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Acharya BD, Karki A, Prasertsukdee S, Reed D, Rawal L, Baniya PL, Boyd RN. Effect of Adaptive Seating Systems on Postural Control and Activity Performance: A Systematic Review. Pediatr Phys Ther 2023; 35:397-410. [PMID: 37747975 DOI: 10.1097/pep.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
PURPOSE To systematically review the effectiveness of adaptive seating systems on sitting posture, postural control, and seated activity performance in children with cerebral palsy (CP). SUMMARY OF KEY POINTS From 5 databases, 3 of 21 (14%) articles were of good quality based on the Downs and Black checklist. Commercial modular contoured seating and paper-based low-cost, and contoured foam seating were effective at improving sitting posture, postural control, and seated activity performance. Parents and service providers reported that seating systems reduced stress, burden and psychosocial well-being, and quality of life in children with CP. CONCLUSION Limited evidence demonstrated that adaptive seating systems were effective at improving sitting ability and postural control. Randomized controlled trials with objective outcome measures of seating performance in children with CP are needed to evaluate effectiveness. RECOMMENDATIONS FOR CLINICAL PRACTICE Adaptive seating devices are preferred by parents and therapists for children with CP; however, objective measures of seating outcomes are needed.
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Affiliation(s)
- Bishnu Dutta Acharya
- Department of Physical Therapy (Mr Acharya), Karnali Academy of Health Sciences, Jumla, Nepal; Community-Based Rehabilitation (Ms Karki) International Nepal Fellowship, Mugu, Nepal; Faculty of Physical Therapy (Dr Prasertsukdee), Mahidol University, Salaya, Thailand; School of Medical Sciences (Dr Reed), Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; School of Health, Medical and Applied Sciences (Dr Rawal), Central Queensland University, Sydney, Australia; Nepal Health Research Council (Ms Baniya), Kathmandu, Nepal; Queensland Cerebral Palsy and Rehabilitation Research Centre (Dr Boyd), Faculty of Medicine, The University of Queensland, Brisbane, Australia
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2
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Sutherland E, Hill B, Singer BJ, Ashford S, Hoare B, Hastings-Ison T, Fheodoroff K, Berwick S, Dobson F, Williams G. Do randomised controlled trials evaluating functional outcomes following botulinum neurotoxin-A align with focal spasticity guidelines? A systematic review. Disabil Rehabil 2022; 44:8515-8523. [PMID: 34982603 DOI: 10.1080/09638288.2021.2011437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The impact of botulinum neurotoxin-A (BoNT-A) on functional outcomes when managing focal muscle spasticity remains unclear. It is possible that randomised controlled trial (RCT) design and/or reporting may be a contributing factor. The objective of this review was to determine the extent to which RCTs evaluating functional outcomes following BoNT-A align with focal spasticity guidelines. MATERIALS AND METHODS RCTs published from 2010 were included if they targeted focal spasticity, included BoNT-A, randomised a physical intervention to the upper/lower limb, or the primary outcome(s) related to the activity/participation domains of the International Classification of Functioning, Disability, and Health. Data extraction and quality appraisal using the Modified PEDro and Modified McMasters Tool were performed independently by two reviewers. General research practices were also extracted such as compliance with therapy reporting guidelines. RESULTS Fifty-two RCTs were eligible. Individualised goal setting was uncommon (25%). Six studies (11.5%) included multi-disciplinary management, and five (9.6%) included patient/caregiver education. Four studies (7.7%) measured outcomes beyond 6 months. The Median Modified PEDro score was 11/15. CONCLUSIONS Alignment with focal spasticity guidelines in RCTs was generally low. Our understanding of the impact of focal spasticity management on functional outcomes may be improved if RCT design aligned more closely with guideline recommendations.IMPLICATIONS FOR REHABILITATIONThe influence of BoNT-A on improved functional outcomes is yet to be determined.Individualised goal setting with a multi-disciplinary team is uncommon in an RCT design, despite it being a key guideline recommendation.Given the long-term nature of spasticity management, guidelines recommend short as well as long-term reviews following intervention however RCTs rarely assess beyond 6 months.
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Affiliation(s)
- Edwina Sutherland
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Bridget Hill
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Barby J Singer
- Centre for Training in Subacute Care, WA Health, Fremantle Hospital, Fremantle, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.,Centre for Nurse, Midwife and Allied Health Led Research, University College London Hospitals, London, UK.,Faculty of Nursing, Midwifery and Palliative Care, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Brian Hoare
- School of Occupational Therapy, La Trobe University, Bundoora, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Tandy Hastings-Ison
- Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Parkville, Australia
| | | | - Steffen Berwick
- Speciality Clinic for Paediatric Neurology, Neurorehabilitation and Epilepsy, Schön Clinic Vogtareuth, Vogtareuth, Germany.,von Hauners' Children's Hospital, Munich University, Munich, Germany
| | - Fiona Dobson
- Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia.,Faculty of Medicine, School of Physiotherapy, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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van Tittelboom V, AlemdaroĞlu-GÜrbÜz I, Hanssen B, Plasschaert F, Heyrman L, Feys H, Desloovere K, Calders P, Van den Broeck C. Reliability of functional tests of the lower limbs and core stability in children and adolescents with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:738-746. [PMID: 33470579 DOI: 10.23736/s1973-9087.21.06627-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Muscle weakness in children and adolescents with cerebral palsy (CP) can affect daily life activities, even more if functional capabilities are poor. Also core stability plays an important role in distal force generation. AIM The main purpose of this study was to investigate the reliability of functional tests of the lower limbs and the core stability in children and adolescents with bilateral spastic CP with Gross Motor Function Classification System (GMFCS) levels II and III. Secondary, associations within the functional tests and between the functional tests and gait capacity were analyzed. DESIGN Cross sectional study. SETTING CP reference center *blinded for reviewers*, pediatric physiotherapists and schools for children and adolescents with motor impairments. POPULATION Twenty-four children and adolescents with CP (11.4±2.5 yrs, GMFCS II/III:13/11) participated in this study. METHODS Functional tests of the lower limbs (GMFCS II: Sit-To-Stand (STS), Lateral Step-Up (LSU), bilateral heel rise (BHR), high jump (HJ), long jump (LJ); GMFCS III: STS, LSU) and core stability (bridging and Rolling Like a Ball (RLB)) were tested twice. On the second test occasion, gait capacity (1-Minute Walk Test (1MWT) and modified Timed Up and Go (mTUG)) were also assessed. RESULTS Relative reliability of the functional tests ranged from good to excellent (Intraclass Correlation Coefficients (ICC), 0.88 - 0.96). Absolute reliability showed large variability with acceptable results for the BHR, HJ, LJ and RLB (Minimal Detectable Change % (MDC %) < 40%). Strong associations were found of the RLB test and the mTUG with the BHR, HJ and LJ tests. CONCLUSIONS The functional tests of the lower limbs and core stability were found reliable. To measure change over time, the BHR, the HJ and LJ can be used for children and adolescents with GMFCS level II. The RLB test can be used for both GMFCS levels. Associations between the BHR, HJ and LJ tests in particular showed strong associations with the RLB test and with the mTUG. CLINICAL REHABILITATION IMPACT this study highlighted the importance of developing functional tests for children and adolescents with lower motor function capacities and to integrate core stability tests in routine clinical assessments.
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Affiliation(s)
- Vanessa van Tittelboom
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium - .,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium -
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank Plasschaert
- Department of Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lieve Heyrman
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Lundkvist Josenby A, Westbom L. No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain - a longitudinal population-based register study from four to 25 years of age. BMC Musculoskelet Disord 2020; 21:782. [PMID: 33246436 PMCID: PMC7697382 DOI: 10.1186/s12891-020-03782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification. Result Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age. Conclusion Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03782-5.
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Affiliation(s)
- Annika Lundkvist Josenby
- Children's Hospital, Skåne University Hospital, Lund, Sweden. .,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden.
| | - Lena Westbom
- Children's Hospital, Skåne University Hospital, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
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Adaikina A, Hofman PL, Gusso S. The effect of side-alternating vibration therapy on mobility and health outcomes in young children with mild to moderate cerebral palsy: design and rationale for the randomized controlled study. BMC Pediatr 2020; 20:508. [PMID: 33153439 PMCID: PMC7643348 DOI: 10.1186/s12887-020-02377-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common cause of physical disability in early childhood. Vibration therapy (VT) is a promising rehabilitation approach for children with CP with potential to impact mobility, bone and muscle health as demonstrated by extant research. However, it is still unclear how long therapy must be conducted for and what the optimal vibration frequency is in order to gain health benefits. Methods/design The study is a randomized clinical trial evaluating and comparing the effects of two vibration frequency (20 Hz vs 25 Hz) and duration protocols (12 weeks vs 20 weeks) of side-alternating VT on mobility and other health parameters in children with CP. Children aged 5–12 years old with CP and GMFCS level I-III who are able to understand instruction and safely stand are eligible for the study. Exclusion criteria include bone fracture within 12 weeks of enrolment; acute conditions; the history of significant organic disease; the history of taking anabolic agents, glucocorticoids, growth hormone, and botulinum toxin injection into lower limbs within 3 months of enrolment. All participants will act as their own control with a 12-week lead-in period prior to intervention. The intervention period will consist of 20 weeks of home- or school-based VT 9 min per day, 4 times a week. After the baseline assessment, participants will be randomized to either a 20 Hz or 25 Hz vibration-frequency group. The primary outcome is mobility measured by a 6-min walking test, with analysis performed on the principle of intention to treat. Secondary outcomes include body composition, muscle strength, physical activity level, balance, gross motor function, respiratory function, and quality of life. Participants will undergo four assessment visits over the study period: baseline, at weeks 12, 24, and 32. Discussion The results of the study will provide evidence-based insights into the health benefits of side-alternating VT as a therapeutic tool in young children with cerebral palsy. The investigation of different vibration training protocols will help define the optimal parameters of intervention protocols (duration, frequency) of side-alternating VT to maximize outcomes on the health of 5–12-year-old children with CP. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12618002026202 (Registration date 18/12/2018).
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Affiliation(s)
- Alena Adaikina
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Silmara Gusso
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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6
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Barton C, Buckley J, Samia P, Williams F, Taylor SR, Lindoewood R. The efficacy of appropriate paper-based technology for Kenyan children with cerebral palsy. Disabil Rehabil Assist Technol 2020; 17:927-937. [DOI: 10.1080/17483107.2020.1830442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Catherine Barton
- Physiotherapy Department, Powys Teaching Health Board, Brecon, Wales, UK
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - John Buckley
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Fiona Williams
- Department of Geography and International Development, University of Chester, Chester, UK
| | - Suzan R. Taylor
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - Rachel Lindoewood
- Brecon Children’s Centre, Powys Teaching Health Board, Brecon, Wales, UK
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7
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Plasschaert VFP, Vriezekolk JE, Aarts PBM, Geurts ACH, Van den Ende CHM. Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:899-907. [PMID: 30632139 PMCID: PMC6850353 DOI: 10.1111/dmcn.14141] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/19/2023]
Abstract
AIM To systematically review the efficacy of interventions on upper limb function in children 0 to 19 years of age with bilateral cerebral palsy on the basis of outcome measures of upper limb function and measures of activities and/or participation according to the International Classification of Functioning, Disability and Health. METHOD Cochrane, PubMed, Embase, CINAHL, and Web of Science were searched from inception to September 2017. Methodological quality and strength of evidence were analysed by two independent raters using Sackett's level of evidence and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. RESULTS Fifteen studies with a large variety of interventions and heterogeneity in outcome measures met the inclusion criteria. Twelve studies provided level IV evidence according to AACPDM guidelines. For three small randomized controlled trials the level of evidence was II. Only one of these trials showed strong methodological quality: a study on hand-arm bimanual intensive therapy including lower extremities. INTERPRETATION We identified a large variety of interventions, heterogeneity in outcome measures, and generally weak to moderate methodological quality for most studies. We recommend further research specifically aimed at bimanual-intensive, goal-directed, and task-specific training programmes for the upper limb in children with bilateral cerebral palsy, using either high-quality (multicentre) trials or well-designed single-case trials. WHAT THIS PAPER ADDS There is a large variety of interventions on upper limb function in children with bilateral cerebral palsy. Heterogeneity of outcome measures and interventions impeded firm conclusions about intervention efficacy. Most studies had low-level evidence and weak to moderate methodological quality. The strongest evidence from a small randomized controlled trial was for hand-arm bimanual intensive therapy including lower extremities.
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Affiliation(s)
- Véronique F P Plasschaert
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | | | - Pauline B M Aarts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenthe Netherlands
| | - Cornelia H M Van den Ende
- Department of Rehabilitation MedicineSint MaartenskliniekNijmegenthe Netherlands,Department of RheumatologySint MaartenskliniekNijmegenthe Netherlands
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8
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Mishra A, Sheppard JJ, Kantarcigil C, Gordon AM, Malandraki GA. Novel Mealtime Duration Measures: Reliability and Preliminary Associations With Clinical Feeding and Swallowing Performance in Self-Feeding Children With Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:99-107. [PMID: 29273816 DOI: 10.1044/2017_ajslp-16-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study is to examine (a) the reliability of newly developed measures of mealtime duration and (b) their relationship to clinical feeding/swallowing performance in children with spastic cerebral palsy (SCP). METHOD Seventeen self-feeding children (9 boys, 8 girls) with SCP (age range = 5;1 [years;months] to 17;6, Gross Motor Function Classification System range = I-IV) were assessed during mealtimes using the Dysphagia Disorder Survey (DDS; Sheppard, Hochman, & Baer, 2014). Children were divided into 2 groups, children with primarily unilateral or bilateral brain involvement. Duration measures included mealtime duration and total sip/bite duration for each bolus type (liquid and solid). RESULTS Excellent intra- and inter-rater reliability for all duration measures was observed (intraclass correlation coefficient [ICC] = 1.00 and 0.955, respectively, for mealtime duration; ICC = 1.00 and 0.963, respectively, for solid/bite duration; ICC = 1.00 and 0.957, respectively, for liquid/sip duration). Positive correlations were found between total mealtime duration and DDS Part 1, rs = .514 [.045-.797], p = .035; Part 2, rs = .528 [.064-.804], p = .029; and total scores, rs = .665 [.271-.868], p = .004, and between total solid/bite duration and DDS Part 1, rs = .579 [.137-.828], p = .015; Part 2, rs = .620 [.199-.847], p = .007; and total scores, rs = .762 [.444-.909], p < .001. Children with unilateral brain involvement exhibited significantly lower DDS total (p = .049) and Part 2 scores (p = .026), indicating better feeding/swallowing performance/skills. They also had shorter mealtime duration (p = .019) and solid/bite duration (p = .025) compared with children with bilateral involvement. CONCLUSIONS Our new mealtime duration measures are reliable and correlate with feeding/swallowing performance in a sample of self-feeding children with SCP. Therefore, they may be useful supplements to feeding/swallowing assessments for this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.5715076.
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Affiliation(s)
- Avinash Mishra
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Justine J Sheppard
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Cagla Kantarcigil
- Department of Speech, Language, & Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language, & Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN
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9
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Eek MN, Himmelmann K. No Decrease in Muscle Strength after Botulinum Neurotoxin-A Injection in Children with Cerebral Palsy. Front Hum Neurosci 2016; 10:506. [PMID: 27766077 PMCID: PMC5052872 DOI: 10.3389/fnhum.2016.00506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with botulinum neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with CP. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic CP were included in the study, 8 girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around 6 weeks after at the peak effect of BoNT-A, and at 6 months after treatment, with measurement of muscle strength, gait analysis, and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions.
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Affiliation(s)
- Meta N Eek
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
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Angsupaisal M, Maathuis CGB, Hadders-Algra M. Adaptive seating systems in children with severe cerebral palsy across International Classification of Functioning, Disability and Health for Children and Youth version domains: a systematic review. Dev Med Child Neurol 2015; 57:919-30. [PMID: 25857828 DOI: 10.1111/dmcn.12762] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to systematically review the effect of adaptive seating systems (AdSSs) in young people less than 19 years of age with severe cerebral palsy (CP), with particular focus on child-related outcomes across all components of the functioning and disability domains of the International Classification of Functioning, Disability, and Health for Children and Youth version (ICF-CY). METHOD Literature searches of studies published from 1975 to October 2014 were performed. Methodological quality and the risk of bias were analysed using Sackett's level of evidence, the American Academy for Cerebral Palsy and Developmental Medicine guidelines, and Mallen criteria for observational studies. RESULTS Nine studies fulfilled the selection criteria. All studies had level IV evidence and were of moderate methodological quality. The results focused on the effects of AdSSs on postural control and on upper extremity function and on additional child-related outcomes. The results suggested that AdSSs that include trunk and hip support devices may improve postural control outcomes, and that special-purpose AdSSs may improve self-care and play behaviour at home. INTERPRETATION Because of a low level of evidence and the moderate methodological quality of the studies available, no robust conclusions can be drawn. Nevertheless, the data suggest that AdSSs may be able to improve activity and participation at home among children with severe CP. More studies of high methodological quality addressing the effect of AdSSs on activity and participation are urgently needed. Suggestions for future research are provided.
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Affiliation(s)
- Mattana Angsupaisal
- Department of Paediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Carel G B Maathuis
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mijna Hadders-Algra
- Department of Paediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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11
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Simon ADS, do Pinho AS, Grazziotin Dos Santos C, Pagnussat ADS. Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2547-2557. [PMID: 25010566 DOI: 10.1016/j.ridd.2014.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 06/03/2023]
Abstract
This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.
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Affiliation(s)
- Anelise de Saldanha Simon
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Alexandre Severo do Pinho
- Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Camila Grazziotin Dos Santos
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | - Aline de Souza Pagnussat
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Programa de Pós Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
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Eken MM, Dallmeijer AJ, Doorenbosch CA, Dekkers H, Becher JG, Houdijk H. Assessment of Muscle Endurance of the Knee Extensor Muscles in Adolescents With Spastic Cerebral Palsy Using a Submaximal Repetitions-to-Fatigue Protocol. Arch Phys Med Rehabil 2014; 95:1888-94. [DOI: 10.1016/j.apmr.2014.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/10/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Schroeder AS, Homburg M, Warken B, Auffermann H, Koerte I, Berweck S, Jahn K, Heinen F, Borggraefe I. Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. Eur J Paediatr Neurol 2014; 18:502-10. [PMID: 24821475 DOI: 10.1016/j.ejpn.2014.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy. AIM To evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study. METHODS Participants trained for 30-60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain "Activity"), and Canadian Occupational Performance Measure (COPM; "Participation") were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4). RESULTS 18 patients with BS-CP participated; age 11.5 (mean, range: 5.0-21.8) years, body weight 36.4 (15.0-72.0) kg. GMFCS levels I-IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement. INTERPRETATION Following ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of "activity" and "participation" in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.
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Affiliation(s)
- A S Schroeder
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
| | - M Homburg
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - B Warken
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - H Auffermann
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Koerte
- Institute of Clinical Radiology, University of Munich, Germany
| | - S Berweck
- Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany
| | - K Jahn
- German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
| | - F Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Borggraefe
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
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Anti-transglutaminase 6 antibodies in children and young adults with cerebral palsy. Autoimmune Dis 2014; 2014:237107. [PMID: 24804082 PMCID: PMC3996887 DOI: 10.1155/2014/237107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 01/31/2023] Open
Abstract
Objectives. We have previously reported a high prevalence of gluten-related serological markers (GRSM) in children and young adults with cerebral palsy (CP). The majority had no enteropathy to suggest coeliac disease (CD). Antibodies against transglutaminase 6 (anti-TG6) represent a new marker associated with gluten-related neurological dysfunction. The aim of this study was to investigate the prevalence of anti-TG6 antibodies in this group of individuals with an early neurological injury resulting in CP. Materials and Methods. Sera from 96 patients with CP and 36 controls were analysed for IgA/IgG class anti-TG6 by ELISA. Results. Anti-TG6 antibodies were found in 12/96 (13%) of patients with CP compared to 2/36 (6%) in controls. The tetraplegic subgroup of CP had a significantly higher prevalence of anti-TG6 antibodies 6/17 (35%) compared to the other subgroups and controls. There was no correlation of anti-TG6 autoantibodies with seropositivity to food proteins including gliadin. Conclusions. An early brain insult and associated inflammation may predispose to future development of TG6 autoimmunity.
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Lorena Llorente D, Katherine Robles C. Experiencia de la terapia con lokomat en pacientes portadores de parálisis cerebral y síndromes atáxicos, instituto de rehabilitación infantil teletón concepción Chile. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Muscle fatigue during repetitive voluntary contractions: a comparison between children with cerebral palsy, typically developing children and young healthy adults. Gait Posture 2013; 38:962-7. [PMID: 23810336 DOI: 10.1016/j.gaitpost.2013.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/03/2013] [Accepted: 05/15/2013] [Indexed: 02/02/2023]
Abstract
AIM To combine peak torque and EMG analyses to investigate the hypothesis that 1) children with cerebral palsy (CP) have lower muscle fatigability than typically developing children (TD) and whether 2) muscle fatigue correlates with muscle strength. METHODS Seven CP children, eight TD children and ten young healthy adults (YHA) performed an all-out fatigue test of 35 maximal concentric knee extension and flexion contractions on an isokinetic dynamometer. Angular velocity was set at 60°/s. Peak torque (PT) was determined per repetition and either normalized to bodyweight or maximum voluntary torque. Surface-EMG of quadriceps and hamstring muscles was measured to obtain changes in median frequency (EMG-mf) and smooth rectified EMG amplitude per contraction. RESULTS Decline in PT differed between all groups for extensors and flexors, where YHA showed the largest decline and CP children the smallest decline over the course of the test. YHA showed a larger decline in EMG-mf of all quadriceps and hamstrings than TD and CP children, while TD children showed a larger decline in EMG-mf of m.rectus femoris and m.vastus lateralis than CP children. INTERPRETATION Results confirm that children with CP show lower fatigability than TD children and that the lower fatigability coincides with lower maximal muscle strength.
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Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy. J Pediatr Gastroenterol Nutr 2013; 56:233-8. [PMID: 22983381 DOI: 10.1097/mpg.0b013e318272cbf4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case-control study of IgG antibodies against other dietary antigens, AGA, anti-tTG, and IgE antibodies against wheat and gluten. METHODS Sera from 99 cases with CP and 99 healthy, age- and sex-matched controls were analysed with fluorescence enzyme-linked immunosorbent assay for detection of IgG antibodies against β-lactoglobulin, casein, egg white, IgG- and IgA-AGA, IgA-anti-tTG, and IgE antibodies against gluten and wheat. RESULTS Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β-lactoglobulin was 17.0 (95% confidence interval [CI] 2.3-128), against casein 11.0 (95% CI 2.6-46.8), and against egg white 7.0 (95% CI 1.6-30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA-anti-tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology. CONCLUSIONS Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.
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Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130:e1285-312. [PMID: 23045562 DOI: 10.1542/peds.2012-0924] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages. METHODS A search was conducted of the databases PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; >90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist. RESULTS A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 LEVELS OF EVIDENCE: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed. CONCLUSIONS Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Sydney, Australia.
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Elkamil AI, Andersen GL, Skranes J, Lamvik T, Vik T. Botulinum neurotoxin treatment in children with cerebral palsy: a population-based study in Norway. Eur J Paediatr Neurol 2012; 16:522-7. [PMID: 22325829 DOI: 10.1016/j.ejpn.2012.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 01/02/2012] [Accepted: 01/07/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIM To study proportions and characteristics of children treated and un-treated with Botulinum neurotoxin (BoNT) in a population-based cohort of children with cerebral palsy (CP). METHODS All children with CP born during 1999-2003, recorded in the Norwegian CP Register were included (N=411). Gross motor function was assessed using the gross motor classification system (GMFCS). RESULTS Sixty-eight percent of children with bilateral spastic, 63% with unilateral spastic and 41% with dyskinetic CP had received BoNT. The percentage of children treated increased from 62% at GMFCS level I to 88% at level IV, but was only 38% among children at level V. A similar trend was seen for fine motor function. Ninety-four percent of the children received BoNT in their lower limbs. Children without significant cognitive impairment were more often treated than children with such impairment (OR: 2.61; 95% CI: 1.49-4.58). INTERPRETATION In this first population-based study, approximately 2/3 of all children with spastic CP were treated with BoNT. The results suggest preference for treatment of children with potential for functional improvement, while treatment to relieve pain and facilitate care, and of children with cognitive impairment appeared to be less common. Whether the latter groups are treated appropriately requires further studies.
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Affiliation(s)
- Areej I Elkamil
- Department of Laboratory Medicine, Children's and Women's Health (LBK), Norwegian University of Science and Technology, Trondheim, Norway.
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Magnuson B, Peppard A, Auer Flomenhoft D. Hypocaloric considerations in patients with potentially hypometabolic disease States. Nutr Clin Pract 2011; 26:253-60. [PMID: 21586410 DOI: 10.1177/0884533611405673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The provision of nutrition has traditionally been driven by the desire to provide adequate calories. However, over the past decade it has become evident that provision of excess calories can be detrimental to patients' outcomes in both critical care and long-term care settings. This review examines patient populations for whom hypocaloric nutrition can be both appropriate and beneficial. In specific situations, critically ill patients, such as those with obesity, stroke, and spinal cord injury, may have decreased energy requirements. In patients with spinal cord injury, the level of injury significantly correlates with the extent of reduced caloric energy expenditure. Ventilator-dependent patients with amyotrophic lateral sclerosis (ALS) have decreased energy needs; energy expenditure for ALS patients is lower than the predictive equation value. Aging patients will have decreased energy needs relative to a reduction in lean body mass. Patients with cerebral palsy (CP) have significantly lower caloric requirements than anticipated using predictive equations. Patients with CP pose a particular challenge in nutrition assessment. Several studies demonstrate that patients with CP have significantly lower caloric requirements than anticipated using predictive equations; thus, patients with CP benefit from indirect calorimetry. Provision of nutrition for obese patients is briefly addressed, as this is an increasingly important consideration for nutrition support in both the critical care and long-term care settings. When indirect calorimetry is not available, clinicians should remember that most patients will have low resting energy expenditure regardless of functional status and require frequent evaluation during institution of nutrition recommendations to guard against overfeeding and obesity.
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Masia L, Frascarelli F, Morasso P, Di Rosa G, Petrarca M, Castelli E, Cappa P. Reduced short term adaptation to robot generated dynamic environment in children affected by Cerebral Palsy. J Neuroeng Rehabil 2011; 8:28. [PMID: 21600031 PMCID: PMC3117777 DOI: 10.1186/1743-0003-8-28] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 05/21/2011] [Indexed: 11/20/2022] Open
Abstract
Background It is known that healthy adults can quickly adapt to a novel dynamic environment, generated by a robotic manipulandum as a structured disturbing force field. We suggest that it may be of clinical interest to evaluate to which extent this kind of motor learning capability is impaired in children affected by cerebal palsy. Methods We adapted the protocol already used with adults, which employs a velocity dependant viscous field, and compared the performance of a group of subjects affected by Cerebral Palsy (CP group, 7 subjects) with a Control group of unimpaired age-matched children. The protocol included a familiarization phase (FA), during which no force was applied, a force field adaptation phase (CF), and a wash-out phase (WO) in which the field was removed. During the CF phase the field was shut down in a number of randomly selected "catch" trials, which were used in order to evaluate the "learning index" for each single subject and the two groups. Lateral deviation, speed and acceleration peaks and average speed were evaluated for each trajectory; a directional analysis was performed in order to inspect the role of the limb's inertial anisotropy in the different experimental phases. Results During the FA phase the movements of the CP subjects were more curved, displaying greater and variable directional error; over the course of the CF phase both groups showed a decreasing trend in the lateral error and an after-effect at the beginning of the wash-out, but the CP group had a non significant adaptation rate and a lower learning index, suggesting that CP subjects have reduced ability to learn to compensate external force. Moreover, a directional analysis of trajectories confirms that the control group is able to better predict the force field by tuning the kinematic features of the movements along different directions in order to account for the inertial anisotropy of arm. Conclusions Spatial abnormalities in children affected by cerebral palsy may be related not only to disturbance in motor control signals generating weakness and spasticity, but also to an inefficient control strategy which is not based on a robust knowledge of the dynamical features of their upper limb. This lack of information could be related to the congenital nature of the brain damage and may contribute to a better delineation of therapeutic intervention.
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Affiliation(s)
- Lorenzo Masia
- Robotics Brain and Cognitive Sciences Dept,, Italian Institute of Technology, Genoa, Italy.
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Chiarello LA, Palisano RJ, Bartlett DJ, McCoy SW. A multivariate model of determinants of change in gross-motor abilities and engagement in self-care and play of young children with cerebral palsy. Phys Occup Ther Pediatr 2011; 31:150-68. [PMID: 20964514 DOI: 10.3109/01942638.2010.525601] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A multivariate model of determinants of change in gross-motor ability and engagement in self-care and play provides physical and occupational therapists a framework for decisions on interventions and supports for young children with cerebral palsy and their families. Aspects of the child, family ecology, and rehabilitation and community services may influence children's activity and participation. Aspects of the child include primary and secondary impairments, associated and comorbid health conditions, and adaptive behaviors. Literature support for the model is reviewed. A clinical scenario illustrates the use of the model as a framework for practice. The model encourages therapists to broaden the focus of rehabilitation services for young children with CP to include not only development of motor abilities but also comprehensive interventions and supports to enhance participation in daily activities and routines. Therapists are encouraged to consider how child, family, and service factors interact when planning interventions and evaluating outcomes.
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Affiliation(s)
- Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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Borggraefe I, Schaefer JS, Klaiber M, Dabrowski E, Ammann-Reiffer C, Knecht B, Berweck S, Heinen F, Meyer-Heim A. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. Eur J Paediatr Neurol 2010; 14:496-502. [PMID: 20138788 DOI: 10.1016/j.ejpn.2010.01.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 01/09/2010] [Accepted: 01/16/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Task-specific body-weight-supported treadmill therapy improves walking performance in children with central gait impairment. The aim of the study was to investigate the effect of robotic-assisted treadmill therapy on standing and walking performance in children and adolescents with cerebral palsy and to determine parameters influencing outcome. METHODS 20 Patients (mean age 11.0 ± 5.1, 10 males and 10 females) with cerebral palsy underwent 12 sessions of robotic-assisted treadmill therapy using the driven gait orthosis Lokomat. Outcome measures were the dimensions D (standing) and E (walking) of the Gross Motor Function Measure (GMFM). RESULTS Significant improvements in dimension D by 5.9% (± 5.2, p=0.001) and dimension E by 5.3% (± 5.6, p<0.001) of the GMFM were achieved. Improvements in the GMFM D and E were significantly greater in the mildly affected cohort (GMFCS I and II) compared to the more severely affected cohort (GMFCS III and IV). Improvement of the dimension E but not of D correlated positively with the total distance and time walked during the trial (r(s)=0.748, p<0.001). CONCLUSIONS Children and adolescents with bilateral spastic cerebral palsy showed improvements in the functional tasks of standing and walking after a 3-week trial of robotic-assisted treadmill therapy. The severity of motor impairment affects the amount of the achieved improvement.
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Affiliation(s)
- Ingo Borggraefe
- Department of Paediatric Neurology and Developmental Medicine, Dr. von Haunersches Children's Hospital, University of Munich, Germany.
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Mwaniki MK, Gatakaa HW, Mturi FN, Chesaro CR, Chuma JM, Peshu NM, Mason L, Kager P, Marsh K, English M, Berkley JA, Newton CR. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years. BMC Public Health 2010; 10:591. [PMID: 20925939 PMCID: PMC2965720 DOI: 10.1186/1471-2458-10-591] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 10/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. METHODS Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old) admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1(st) 1990 up to December 31(st) 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. RESULTS The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45-1.21). Most of the increase in burden was from neonates born in hospital and very young neonates aged < 7 days. Hospital deliveries also increased significantly. Clinical diagnoses of neonatal sepsis, prematurity, neonatal jaundice, neonatal encephalopathy, tetanus and neonatal meningitis accounted for over 75% of the inpatient neonatal admissions. Inpatient case fatality for all ≤ 5 years declined significantly over the 19 years. However, neonatal deaths comprised 33% of all inpatient death among children aged ≤ 5 years in 1990, this increased to 55% by 2008. Tetanus 256/390 (67%), prematurity 554/1,280(43%) and neonatal encephalopathy 253/778(33%) had the highest case fatality. A combination of six indicators: irregular respiration, oxygen saturation of <90%, pallor, neck stiffness, weight < 1.5 kg, and abnormally elevated blood glucose > 7 mmol/l predicted inpatient neonatal death with a sensitivity of 81% and a specificity of 68%. CONCLUSIONS There is clear evidence of increasing burden in neonatal admissions at a rural district hospital in contrast to reducing numbers of non-neonatal paediatrics' admissions aged ≤ 5 years. Though the inpatient case fatality for all admissions aged ≤ 5 years declined significantly, neonates now comprise close to 60% of all inpatient deaths. Simple indicators may identify neonates at risk of death.
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Affiliation(s)
- Michael K Mwaniki
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, Kenya.
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Himmelmann K, Hagberg G, Uvebrant P. The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002. Acta Paediatr 2010; 99:1337-43. [PMID: 20377538 DOI: 10.1111/j.1651-2227.2010.01819.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to describe the prevalence and origin of cerebral palsy (CP), which is the tenth report from the western Swedish study. METHODS A population-based study covering 85,737 live births in the area in 1999-2002. Birth characteristics and neuroimaging findings were recorded, prevalence of CP was calculated and aetiology was analysed. RESULTS CP was found in 186 children. The crude prevalence was 2.18 per 1000 live births. The gestational age-specific prevalence for <28 gestational weeks was 55.6 per 1000 live births, whereas it was 43.7 for 28-31 weeks, 6.1 for 32-36 weeks and 1.43 per 1000 for >36 weeks. There was a female majority among children born at term and a male predominance in children born preterm. Hemiplegia accounted for 38%, diplegia for 32%, tetraplegia for 7%, whereas 17% had dyskinetic CP and 5% ataxia. Neuroimaging showed white-matter lesions in 31% and cortical/subcortical lesions in 29%. The aetiology was considered to be prenatal in 36%, peri/neonatal in 42%, whereas it remained unclassified in 21%. CONCLUSION The decrease in CP prevalence observed since the 1980s had ceased. An increase in children born at term and in dyskinetic CP was found. In children born before 28 weeks of gestation, the prevalence decreased significantly. White-matter and cortical/subcortical lesions dominated on neuroimaging.
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Affiliation(s)
- K Himmelmann
- Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
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Westbom L, Lundkvist Josenby A, Wagner P, Nordmark E. Growth in children with cerebral palsy during five years after selective dorsal rhizotomy: a practice-based study. BMC Neurol 2010; 10:57. [PMID: 20594320 PMCID: PMC2913912 DOI: 10.1186/1471-2377-10-57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 07/01/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Overweight is reported as a side effect of SDR. The aims were to study the development of weight, height and body mass index (BMI) during five years after SDR. METHODS This prospective, longitudinal and practice-based study included all 56 children with CP spastic diplegia undergoing SDR from the start in March 1993 to April 2003 in our hospital. The preoperative Gross Motor Function Classification System (GMFCS) levels were I-II in 17, III in 15, IV-V in 24 children. Median age at SDR was 4.3 years (range 2.4-7.4 years). Weight and height/recumbent length were measured. Swedish growth charts for typically developing children generated weight, height and BMI z-scores for age and gender. RESULTS The preoperative median z-scores were for height -1.92 and for body mass index (BMI) -0.22. Five years later, the median BMI z-score was increased by + 0.57 (p < 0.05). The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05). Baseline BMI and age at the start of follow-up influenced the BMI change during the five years (p < 0.001 and p < 0.05 respectively).The individual growth was highly variable, but a tendency towards increasing stunting with age was seen in severe gross motor dysfunction (GMFCS levels IV-V) and the opposite, a slight catch-up of height in children with walking ability (GMFCS levels I-III). CONCLUSIONS These are the first available subtype- and GMFCS-specific longitudinal growth data for children with CP spastic diplegia. Their growth potential according to these data should be regarded as a minimum, as some children were undernourished. It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic".For some children the weight increase was highly desirable. In others, it resulted in overweight and obesity with risk of negative health effects. Weight and height should be monitored to enable early prevention of weight aberrations also causing problems with mobility, activity and participation.
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Affiliation(s)
- Lena Westbom
- Division of Paediatrics, Department of Clinical Sciences (Lund), Lund University, Lund, Sweden
- Children's Hospital, Skåne University Hospital, SE 221 85 Lund, Sweden
| | - Annika Lundkvist Josenby
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
- Children's Hospital, Skåne University Hospital, SE 221 85 Lund, Sweden
| | - Philippe Wagner
- Swedish National Competence Centre for Musculoskeletal Disorders (NKO), Department of Orthopaedics, Skåne University Hospital, SE 221 85 Lund, Sweden
| | - Eva Nordmark
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
- Children's Hospital, Skåne University Hospital, SE 221 85 Lund, Sweden
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Loeters MJB, Maathuis CGB, Hadders-Algra M. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol 2010; 52:605-11. [PMID: 20345960 DOI: 10.1111/j.1469-8749.2010.03617.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Scoliosis is a frequently occurring and serious complication of severe cerebral palsy (CP). This systematic review aims to the assess the risk factors associated with the emergence and progression of scoliosis in children with CP functioning at level IV or V of the Gross Motor Function Classification System (GMFCS). METHOD Relevant studies conducted from 1966 to March 2009 were identified in Embase, Medline, and Scopus. The methodological quality of the studies was assessed and relations between risk factors and scoliosis were documented systematically. RESULTS Ten studies were included. They had a low level of evidence and heterogeneous methodological quality. No systematic associations were found between type of CP and scoliosis or between age, type, and location of scoliotic curve and progression of scoliosis. Weak evidence was present for an association between the severity of CP, hip dislocation, and pelvic obliquity and scoliosis. INTERPRETATION The low level of evidence precludes the drawing of firm conclusions on risk factors for the emergence and progression of scoliosis in children with severe CP. However, given the high prevalence of the disorder and its serious consequences for daily life, more research in this area is urgently needed.
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Affiliation(s)
- Marianne J B Loeters
- Department of Paediatrics-Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
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Simard-Tremblay E, Shevell M, Dagenais L. Determinants of ambulation in children with spastic quadriplegic cerebral palsy: a population-based study. J Child Neurol 2010; 25:669-73. [PMID: 19794101 DOI: 10.1177/0883073809342590] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to identify factors that predict ambulation in spastic quadriplegic cerebral palsy. A 4-year registry-based birth cohort was searched for patients with a diagnosis of spastic quadriplegic cerebral palsy. All patients were then divided in 2 groups: (a) Gross Motor Function Classification System level < or = III (ambulant group) and (b) Gross Motor Function Classification System level > or = IV (nonambulant group). Clinical features were then compared between the 2 groups. A total of 85 children with a diagnosis of spastic quadriplegic cerebral palsy were identified. Of these, 65 and 20 were classified in the ''nonambulant'' and ''ambulant'' groups, respectively. The presence of seizures in the first 24 or 72 hours of life and the administration of antibiotics during pregnancy/delivery were all associated with an eventual inability to achieve ambulation. A gestational age < or = 27 weeks, birth weight <1000 g, Caucasian mother, and the presence of hyperbilirubinemia were significantly linked with independent ambulation.
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Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy. Disabil Rehabil 2010; 32:1910-6. [DOI: 10.3109/09638281003763796] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pierce SR, Prosser LA, Lauer RT. Relationship between age and spasticity in children with diplegic cerebral palsy. Arch Phys Med Rehabil 2010; 91:448-51. [PMID: 20298838 DOI: 10.1016/j.apmr.2009.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 11/13/2009] [Accepted: 11/17/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the relationship between passive torque, reflex activity, co-contraction, and age during the assessment of spasticity of knee flexors and extensors in children with spastic diplegic cerebral palsy (CP). DESIGN Retrospective. SETTING Pediatric orthopedic hospital. PARTICIPANTS Children (N=36) with spastic diplegic CP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Spasticity of the knee flexors and knee extensors (as measured by peak passive torque, mean passive torque, reflex activity of the medial hamstrings, reflex activity of vastus lateralis, and co-contraction) was assessed during passive movements completed using an isokinetic dynamometer with concurrent electromyography. RESULTS A significant positive relationship was found between age and mean knee flexor passive torque (P<.05), while a significant negative relationship was found between age and mean percentage of the range of motion with co-contraction (P<.05). CONCLUSIONS Our results suggest that passive stiffness may play a larger role in spasticity than reflex activity as children with spastic diplegic CP age. Additional research is needed to determine whether subject age could influence the effectiveness of interventions, such as serial casting or botulinum toxin, for spasticity in children with spastic diplegic CP.
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The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
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Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, Deagostini MC, Bontempo S, Todros T. Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol 2009; 5:62-71. [PMID: 19965547 DOI: 10.2215/cjn.05660809] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Although successful pregnancy is rare, results attained with higher dialysis efficiency and the spread of dialysis to different cultural and religious settings are changing the panorama. In this study, we systematically review the recent literature (2000 through 2008) on pregnancy in dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Medline on OVID was searched in November 2008, with MESH and free terms on pregnancy and chronic kidney disease or dialysis; limits were human subjects and English-language articles. Case reports were excluded to minimize publication bias. The final selection and extraction of data were performed in duplicate. RESULTS From 2840 references, 241 full-text articles were retrieved; eight fulfilled the selection criteria, and two were added from reference lists. In the 10 studies (nine of 10 monocentric), 90 pregnancies were observed in 78 patients (range of cases five to 15). The studies were heterogeneous for definition of outcomes, duration (2 to 16 yr), period (1988 through 1998 to 2000 through 2006), age (25 to 35 yr), and support and dialysis therapy. Daily dialysis was frequently used; type of treatment, membranes, and flows varied widely. Hypertension and anemia were frequent concerns for the mothers. Intrauterine deaths, hydramnios, and small-for-gestational-age or preterm infants were frequent. The possibility of a healthy offspring ranged from 50 to 100% (overall 76.25%). CONCLUSIONS Evidence on pregnancy in dialysis is heterogeneous; however, the growing number of reports worldwide and the improving results suggest that we should reconsider our counseling policy, which only rarely includes pregnancy in dialysis patients.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Unit of Nephrology, Department of Clinical and Biological Sciences, University of san Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy.
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Komorbiditäten bei Zerebralparesen. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-2039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Outcomes for the extremely premature infant: what is new? And where are we going? Pediatr Neurol 2009; 40:189-96. [PMID: 19218032 DOI: 10.1016/j.pediatrneurol.2008.09.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 02/07/2023]
Abstract
Two approaches were taken to determine what is new and where we are going in terms of outcomes for the extremely premature infant: publications from 2004 to 2007 were reviewed, and the 30-year outcome at the authors' institutions was assessed. Recent literature documents improving early childhood outcomes in the face of improved survival. Childhood cerebral palsy prevalence rates have been reported to be as low as 19 per 1000 live births for infants born at 20-27 weeks gestation. Vision and hearing loss have been reported in fewer than 1% of survivors. The rate of overall intellectual impairment has not improved, although impairment was reduced in a recent trial of caffeine therapy for apnea of prematurity, and this remains an important area for study. In sum, recent findings herald a more positive perspective on the outcome for extremely premature survivors. It can thus be expected that new intensive-care trials will attempt to reduce the proportion of survivors with adverse outcomes. Childhood assessments will have a greater focus on function and participation. Information on improved outcomes for preterm infants will inform guidelines of decision making used to help parents to determine what is best for their child. The audit component of follow-up studies will expand and more cohort and trial studies will become multicenter, national, and international.
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Abstract
PURPOSE OF REVIEW To use evidence of good medical quality to update information on strategies for prevention of cerebral palsy, and on the success of these preventive efforts to date. RECENT FINDINGS Causes of cerebral palsy, and therefore promising approaches to prevention, differ by gestational age group and by clinical subtype. Neuroimaging and neuropathology indicate the importance of white matter disorders and of ischemic stroke in cerebral palsy; birth asphyxia, congenital malformations, placental pathology, and genetic variants also contribute to cerebral palsy risk. Multiplicity of risk factors markedly increases risk. Recent studies indicate that mild hypothermia lessens cerebral palsy risk in term infants with moderate neonatal encephalopathy, and the possibility that administration of magnesium sulphate to women in preterm labor may aid in primary prevention of cerebral palsy in very preterm infants. SUMMARY Past efforts to prevent cerebral palsy have not had the benefits sought, but recent results provide new hope and new challenges.
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Okereafor A, Allsop J, Counsell SJ, Fitzpatrick J, Azzopardi D, Rutherford MA, Cowan FM. Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008; 121:906-14. [PMID: 18450893 DOI: 10.1542/peds.2007-0770] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We studied (1) the pattern of brain injury in term neonates with encephalopathy with evidence of a preceding hypoxic sentinel event, (2) prenatal and perinatal risk factors, and (3) the correlation between neuroimaging findings and developmental outcomes. METHODS We identified, among 500 term neonates with encephalopathy who were studied with MRI between 1992 and 2005, 48 infants with evidence of a preceding acute hypoxic event, and we reviewed their MRI scans retrospectively. Prenatal and perinatal data were compared with those for term normal low-risk infants. Neurodevelopmental outcomes were assessed at a minimum of 12 months. RESULTS Five patterns of brain injury were identified, as follows: pattern I, basal ganglia and thalami lesions associated with severe white matter damage (n = 6; 14%); pattern II, basal ganglia and thalami lesions with mild or moderate white matter changes (n = 24; 56%); pattern III, isolated thalamic injury (n = 2; 5%); pattern IV, moderate white matter damage only (n = 1; 2%); pattern V, mild white matter changes or normal findings (n = 10; 23%). No scan showed evidence of long-standing injury. The internal capsule was abnormal in 93% of infants with patterns I and II, and 86% of those infants died or developed cerebral palsy. Infants with patterns III and IV had developmental delay and diplegic cerebral palsy, respectively. Pattern V was associated with normal outcomes. Case infants were significantly more often of African descent, born to pluriparous or hypertensive mothers. Uterine rupture followed previous cesarean section in 8 of 11 cases. Cord prolapse accompanied undiagnosed breech presentation in 4 of 9 cases. CONCLUSIONS Basal ganglia and thalami lesions are the imaging signature in term neonates exposed to hypoxic-ischemic sentinel events. Patterns of central gray matter and secondary white matter injury were associated with higher risks of severe morbidity and death. Affected infants did not seem intrinsically different from our low-risk population. These data support the need for anticipating sentinel events and expediting delivery.
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Affiliation(s)
- Akudo Okereafor
- Department of Paediatrics and Neonatal Medicine, Hammersmith Hospital, Du Cane Rd, London, W12 OHS, United Kingdom
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