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Jaleel F, Rust A, Cheung S, Pearson TS, Ueda K, Robichaux‐Viehoever A, Leger K, Chintalapati K, Guez‐Barber D, Shusterman M, Aravamuthan B. Caregiver descriptions of dystonia in cerebral palsy. Ann Clin Transl Neurol 2024; 11:242-250. [PMID: 38174361 PMCID: PMC10863918 DOI: 10.1002/acn3.51941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/18/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To determine how caregivers describe dystonia in people with cerebral palsy (CP). METHODS In this prospective cohort study, paper surveys were administered to caregivers between September 7, 2021 and October 28, 2021 during CP Center visits at a large tertiary care center. Caregivers were asked to describe involuntary movements triggered by voluntary movement or triggered by tactile stimulation in the people with CP they cared for. Their CP Center medical provider separately assessed people with CP for dystonia. Movement features described exclusively by caregivers of people with CP and dystonia were determined using conventional content analysis. RESULTS 113 caregivers responded on behalf of 56 people with and 57 people without dystonia. If caregivers noted that both voluntary movement and tactile stimulation triggered involuntary movements, that had a 92% positive predictive value for a dystonia diagnosis. Movement features exclusively described in people with CP and dystonia included: (1) stiffening, tensing, or tightening (15% of respondents); (2) involvement of the head (10%), torso (5%), or feet (5%); and (3) triggers of stretching (12.5%), excitement (5%), or transfers (5%). INTERPRETATION In addition to a thorough exam, asking caregivers of people with CP to describe involuntary movements triggered by voluntary movement or tactile stimulation may inform clinical dystonia diagnosis.
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Affiliation(s)
- Fayza Jaleel
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Alyssa Rust
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Shirley Cheung
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Toni S. Pearson
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Division of Neurology, Nationwide Children's HospitalOhio State UniversityColumbusOhioUSA
| | - Keisuke Ueda
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Amy Robichaux‐Viehoever
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Katie Leger
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Keerthana Chintalapati
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Danielle Guez‐Barber
- Division of Child Neurology, Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Bhooma Aravamuthan
- Division of Pediatric Neurology, Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
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Gillespie CS, Hall BJ, George AM, Hennigan D, Sneade C, Cawker S, Silva AHD, Vloeberghs M, Aquilina K, Pettorini B. Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study. Childs Nerv Syst 2024; 40:171-180. [PMID: 37439914 PMCID: PMC10761507 DOI: 10.1007/s00381-023-06062-4] [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: 03/12/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). METHODS This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. RESULTS Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients. CONCLUSIONS SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.
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Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Neurology, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
| | - Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Alan M George
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Christine Sneade
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Stephanie Cawker
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michael Vloeberghs
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
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Gilbert LA, Gandham S, Ueda K, Chintalapati K, Pearson T, Aravamuthan BR. Upper Extremity Dystonia Features in People With Spastic Cerebral Palsy. Neurol Clin Pract 2023; 13:e200207. [PMID: 37780812 PMCID: PMC10540938 DOI: 10.1212/cpj.0000000000200207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023]
Abstract
Background and Objectives Dystonia in cerebral palsy (CP) is debilitating and common, but underdiagnosed, especially when coexistent with spasticity. With dedicated research-based assessment, dystonia is found in most people with spastic CP but is only clinically diagnosed in the minority. To begin addressing the high rates of dystonia underdiagnosis in this population, we determined the key feature experts use to assess upper extremity dystonia in people with spastic CP. Methods In this prospective cohort study, 3 pediatric movement disorder specialists assessed upper extremity dystonia in neurologic examination videos of people with spastic CP and isolated periventricular leukomalacia (PVL) on brain MRI (i.e., those with a brain injury pattern typical for spastic CP). Dystonia severity was rated using the 10-point Global Dystonia Severity Rating Scale, first by each expert independently and then again after consensus-building discussion. Conventional content analysis of these discussions revealed salient features ("codes") that experts used to assess upper extremity dystonia. Code frequency distributions were compared between dystonia severity categories using χ2 tests. Results We identified 96 people with spastic CP with isolated PVL on brain MRI seen in the St. Louis Children's Hospital CP Center between 2005 and 2018. Of them, 26 people were able and willing to be recorded while doing a standardized set of upper extremity examination maneuvers (age 4-25 years; 28% nonambulatory, 77% White). When assessing their videos, experts cited the "hand" less often and "shoulder" more often with increasing dystonia severity (p < 0.005, χ2 test). "Mirror movements" and the "hand open/close" examination maneuver were cited significantly more frequently in videos when experts were attempting to distinguish between no dystonia and mild dystonia (p < 0.005). Discussion Expert clinicians use distinct movement features to assess upper extremity dystonia in people with spastic CP and PVL. Attention to involuntary shoulder (vs hand) movements can help gauge dystonia severity. Differentiation between mirror movements and dystonia, particularly during the hand open/close examination maneuver, may help identify mild dystonia. These results can help guide upper extremity dystonia assessment in people with spastic CP, thus potentially helping mitigate dystonia underdiagnosis.
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Affiliation(s)
- Laura A Gilbert
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
| | - Sushma Gandham
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
| | - Keisuke Ueda
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
| | - Keerthana Chintalapati
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
| | - Toni Pearson
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
| | - Bhooma R Aravamuthan
- Division of Pediatric Neurology (LAG, SG, KU, KC, BRA), Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Division of Neurology (TP), Nationwide Children's Hospital, Ohio State University, Columbus
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Gavazzi F, Patel V, Charsar B, Glanzman A, Erler J, Sevagamoorthy A, McKenzie E, Kornafel T, Ballance E, Pierce SR, Teng M, Formanowski B, Woidill S, Shults J, Wassmer E, Tonduti D, Magrinelli F, Bernard G, Van Der Knaap M, Wolf N, Adang L, Vanderver A. Gross Motor Function in Pediatric Onset TUBB4A-Related Leukodystrophy: GMFM-88 Performance and Validation of GMFC-MLD in TUBB4A. J Child Neurol 2023; 38:498-504. [PMID: 37461315 PMCID: PMC10527384 DOI: 10.1177/08830738231188159] [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] [Indexed: 07/27/2023]
Abstract
TUBB4A pathogenic variants are associated with a spectrum of neurologic impairments including movement disorders and leukodystrophy. With the development of targeted therapies, there is an urgent unmet need for validated tools to measure mobility impairment. Our aim is to explore gross motor function in a pediatric-onset TUBB4A-related leukodystrophy cohort with existing gross motor outcome tools. Gross Motor Function Measure-88 (GMFM-88), Gross Motor Function Classification System (GMFCS-ER), and Gross Motor Function Classification-Metachromatic Leukodystrophy (GMFC-MLD) were selected through face validity. Subjects with a confirmed clinical and molecular diagnosis of TUBB4A-related leukodystrophy were enrolled. Participants' sex, age, genotype, and age at disease onset were collected, together with GMFM-88 and concurrent GMFCS-ER and GMFC-MLD. Performances on each measure were compared. GMFM-88 floor effect was defined as total score below 20%. A total of 35 subjects participated. Median performance by GMFM-88 was 16.24% (range 0-97.31), with 42.9% (n = 15) of individuals performing above the floor. GMFM-88 Dimension A (Lying and Rolling) was the best-performing dimension in the GMFM-88 (n = 29 above the floor). All levels of the Classification Scales were represented, with the exception of the GMFC-MLD level 0. Evaluation by GMFM-88 was strongly correlated with the Classification Scales (Spearman correlations: GMFCS-ER:GMFM-88 r = 0.90; GMFC-MLD:GMFM-88 r = 0.88; GMFCS-ER:GMFC-MLD: r = 0.92). Despite overall observation of a floor effect, the GMFM-88 is able to accurately capture the performance of individuals with attenuated phenotypes. GMFM-88 Dimension A shows no floor effect. GMFC-MLD shows a strong correlation with GMFCS-ER and GMFM-88, supporting its use as an age-independent functional score in TUBB4A-related leukodystrophy.
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Affiliation(s)
- Francesco Gavazzi
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Virali Patel
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brittany Charsar
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan Glanzman
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacqueline Erler
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anjana Sevagamoorthy
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emma McKenzie
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tracy Kornafel
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Ballance
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel R. Pierce
- Department of Physical Therapy, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Teng
- Synaptixbio Ltd, Fermi Avenue, Harwell, Oxfordshire OX11 0QX
| | - Brielle Formanowski
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Woidill
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justine Shults
- Synaptixbio Ltd, Fermi Avenue, Harwell, Oxfordshire OX11 0QX
| | - Evangeline Wassmer
- Neurology Department, Birmingham Children’s Hospital, Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Davide Tonduti
- Unit of Pediatric Neurology, C.O.A.L.A (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Geneviève Bernard
- Departments of Neurology and Neurosurgery, Pediatrics and Human Genetics, McGill University, Montreal, Quebec, Canada
- Department Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marjo Van Der Knaap
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Centers, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, The Netherlands
| | - Nicole Wolf
- Department of Child Neurology, Amsterdam Leukodystrophy Center, Emma Children’s Hospital, Amsterdam University Medical Centers, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laura Adang
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Aravamuthan B, Pearson TS, Chintalapati K, Ueda K. Under-recognition of leg dystonia in people with cerebral palsy. ANNALS OF THE CHILD NEUROLOGY SOCIETY 2023; 1:162-167. [PMID: 38464792 PMCID: PMC10923506 DOI: 10.1002/cns3.20018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/11/2023] [Indexed: 03/12/2024]
Abstract
Objective To determine the rates of clinical under-documentation of leg dystonia in people with cerebral palsy (CP). Methods In this prospective cohort study, we identified independently ambulatory people age 10-20yo with CP-associated spasticity seen in a tertiary care CP center between 1/1/20 to 11/4/21. Three pediatric movement disorders specialists assessed gait videos from these visits for leg dystonia using the Global Dystonia Rating Scale. We compared the gold standard expert consensus assessment for each patient with the clinical documentation of dystonia during a contemporaneous CP Center clinic visit and also with dystonia documentation longitudinally in their medical record. Results Of 116 people with CP-associated spasticity assessed in this study, 70 were found to have leg dystonia in their gait videos. Only 13% of these 70 individuals (n=9/70) had leg dystonia documented in their contemporaneous CP Center clinic visit, even though they were assessed during this visit by clinicians well-trained in CP and dystonia assessment. Even with repeated assessment, only 54% (n=38/70) of these individuals had leg dystonia documented in their medical record. Conclusions Leg dystonia is clinically under-documented in people with CP-associated spasticity, even when these people are evaluated by well-trained clinicians. Longitudinal evaluation and vigilance for leg dystonia is critical to address this diagnostic gap.
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Affiliation(s)
- Bhooma Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Toni S. Pearson
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Division of Neurology, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio, USA
| | - Keerthana Chintalapati
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Keisuke Ueda
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Rasadurai A, Frank NA, Greuter LA, Licci M, Weber P, Jünemann S, Guzman R, Soleman J. Patient- and Caregiver-Reported Outcome Measures after Single-Level Selective Dorsal Rhizotomy in Pediatric and Young Adult Patients with Spastic Cerebral Palsy. Pediatr Neurosurg 2023; 58:128-135. [PMID: 37075708 PMCID: PMC10614523 DOI: 10.1159/000530748] [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: 01/15/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The aim of this cohort study was to assess the outcome of single-level selective dorsal rhizotomy (SDR) in children and young adults with spastic cerebral palsy (CP) treated at our institution, focusing on patient-reported outcome measures (PROMs) and quality of life (QoL) of patients and their caregivers. METHODS We included consecutive patients undergoing SDR from 2018 to 2020 at our institution. Subjective outcome was measured through PROMs, while functional outcome was measured through baseline characteristics, operative outcome, as well as short- and long-term follow-up. Furthermore, the effect of age at the time of surgery on patient/caregiver satisfaction was analyzed. RESULTS Seven patients (3 female, 43%) with a median age at surgery of 11.9 years (IQR 8.7-15.5) were included. All patients had a Gross Motor Function Classification (GMFCS) score of at least IV before surgery. Five surgeries were palliative and two non-palliative. Based on PROMs, SDR showed very good QoL and health-related outcome measures for both palliative and non-palliative patients. Patient/caregiver satisfaction was higher for the early subgroup (age ≤11) than the late subgroup (age >11). Functional outcome showed reduced spasticity in both groups. Blood transfusions were never needed, while no cerebrospinal fluid leak, infection, or permanent morbidity was seen. CONCLUSION Based on PROMs, SDR leads to high satisfaction and improved QoL, especially if done at an early age. Further studies with larger cohorts are necessary to underline and confirm our observations.
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Affiliation(s)
- Abeelan Rasadurai
- Faculty of Medicine, University of Basel, Basel, Switzerland,
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland,
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland,
| | - Nicole Alexandra Frank
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Ladina Aurea Greuter
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Maria Licci
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Peter Weber
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Stephanie Jünemann
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Raphael Guzman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
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Towards functional improvement of motor disorders associated with cerebral palsy. Lancet Neurol 2023; 22:229-243. [PMID: 36657477 DOI: 10.1016/s1474-4422(23)00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
Cerebral palsy is a lifelong neurodevelopmental condition arising from non-progressive disorders occurring in the fetal or infant brain. Cerebral palsy has long been categorised into discrete motor types based on the predominance of spasticity, dyskinesia, or ataxia. However, these motor disorders, muscle weakness, hypotonia, and impaired selective movements should also be discriminated across the range of presentations and along the lifespan. Although cerebral palsy is permanent, function changes across the lifespan, indicating the importance of interventions to improve outcomes in motor disorders associated with the condition. Mounting evidence exists for the inclusion of several interventions, including active surveillance, adapted physical activity, and nutrition, to prevent secondary and tertiary complications. Avenues for future research include the development of evidence-based recommendations, low-cost and high-quality alternatives to existing therapies to ensure universal access, standardised cerebral palsy registers to harmonise epidemiological and clinical information, improved adult screening and check-up programmes to facilitate positive lived experiences, and phase 3 trials for new interventions.
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Murgia M, de Sire A, Ruiu P, Agostini F, Bai AV, Pintabona G, Paolucci T, Bemporad J, Paoloni M, Bernetti A. Botulinum toxin type A for spasticity in cerebral palsy patients: Which impact on popliteal angle to hamstring length? A proof-of-concept study. J Back Musculoskelet Rehabil 2023; 36:1193-1201. [PMID: 37458025 DOI: 10.3233/bmr-220381] [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: 07/18/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait. OBJECTIVE The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients. METHODS In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018. METHODS Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent). RESULTS Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle -51.7∘± 11.0∘, modified popliteal angle of -39.5∘± 11.0∘, passive knee extension of -14.0∘± 8.7∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p< 0.01), popliteal angle 41.3∘± 7.0∘ (p< 0.001), modified popliteal angle -32.9∘± 10.4∘ (p< 0.001), passive knee extension -4.0∘± 4.2∘ (p< 0.05) and 10MWT 12.6 ± 4.8 seconds (p< 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection. CONCLUSION Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle.
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Affiliation(s)
- Massimiliano Murgia
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Pierangela Ruiu
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | | | - Giovanni Pintabona
- Specialist Functional Rehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Teresa Paolucci
- Department of Oral Medical Science and Biotechnology, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Marco Paoloni
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
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Lewis JA, Bear N, Smith N, Baker F, Lee OS, Wynter M, Paget SP. Goal setting, goal attainment and quality of life of children following selective dorsal rhizotomy. Child Care Health Dev 2022. [PMID: 36513964 DOI: 10.1111/cch.13090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study is to describe the individualized occupational performance issues identified by parents/carers and children prior to selective dorsal rhizotomy (SDR) surgery and analyse change up to 2 years post surgery in goal attainment and quality of life (QoL). METHOD The Australian SDR Research Registry (trial registration: ACTRN12618000985280) was used to extract data for individualized goals, goal attainment and QoL based on the Canadian Occupational Performance Measure (COPM) and the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child parent-proxy) at baseline and 1 and 2 years following SDR. Change in mean scores was analysed using linear mixed models. RESULTS Fifty-two children had COPM scores at baseline and 1 and/or 2 years post, of which 28 had two QoL scores. COPM problem areas included leisure (n = 39), productivity (n = 37) and self-care (n = 173). The most common goals were walking (26.1%), participation in physical activities (17.7%) and transitions (14.1%). Mean COPM scores improved significantly between baseline to 1 year and baseline to 2 years (P < 0.001). Mean QoL scores improved between baseline to 1 year for functional QoL domains: participation and physical health (P = 0.003) and pain and impact of disability (P = 0.011). CONCLUSIONS Collaborative goal setting is an integral part of family-centred rehabilitation practice. The COPM was an appropriate individualized outcome measure in identifying meaningful goals for our SDR cohort. Results demonstrate improved scores in goal attainment and improvement in functional QoL domains. This paper highlights the need to include outcomes that measure daily life experiences.
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Affiliation(s)
| | | | | | - Felicity Baker
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - Olivia S Lee
- Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Simon P Paget
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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- The Children's Hospital at Westmead, Sydney, NSW, Australia.,Notre Dame University, Perth, WA, Australia.,Perth Children's Hospital, Perth, WA, Australia.,Women's and Children's Hospital, Adelaide, SA, Australia.,Royal Children's Hospital, Melbourne, Vic, Australia.,Queensland Children's Hospital, Brisbane, Qld, Australia
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