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Basoya S, Kumar S, Wanjari A. Cerebral Palsy: A Narrative Review on Childhood Disorder. Cureus 2023; 15:e49050. [PMID: 38116360 PMCID: PMC10728574 DOI: 10.7759/cureus.49050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
Cerebral palsy, one of the most common reasons for infirmity in children and young people in developed countries, refers to several neurological diseases that impact movement and coordination. Central nervous system damage received during the first stages of brain development can cause cerebral palsy, a non-progressive condition that manifests as impairments of movement and posture. Two cases per 1000 are reported, and the causes include those mentioned for high-risk infants. Mental retardation, sensory deficiencies, failure to thrive, seizures, and behavioral or emotional issues are some of the associated difficulties. To enable interdisciplinary intervention, early identification is crucial. The result varies depending on the topography, severity, and presence of concomitant abnormalities in cerebral palsy. Cerebral palsy is caused by a static injury to the cerebral motor cortex that happens before, during, or within five years after birth. Various circumstances can influence the disease, including cerebral anoxia, cerebral hemorrhage, infection, and hereditary disorders. Interventions for children are typically provided as part of multidisciplinary rehabilitation programs. Musculoskeletal complaints are common, and pain is a significant underreported symptom.
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Affiliation(s)
- Sakshi Basoya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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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Muthukumar S, Mehrotra K, Fouda M, Hamimi S, Jantzie LL, Robinson S. Prenatal and postnatal insults differentially contribute to executive function and cognition: Utilizing touchscreen technology for perinatal brain injury research. Exp Neurol 2022; 354:114104. [PMID: 35525306 PMCID: PMC10085749 DOI: 10.1016/j.expneurol.2022.114104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 12/19/2022]
Abstract
The use of touchscreen technology to evaluate cognitive deficits in animal models has grown tremendously over the past 20 years. The touchscreen apparatus encompasses many advantages, namely a high level of standardization and translational capability. Improvements in technology in recent years have expanded the versatility of the touchscreen platform, as it is able to test distinct cognitive modalities including working memory, attention, discrimination, and association. Importantly, touchscreen technology has allowed researchers to explore deficits in multiple pillars of cognition in a wide variety of perinatal disorders with neurological sequelae across critical developmental windows. The touchscreen platform has been used to dissect deficits in antenatal CNS injury including fetal alcohol syndrome, prenatal opioid exposure, and chorioamnionitis, to peripartum insults such as term hypoxic-ischemic encephalopathy, to early postnatal insults including infantile traumatic brain injury. Most importantly, touchscreen technology offers the sensitivity necessary to detect subtle injury and treatment-induced changes in cognition and executive function beyond those offered by more rudimentary tests of rodent cognition. Understanding the pathophysiology of these disorders in rodents is paramount to addressing these deficits in human infants and dissecting the neural circuitry essential to perinatal brain injury pathophysiology and responsiveness to novel therapeutics. Touchscreen testing provides an effective, facile, sophisticated technique to accelerate the goal of improving cognitive and behavioral outcomes of children who suffer perinatal brain injury.
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Affiliation(s)
- Sankar Muthukumar
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karnika Mehrotra
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammed Fouda
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Hamimi
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren L Jantzie
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Xue Y, Shi S, Zheng S, Yang Z, Xu J, Gong F. Therapeutic effect of scalp-based acupuncture and moxibustion as an adjunctive treatment on children with cerebral palsy comparing to conventional rehabilitation therapy: a systematic review and meta-analysis of randomized controlled trials. Transl Pediatr 2022; 11:631-641. [PMID: 35685079 PMCID: PMC9173885 DOI: 10.21037/tp-22-85] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) in children is a predominantly congenital developmental disease with complex causes and diverse symptoms. Chinese medicine mainly uses acupuncture for the treatment of CP; as the disease site is in the brain, emphasis is placed on scalp acupuncture therapy. There were studies about the treatment but different studies had very different results. In this study, we performed a systematic review and meta-analysis of the recent reports on scalp acupuncture in the treatment of CP in children, providing evidence for clinical diagnosis and treatment. METHODS The databases of PubMed, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), and VIP were searched for randomized controlled trials (RCTs) on scalp acupuncture treatment of pediatric CP published from January 2000 to December 2021. The inclusion criteria of studies were made according to the Participants, Intervention, Control, Outcomes, Study design (PICOS) principles. The Cochrane risk of bias 2.0 was used to evaluate the bias of the included literature. Meta-analysis was performed using the effective rate, Mental Development Index (MDI), Psychological Development Index (PDI), and Gross Motor Function Measure (GMFM-88 scale) as outcome indicators for the efficacy, and the safety of scalp acupuncture was assessed. RESULTS Initially, 332 articles were retrieved; after screening, 11 articles were included in the selection, including a total of 731 children, with 369 and 362 children for the experimental group and control group respectively. Meta-analysis showed that scalp acupuncture significantly improved the symptoms of children with CP [odds ratio (OR) =3.73, 95% confidence interval (CI): 2.49-5.58, Z=6.41, P<0.00001], could significantly improve their mental development [mean difference (MD) =15.58, 95% CI: 11.74-19.43, Z=7.95, P<0.00001] and psychological development (MD =13.23, 95% CI: 6.17-20.28, Z=3.67, P=0.0002) of children, and significantly improved the motor ability of CP children (MD =17.45, 95% CI: 8.19-26.72, Z=3.69, P=0.0002). DISCUSSION The curative effect of scalp acupuncture is better than that of conventional rehabilitation. Scalp-based acupuncture therapy can effectively improve the symptoms of pediatric CP, promote the mental and psychological development of children, and improve their gross motor function, the treatment is safe.
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Affiliation(s)
- Yuman Xue
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Department of Rehabilitation II, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
| | - Shuai Shi
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Department of Rehabilitation III, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
| | - Shuang Zheng
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Key Disciplines Office, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
| | - Zhongfeng Yang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Department of Rehabilitation Center, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
| | - Jiaben Xu
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Department of Massage II, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
| | - Feifei Gong
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China.,Department of Rehabilitation II, Second Affiliated Hospital of Traditional Chinese Medicine of Heilongjiang University, Harbin, China
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Jantzie L, Muthukumar S, Kitase Y, Vasan V, Fouda MA, Hamimi S, Burkhardt C, Burton VJ, Gerner G, Scafidi J, Ye X, Northington F, Robinson S. Infantile Cocktail of Erythropoietin and Melatonin Restores Gait in Adult Rats with Preterm Brain Injury. Dev Neurosci 2022; 44:266-276. [PMID: 35358965 PMCID: PMC10066804 DOI: 10.1159/000524394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of physical disability for children worldwide. Many infants and toddlers are not diagnosed with CP until they fail to achieve obvious motor milestones. Currently, there are no effective pharmacologic interventions available for infants and toddlers to substantially improve their trajectory of neurodevelopment. Because children with CP from preterm birth also exhibit a sustained immune system hyper-reactivity, we hypothesized that neuro-immunomodulation with a regimen of repurposed endogenous neurorestorative medications, erythropoietin (EPO) and melatonin (MLT), could improve this trajectory. Thus, we administered EPO + MLT to rats with CP during human infant-toddler equivalency to determine whether we could influence gait patterns in mature animals. After a prenatal injury on embryonic day 18 (E18) that mimics chorioamnionitis at ∼25 weeks human gestation, rat pups were born and raised with their dam. Beginning on postnatal day 15 (P15), equivalent to human infant ∼1 year, rats were randomized to receive either a regimen of EPO + MLT or vehicle (sterile saline) through P20. Gait was assessed in young adult rats at P30 using computerized digital gait analyses including videography on a treadmill. Results indicate that gait metrics of young adult rats treated with an infantile cocktail of EPO + MLT were restored compared to vehicle-treated rats (p < 0.05) and similar to sham controls. These results provide reassuring evidence that pharmacological interventions may be beneficial to infants and toddlers who are diagnosed with CP well after the traditional neonatal window of intervention.
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Affiliation(s)
- Lauren Jantzie
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Sankar Muthukumar
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuma Kitase
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vikram Vasan
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohammed A. Fouda
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah Hamimi
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Vera Joanna Burton
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Gwendolyn Gerner
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Joseph Scafidi
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Infant Neurodevelopment, Kennedy Krieger Institute, Baltimore, MD
| | - Xiaobu Ye
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Frances Northington
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shenandoah Robinson
- Dept. of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Dept. of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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Tamboosi ME, Al-Khathami SS, El-Shamy SM. The effectiveness of tele-rehabilitation on improvement of daily living activities in children with cerebral palsy: narrative review. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [PMCID: PMC8702376 DOI: 10.1186/s43161-021-00055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim To investigate the effectiveness of tele-rehabilitation for children diagnosed with unilateral cerebral palsy. Method The design of this study is a narrative review. An electronic search was conducted for studies that related to tele-rehabilitation using the following databases: CINAHL, PubMed, MEDLINE, OTSeeker, and PEDro. The data extracted were analyzed by evaluating them according to the key results, limitations, suitability of the methods used to the initial hypothesis, interpretation of the results, and impact of the conclusions in the field. Results Out of 139 studies, 3 studies met the inclusion criteria. Further, manual searches of the references of included studies identified 2 more relevant studies. The interventions applied in those studies were web-based multi-modal therapy program using Move-it-to-improve-it (Mitii™), home-based hand-arm bimanual intensive therapy (H-HABIT), and lower-extremity functional training (LIFT). The outcomes were executive functions, occupational performance, activity capacity, dexterity, quality of bimanual hand-use, functional goals, gait capacity, and performance. Conclusion Tele-rehabilitation is effective in improving the functions of the upper and lower extremities in daily living activities for children with unilateral cerebral palsy (UCP), aged between 2 to 18 years old, classified to levels I and II in GMFCS and levels I, II, and III in MACS. Webcam and good internet connection are essential requirements to conduct tele-rehabilitation. Children need to be contacted weekly via phone or e-mail for further follow-ups. Additionally, tele-rehabilitation may be considered one of the intervention strategies for patients who live in rural areas.
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Francisco-Martínez C, Prado-Olivarez J, Padilla-Medina JA, Díaz-Carmona J, Pérez-Pinal FJ, Barranco-Gutiérrez AI, Martínez-Nolasco JJ. Upper Limb Movement Measurement Systems for Cerebral Palsy: A Systematic Literature Review. SENSORS 2021; 21:s21237884. [PMID: 34883885 PMCID: PMC8659477 DOI: 10.3390/s21237884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 01/06/2023]
Abstract
Quantifying the quality of upper limb movements is fundamental to the therapeutic process of patients with cerebral palsy (CP). Several clinical methods are currently available to assess the upper limb range of motion (ROM) in children with CP. This paper focuses on identifying and describing available techniques for the quantitative assessment of the upper limb active range of motion (AROM) and kinematics in children with CP. Following the screening and exclusion of articles that did not meet the selection criteria, we analyzed 14 studies involving objective upper extremity assessments of the AROM and kinematics using optoelectronic devices, wearable sensors, and low-cost Kinect sensors in children with CP aged 4–18 years. An increase in the motor function of the upper extremity and an improvement in most of the daily tasks reviewed were reported. In the population of this study, the potential of wearable sensors and the Kinect sensor natural user interface as complementary devices for the quantitative evaluation of the upper extremity was evident. The Kinect sensor is a clinical assessment tool with a unique markerless motion capture system. Few authors had described the kinematic models and algorithms used to estimate their kinematic analysis in detail. However, the kinematic models in these studies varied from 4 to 10 segments. In addition, few authors had followed the joint assessment recommendations proposed by the International Society of Biomechanics (ISB). This review showed that three-dimensional analysis systems were used primarily for monitoring and evaluating spatiotemporal variables and kinematic parameters of upper limb movements. The results indicated that optoelectronic devices were the most commonly used systems. The joint assessment recommendations proposed by the ISB should be used because they are approved standards for human kinematic assessments. This review was registered in the PROSPERO database (CRD42021257211).
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Affiliation(s)
- Celia Francisco-Martínez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Juan Prado-Olivarez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
- Correspondence: ; Tel.: +52-(461)-111-2862
| | - José A. Padilla-Medina
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Javier Díaz-Carmona
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Francisco J. Pérez-Pinal
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Alejandro I. Barranco-Gutiérrez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Juan J. Martínez-Nolasco
- Mechatronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico;
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Li S, Luo X, Zhang S, Tang Y, Sun J, Meng Q, Yu H, Sun C. Evaluation of Multilevel Surgeries in Children With Spastic Cerebral Palsy Based on Surface Electromyography. Front Neurosci 2021; 15:680645. [PMID: 34335161 PMCID: PMC8319621 DOI: 10.3389/fnins.2021.680645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
The root mean square (RMS) of the surface electromyography (sEMG) signal can respond to neuromuscular function, which displays a positive correlation with muscle force and muscle tension under positive and passive conditions, respectively. The purpose of this study was to investigate the changes in muscle force and tension after multilevel surgical treatments, functional selective posterior rhizotomy (FSPR) and tibial anterior muscle transfer surgery, and evaluate their clinical effect in children with spastic cerebral palsy (SCP) during walking. Children with diplegia (n = 13) and hemiplegia (n = 3) with ages from 4 to 18 years participated in this study. They were requested to walk barefoot at a self-selected speed on a 15-m-long lane. The patient's joints' range of motion (ROM) and sEMG signal of six major muscles were assessed before and after the multilevel surgeries. The gait cycle was divided into seven phases, and muscle activation state can be divided into positive and passive conditions during gait cycle. For each phase, the RMS of the sEMG signal amplitude was calculated and also normalized by a linear envelope (10-ms running RMS window). The muscle tension of the gastrocnemius decreased significantly during the loading response, initial swing, and terminal swing (p < 0.05), which helped the knee joint to get the maximum extension when the heel is on the ground and made the heel land smoothly. The muscle force of the gastrocnemius increased significantly (p < 0.05) during the mid-stance, terminal stance, and pre-swing, which could generate the driving force for the human body to move forward. The muscle tension of the biceps femoris and semitendinosus decreased significantly (p < 0.05) during the terminal stance, pre-swing, and initial swing. The decreased muscle tension could relieve the burden of the knee flexion when the knee joint was passively flexed. At the terminal swing, the muscle force of the tibial anterior increased significantly (p < 0.05), which could improve the ankle dorsiflexion ability and prevent foot drop and push forward. Thus, the neuromuscular function of cerebral palsy during walking can be evaluated by the muscle activation state and the RMS of the sEMG signal, which showed that multilevel surgical treatments are feasible and effective to treat SCP.
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Affiliation(s)
- Sujiao Li
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Xueqin Luo
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Song Zhang
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China.,Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuanmin Tang
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiming Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
| | - Qingyun Meng
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Medical Device and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Chengyan Sun
- Department of Functional Neurosurgery, Shanghai Punan Hospital, Shanghai Eber Medical Group, Shanghai, China
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Why the Hips Remain Stable When the Spine Strays: A Deeper Analysis of the Relationship Between Hip Displacement and Severe Scoliosis in Patients With Cerebral Palsy. J Pediatr Orthop 2021; 41:261-266. [PMID: 33825716 DOI: 10.1097/bpo.0000000000001765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many patients with spastic quadriplegic cerebral palsy (CP) and severe scoliosis develop hip displacement, whereas others do not. We investigated demographic characteristics, risk factors for CP, and imaging findings associated with nondisplaced hips in patients with CP and severe scoliosis. METHODS We retrospectively analyzed records of 229 patients with spastic quadriplegic CP and severe scoliosis who presented for treatment at our US academic tertiary care hospital between August 2005 and September 2015. Demographic characteristics, risk factors for CP, and brain magnetic resonance imaging (MRI) findings were documented. Patients were classified as Gross Motor Function Classification System (GMFCS) level 4 or higher, with 58% at GMFCS level 5.3. Displaced hips (n=181 patients) were defined as a migration percentage of ≥30% or previous surgery for hip displacement/adductor contractures. Patients who did not meet these criteria were classified as nondisplaced (n=48 patients). We used univariate analysis and multivariate logistic regression to determine associations between patient factors and hip displacement (alpha=0.05). RESULTS Patients born at term (≥37 wk) had 2.5 times the odds [95% confidence interval (CI): 1.3-5.0] of having nondisplaced hips compared with patients born prematurely. Females had 2.0 times the odds (95% CI: 1.0-3.9) of having nondisplaced hips compared with males. Patients with normal brain MRI findings had 9.6 times the odds (95% CI: 2.3-41) of having nondisplaced hips compared with patients with abnormal findings. Hip displacement was not associated with race (P>0.05). CONCLUSIONS Gestational age 37 weeks or above, female sex, and normal brain MRI findings are independently associated with nondisplaced hips in patients with spastic quadriplegic CP and severe scoliosis. These findings direct attention to characteristics that may place patients at greater risk of displacement. Future work may influence preventative screening practices and improve patient counseling regarding the risk of hip displacement. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, Ivanenko Y. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol 2020; 11:583296. [PMID: 33362693 PMCID: PMC7759523 DOI: 10.3389/fneur.2020.583296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Surface electromyography (sEMG) can be used to assess the integrity of the neuromuscular system and its impairment in neurological disorders. Here we will consider several issues related to the current clinical applications, difficulties and limited usage of sEMG for the assessment and rehabilitation of children with cerebral palsy. The uniqueness of this methodology is that it can determine hyperactivity or inactivity of selected muscles, which cannot be assessed by other methods. In addition, it can assist for intervention or muscle/tendon surgery acts, and it can evaluate integrated functioning of the nervous system based on multi-muscle sEMG recordings and assess motor pool activation. The latter aspect is especially important for understanding impairments of the mechanisms of neural controllers rather than malfunction of individual muscles. Although sEMG study is an important tool in both clinical research and neurorehabilitation, the results of a survey on the clinical relevance of sEMG in a typical department of pediatric rehabilitation highlighted its limited clinical usage. We believe that this is due to limited knowledge of the sEMG and its neuromuscular underpinnings by many physiotherapists, as a result of lack of emphasis on this important methodology in the courses taught in physical therapy schools. The lack of reference databases or benchmarking software for sEMG analysis may also contribute to the limited clinical usage. Despite the existence of educational and technical barriers to a widespread use of, sEMG does provide important tools for planning and assessment of rehabilitation treatments for children with cerebral palsy.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Carla Assenza
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Laura Libernini
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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