Cerebral palsy-definition, classification, etiology and early diagnosis

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BACKGROUND

Cerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.

METHODS

A hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.

RESULTS

Eighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08-6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days' hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.

CONCLUSIONS

The clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

Identification of potential biomarkers for cerebral palsy and the development of prediction models

Cerebral palsy (CP) is a prevalent motor disorder originating from early brain injury or malformation, with significant variability in its clinical presentation and etiology. Early diagnosis and personalized therapeutic interventions are hindered by the lack of reliable biomarkers. This study aims to identify potential biomarkers for cerebral palsy and develop predictive models to enhance early diagnosis and prognosis. We conducted a comprehensive bioinformatics analysis of gene expression profiles in muscle samples from CP patients to identify candidate biomarkers. Six key genes (CKMT2, TNNT2, MYH4, MYH1, GOT1, and LPL) were validated in an independent cohort, and potential biological pathways and molecular networks involved in CP pathogenesis were analyzed. The importance of processes such as functional regulation, energy metabolism, and cell signaling pathways in the muscles of CP patients was emphasized. Predictive models of muscle sample biomarkers related to CP were developed and visualized. Calibration curves and receiver operating characteristic analysis demonstrated that the predictive models exhibit high sensitivity and specificity in distinguishing individuals at risk of CP. The identified biomarkers and developed prediction models offer significant potential for early diagnosis and personalized management of CP. Future research should focus on validating these biomarkers in larger cohorts and integrating them into clinical practice to improve outcomes for individuals with CP.

Cognitive approaches in the rehabilitation of upper limbs function in children with cerebral palsy: a systematic review and meta-analysis

INTRODUCTION

Cerebral palsy (CP) is the predominant cause of children disability. It is characterized by motor, sensory, and postural deficits due to a non-progressive injury to the developing central nervous system. In recent years, new rehabilitation techniques targeting the central representations of motor patterns have been introduced: the most used are action observation therapy (AOT), motor imagery (MI), and mirror therapy (MT). Aim of this study is to assess the effectiveness of these cognitive strategies on the recovery of upper limb motor functions in children with CP.

EVIDENCE ACQUISITION

This study was designed as a systematic review and meta-analysis, registered in PROSPERO (CRD42023403794). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed. A total of 3 electronic databases (PubMed, Scopus, and Web of Science) were searched for relevant Randomized Control Trials (RCT) using the combinations of terms "cerebral palsy" AND "action observation" OR "motor imagery" OR "mirror therapy" OR "cognitive therapy." A meta-analysis was carried out to compare cognitive and conventional approaches and combine direct and indirect effects. A random-effects meta-analysis model was used to derive pooled effect estimates.

EVIDENCE SYNTHESIS

Out of 328 records, 12 RCTs were analyzed in this systematic review published from 2012 to 2022, and included 375 children, of whom 195 received cognitive therapies, and 180 underwent conventional rehabilitation. AOT was the most investigated (RCTs N.=7), and showed significant results in the recovery of upper limb motor functions, albeit the meta-analysis demonstrated a non-significant difference in Melbourne Unilateral Upper limb Scale (MUUL) (95% CI: -7.34, 12); in Assisting Hand Assessment (AHA) (95% CI: -4.84, 10.74), and in AbilHand-Kids Questionnaire (95% CI: -1.12, 1.45). Five RCTs investigated MT showing significant improvements in grip and dexterity; none used MI as intervention therapy.

CONCLUSIONS

Cognitive therapies provided with encouraging results in the recovery of upper limb motor functions, although not a clinical effect in bimanual or unimanual performance; they could represent a valid therapeutic solution integrated to conventional rehabilitation in the treatment of upper limb motor impairment in children with CP.

Is Chewing Performance Related to Dietary Intake in Children with Cerebral Palsy?

To examine the relationship between chewing performance and dietary intakes in children with Cerebral Palsy (CP). Forty children with CP aged between 2 and 6 years were included. The Karaduman Chewing Performance Scale (KCPS) and the Mastication Observation and Evaluation (T-MOE) instruments were used to evaluate chewing performance. Daily dietary intakes were measured from a 24-h food record with digital photographs including the amount and textures of all foods consumed during the meal. Chewing function was impaired in 70% of children. There was a negative low-to-moderate correlation between KCPS scores and daily protein intake (r = -0.32, p = 0.04), but not with energy and other macronutrients. The percentage of daily dietary intakes from 'liquid-blenderized' foods were positively correlated with KCPS, and negatively correlated with T-MOE scores (p < 0.001). There was a significant negative association between the percentage of daily dietary intakes from 'easy to chew & regular solid' foods and KCPS scores, and a significant positive association was found with T-MOE scores. In conclusion, the amount of daily protein intake decreased, and daily intake ratios of energy and macronutrients from liquid-blenderized foods increased as chewing performance decreased in children with CP. Timely diagnosis and treatment of chewing dysfunction can serve as a useful treatment option to ensure adequate dietary intake in children with CP, and also to decrease the burden of their parents and improve their quality of life.

Effectiveness of Wii-Fit Combined with Conventional Exercises on the Functional Mobility and Balance of Children with Cerebral Palsy and Their Typically Growing Peers

Nintendo Wii Fit is an accessible, affordable, and productive inclusion into rehabilitation programs for children with cerebral palsy (CP) as a physical activity intervention; however, to our knowledge, there are no comparative studies 8 investigating the effects on the functional mobility and balance of children with CP compared to typically growing (TG) children. We evaluated the effects of Nintendo Wii Fit video exercises on static and dynamic balance, functional capacity, and walking endurance in children with CP compared to their TG peers. Children with CP and their TG peers were trained with Nintendo Wii Fit Balance Board games and conventional exercises (40 minutes each) for 16 weeks, twice a week. Their static and dynamic balance, functional capacity, and walking endurance were evaluated at the beginning and end of the study. The improvement achieved within the groups in all parameters, as well as between the groups, was significant, except for the dynamic balance and walking endurance. Standing Nintendo Wii Fit exercises combined with conventional exercises can be included as axial exercises in the physiotherapy program for children with CP as an enjoyable physical activity. TG children may also benefit, increasing their functional mobility and walking endurance in a fun way.

Caregiver's Quality of Life Among Children with Cerebral Palsy in the Kingdom of Saudi Arabia, and Various Influencing Factors: A Single Cohort Study

Purpose

Quality of life (QOL) among disabled children and their caregivers is an important concern in healthcare. We aim to evaluate the quality of life among caregivers of children with cerebral palsy and to observe the effects of various demographic factors and affected child-related factors on caregivers' quality of life.

Patients and Methods

After ethical approval and written consent was obtained from the participants. One hundred six caregivers of children with cerebral palsy from the Asir region were recruited for the study. Caregivers provided details, including their demographic characteristics, social factors, and information regarding their affected children regarding age, gender, mobility levels, etc. They also completed the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire for assessing their QOL.

Results

All the caregivers were women; their mean age was 40.38 years and SD7.09, and the overall QOL mean and standard deviations were 66.38 ± 12.88. There was a moderately significant correlation between total QOL in comparison with caregivers' educational level and mobility capacity, with R values of 0.54 (p<0.001) and 0.62 (p<0.001), respectively.

Conclusion

All the subdomains of WHOQOL-BREF were found to be very closely related to the total scores for QOL. The caregivers of children with cerebral palsy had better QOL scores than the cutoff scores proposed in the WHOQOL-BREF scale. Factors such as increased mobility and education of the affected child contributed to better total QOL scores.

Cerebral Palsy: A Narrative Review on Childhood Disorder

Cerebral palsy, one of the most common reasons for infirmity in children and young people in developed countries, refers to several neurological diseases that impact movement and coordination. Central nervous system damage received during the first stages of brain development can cause cerebral palsy, a non-progressive condition that manifests as impairments of movement and posture. Two cases per 1000 are reported, and the causes include those mentioned for high-risk infants. Mental retardation, sensory deficiencies, failure to thrive, seizures, and behavioral or emotional issues are some of the associated difficulties. To enable interdisciplinary intervention, early identification is crucial. The result varies depending on the topography, severity, and presence of concomitant abnormalities in cerebral palsy. Cerebral palsy is caused by a static injury to the cerebral motor cortex that happens before, during, or within five years after birth. Various circumstances can influence the disease, including cerebral anoxia, cerebral hemorrhage, infection, and hereditary disorders. Interventions for children are typically provided as part of multidisciplinary rehabilitation programs. Musculoskeletal complaints are common, and pain is a significant underreported symptom.

Effectiveness of Neurodevelopmental Treatment and Sensory Integration Therapy on Gross Motor Function, Balance and Gait Parameters in Children With Spastic Diplegia

Background Spastic diplegic cerebral palsy is the type that is most frequently seen in clinical settings. Spastic diplegic children have trouble maintaining their balance, gait, and gross motor function. This study investigated the effects of the Neurodevelopmental Technique (NDT) and Sensory Integration Technique (SIT) on balance, gross motor function, and gait characteristics in children with spastic diplegia. Method The study's participants were 8 to 12 years old, with spastic diplegia, categorized into stages I to III of the Gross Motor Function Classification System. While individuals in group B underwent sensory integration therapy, group A's subjects received NDT for 45 minutes. Both groups received traditional physiotherapy for 15 minutes. The protocol was given for five days a week, continuously for four weeks. All 40 subjects underwent pre- and post-treatment assessments using the Gross Motor Function Measure-88 (GMFM-88), Paediatric Balance Scale, Gait Parameters, and Gross Motor Function Classification System. Results The trial involved 40 children, divided into two groups of 20 each. Statistical analysis demonstrated a substantial improvement in group B post-intervention (P>0.0001). The study's findings were drawn using the Chi-Square test, paired and unpaired t-tests, and SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, USA).A p<0.05 and the GraphPad Prism version 7.0 (GraphPad Software, Boston, USA) were used. A total of 40 children completed the entire duration of treatment for a month. 20 subjects participated in group A (age range 8-12 years; mean age 10.3 years) and 20 subjects in group B (age range 8-12 years; mean age 10.25 years). The GMFM-88, which assesses motor function, reveals that the between-group comparison indicates a substantial difference of 7.95 (6.04-9.86) in favor of Group B, with a p-value of 0.0001, signifying statistical significance. Similarly, the Pediatric Balance Scale (PBS) outcomes significantly enhanced in both groups post-intervention. The comparison between groups yields a difference of 1.85 (1.11-2.59) in favor of Group B, with a p-value of 0.0001. Conclusion The study concluded that SIT has a positive impact on gait metrics, balance, and gross motor function in children with spastic diplegia.

A Report on Cases with Communication Disorders at a Tertiary care Hospital in Mysore District of Karnataka, India: A Retrospective Study Across Five Years

Communication disorders affect an individual's social, emotional and behavioural well-being. Estimating the number of clients with various causes of communication disorders can assist in the prevention, early identification, intervention, rehabilitation and counselling process. India is the second-largest populated country with diversity in terms of culture and geography. Therefore, estimating the data on number of clients presenting with communication disorders is warranted across different parts of the country. In a retrospective study, the clinical records of cases reporting to the JSS Institute of Speech and Hearing, Mysore, for the last five years were reviewed. A total of 9511 cases diagnosed with communication disorders were included in the study. The percentage of male cases was higher than the females amongst all the types of communication disorders. The percentage of paediatric cases with speech and language disorders was the highest, followed by adult cases. Across the hearing disorders, the highest number of cases were from the adult age group, and the lowest number of hearing-disordered cases were noted in the paediatric age group throughout all five years. Among all the risk factors, perinatal history was the highest seen risk factor, and consanguinity was the lowest seen risk factor associated with communication disorders. The results of the present study revealed that among cases with communication disorders at the tertiary care hospital in Mysore, hearing impairment was one of the most commonly seen conditions, followed by child language disorders. The history of perinatal factors as a risk for communication disorders was noted in a maximum number of cases.

Translation and Psychometric Properties of the Persian Version of the Feeding/Swallowing Impact Survey in Iranian Mothers

INTRODUCTION

Feeding is an interactive process between a child and a caregiver, and its early and chronic problems can affect the stress and quality of life of parents. Since the health and support of caregivers can affect the child's disability and performance, it is important to consider the impact of feeding and swallowing disorders on caregivers. Hence, the present study aimed to translate and investigate the validity and reliability of the Feeding/Swallowing Impact Survey (FS-IS) in Persian.

METHODS

This methodological study consisted of two phases: translating the test to Persian (P-FS-IS) and evaluating psychometric properties including face and content validity (through experts' opinions and cognitive interviews), construct validity (by known-group validity and exploratory factor analysis), and reliability of the questionnaire (by internal consistency and test-retest reliability). The present study was performed on 97 Iranian mothers of children with cerebral palsy aged 2-18 years with swallowing impairments.

RESULTS

Exploratory factor analysis rendered two factors with a cumulative variance of 59.71%. When evaluating known-group validity, the questionnaire scores were significantly different across the groups with different severity of the disorder (F(2, 94) = 57.1, p ≤ 0.001). P-FS-IS had a high internal consistency with Cronbach's alpha of 0.95, and there was an appropriate intra-class correlation coefficient of 0.97 for the total questionnaire.

CONCLUSION

P-FS-IS has good validity and reliability and is a suitable questionnaire for assessing the impact of pediatric feeding and swallowing disorders on Persian language mothers. This scale can be used in research and clinical settings to evaluate and determine therapeutic goals.

Effect of Intrathecal Baclofen Pump on Scoliosis in Children With Cerebral Palsy: A Meta-Analysis

OBJECTIVE

To systematically review the effect of intrathecal baclofen pump insertion in children with cerebral palsy (CP) with respect to scoliosis.

METHODS

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Google Scholar databases up to June 2022. The inclusion criteria were as follows: (1) studies with a quantitative study design; (2) studies with a study group of children with CP; (3) studies comparing scoliosis in children with and without an intrathecal baclofen pump; and (4) studies with Cobb's angle as a parameter.

RESULTS

Of the 183 studies found, four studies, all of which were retrospective comparative studies, met the aforementioned inclusion criteria. All studies were homogeneous (I2=0%, p=0.53) and intrathecal baclofen pump insertion accelerated the progression of scoliosis (standard mean difference=0.27; 95% confidence interval=0.07-0.48).

CONCLUSION

Intrathecal baclofen pumps have been used to alleviate spasticity in children with CP, thus aiding their daily activities and movements. However, their advantages and disadvantages should be reviewed after sufficient time considering the pumps' negative effect on the course of scoliosis.

Optical spectral diagnostics of the oxygenation level in periodontal tissues and photodynamic therapy using methylene blue in children with cerebral palsy

Dental diseases occur in children with cerebral palsy three times higher than in healthy children. Low values of the unstimulated salivation rate (<0.3 ml per minute), pH and buffer capacity, changes in enzyme activity and sialic acid concentration, as well as increased saliva osmolarity and total protein concentration, which indicates impaired hydration, are the factors in the development of a gingiva disease in case of cerebral palsy. This leads to increased bacterial agglutination and the formation of acquired pellicle and biofilm, leading to the formation of dental plaque. There is a tendency toward an increase in the concentration of hemoglobin and a decrease in the degree of hemoglobin oxygenation, as well as an increase in the generation of reactive oxygen and nitrogen species. Photodynamic therapy (PDT) with the use of photosensitizer methylene blue improves blood circulation and the degree of oxygenation in periodontal tissues, as well as eliminates a bacterial biofilm. Analysis of back diffuse reflection spectra makes it possible to conduct non-invasive monitoring determine tissue areas with a low level of hemoglobin oxygenation for precision photodynamic exposure.

Aim

To improve the effectiveness of phototheranostics methods using, namely PDT with simultaneous optical-spectral control, for the treatment of gingivitis in children with complex dental and somatic status (cerebral palsy).

Methods

The study involved 15 children (6-18 y.o.) with various forms of cerebral palsy, in particular, spastic diplegia and atonic-astatic form and with gingivitis. The degree of hemoglobin oxygenation was measured in tissues before PDT and on the 12th day. PDT was performed using laser radiation (λ = 660 nm) with a power density of 150 mW/cm² with a five-minute application of 0.01% MB. The total light dose was 45 ± 15 J/cm². For statistical evaluation of the results, a paired Student's t-test was used.

Results

The paper presents the results of phototheranostics using methylene blue in children with cerebral palsy. An increase in the level of hemoglobin oxygenation from 50 to 67% (p < 0.001) and a decrease in blood volume in the microcirculatory bed of periodontal tissues were shown.

Conclusion

Photodynamic therapy methods with application of methylene blue make it possible to assess the state of the gingival mucosa tissue diseases objectively in real time, and to provide effective targeted therapy for gingivitis in children with cerebral palsy. There is a prospect that they can become widely used clinical methods.

Serebral Palsili Çocuklarda Beslenme Alışkanlıkları ve Sorunları: Kesitsel Bir Çalışma

Amaç: Serebral Palsi’li (SP) çocuklarda beslenme sorunları yetersiz ve dengesiz beslenmeye neden olmanın yanı sıra günlük yaşamı ve psikososyal gelişimi de olumsuz etkileyebilmektedir. Bu çalışmanın amacı; özel bir kliniğe başvuran SP tanısı almış 6-14 yaş aralığındaki çocukların beslenme alışkanlıklarını değerlendirmek ve yaşadıkları beslenme sorunlarını saptamaktır.Yöntem: Çalışma, literatür taranarak hazırlanan anket formu kullanılarak 50 SP tanılı çocuk ile gerçekleştirilmiştir. Anket formunda tanımlayıcı bilgilerin yanı sıra çocuğun beslenmesine ayrılan süre (dk), tüketilen ara öğün ve ana öğün sayısı, tüketilen su miktarı gibi beslenme alışkanlıklarına yönelik sorular yer almaktadır. Ayrıca çocuklar Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS)’ne göre değerlendirilmiştir. Besin tüketim sıklığı formu ile hangi besinin ne sıklıkla tüketildiği saptanmıştır. Verilerin analizinde SPSS 22.0 Programı kullanılmıştır ve p değeri 0,05 olarak kabul edilmiştir.Bulgular: Hastaların tamamına yakınının SP’ye ek bir hastalığı bulunmakta olup en sık görülen hastalık gastroözofageal reflü (%84,0) olarak saptanmıştır. Oral yoldan normal diyetle beslenen hastaların oranı %18,0; en sık görülen beslenme sorunu yutma güçlüğüdür (%76,0). Çocukların yarısına yakını haftanın 5-6 günü süt ve süt ürünleri (%50,0), yumurta (%46,0) ve sebze (%40,0) tüketmektedir. Çalışmaya katılan SP tanılı çocukların beslenme şekilleri; cinsiyet, yaş grubu ve babanın eğitim durumu ile ilişkili bulunmazken (p&gt;0,05), annenin eğitim durumu ve kaba motor fonksiyon sınıflandırma sistemi ile aralarında anlamlı ilişki saptanmıştır (p&lt;0,05).Sonuç: Serebral palsili çocuklar beslenme yetersizliği açısından risk altında olmaları nedeniyle diyetisyeni de içeren multidisipliner bir ekip tarafından takip edilmeli, beslenme durumları izlenmeli ve aileleri bilgilendirilmelidir. 

Measuring muscle activation using electromyography during neurodevelopmental treatment in individuals with severe cerebral palsy

BACKGROUND

In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide.

OBJECTIVE

To verify muscle activation in NDT handling in individuals with severe CP using electromyography.

METHODS

This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV-V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender.

RESULTS

There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, "sitting on horseback", sitting on the roll, and proprioceptive stimulation sitting on the ball.

CONCLUSION

The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.

DNA Methylation Analysis Reveals Distinct Patterns in Satellite Cell-Derived Myogenic Progenitor Cells of Subjects with Spastic Cerebral Palsy

Spastic type cerebral palsy (CP) is a complex neuromuscular disorder that involves altered skeletal muscle microanatomy and growth, but little is known about the mechanisms contributing to muscle pathophysiology and dysfunction. Traditional genomic approaches have provided limited insight regarding disease onset and severity, but recent epigenomic studies indicate that DNA methylation patterns can be altered in CP. Here, we examined whether a diagnosis of spastic CP is associated with intrinsic DNA methylation differences in myoblasts and myotubes derived from muscle resident stem cell populations (satellite cells; SCs). Twelve subjects were enrolled (6 CP; 6 control) with informed consent/assent. Skeletal muscle biopsies were obtained during orthopedic surgeries, and SCs were isolated and cultured to establish patient-specific myoblast cell lines capable of proliferation and differentiation in culture. DNA methylation analyses indicated significant differences at 525 individual CpG sites in proliferating SC-derived myoblasts (MB) and 1774 CpG sites in differentiating SC-derived myotubes (MT). Of these, 79 CpG sites were common in both culture types. The distribution of differentially methylated 1 Mbp chromosomal segments indicated distinct regional hypo- and hyper-methylation patterns, and significant enrichment of differentially methylated sites on chromosomes 12, 13, 14, 15, 18, and 20. Average methylation load across 2000 bp regions flanking transcriptional start sites was significantly different in 3 genes in MBs, and 10 genes in MTs. SC derived MBs isolated from study participants with spastic CP exhibited fundamental differences in DNA methylation compared to controls at multiple levels of organization that may reveal new targets for studies of mechanisms contributing to muscle dysregulation in spastic CP.

Physicians' Ineffective Communication Leading to Cerebral Injuries in Children With Cerebral Palsy

Inspirational enlightenment has guided me to write this review article while encountering, during my practice as a pediatrician, referred cases of previously stable, positively progressing cerebral palsy (CP) children who had not yet celebrated their first teen birthday but ended up being in a deep coma and mechanical ventilation-dependent post a cardiac arrest outside the hospital. The dramatic end was believed to be probably caused by food aspiration, which could have been prevented by effective counseling to the in-denial, struggling parents about their children’s condition. This report tries to emphasize the importance of effective communication between physicians and caregivers of children who were diagnosed with CP. The importance is elaborated by linking the level of the provided communication/education to the caregivers with cerebral injuries, such as intracranial hemorrhage (ICH), which potentially could have been prevented among CP children. The sequence of the injury is believed to be initiated by aspiration of food, which resulted in apnea/asphyxia, followed by a cardiopulmonary arrest outside hospital settings. Such a life-threatening event is hypothesized to be the leading cause of non-reversible intracranial injuries to the CP child of misinformed/unaware parents. Data on unsolved parental status, parent-provider miscommunications, and aspiration pneumonia leading to cerebral injuries and their permanent neurological insult in CP children were reviewed.

Economics of Sesame and Its Use Dynamics in Ethiopia

Ethiopia's oilseed industry makes a major contribution to foreign exchange revenues. Ethiopia's three main oilseed crops (sesame, soybean, and Niger seed) account for about 20% of the country's total agricultural export profits, second only to coffee. Even though Ethiopia is one of the world's largest producers and exporters of sesame seeds, the country is facing increasing supply and demand restrictions. This paper begins with an examination of one of the most prominent oil crops in the country. It is a highly adaptable crop that may be used for anything from subsistence to commercial output. We established a comprehensive scientific understanding of the crop using a systematic review of the current literature and deductive logical reasoning that can be used to inform future research and policies. Various exclusion and inclusion criteria were used to filter the most notable findings. Millions of growers and other market participants are employed throughout the oilseed value chain. Reduced sesame productivity, pests and diseases, and limited access to modern technologies are all severe supply-side constraints. On the demand side, traders and market distortion, as well as an artificially higher home price and the ease with which unskilled labor can enter the market, are all factors. Other demand-side constraints include worldwide price volatility, a highly concentrated export market, and intense global competition. Ethiopia's sesame seed development potential is being severely hampered by these restrictions. If farmers, dealers, and the government do not address these issues strategically, the country may soon lose its competitiveness in the global sesame seed market. This will contribute to Ethiopia's ongoing discussion about how to better inform private and public sector policies and investments to increase sesame production, transform agriculture, improve nutrition and food systems, and be able to ease supply- and demand-side restrictions. In a nutshell, an increased area under cultivation combined with best agronomic practices could boost sesame production. Farmers, policymakers, researchers, and other stakeholders must thus intervene to enhance sesame production. Future studies should concentrate on how to boost sesame output in farmers' fields while following appropriate sesame production technology and agronomic principles.

Risk Factors for Dental Caries Experience in Children and Adolescents with Cerebral Palsy—A Scoping Review

Cerebral palsy is a developmental motor disorder which has far-reaching impacts on oral health. This scoping review examined the extent of research undertaken regarding the risk factors affecting dental caries experience in children and adolescents with cerebral palsy. Data were obtained from the electronic databases Web of Science and PubMed, using 10 search strings, for studies published between 1983 and 2018. Eligible studies were required to have investigated caries in children under 18 with cerebral palsy, as well as be written in English. 30 papers published were identified for inclusion in the review. These included 23 cross-sectional, 6 case–control, and 1 longitudinal study. Studies were categorized into six domains of risk factors: socioeconomic status (SE); cerebral palsy subtype (CPS); demographics (D); condition of oral cavity (OC); dental habits (DH); nutrition and diet (ND). This review was conducted and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The most significant risk factors were caregiver-related education levels, oral health literacy, and sugar intake; this underlines the important role of special education and dental awareness in reducing dental caries incidence in CP children. Other factors showed divergent findings, highlighting the need for standardization and culturally specific studies in future literature.

Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.

Socio-demographic and clinical profile of pediatric patients with cerebral palsy in Gujarat, India

Purpose

Cerebral palsy is a common childhood neurodevelopmental disorder. The estimated prevalence of cerebral palsy in India ranges from 2.1 to 3 per 1000 live births as per published literature. The present study was aimed to study socio-demographic and clinical profiles of cerebral palsy children in the Gujarat state of India.

Materials and methods

A total of 481 cerebral palsy children were included from various physiotherapy, rehabilitation, and neurological setups across Gujarat between May 2018 and April 2019. Information regarding gender, age, city of residence, family details, types of cerebral palsy, and gross motor function classification system was collected using a simple survey form designed for the study.

Result

The study showed that 67.57% of children were male and 32.22% were in the age group of 48–96 months. When classified 77.34% had a spastic type of cerebral palsy, out of which diplegic cerebral palsy was reported to be the most common (42.83%). When assessed for functional levels, most of the children were classified in gross motor function classification system levels 3 and 4 (76.30%).

Conclusion

The findings of this study support the published data and emphasize the need for a robust and authentic official database of cerebral palsy in Gujarat and India to help in the estimation of the current disease burden and implementation policies for the prevention and management of cerebral palsy.

The Effect of Individual Combination Therapy on Children with Motor Deficits from the Perspective of Comprehensive Rehabilitation

Objective: The paper presents the results of a research survey focused on individual combination therapy in individuals with motor deficits during childhood. The research was carried out in 2020/2021. Two patients were selected based on predetermined relevant criteria and participated in the research survey. Intervention approaches within the research survey were focused on the development of the motor skills of the chosen patients suffering from cerebral palsy or dyspraxia. Furthermore, the patients’ social adaptability was supported together with their independence and self-sufficiency in coping with everyday tasks. Sample: Two patients (N = 2) participated in the research survey based on intended sampling (i.e., motor deficit, age 7–9 years, participation in rehabilitation interventions max. 4 times a month). Based on the predetermined criteria, the two patients were contacted, one of which (N = 1) was diagnosed with cerebral palsy diparesis (ICD-10; G80.1: spastic diplegic cerebral palsy, 8.8 years of age), and the other patient (N = 1) suffered from developmental dyspraxia (ICD-10; F82: a specific developmental disorder of motor functions, 7.4 years of age). The single-case research design method was applied to process the results. This type of qualitative research enabled us to study in detail a small number of participants, specifically in our research (N = 2), one individual patient who suffered from cerebral palsy and the other individual patient diagnosed with developmental dyspraxia. The choice of two individual patients would help us to obtain a better idea of the effect of the chosen combination therapy. A standardized modified FIM test (Functional Independence Measure) was used to present the results. Results: The presented results of the research survey using the single-case research design method point to the following findings. The chosen intervention method using combination therapy demonstrably improved the patients’ conditions within the monitored indicators. When the intervention was omitted and only the usual rehabilitation procedures were conducted, the patients’ conditions deteriorated and decreased to the initial values. Conclusion: Based on the presented results, combination therapy appears to be an effective approach for individuals with motor deficits at a younger school age. The combination of selected rehabilitation approaches using classical procedures as well as robotically assisted therapy is desirable in practice as it meets the requirements for rehabilitation in the 21st century. The survey results offer conclusions and recommendations for practice regarding the research topic.

Effect of positioning error on the Hilgenreiner epiphyseal angle and the head-shaft angle compared to the femoral neck-shaft angle in children with cerebral palsy

Children with cerebral palsy (CP) often have changes in proximal femoral geometry. Neck-shaft angle (NSA), Hilgenreiner epiphyseal angle (HEA) and head-shaft angle (HSA) are used to measure these changes. The impact of femoral rotation on HEA/HSA and of ab/adduction on HEA/HSA/NSA is not well known. This study aimed to determine and compare the effect of rotation, ab/adduction and flexion/extension on HEA/HSA/NSA. Radiographic measurements from 384 patients with Gross Motor Function Classification System (GMFCS) levels I-V were utilized. NSA/HSA for affected hips were used with femoral anteversion averages to create three-dimensional models of 694 hips in children with CP. Each hip was rotated, ab/adducted and flexed/extended to simulate malpositioning. HEA/HSA/NSA of each model were measured in each joint position, and differences from correct positioning were determined. Mean HEA error at 20° of internal/external rotations were -0.60°/3.17°, respectively, with the NSA error of -6.56°/9.94° and the HSA error of -3.69°/1.21°. Each degree of ab/adduction added 1° of the HEA error, with no NSA/HSA error. NSA was most sensitive to flexion. Error for all measures increased with increasing GMFCS level. HEA/HSA were minimally impacted by rotation. NSA error was much higher than HEA/HSA in internal rotation and flexion whereas HEA was sensitive to changes in ab/adduction. Given abduction is more easily detectable on imaging than rotation, HEA may be less affected by positioning errors that are common with children with CP than NSA. HSA was least affected by position changes. HEA/HSA could be robust, complementary measures of hip deformities in children with CP.

Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives

Children with neurodevelopmental disabilities in low- and middle-income countries (LMICs) experience profound health and social inequities. While challenges faced by children living with disabilities and their caregivers have been widely documented, little is known about barriers faced by healthcare providers (HCPs) who serve these children. This study seeks to understand the barriers to testing, diagnosing, referral, and treatment of children living with cerebral palsy (CLWCP) from the perspectives of HCPs in Ghana. This qualitative study was conducted in the Greater Accra region of Ghana. A snowball sampling strategy was used to recruit HCPs from major hospitals, education centers, and health facilities. Data were collected through 11 semi-structured in-depth interviews (IDIs) with HCPs. Using an adapted version of the Sweat & Denison socio-ecological framework (SDSF), barriers to providing healthcare to CLWCPs were organized into superstructural, structural, environmental, relational, individual, and technological levels. We found that barriers to providing healthcare to CLWCPs exist at all levels of the adapted framework. The most salient barriers were identified at the superstructural, structural, and environmental levels. All HCPs expressed frustration with Ghana's health insurance policies and inadequacies of the health systems infrastructures, such as patient assessment rooms, health information systems, and pharmaceutical products for CP care. HCPs also reported that disability-related stigma often discourages providers in training from specializing in the area of developmental disabilities. HCPs emphasized critical challenges related to local perceptions of disability, gender norms and ideologies, and health system policies and infrastructure. Findings highlight the importance of identifying multi-level factors that can influence testing, diagnosing, referral, treatment, and provision of care for CLWCPs in Ghana. Addressing identified challenges from each level of influence may improve CLWCP's experiences throughout the care continuum.

An overview of the effects of whole-body vibration on individuals with cerebral palsy

The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration's influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population.

Non-pharmacological and non-surgical treatment of pain in children and adolescents with cerebral palsy: A scoping review

PURPOSE

To explore the existing literature on non-pharmacological and non-surgical pain management in children and adolescents with cerebral palsy (CP).

METHODS

Databases (Cochrane Library, PubMed MEDLINE, Ovid Embase, and PsycINFO) were systematically searched to identify literature on non-pharmacological and non-surgical interventions for relieving pain in children with CP or similar conditions.

RESULTS

Thirteen publications met the inclusion criteria. Based on study designs, the overall level of evidence of the included studies was low, justifying the use of a scoping review. Only three were randomized controlled trials. Pain reduction was reported in 8 of the 13 studies from following interventions: physiotherapy/rehabilitation, massage, cranial osteopathy, swimming and aquatics, and assistive devices. These complementary strategies should not omit conventional treatment, and a multidisciplinary approach using multifaceted treatment of pharmacological and non-pharmacological therapy is recommended to increase the pain-relieving effect.

CONCLUSION

The results indicate that physiotherapy, massage, swimming exercise, and various assistive devices can have pain-relieving effects. We found limited evidence on the topic of non-pharmacological and non-surgical treatment of pain in children with CP. Due to the lack of power in the included studies, no true evidence-based recommendations can be made from the collected articles; thus, further studies with larger cohorts and more power are needed to substantiate evidence-based treatment of pain in children and adolescents with CP.

Gait changes following robot-assisted gait training in children with cerebral palsy

This study investigated changes of gait pattern induced by a 4-week robot-assisted gait training (RAGT) in twelve ambulatory spastic diparesis children with cerebral palsy (CP) aged 10.4+/-3.2 years old by using computerized gait analysis (CGA). Pre-post intervention CGA data of children with CP was contrasted to the normative data of typically developing children by using cross-correlation and statistically evaluated by a Wilcoxon test. Significant pre-post intervention changes (p<0.01) include: decreased muscle activity of biceps femoris, rectus femoris, and tibialis anterior; a decrease in range of internal hip joint rotation, higher cadence, step length, and increased stride time. This study suggests that RAGT can be used in muscle reeducation and improved hip joint motion range in ambulatory children with CP.

Transcutaneous electrical nerve stimulation in the management of calf muscle spasticity in cerebral palsy: A pilot study

This study sets out to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of calf muscle spasticity in children with cerebral palsy. The study follows a one group pre-test–post-test design involving fifteen children with spastic cerebral palsy, presenting with calf muscle spasticity. Spasticity was assessed before and after a 30 min application of TENS to the bilateral calf muscles. The H-reflex (electromyography) of the calf muscles and Modified Ashworth Scale (MAS) served as a measure of spasticity. A goniometer was used to measure the range of motion (ROM) angles for ankle dorsiflexion. We report here no significant difference (p > 0.05) between the left and right H-reflex responses, MAS scores, and ROM scores recorded at baseline (pre-test). Correlation analysis show no correlation (p > 0.05) between the pre-test HA Max (maximum H-reflex amplitude)/MA Max (maximum M-Wave Amplitude) ratio and MAS scores of both the left and right calf muscles. However, TENS significantly reduced (p < 0.05) the HA of the left calf muscle and MAS scores of the left and right calf muscles. Additionally, TENS significantly increased the ROM scores of the left and right calf muscles. Our findings lend support to existing evidence that TENS is effective in reducing spasticity. The potential mechanism underlying this effect is a reduction in neuron excitability.

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The application of TENS in children with spastic Cerebral palsy is well tolerated.

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H-reflex is an effective tool in measuring spasticity objectively.

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TENS may be effective as an adjunct treatment option in the management of spasticity.

Wearable Lower-Limb Exoskeleton for Children With Cerebral Palsy: A Systematic Review of Mechanical Design, Actuation Type, Control Strategy, and Clinical Evaluation

Children with a neurological disorder such as cerebral palsy (CP) severely suffer from a reduced quality of life because of decreasing independence and mobility. Although there is no cure yet, a lower-limb exoskeleton (LLE) has considerable potential to help these children experience better mobility during overground walking. The research in wearable exoskeletons for children with CP is still at an early stage. This paper shows that the number of published papers on LLEs assisting children with CP has significantly increased in recent years; however, no research has been carried out to review these studies systematically. To fill up this research gap, a systematic review from a technical and clinical perspective has been conducted, based on the PRISMA guidelines, under three extended topics associated with "lower limb", "exoskeleton", and "cerebral palsy" in the databases Scopus and Web of Science. After applying several exclusion criteria, seventeen articles focused on fifteen LLEs were included for careful consideration. These studies address some consistent positive evidence on the efficacy of LLEs in improving gait patterns in children with CP. Statistical findings show that knee exoskeletons, brushless DC motors, the hierarchy control architecture, and CP children with spastic diplegia are, respectively, the most common mechanical design, actuator type, control strategy, and clinical characteristics for these LLEs. Clinical studies suggest ankle-foot orthosis as the primary medical solution for most CP gait patterns; nevertheless, only one motorized ankle exoskeleton has been developed. This paper shows that more research and contribution are needed to deal with open challenges in these LLEs.

Orthodontic treatment of an adolescent with cerebral palsy - A case report

Cerebral palsy is a common cause of chronic motor neuron impairment. A constant prevalence of 2 to 3/1000 births in industrialized countries has been described. This case report describes the treatment of a 9 year old boy presenting this form of motor neuron impairment and class II malocclusion with an overjet of 14 mm, hyperdivergent growth pattern and various habits. Orthodontic treatment consisted mainly of a two-phase treatment. The first phase was treated with removable appliances and followed by a phase with fixed appliances. Treatment duration with removable appliances was 4 years and 5 months and for the fixed appliance phase, 1 year and 7 months. A class I occlusion could be achieved in this case by removable and fixed orthodontic appliances combined with adjunctive treatment for the hypotonic orofacial musculature.

Predictors of gross motor function and activities of daily living in children with cerebral palsy

To determine the influence of selected impairment variables, spasticity, trunk control, upper limb function and selective motor control of the lower limb on gross motor function and activities of daily living in children with cerebral palsy (CP). Seventy children with CP, 40 boys and 30 girls, with age range between 11 and 156 months were recruited in this cross-sectional study. Data on spasticity, selective motor control of the lower limb, upper limb function and trunk control were assessed using modified Ashworth scale (MAS), selective motor control of the lower limb (SCALE), paediatric arm function test, trunk motor control assessment and GMFM88, respectively. Among all the variables assessed, only trunk control significantly predicted gross motor function (beta = 0.880; P < 0.001) and activities of daily living (beta = 0.550; P < 0.05). However, gross motor function and activities of daily living have significant (P < 0.05) negative correlations with spasticity, and positive correlations with selective motor control of the lower limb and trunk control. Trunk control is the most influencing factor on gross motor function and activities of daily living in children with CP. Therefore, achieving trunk control especially in those at GMFCS levels V and VI should be a priority during the rehabilitation of children with CP.

Numerical cognition in children with cerebral palsy

Children with Cerebral Palsy (CP) often perform poorly in mathematics. It is not yet clear to what extent mathematics difficulties in this clinical condition are similar to those observed in developmental dyscalculia. To better elucidate this issue, we conducted an exploratory cross-sectional study with a sample of children and adolescents with congenital brain injuries and educational history of problems in Mathematics. Fifty students aged 7-15 years, of both genders (28 males) participated in the study, 31 with typical development (TD) and 19 of whom diagnosed with spastic CP. Nine had hemiplegia and ten diplegia. Assessment procedures included a neuropsychological battery covering numerical cognition (ZAREKI-R) and working memory (AWMA) skills, and a computerized task for comparing non-symbolic magnitudes as a measure of number sense. Despite average intelligence coefficient, participants with CP underperformed the TD in five of the 12 ZAREKI-R subtests, as well as in the number sense and working memory tasks. scores were lower among hemiplegic children compared to diplegic, numerical cognition was impaired in all CP group, unveiling a dyscalculia secondary to neurodevelopmental impairments. Therefore, we can consider that mathematical learning difficulties in CP as being heterogeneous and associated with the immaturity of neuropsychological functions, with consequences for the development of numerical cognition.

Feeding problems and malnutrition associated factors in a North African sample of multidisabled children with cerebral palsy

BACKGROUND

In European and North American countries, stunting and malnutrition are common in children with cerebral palsy (CP), especially those with multiple disabilities. The extent of this problem in children with CP in North African countries is still unknown.

AIMS

To evaluate feeding problems and growth in a sample of North African multidisabled children with CP and to determine the factors associated with malnutrition in this population.

METHOD

We conducted a cross-sectional study including multidisabled children with severe CP. Anthropometric measurements (body weight, height, mid-upper arm circumference and triceps skinfold thickness) were performed. In addition, a thorough nutritional survey was conducted including feeding time and the presence of signs in favor of gastrointestinal problems.

RESULTS

We included 40 children, mainly boys (60 %) with a mean age of 6.4 ± 3.7 (range 2-16 years). The nutritional survey had revealed the presence of dysphagia, constipation and gastroesophageal reflux in 55 %, 67.5 % and 70 % of cases, respectively. Sixty-five percent of children had a mealtime over 30 min. Based on World Health Organization (WHO) growth charts, 67.5 % of children were underweight. Forty percent of the children had their weight below the 20th percentile, 5 % and 7.5 % had their height and BMI below the 5th percentile according to CP specific growth charts. Triceps skinfold thickness and mid-upper arm circumference were below the 5th percentile in 50 % and 55 % of cases, respectively. Age (p = 0.047) and constipation (p = 0.003) were identified as predictors of malnutrition.

CONCLUSIONS

Growth parameters and nutritional status are significantly altered in in our sample of North African multidisabled children with CP with a high prevalence of feeding problems represented especially by dysphagia, constipation and GER. Among the studied factors age and constipation may predict the existence of undernutrition.

Spatial accessibility to health care services among children with cerebral palsy in Johor, Peninsular Malaysia

Cerebral palsy (CP) is one of the most common causes of disability in childhood, leading to functional limitations and poor nutritional status. Families with CP children face challenges in providing proper care. Thus, accessibility of CP patients to health facilities is important to ensure that they can maintain regular visits to health facilities for proper treatment and care. The current study aimed to map the spatial distribution of CP in Johor, Malaysia and measure the accessibility of CP patients to nearby hospitals, health clinics and community-based rehabilitation centres. The study is based on CP cases in 2017 obtained from the Department of Social Welfare, Malaysia and analysed using the average nearest neighbour, buffer analysis and Kernel Density Estimation. Results indicate that there is generally good access to health care services for many of the CP children in Johor, but for 25% of those living more than 10 km away from the health clinics or community-based rehabilitation centres, regular visits can be a problem. This information should be used for targeted intervention and planning for health care strategies. Furthermore, information on hospital accessibility of CP children would allow for planning of proper and regular treatment for these patients. The study has shown that it is possible to improve the understanding of the distribution of CP cases by integrating spatial analysis using geographical information systems without relying on official information about the density of populations.

Assessment of dental caries in children with organic lesions of the nervous system using ICDAS II criteria

Studies of the dental status of children with cerebral palsy (CP) indicate a high prevalence and intensity of damage to the hard tissues of the teeth. The risk of developing dental diseases is known to increase significantly as the severity of neurological symptoms increase. The purpose of the study was to assess the incidence of dental caries using the International Caries Detection and Assessment System (ICDAS II) criteria in children with organic diseases of the nervous system depending on the severity of motor impairment. A number of 122 children (mean age 8.8±3.7 years) with spastic forms of cerebral palsy were examined. They were divided into groups according to the Gross Motor Function Classification System – Expanded & Revised (GMFCS-ER). All patients underwent a neurological examination, and the state of dental caries was determined using the ICDAS II criteria. In children with cerebral palsy, lesions of the occlusal surfaces of the teeth predominate, lesions of the proximal surfaces appeared to be three times less, but more than three times higher than in healthy children. Higher intensity of the carious process and the frequency of deep cavities are observed in children with cerebral palsy with severe motor impairment, according to GMFCS-ER. Establishing the features of caries development in children with cerebral palsy depending on the severity of neurological symptoms according to the ICDAS II system is an essential factor in determining the direction of preventive measures that should be taken for this group of children.

Resistance to Neuromuscular Blockade by Rocuronium in Surgical Patients with Spastic Cerebral Palsy

Individuals with spastic cerebral palsy (CP) often exhibit altered sensitivities to neuromuscular blocking agents (NMBAs) used for surgical intubation. We assessed usage of the NMBA rocuronium in patients with spastic CP and evaluated potential modifiers of dosing including gross motor function classification system (GMFCS) level, birthweight, gestational age, and the use of anticonvulsant therapy. In a case-control study, surgical patients with spastic CP (n = 64) or with idiopathic or non-neuromuscular conditions (n = 73) were enrolled after informed consent/assent. Patient data, GMFCS level, anticonvulsant use, and rocuronium dosing for intubation and post-intubation neuromuscular blockade were obtained from medical records. Findings reveal participants with CP required more rocuronium per body weight for intubation than controls (1.00 ± 0.08 versus 0.64 ± 0.03 mg/kg; p < 0.0001). Dosing increased with GMFCS level (Spearman's rho = 0.323; p = 0.005), and participants with moderate to severe disability (GMFCS III-V) had elevated rocuronium with (1.21 ± 0.13 mg/kg) or without (0.86 ± 0.09 mg/kg) concurrent anticonvulsant therapy. Children born full-term or with birthweight >2.5 kg in the CP cohort required more rocuronium than preterm and low birthweight counterparts. Individuals with CP exhibited highly varied and significant resistance to neuromuscular blockade with rocuronium that was related to GMFCS and gestational age and weight at birth.

Perinatal asphyxia from the obstetric standpoint

Perinatal asphyxia remains one of the major causes of morbidity and mortality for term newborns. Though access to health care and birth attendants have decreased the rate, Neonatal encephalopathy (NE) has not been eliminated. Worldwide, women at socioeconomic disadvantage have the highest risk of delivering a neonate with NE. Neonates that will experience perinatal asphyxia cannot be easily identified prospectively and the intrapartum testing available is not specific enough to clearly indicate the best course of action in most cases. Despite this, training programs that aim to decrease morbidity and mortality from all causes appear to be associated with fewer cases of perinatal asphyxia. The current best approach is to support education and communication for all people involved in the care of birthing women. Ideally, new technology will address identification of the fetus likely to be affected or the fetus who is beginning to experience injury in advance of delivery.

Maternal age as a risk factor for cerebral palsy

The relationship between maternal age and the occurrence of cerebral palsy is still highly controversial. The aim of the study was to examine the effect of maternal age on the risk of CP development, taking into account all significant risk factors and the division into single, twin, full-term, and pre-term pregnancies.

The survey covered 278 children with CP attending selected educational institutions in Poland. The control group consisted of data collected from the medical records of 435 children born at Limanowa county hospital, Poland. The analyses included socio-economic factors, factors related to pregnancy and childbirth, and factors related to the presence of comorbidities and diseases in the child. Constructed logistic regression models were used for statistical analyses.

For all age categories included in the estimated models (assessing the effect of demographic factors on the development of CP), only the category of ≤24 years of age (in the group of all children) was significant. It was estimated that in this mother’s age category, the risk of CP is lower (OR 0.6, 95% CI: 0.3–1.0) in comparison to mothers aged 25-29 (p = 0.03). However, estimation with the use of a complex logistic regression model did not show any significant effect of maternal age on the incidence of CP in groups from different pregnancies types.

It became apparent that maternal age is a weak predictor of CP, insignificant in the final logistic regression model. It seems correct to assume that the studies conducted so far, showing a significant effect of maternal age in this respect, may be associated with bias in the estimators used to assess the risk of CP due to the fact that other important risk factors for CP development were not included in the research.

Childhood neurodevelopmental outcomes of survivors of acute bilirubin encephalopathy: A retrospective cohort study

BACKGROUND

Reports on childhood neurodevelopmental and neurosensory outcomes following acute bilirubin encephalopathy from low- and middle-income countries are scarce.

AIM

This study aimed to analyze the neurodevelopmental and neurosensory outcomes of survivors of acute bilirubin encephalopathy.

STUDY DESIGN

Retrospective cohort.

SUBJECTS

Neonates with admission diagnosis of acute bilirubin encephalopathy were followed up and assessed for neuromotor, neurodevelopmental and neurosensory functions between 18 m and 12.5 years of age.

RESULTS

In 67 neonates with acute bilirubin encephalopathy, a composite outcome of cerebral palsy or death was observed in 33 (49%) subjects. Choreo-athetoid cerebral palsy [19 (73%)] was the most common type observed. Sensori-neural hearing loss was observed in 46 (79%) subjects. Subjects with cerebral palsy had significantly low Developmental profile-3 scores in all assessed domains. Neonates with an early-stage acute bilirubin encephalopathy (aOR (95% C.I): 0.12 (0.05-0.71); p = 0.02) and those with a normal neurological examination at discharge (aOR (95% C.I): 0.11 (0.06-0.7); p = 0.049) had significantly lower odds of the primary outcome.

CONCLUSIONS

Majority of survivors of acute bilirubin encephalopathy had adverse outcomes during childhood in the form of cerebral palsy and sensory-neural hearing loss. Cognitive functions were better preserved than the language and general development in the affected children.

The Relationship Between Caregiver Workload and Stress Levels with Clinical Symptom Severity in Cerebral Palsy

The aim of this study is to compare the functional status, spasticity, motor function status of children with cerebral palsy and their caregivers' workload and stress levels. A single-center prospective cross-sectional study was carried out with 30 children with Cerebral Palsy (CP) and their 30 caregivers. The clinical status of the children was assessed with the Modified Ashworth Scale (MAS), Gross Motor Function Classification System (GMFCS), The Functional Independence Measure for Children (WeeFIM). The caregivers' workload and stress levels were evaluated with Bakas Caregiving Outcomes Scale (BCOS) and Perceived Stress Scale (PSS), respectively. The mean age of the children was 11.46±7.45 years. In correlation analysis, the caregivers' BCOS score was related to the children's MAS score (p&lt;0.05). On the other hand, there was a significant relationship between BCOS and PSS scores of the caregivers (p&lt;0.05). Greater levels of spasticity in the children were associated with greater levels of workload. Stress level is higher in caregivers with a high workload.

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data

OBJECTIVES

Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.

DESIGN

Retrospective cohort study.

SETTING

UK GPs linked into the Clinical Practice Research Datalink (CPRD).

PARTICIPANTS

CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female.

PRIMARY OUTCOME

New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015).

RESULTS

During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02).

CONCLUSIONS

There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.

Management of Muscle Spasticity in Children with Cerebral Palsy by Means of Extracorporeal Shockwave Therapy: A Systematic Review of the Literature

The purpose of this systematic review was to investigate the effectiveness of extracorporeal shockwave therapy for the management of muscle spasticity in children with cerebral palsy. An electronic database search was performed to identify studies relevant to the research question. Assessment of the quality of evidence in all relevant studies was performed with the help of the Oxford Center for Evidence-based Medicine guide. Four studies met our inclusion criteria for review: one was a low-quality randomized controlled clinical trial, two were individual case-control studies and one was a case series study. Reduction in muscle stiffness and improvement in joint range of motion were the outcomes in all of the selected studies that used extracorporeal shockwave therapy. However, considering the limited evidence provided by these studies, further research is needed to support the use of extracorporeal shockwave therapy in the management of muscle spasticity in children with cerebral palsy.

Intrauterine cytomegalovirus infection: a possible risk for cerebral palsy and related to its clinical features, neuroimaging findings: a retrospective study

Background

Abundant clinical evidences indicate that the increased risk of cerebral palsy (CP) may be associated with the intrauterine exposure to maternal infection. Cytomegalovirus (CMV) is a common cause of CP. However, little is known about the relationship between the intrauterine exposure of the fetus to CMV infection and CP. This study aims to explore the relationships between intrauterine CMV infection and clinical symptoms, classification, intelligence development and brain neuroimaging findings in children with CP.

Methods

In this study, 147 children with CP in recent 6 years were retrospectively analyzed (average age: 14.76 ± 3.07months; sex (M/F): 103/44). 148 children had CMV IgG and IgM positive sera identified by TORCH examination were selected as the control group (average age: 15.10 ± 3.21months; sex (M/F): 102/46), which also undergo the examination of CMV-DNA in urine. The age and sex of children in the control group were matched with those in the CP group. CMV-DNA in urine was detected by CMV fluorescence quantitative PCR, and t-test was performed to analyze the number of copies. For the CP group, standardized rehabilitation treatment was performed and the function of gross motor was evaluated by GMFM scale before and after treatment. The Gesell developmental scale (GDS) was used to assess the level of intellectual development. The classification of CP was conducted and the results of magnetic resonance imaging were analyzed. Finally, the correlations between the copy number of CMV-DNA and the clinical characteristics of children with CP were evaluated by the method of Pearson and Spearman correlation analysis.

Results

The level of CMV infection was negatively correlated with the developmental quotient (DQ) of children with CP. Negative association was found between the level of CMV infection and the level of the gross motor development. The level of CMV infection was positively related with the occurrence probability of spastic quadriplegia. However, no associations were found between the abnormalities of brain tissue and the number of CMV copies. Moreover, CMV infection might add the difficulty of the rehabilitation treatment.

Conclusions

CMV infection is a risk factor for the occurrence of CP in children. Pregnancy examination should be strengthened. Early detection and control of CMV infection may contribute to the rehabilitation of children with CP and reduce the disability and social burden.

Application of vocal organ correction combined with language training in the rehabilitation of children with cerebral palsy and language disorder

BACKGROUND

To explore the effect of vocal organ correction combined with language training on the rehabilitation of children with cerebral palsy (CP) and language disorder.

METHODS

A total of 98 children with CP and language disorder were divided into two groups (49 cases in each group) using a random number table: the control group and the test group. The control group was given language training alone, while the test group received vocal organ correction combined with language training. The changes in language function classification, efficacy, and family satisfaction before and after the treatments were compared.

RESULTS

A significant difference was identified in language function classification between the two groups before and after treatment (P<0.05). The language function classification of the two groups was also significantly different after treatment (P<0.05), as was the distribution of clinical efficacy between the two groups (P<0.05). The total effective rate for the test group was 91.84%, which was higher than the 73.47% for the control group (P<0.05). Family satisfaction between the two groups differed significantly (P<0.05), and the total satisfaction rate of families in the test group was 87.76%, which was higher than the 69.39% in the control group (P<0.05).

CONCLUSIONS

Vocal organ correction combined with language training can improve the language function of children with CP and language disorder, has ideal efficacy, and can also enhance family satisfaction during rehabilitation.

Efficacy of Repeat AbobotulinumtoxinA (Dysport®) Injections in Improving Gait in Children with Spastic Cerebral Palsy

Purpose: This secondary analysis of a randomized, double-blind study plus open-label extension (NCT01249417/NCT01251380) evaluated the efficacy of abobotulinumtoxinA versus placebo in improving gait pattern in children with dynamic equinus due to cerebral palsy (CP) as assessed by the observational gait scale (OGS). Methods: Ambulatory children with CP (N = 241, aged 2-17) and dynamic equinus were randomized to treatment with abobotulinumtoxinA (10 or 15U/kg/leg) or placebo injected into the gastrocsoleus. All children received abobotulinumtoxinA in the open-label phase. Results: In the double-blind phase, abobotulinumtoxinA significantly improved OGS total scores versus placebo at Week 4 (treatment effect vs. placebo: 10U/kg/leg: 1.5 [0.7, 2.3], p = .0003; 15U/kg/leg: 1.1 [0.3, 1.9], p = .01). In the open-label phase, treatment with abobotulinumtoxinA continued to improve the OGS score at the same magnitude as seen in the double-blind study. Conclusion: Repeat treatment with abobotulinumtoxinA improved gait in children with dynamic equinus.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy

BACKGROUND

Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination.

AIMS

We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy.

METHODS AND PROCEDURES

Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months.

OUTCOMES AND RESULTS

Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention.

CONCLUSIONS AND IMPLICATIONS

Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

Paternal age and the risk of cerebral palsy

In the literature there are no unequivocal assessments of the effect of paternal age on the risk of cerebral palsy (CP). The objective of the studies was the analysis of the influence of paternal age on this risk, considering all the important risk factors and division into singleton and twin, as well as term- and preterm-born infants. The inquiry included a group of 278 children with cerebral palsy from selected education-therapeutic institutions in Poland. The control group consisted of the data from medical records of 435 neonates born in God’s Mercy Hospital in Limanowa, Poland. The data were based on a questionnaire designed to obtain information which would make it possible to ascertain the probable etiological factors. Constructed models of logistic regression were used in statistical analysis. The results were presented as the odds ratio (OR) with 95% confidence interval (CI). Though the estimation with a complex model of logistic regression showed no significant effect of paternal age on the occurrence of cerebral palsy, it confirmed it as a stronger predictor compared to maternal age. Disregarding paternal of age while considering maternal age and other risk factors may lead to a bias in the estimations of the risk cerebral palsy.

Retained primitive reflexes in children, clinical implications and targeted home-based interventions

This article discusses problems such as learning difficulties and behavioural problems that children may experience when they have retained primitive reflexes, which are typically only present in the first few months of life. The authors outline different types of primitive reflex present in infants and how each may affect a child when retained beyond the time when they are normally inhibited. Where relevant health professionals with expertise in this area are not available, children's nurses may need to assess and manage children with retained reflexes. This article explains how a nurse can assess a child for each primitive reflex and describes exercises that can be taught to a child and his or her parents to carry out at home to reintegrate the reflex.