was performed. RESULTS Included were 60 infants (27 female). The mean onset age of epilepsy was 5.3 (±2.5 standard deviation) months. The incidence of epilepsy in the population-based cohort was 131 (95% confidence interval 99-172)/100 000. Epilepsy syndrome was identified in 80% and etiology in 58% of infants. Self-limited infantile epilepsy was the second most common syndrome (incidence 18/100 000) after infantile epileptic spasms syndrome. PRRT2 was the most common monogenic cause. At age 24 months, 37% of the infants had drug-resistant epilepsy (DRE) and half had a global developmental delay (GDD). Abnormal first HINE was the strongest predictor of GDD, followed by DRE and identified etiology. DRE was associated with structural etiology and GDD. Those with normal first HINE and good response to treatment had favorable outcomes, irrespective of the identified etiology. SIGNIFICANCE Our results support a high incidence of self-limited epilepsy in infancy and PRRT2 as the genetic cause in the first year of life. Notwithstanding the advances in etiological discovery, we want to highlight the importance of clinical evaluation as standardized neurological examination with HINE proved a valuable tool in prognostication. PLAIN LANGUAGE SUMMARY One in every 700-800 babies develop epilepsy within the first year after birth. Our study identified an epilepsy syndrome in 80% and the cause of epilepsy in 60% of the participants. By age 2 years, over one-third of the children still experienced seizures, and almost half faced significant developmental delay. Structural brain abnormalities increased the likelihood of difficult epilepsy and developmental challenges. Babies whose epilepsy was caused by a gene defect varied widely in development and response to medications. Babies with normal neurological examination at first visit, especially if their seizures stopped quickly, had favorable development.
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Affiliation(s)
- Henna Jonsson
- Epilepsia Helsinki, full member of ERN Epicare and Division of Child Neurology, Children's Hospital and Pediatric Research CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Eija Gaily
- Epilepsia Helsinki, full member of ERN Epicare and Division of Child Neurology, Children's Hospital and Pediatric Research CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Susanna Stjerna
- BABA Center, Pediatric Research Center, Children's Hospital and Division of Neuropsychology, HUS NeurocenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Tarja Joensuu
- Folkhälsan Research CenterHelsinkiFinland
- Department of Medical and Clinical Genetics, MedicumUniversity of HelsinkiHelsinkiFinland
| | - Mridul Johari
- Folkhälsan Research CenterHelsinkiFinland
- Department of Medical and Clinical Genetics, MedicumUniversity of HelsinkiHelsinkiFinland
- Harry Perkins Institute of Medical Research, Centre for Medical ResearchUniversity of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Anna‐Elina Lehesjoki
- Folkhälsan Research CenterHelsinkiFinland
- Department of Medical and Clinical Genetics, MedicumUniversity of HelsinkiHelsinkiFinland
| | - Tarja Linnankivi
- Epilepsia Helsinki, full member of ERN Epicare and Division of Child Neurology, Children's Hospital and Pediatric Research CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Mendonça ASGB, Oliveira BLLD, Fernandes TG, Barroso RB, Ribeiro KSQS, Schmitt ACB. Children's health care in the care network for people with disabilities in Brazil: a multicenter study. CIENCIA & SAUDE COLETIVA 2024; 29:e06802023. [PMID: 39140549 DOI: 10.1590/1413-81232024298.06802023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/22/2023] [Indexed: 08/15/2024] Open
Abstract
The aim of this study was to identify factors associated with early identification of disabilities and developmental follow-up of children in primary health care (PHC) services under the Care Network for People with Disabilities (RCPCD). We conducted a cross-sectional study using data from a multicenter study undertaken in eight states. The data were collected using a structured questionnaire answered by PHC professionals with degree-level qualifications selected using random sampling and stratified by state and municipality. Poisson regression with robust variance was performed for the two outcomes. Of the 1,488 workers in the final sample, 63.6% performed early identification of disabilities and 49% provided developmental follow-up. Family health teams performed early identification of disabilities and follow-up more than traditional model teams, and expanded family health teams provided developmental follow-up more than both these teams. The factors that showed the strongest association with identification and developmental follow-up were profession, working in a family health team and knowledge of the RCPCD.
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Affiliation(s)
| | | | - Tiótrefis Gomes Fernandes
- Universidade Federal do Amazonas. Av. General Rodrigo Octavio Jordão Ramos 1200, Coroado I. 69067-005 Manaus AM Brasil.
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Chen Y, Huang JY, Wei JCC, Lee SY, Huang YF. Risk factors for cerebral palsy in children in Taiwan. Dev Med Child Neurol 2024; 66:1062-1073. [PMID: 38263613 DOI: 10.1111/dmcn.15846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024]
Abstract
AIM To determine the significant risk factors of cerebral palsy (CP) in Taiwanese children and the associations between infant-related and parent-related factors. METHOD Data from 1 459 093 infants and their parents in Taiwan's national databases collected between 2009 and 2016 were used. The cohort with CP included children diagnosed with CP between birth and age 3 years; a total of 3254 children with CP were included in the final analysis. Hierarchical logistic regression models were used to estimate the odds ratio for the risk factors of CP. RESULTS The hierarchical logistic regression models indicated that significant risk factors associated with CP are suburban location, low income, maternal and paternal diabetes mellitus, paternal substance abuse, paternal seizure disorder, male sex, birth by Cesarean section, singleton birth, low birthweight, being born extremely and very preterm, intraventricular hemorrhage, and periventricular leukomalacia, as well as tube feeding, ventilator use, and dopamine administration within 6 months of age. INTERPRETATION In addition to common maternal and infant risk factors, we identified significant paternal risk factors associated with CP, including diabetes mellitus, seizure disorder, and substance abuse. The combination of maternal, paternal, and infant risk factors in CP holds great promise for early identification and intervention.
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Affiliation(s)
- Yuping Chen
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Allergy, Immunology, and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Shih-Yu Lee
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Ya-Fang Huang
- College of Nursing, Hungkuang University, Taichung, Taiwan
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Vesoulis ZA, Diggs S, Brackett C, Sullivan B. Racial and geographic disparities in neonatal brain care. Semin Perinatol 2024; 48:151925. [PMID: 38897830 DOI: 10.1016/j.semperi.2024.151925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
In this review, we explore race-based disparities in neonatology and their impact on brain injury and neurodevelopmental outcomes. We discuss the historical context of healthcare discrimination, focusing on the post-Civil War era and the segregation of healthcare facilities. We highlight the increasing disparity in infant mortality rates between Black and White infants, with premature birth being a major contributing factor, and emphasize the role of prenatal factors such as metabolic syndrome and toxic stress in affecting neonatal health. Furthermore, we examine the geographic and historical aspects of racial disparities, including the consequences of redlining and limited access to healthcare facilities or nutritious food options in Black communities. Finally, we delve into the higher incidence of brain injuries in Black neonates, as well as disparities in adverse neurodevelopmental outcome. This evidence underscores the need for comprehensive efforts to address systemic racism and provide equitable access to healthcare resources.
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Affiliation(s)
- Zachary A Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Stephanie Diggs
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Cherise Brackett
- Department of Pediatrics, Division of Neonatology, University of Virginia, USA
| | - Brynne Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia, USA
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Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, Pryde P, Wolf HT, Crowther CA. Magnesium Sulfate Before Preterm Birth for Neuroprotection: An Updated Cochrane Systematic Review. Obstet Gynecol 2024; 144:161-170. [PMID: 38830233 PMCID: PMC11250087 DOI: 10.1097/aog.0000000000005644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To systematically review the evidence for the effectiveness and safety of magnesium sulfate as a fetal neuroprotective agent when given to individuals at risk of preterm birth. DATA SOURCES We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov , the World Health Organization International Clinical Trials Registry Platform (through March 17, 2023), and reference lists of relevant studies. METHODS OF STUDY SELECTION Randomized controlled trials (RCTs) assessing magnesium sulfate for fetal neuroprotection in pregnant participants at risk of imminent preterm birth were eligible. Two authors assessed RCTs for inclusion, extracted data, and evaluated risk of bias, trustworthiness, and evidence certainty (GRADE [Grading of Recommendations Assessment, Development and Evaluation]). TABULATION, INTEGRATION, AND RESULTS We included six RCTs (5,917 pregnant participants and 6,759 fetuses at less than 34 weeks of gestation at randomization). They were conducted in high-income countries (two in the United States, two across Australia and New Zealand, and one each in Denmark and France) and commenced between 1995 and 2018. Primary outcomes: up to 2 years of corrected age, magnesium sulfate compared with placebo reduced the risk of cerebral palsy (risk ratio [RR] 0.71, 95% CI, 0.57-0.89; six RCTs, 6,107 children) and death or cerebral palsy (RR 0.87, 95% CI, 0.77-0.98; six RCTs, 6,481 children) (high-certainty evidence). Magnesium sulfate had little or no effect on death up to 2 years of corrected age (moderate-certainty evidence) or these outcomes at school age (low-certainty evidence). Although there was little or no effect on death or cardiac or respiratory arrest for pregnant individuals (low-certainty evidence), magnesium sulfate increased adverse effects severe enough to stop treatment (RR 3.21, 95% CI, 1.88-5.48; three RCTs, 4,736 participants; moderate-certainty evidence). Secondary outcome: magnesium sulfate reduced the risk of severe neonatal intraventricular hemorrhage (moderate-certainty evidence). CONCLUSION Magnesium sulfate for preterm fetal neuroprotection reduces cerebral palsy and death or cerebral palsy for children. Further research is required on longer-term benefits and harms for children, effect variation by participant and treatment characteristics, and the generalizability of findings to low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION The review protocol was based on a standard Cochrane Pregnancy and Childbirth template and our previous Cochrane Systematic Review (doi: 10.1002/14651858.CD004661.pub3 ; published before the introduction of PROSPERO).
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Affiliation(s)
- Emily S Shepherd
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), and Adelaide Medical School, University of Adelaide, Adelaide, the Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, and the Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia; INSERM Unit 1245, Team 4, Rouen School of Medicine, Normandy University, and the Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France; Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; the Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark; and the Liggins Institute, University of Auckland, Auckland, New Zealand
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Bradley SS, de Holanda LJ, Chau T, Wright FV. Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Front Neurosci 2024; 18:1398459. [PMID: 39145294 PMCID: PMC11322617 DOI: 10.3389/fnins.2024.1398459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. Clinical trial registration https://clinicaltrials.gov, identifier NCT05463211.
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Affiliation(s)
- Stefanie S. Bradley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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