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Vishwakarma S, Kumar D, Garg RK, Gupta AK, Singh A, Mishra S, Yadav G. Effectiveness of Botulinum Toxin Injection With Casting in Children With Spastic Cerebral Palsy: A Randomized Controlled Trial. Cureus 2024; 16:e61515. [PMID: 38957257 PMCID: PMC11217874 DOI: 10.7759/cureus.61515] [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] [Accepted: 06/02/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The most common form of movement disorder presented in children with cerebral palsy is spasticity, and dynamic equinus is the most common spastic ankle deformity. Botulinum toxin (BT) injection is now an established first-line treatment for focal spasticity. AIM To assess the effects of BT injection with casting in the treatment of dynamic equinus in children diagnosed with cerebral palsy with spastic diplegia. SETTING AND DESIGN A prospective randomized controlled trial was conducted among patients aged 2-12 years with cerebral palsy and spastic diplegia, attending the general outpatient department and admitted to the indoor facility of the Department of Physical Medicine and Rehabilitation and the Department of Pediatric Orthopedics at King George's Medical University, Lucknow. MATERIAL AND METHODS Two groups of 19 patients each were formed. Group A received BT injection with casting, whereas in group B, only a cast was applied. Outcome measures including spasticity by Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), range of motion (ROM), passive ankle dorsiflexion, and Gross Motor Function Measure (GMFM-66) (dimensions D and E) were assessed before and after the intervention. RESULTS The participants in groups A and B were age-matched. A statistically significant difference was seen within group A and group B for MAS, passive ROM-dorsiflexion (PROM-DF), and passive ROM-plantarflexion (PROM-PF) at various follow-ups. In the 3rd week, MAS in each group was statistically insignificant (p-value> 0.05). CONCLUSION There was a significant improvement in tone and a significant increase in the passive range of motion in both groups.
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Affiliation(s)
- Shivansh Vishwakarma
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Dileep Kumar
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | | | - Anil K Gupta
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Ajai Singh
- Department of Pediatric Orthopaedics, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sudhir Mishra
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Ganesh Yadav
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
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Assumpcao de Monaco B, Alves Du Rocher Candido A, Jacobsen Teixeira M, Lopes Alho EJ. Impact of selective dorsal rhizotomy to cerebral palsy children caregivers' burden. Childs Nerv Syst 2024; 40:1461-1469. [PMID: 38252157 DOI: 10.1007/s00381-024-06291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE It is known that cerebral palsy (CP) children's caregivers suffer from burden, depression, and stress, impairing their quality of life (QoL). The more severe the CP, the more burden the caregiver has. Psychosocial support, education, therapies, and financial support are inversely related to the level of stress of the caregiver. Most parents of CP patients submitted to selective dorsal rhizotomy (SDR) report improvement not just on spasticity, but also in the functional role of the children, what can impact on caregiver's QoL. Our objective was to evaluate the burden of CP children's caregivers with and without previous SDR. METHODS Spastic CP children caregivers were divided into two groups: those who take care of children without previous SDR (control group) and those that children were previously submitted to SDR (surgical group). The burden index was compared between groups using Burden Interview Questionnaire (BIQ). For statistical analysis, we used SPSS. RESULTS The control group had enrolled 31 participants and the surgical group 36. The mean GMFCS level on the control and surgical groups was 3.94 ± 1.26 and 3.74 ± 1.12 (p = 0.61), respectively. The surgical group caregivers presented less burden related to the feeling that they should be doing more to their child (p = 0.003) and if they could do a better job in caring (p = 0.032), compared to controls. The total BIQ index was not significantly different between groups (surgical 32.14 ± 12.34 vs. control 36.77 ± 12.77; p = 0.87). Low economic status had a weak correlation to a higher BIQ index (R2 = 0.24). After age-matching, there was a significative higher BIQ index in the control group (p = 0.008). CONCLUSION Caregivers of spastic CP children who were previously submitted to SDR presented less burden related to feeling of the amount of given care than those without previous surgery. The impression that they could do a better job with their kids was higher in the control group. The severity of CP and low economic status were related to more burden in both groups. After pairing groups by age, the control group had a significative higher BIQ index compared to the SDR group. CLINICAL TRIAL REGISTRATION Trial registration number: CAAE 73407317.6.0000.0068 (Ethical and Research Committee of University of Sao Paulo, Sao Paulo, Brazil, approved on 08/06/2021). All the subjects were freely given an informed consent to participate in the study that was obtained from all participants. Non-consented ones were excluded from the study.
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Affiliation(s)
- Bernardo Assumpcao de Monaco
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- CDF-Clinica de Dor e Funcional, R. Mato Grosso 306, cj1306B, Sao Paulo, SP, Brazil.
| | | | - Manoel Jacobsen Teixeira
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Joaquim Lopes Alho
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- CDF-Clinica de Dor e Funcional, R. Mato Grosso 306, cj1306B, Sao Paulo, SP, Brazil
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Osako M, Yamaoka Y, Takeuchi C, Mochizuki Y, Fujiwara T. Health care transition for cerebral palsy with intellectual disabilities: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00820-2. [PMID: 36870883 DOI: 10.1016/j.neurol.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/05/2022] [Accepted: 11/12/2022] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Today, most individuals with cerebral palsy are adults who need a paediatric-to-adult health care transition. However, many remain in paediatric care for treatment of adult-onset health issues. Therefore, a systematic review based on the 'Triple Aim' framework was performed to determine the status of paediatric-to-adult health care transition for people with cerebral palsy. A comprehensive evaluation of transitional care was proposed for using this framework. It consists of 'experience of care', meaning satisfaction with the care, 'population health', meaning the well-being of patients, and 'cost', meaning cost-effectiveness. METHOD Electronic database (PubMed) searches were performed. The inclusion criteria were original articles published between 1990 and 2020. The search terms used in this study were ('cerebral palsy' AND 'transition to adult health care') OR ('cerebral palsy' AND 'transition'). The study type had to be epidemiological, case report, case-control, and cross-sectional, but not qualitative. The outcomes of the studies were categorised into 'care experience', 'population health', and 'cost', according to the Triple Aim framework. RESULTS Thirteen articles met the abovementioned inclusion criteria. Few studies have examined the effect of the intervention of transition for young adults with cerebral palsy. Participants in some studies had no intellectual disability. Young adults were dissatisfied with the 'care experience', 'population health', and 'cost' and had unmet health needs and inadequate social participation. INTERPRETATION Further transition intervention studies with a comprehensive assessment and proactive involvement of individuals are warranted. The presence of an intellectual disability should be considered.
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Affiliation(s)
- M Osako
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan.
| | - Y Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - C Takeuchi
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan
| | - Y Mochizuki
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan
| | - T Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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MacCarthy M, Heyn P, Tagawa A, Carollo J. Walking speed and patient-reported outcomes in young adults with cerebral palsy. Dev Med Child Neurol 2022; 64:1281-1288. [PMID: 35366333 DOI: 10.1111/dmcn.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the relationship between quantitative gait measurements and self-reported physical, psychological, cognitive, and social function status in young adults with cerebral palsy (CP). METHOD Seventy-two adults with CP (range 18-48y; median age 23y [interquartile range 21-27y]; 34 males, 38 females), in Gross Motor Function Classification System levels I to IV, who previously underwent an instrumented gait analysis (IGA) at our center as children were recruited. Participants underwent a repeated IGA. National Institutes of Health Patient-Reported Outcomes Information System (PROMIS) instruments including the PROMIS-57, Applied Cognition - General Concerns (Short Form), and Applied Cognition - Executive Function (Short Form) were administered. Data derived from current and prior IGA were compared via non-parametric correlation analysis with PROMIS subscores. RESULTS Subscores for anxiety, depression, sleep, and fatigue did not significantly correlate with any IGA data. Walking speed, adjusted for stature, correlated strongly with multiple subscores: physical function (p<0.001, rs =0.708); participation in social roles (p=0.007, rs =0.319); executive function (p=0.005, rs =0.335). Pain interference correlated with longitudinal change in adjusted walking speed (p=0.032, rs =-0.259). The Applied Cognition - General Concerns (Short Form) correlated with prior absolute walking speed, but not adjusted values. INTERPRETATION This study underscores the importance of walking speed and its association with a variety of functional domains in adults with CP. WHAT THIS PAPER ADDS Patient-Reported Outcomes Information System measures provide useful clinical data in young adults with cerebral palsy. Temporospatial gait parameters have wide-reaching functional influence in this population. Walking speed is strongly correlated with physical, social, and executive function.
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Affiliation(s)
- Matthew MacCarthy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of South Carolina and Prisma Health Children's Hospital, Columbia, SC, USA
| | - Patricia Heyn
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Tagawa
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA
| | - James Carollo
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Coceski M, Hocking DR, Reid SM, Abu-Rayya HM, Reddihough DS, Wrennall J, Stargatt R. Assessing IQ in adolescents with mild to moderate cerebral palsy using the WISC-V. Clin Neuropsychol 2022; 36:1767-1786. [PMID: 34126856 DOI: 10.1080/13854046.2021.1928290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: To examine the influence of subtests that require fine motor responses on measures of intellectual ability, and compare three approaches to minimizing motor demands while assessing cognitive abilities in adolescents with cerebral palsy (CP) to the traditional method of the Wechsler Intelligence Scale for Children - Fifth edition (WISC-V). Method: Seventy adolescents with CP (M = 14 years 6 months, SD = 10 months) who were able to provide either a verbal or point response were assessed using the WISC-V administered via Q-interactive. The pencil-to-paper version of Coding was also administered. Performance on Block Design and pencil-to-paper Coding was compared to Visual Puzzles and Coding on Q-interactive, respectively. Full Scale IQ (FSIQ) scores derived according to the Traditional method of the WISC-V were compared to alternative estimates of FSIQ derived according to the Q-interactive, Nonmotor, and Motor-free methods, which minimized motor demands. Results: An additional 7-12% of participants were able to respond to Visual puzzles and Coding on Q-interactive compared to Block Design and pencil-to-paper Coding, respectively, and performance was marginally but significantly better. For 54 adolescents (Gross Motor Function Classification System (GMFCS) Level I-III) who were able to obtain FSIQ scores, the Traditional method underestimated FSIQ by 3-6 points compared to the alternative methods and the difference was most pronounced for those with more severe CP as measured by the GMFCS. Conclusion: Adolescents with CP are at an inherent disadvantage when cognitive ability is assessed using the Traditional method of the WISC-V. Findings suggest clinicians should employ the Nonmotor or Motor-free methods when assessing IQ in adolescents with CP.
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Affiliation(s)
- Monika Coceski
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Darren R Hocking
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Hisham M Abu-Rayya
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neurodevelopmental & Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jacquie Wrennall
- Mental Health, Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Robyn Stargatt
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study. J Clin Med 2022; 11:jcm11133711. [PMID: 35806996 PMCID: PMC9267790 DOI: 10.3390/jcm11133711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023] Open
Abstract
Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.
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Bloom T, Sabharwal S. Surgical Management of Foot and Ankle Deformities in Cerebral Palsy. Clin Podiatr Med Surg 2022; 39:37-55. [PMID: 34809794 DOI: 10.1016/j.cpm.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly observed foot and ankle segmental malalignment patterns include equinus, planovalgus, and equinovarus. Assessment of foot deformities is multifaceted, requiring the collection and integration of data from a combination of sources that include the clinical history, standardized physical examination, observational and quantitative gait analysis, GMFCS classification, and radiographic findings. Surgical procedures are determined by identifying all segmental malalignments and assessing the contribution of dynamic or flexible soft-tissue imbalance, fixed soft-tissue imbalance, and skeletal deformities.
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Affiliation(s)
- Tamir Bloom
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Cedar Knolls, NJ 07927, USA.
| | - Sanjeev Sabharwal
- UCSF Pediatric Orthopaedic Fellowship, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA; Limb Lengthening and Reconstruction Center, UCSF Benioff Children's Hospital, 744 52nd Street, Oakland, CA 94609, USA
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Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy. ACTA ACUST UNITED AC 2020; 56:medicina56120673. [PMID: 33297300 PMCID: PMC7762323 DOI: 10.3390/medicina56120673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023]
Abstract
Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.
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Multimodal assessment of motor pathways and intracortical connections in functional hemispherectomy. Childs Nerv Syst 2020; 36:3085-3093. [PMID: 32388813 DOI: 10.1007/s00381-020-04617-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE For selected children with medically intractable epilepsy, hemispherectomy can be an excellent treatment option and its efficacy in achieving seizure freedom or reduction in seizure frequency has been shown in several studies, but patients' selection could not be straightforward and often it is taken on subjective basis. We described a multimodal approach to assess patient eligible for hemispherectomy and possibly predicting post-surgical outcomes. METHODS We describe pre- and post-surgical clinical features along with neuroradiological results by magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), MR-tractography (MRT), and neurophysiological study by single and paired pulses transcranial magnetic stimulation (TMS) in a child with cerebral palsy with epileptic encephalopathy, eligible for epilepsy surgery. RESULTS Presurgical TMS evaluation showed a lateralization of motor function on the left motor cortex for both arms, and results were confirmed by MRI studies. Interestingly, after surgery, both epilepsy and motor performances improved and TMS showed enhancement of intracortical inhibition and facilitation activity. CONCLUSION Functional hemispherectomy is an effective treatment for drug-resistant epilepsy, and multimodal presurgical assessment may be a useful approach to guide surgeons in selecting patients. Moreover, pre- and post-surgical evaluation of these patients may enhance our understanding of brain plasticity phenomena.
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Noroozi S, Mehrabi R, Lotfian M, Nooshiravan F, Shahroki A, Irani A, Mirbagheri MM. Therapeutic Effects of an Anti-Gravity Treadmill (AlterG) Training on Neuromuscular Abnormalities Associated with Spasticity in Children with Cerebral Palsy .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3856-3859. [PMID: 33018842 DOI: 10.1109/embc44109.2020.9175164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We aimed to characterize the therapeutic effects of Anti-Gravity Treadmill (AlterG) Training on neuromuscular abnormalities associated with spasticity in children with cerebral palsy (CP). Eighteen subjects were divided into two groups; AlterG and control. All subjects received up to 40 minutes of training 3 times a week for 8 weeks. The control group received conventional occupational therapy. The advanced parallel-cascade system identification technique was used to characterize the neuromuscular abnormalities associated with spasticity and separated its intrinsic and reflex components. Reflex stiffness gain (GR) and intrinsic stiffness gain (K) were used to track the therapeutic effects of training on neural and muscular abnormalities. Both K and GR were strongly positioned dependent; they varied linearly with the ankle angle at dorsiflexion. Their position dependence was quantified by fitting a linear model to K and GR over dorsiflexion positions. The evaluations were performed at four-time points; i.e. the baseline (before starting the training), 1 and 2 months after starting the training, and 1 month after the completion of the training to assess the persistent effects. We determined the changes in K and GR intercept and slope parameters over these 3 months to evaluate the therapeutic effects of training on neuromuscular abnormalities. The results revealed that all K and GR parameters decreased substantially following using AlterG training and these changes were greater than those observed in the control. The results also showed that these therapeutic effects were persistent to a high extent, particularly in the AlterG group. Our findings suggested that AlterG training could be considered as a robust therapeutic intervention to reduce neuromuscular abnormalities and manage spasticity.
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Carmona-Pérez C, Pérez-Ruiz A, Garrido-Castro JL, Vidal FT, Alcaraz-Clariana S, García-Luque L, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Design, Validity, and Reliability of a New Test, Based on an Inertial Measurement Unit System, for Measuring Cervical Posture and Motor Control in Children with Cerebral Palsy. Diagnostics (Basel) 2020; 10:E661. [PMID: 32882885 PMCID: PMC7555956 DOI: 10.3390/diagnostics10090661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to design and propose a new test based on inertial measurement unit (IMU) technology, for measuring cervical posture and motor control in children with cerebral palsy (CP) and to evaluate its validity and reliability. METHODS Twenty-four individuals with CP (4-14 years) and 24 gender- and age-matched controls were evaluated with a new test based on IMU technology to identify and measure any movement in the three spatial planes while the individual is seated watching a two-minute video. An ellipse was obtained encompassing 95% of the flexion/extension and rotation movements in the sagittal and transversal planes. The protocol was repeated on two occasions separated by 3 to 5 days. Construct and concurrent validity were assessed by determining the discriminant capacity of the new test and by identifying associations between functional measures and the new test outcomes. Relative reliability was determined using the intraclass correlation coefficient (ICC) for test-retest data. Absolute reliability was obtained by the standard error of measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90). RESULTS The discriminant capacity of the area and both dimensions of the new test was high (Area Under the Curve ≈ 0.8), and consistent multiple regression models were identified to explain functional measures with new test results and sociodemographic data. A consistent trend of ICCs higher than 0.8 was identified for CP individuals. Finally, the SEM can be considered low in both groups, although the high variability among individuals determined some high MDC90 values, mainly in the CP group. CONCLUSIONS The new test, based on IMU data, is valid and reliable for evaluating posture and motor control in children with CP.
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Affiliation(s)
- Cristina Carmona-Pérez
- Centro de Recuperación Neurológica de Córdoba (CEDANE), 14005 Córdoba, Spain;
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Alberto Pérez-Ruiz
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Juan L. Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071 Córdoba, Spain; (J.L.G.-C.); (F.T.V.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Francisco Torres Vidal
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071 Córdoba, Spain; (J.L.G.-C.); (F.T.V.)
| | - Sandra Alcaraz-Clariana
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Lourdes García-Luque
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
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Stadskleiv K. Cognitive functioning in children with cerebral palsy. Dev Med Child Neurol 2020; 62:283-289. [PMID: 32010976 DOI: 10.1111/dmcn.14463] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/24/2023]
Abstract
Children with cerebral palsy (CP) have an increased risk of cognitive impairments. This narrative review of the literature discusses assessment of cognition in children with CP, presents the most salient characteristics of cognitive functioning pertaining to each subtype, and discusses the relationships between brain injury, functioning, and intervention from a developmental perspective. A search for original studies of cognitive functioning in children with different subtypes of CP was performed. The search resulted in 81 unique hits. There were few studies with a representative sample of children with CP where all participants were individually assessed. Cognitive functioning in children with the most severe motor impairments were often assumed and not assessed. Furthermore, there was a confounding of IQ below 70 and intellectual disability, possibly leading to an overestimation of the prevalence of intellectual disability. Longitudinal neuropsychological studies, including also very young children and those with the most severe speech and motor impairments, as well as intervention studies, are called for. WHAT THIS PAPER ADDS: Few studies have assessed cognition in a representative sample of children with cerebral palsy. Cognition in children with severe motor impairment is often assumed, not assessed. Lack of assessment may lead to overestimating the prevalence of intellectual disability. Lowered cognitive functioning in older children highlights the need for longitudinal studies.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,Department of Educational Science, University of South-Eastern Norway, Vestfold, Norway
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Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy. Diagnostics (Basel) 2020; 10:diagnostics10020080. [PMID: 32024117 PMCID: PMC7168926 DOI: 10.3390/diagnostics10020080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/29/2023] Open
Abstract
Objective: This study aimed to determine the validity and reliability of Inertial Measurement Units (IMUs) for the assessment of craniocervical range of motion (ROM) in patients with cerebral palsy (CP). Methods: twenty-three subjects with CP and 23 controls, aged between 4 and 14 years, were evaluated on two occasions, separated by 3 to 5 days. An IMU and a Cervical Range of Motion device (CROM) were used to assess craniocervical ROM in the three spatial planes. Validity was assessed by comparing IMU and CROM data using the Pearson correlation coefficient, the paired t-test and Bland–Altman plots. Intra-day and inter-day relative reliability were determined using the Intraclass Correlation Coefficient (ICC). The Standard Error of Measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90) were obtained for absolute reliability. Results: High correlations were detected between methods in both groups on the sagittal and frontal planes (r > 0.9), although this was reduced in the case of the transverse plane. Bland–Altman plots indicated bias below 5º, although for the range of cervical rotation in the CP group, this was 8.2º. The distance between the limits of agreement was over 23.5º in both groups, except for the range of flexion-extension in the control group. ICCs were higher than 0.8 for both comparisons and groups, except for inter-day comparisons of rotational range in the CP group. Absolute reliability showed high variability, with most SEM below 8.5º, although with worse inter-day results, mainly in CP subjects, with the MDC90 of rotational range achieving more than 20º. Conclusions: IMU application is highly correlated with CROM for the assessment of craniocervical movement in CP and healthy subjects; however, both methods are not interchangeable. The IMU error of measurement can be considered clinically acceptable; however, caution should be taken when this is used as a reference measure for interventions.
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Noroozi S, Lotfian M, Nooshiravan F, Shahrokhi A, Irani A, Mirbagheri MM. The Therapeutic Effects of Low-Amplitude, High-Frequency Perturbations on Neuromuscular Abnormalities Associated with Spasticity in Children with Cerebral Palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:114-117. [PMID: 31945857 DOI: 10.1109/embc.2019.8856551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We aimed to investigate the impact of ankle joint therapy with low-amplitude, high-frequency perturbation training on neuromuscular abnormalities associated with spasticity in children with Cerebral Palsy (CP). Four spastic CP children (2 males and 2 females) received a 10-session training of high-frequency and low-amplitude perturbations superimposed on passive stretches over the range of motion of their ankle as well as local perturbations at dorsiflexion position. The associated passive parameters, including total passive range of motions, passive range of motions toward dorsiflexion, stiffness, energy loss and torque dynamic gain were evaluated at the baseline and after a 10 session training. Our findings indicate that passive range of motion increased, and passive reflex stiffness, which usually increases in CP children, decreased following the completion of training. Our results demonstrate that intensive sessions of perturbation therapy could be considered an effective therapeutic mean for the management of spasticity and contracture, and eventually the enhancement of mobility of CP children.
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Lotfian M, Dadashi F, Rafieenazari Z, Shahroki A, Rasteh M, Molavi M, Mirbagheri A, Mirbagheri MM. The Effects of Anti-gravity Treadmill Training on Gait Characteristics in Children with Cerebral Palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5256-5259. [PMID: 31947043 DOI: 10.1109/embc.2019.8856660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral palsy is a disorder that affects muscle tone, movement and motor skills. Most of the children with cerebral palsy (CP) are not able to walk or can walk in incorrect pattern and are dependent on assistive devices. Recently an antigravity treadmill has been found to be beneficial as a new therapeutic approach. Thus, we aimed to investigate the effects of antigravity treadmill training (AlterG) on gait characteristic in children with cerebral palsy. We provided a 45-minute training program, 3 times a week for 8 weeks for six CP children as our experimental group. Our control group was a group consisted of four CP children who took typical occupational therapy, accordingly. All subjects in both AlterG and control groups were evaluated at the gait lab before and after 8 weeks training. Gait patterns were characterized using spatiotemporal parameters and dynamic balance features. We also evaluated the popular clinical gait measures including walking speed and endurance, and mobility and balance.Our results demonstrated that spatiotemporal, dynamic balance and clinical features all improved more after 8 weeks AlterG training rather than control group ones. These findings suggest that AlterG training can be considered as an effective approach for improving walking ability and gait characteristics in children with cerebral palsy.
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17
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Alriksson-Schmidt A, Jarl J, Rodby-Bousquet E, Lundkvist Josenby A, Westbom L, Himmelmann K, Stadskleiv K, Ödman P, Svensson I, Antfolk C, Malesevic N, Jeglinsky I, Saha S, Hägglund G. Improving the Health of Individuals With Cerebral Palsy: Protocol for the Multidisciplinary Research Program MOVING ON WITH CP. JMIR Res Protoc 2019; 8:e13883. [PMID: 31599737 PMCID: PMC6811769 DOI: 10.2196/13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/10/2019] [Accepted: 07/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral palsy (CP) is one of the most common early onset disabilities globally. The causative brain damage in CP is nonprogressive, yet secondary conditions develop and worsen over time. Individuals with CP in Sweden and most of the Nordic countries are systematically followed in the national registry and follow-up program entitled the Cerebral Palsy Follow-Up Program (CPUP). CPUP has improved certain aspects of health care for individuals with CP and strengthened collaboration among professionals. However, there are still issues to resolve regarding health care for this specific population. Objective The overall objectives of the research program MOVING ON WITH CP are to (1) improve the health care processes and delivery models; (2) develop, implement, and evaluate real-life solutions for Swedish health care provision; and (3) evaluate existing health care and social insurance benefit programs and processes in the context of CP. Methods MOVING ON WITH CP comprises 9 projects within 3 themes. Evaluation of Existing Health Care (Theme A) consists of registry studies where data from CPUP will be merged with national official health databases, complemented by survey and interview data. In Equality in Health Care and Social Insurance (Theme B), mixed methods studies and registry studies will be complemented with focus group interviews to inform the development of new processes to apply for benefits. In New Solutions and Processes in Health Care Provision (Theme C), an eHealth (electronic health) procedure will be developed and tested to facilitate access to specialized health care, and equipment that improves the assessment of movement activity in individuals with CP will be developed. Results The individual projects are currently being planned and will begin shortly. Feedback from users has been integrated. Ethics board approvals have been obtained. Conclusions In this 6-year multidisciplinary program, professionals from the fields of medicine, social sciences, health sciences, and engineering, in collaboration with individuals with CP and their families, will evaluate existing health care, create conditions for a more equal health care, and develop new technologies to improve the health care management of people with CP. International Registered Report Identifier (IRRID) DERR1-10.2196/13883
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Affiliation(s)
| | - Johan Jarl
- Department of Health Economics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.,Centre for Clinical Research, Västmanland-Uppsala University, Västerås, Sweden
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Children's Hospital, Skåne University Hospital, Lund, Sweden
| | - Lena Westbom
- Children's Hospital, Skåne University Hospital, Lund, Sweden.,Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kristine Stadskleiv
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Sweden
| | - Pia Ödman
- Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Svensson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | | | - Ira Jeglinsky
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Sanjib Saha
- Department of Health Economics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gunnar Hägglund
- Department of Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
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18
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Blumetti FC, Belloti JC, Tamaoki MJS, Pinto JA. Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy. Cochrane Database Syst Rev 2019; 10:CD001408. [PMID: 31591703 PMCID: PMC6779591 DOI: 10.1002/14651858.cd001408.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of physical disabilities in children in high-income countries. Spasticity is the most common motor disturbance in CP. Botulinum toxin type A (BoNT-A) is considered the first-line treatment for focal spasticity in people with CP. OBJECTIVES To evaluate the effectiveness and safety of BoNT-A compared to other treatments used in the management of lower limb spasticity in children with CP. SEARCH METHODS We searched CENTRAL, PubMed, four other databases, and two trial registers in October 2018. We also searched the reference lists of relevant studies and reviews and contacted experts in the field. We did not apply any date or language restrictions. SELECTION CRITERIA Randomised controlled trials of children with CP, aged between birth and 19 years, treated with BoNT-A injections in the lower limb muscles compared to other interventions. The primary outcomes were gait analysis and function. The secondary outcomes were joint range of motion, quality of life, satisfaction, spasticity, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, assessed risk of bias, and rated the quality of the evidence using GRADE. A third review author arbitrated in case of disagreements. We conducted meta-analyses of available data whenever possible, analysing dichotomous data with risk ratios (RR), and continuous data with mean differences (MD) or standardised mean differences (SMD), with 95% confidence intervals (CI). We considered a 5% significance level for all analyses.Whenever possible, we analysed outcomes at the time points at which they were assessed: short term (2 to 8 weeks); medium term (12 to 16 weeks); and long term (> 24 weeks). MAIN RESULTS We included 31 randomised controlled trials assessing 1508 participants. Most studies included ambulatory patients with more than one motor type of CP, and with a mean age of between three and seven years. There was a slight predominance of males.Studies compared BoNT-A in the lower limb muscles to usual care or physiotherapy (14 studies), placebo or sham (12 studies), serial casting (4 studies), or orthoses (1 study).We rated studies as at high or unclear risk of bias mainly due to random sequence generation, allocation concealment, blinding of participants and personnel, and blinding of outcome assessment.BoNT-A versus usual care or physiotherapyBoNT-A might improve overall gait scores at medium-term follow-up (MD 2.80, 95% CI 1.55 to 4.05; 1 study, 40 children; very low-quality evidence) and is moderately effective at improving function at short-term (SMD 0.59, 95% CI 0.23 to 0.95; 2 studies, 123 children) and medium-term (SMD 1.04, 95% CI 0.16 to 1.91; 4 studies, 191 children) follow-up (all very low-quality evidence).BoNT-A improves ankle range of motion, satisfaction, and ankle plantarflexors spasticity at one or more time points (very low-quality evidence).The proportion of adverse events in the BoNT-A group was 0.37 (95% CI 0.08 to 0.66; I2 = 95%; very low-quality evidence). No adverse events were reported in the control group.BoNT-A versus placebo or shamBoNT-A improves overall gait scores at short-term (RR 1.66, 95% CI 1.16 to 2.37, P = 0.006; 4 studies, 261 assessments) and medium-term (RR 1.90, 95% CI 1.32 to 2.74, P < 0.001; 3 studies, 248 assessments) follow-up, and may improve peak ankle dorsiflexion in stance (MD 15.90 degrees, 95% CI 4.87 to 26.93, P = 0.005; 1 study, 19 children) and in swing (MD 10.20 degrees, 95% CI 4.01 to 16.39, P = 0.001; 1 study, 19 children) at short-term follow-up (all moderate-quality evidence).BoNT-A is not more effective than placebo or sham at improving function at short-term (SMD 0.24, 95% CI -0.35 to 0.83, P = 0.42; 4 studies, 305 children) or long-term (SMD -0.07, 95% CI -0.48 to 0.35, P = 0.76; 2 studies, 91 children) follow-up, but has a small positive effect at medium-term follow-up (SMD 0.28, 95% CI 0.06 to 0.49, P = 0.01; 5 studies, 327 children) (all moderate-quality evidence).BoNT-A improves passive ankle range of motion, satisfaction, and ankle plantarflexors spasticity at one or more time points (moderate-quality evidence).There was no difference between groups in the rate of adverse events at short-term follow-up (RR 1.29, 95% CI 0.87 to 1.93, P = 0.21; 12 studies, 918 children; moderate-quality evidence).BoNT-A versus serial castingThere was no difference between groups for overall gait scores at short-term (MD 0.00, 95% CI -1.66 to 1.66); medium-term (MD 0.65, 95% CI -1.21 to 2.51); or long-term (MD 0.46, 95% CI -1.33 to 2.25) follow-up in one study with 18 children (moderate-quality evidence).BoNT-A improved instrumented gait analysis only in terms of ankle dorsiflexion at initial contact (MD 6.59 degrees, 95% CI 1.39 to 11.78, P = 0.01; 2 studies, 47 children). There was no difference between groups for peak ankle dorsiflexion in stance and swing, and gait speed at any time point (moderate- and low-quality evidence).BoNT-A is not more effective than serial casting at improving function, ankle range of motion, and spasticity at any time point (moderate- and low-quality evidence).BoNT-A is not associated with a higher risk of adverse events than serial casting (RR 0.59, 95% CI 0.03 to 11.03; 3 studies, 64 children; low-quality evidence).BoNT-A versus orthosesThere was no difference between groups for function at medium-term follow-up (MD 11.14, 95% CI -0.05 to 22.33; 1 study, 43 children), but BoNT-A is more effective than orthoses at improving hip range of motion and hip adductors spasticity (all very low-quality evidence). AUTHORS' CONCLUSIONS The quality of the evidence was low or very low for most of the outcomes analysed. We found limited evidence that BoNT-A is more effective than placebo or a non-placebo control at improving gait, joint range of motion, satisfaction, and lower limb spasticity in children with CP, whereas the results for function were contradictory. The rate of adverse events with BoNT-A is similar to placebo. BoNT-A is not more effective than ankle serial casting to treat ankle contractures for any of the assessed outcomes, but is more effective than orthotics at improving range of motion and spasticity.
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Affiliation(s)
- Francesco C Blumetti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5º andarSão PauloSão PauloBrazil04038‐032
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5º andarSão PauloSão PauloBrazil04038‐032
| | - Marcel JS Tamaoki
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5º andarSão PauloSão PauloBrazil04038‐032
| | - José A Pinto
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5º andarSão PauloSão PauloBrazil04038‐032
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The Quality of Life of Polish Children with Cerebral Palsy and the Impact of the Disease on the Family Functioning. J Pediatr Nurs 2019; 47:e75-e82. [PMID: 31153684 DOI: 10.1016/j.pedn.2019.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Care and upbringing of a child with cerebral palsy (CP) may affect the functioning of parents and the whole family. This study aimed to evaluate the quality of life (QOL) of children with CP in parents' opinion and the impact of disease on family functioning. DESIGN AND METHODS This cross-sectional study was conducted among 100 parents of children with CP. Survey instruments used included an Authors-Designed Questionnaire (ADQ) to collect sociodemographic and educational background data as well as four standardized questionnaires for pediatric QOL (PedsQL-GC, PedsQL-CPM, PedsQL-FIM) and for life satisfaction (SWLS). RESULTS Teenagers were characterised by a higher QOL compared to other age groups. The lowest scores were observed in the PedsQL-CPM domain of daily and school activities and in the physical functioning domain of the PedsQL. It was shown that family functioning is affected by the children's age and place of residence as well as the level of parental education. It was also shown that men, parents in a relationship, those living in the city and those with vocational education were characterised by a higher level of satisfaction with life than other groups. CONCLUSIONS The QOL of children with CP is reduced compared to the QOL of healthy children and their condition has a significant impact on family functioning. Therefore, learning about the factors that influence QOL will allow health care providers to properly plan actions aimed at minimising the negative impact of CP on children's QOL and improving the functioning of their families.
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Abstract
BACKGROUND Outcomes after orthopaedic interventions in patients with dystonic cerebral palsy (DCP) are historically regarded as unpredictable. This study aims to evaluate the overall outcome of orthopaedic surgery in children with DCP. METHOD Children with DCP who underwent lower limb orthopaedic surgery with a minimum follow-up of 12 months were included. Data collected included age at time of surgery, surgical procedures performed, Gross Motor Function Classification System (GMFCS) level, and Barry Albright Dystonia Scale (BADS) score. The cohort was divided into 2 groups. Group 1 (GMFCS levels I to III), mean age 12 years 7 months and group 2 (GMFCS levels IV to V), mean age 10 years 7 months. Group 1 had surgery aimed at deformity correction to improve gait and mobility, and group 2 for the management or prevention of hip displacement. Outcome measures analyzed were: the incidence of unpredictable results related to surgery and early recurrence of deformity in both groups. Functional mobility scale scores were evaluated for group 1 and hip migration percentage for group 2. Linear mixed models were used to take into account repeated measures over time and correlations between measurements from the same patient. RESULTS Group 1 (n=18); had low BADS scores and were considered to have mild dystonia. Three children experienced unpredictable results, 2 had early recurrence of deformity, 3 had a decline, and 1 child improved in the functional mobility scale.Group 2 (n=19); had high BADS scores and were considered to have moderate to severe dystonia. Nine surgical events involved bony procedures and 15 were soft tissue surgery only. One surgical event lead to unpredictable results and 2 children had early recurrence of deformity. Postoperatively, a linear trend of increasing migration percentage [0.49% (95% confidence interval, 0.23-0.74; P=0.0002)] was seen up to 21 months. There was no significant change after 21 months [-0.08% (95% confidence interval, -0.24 to +0.041; P=0.18)]. CONCLUSIONS This study suggests that unpredictable results and early recurrence of deformity following orthopaedic surgery in children with DCP are not as common as previously regarded. Furthermore, functional mobility and hip morphology can be improved. LEVEL OF EVIDENCE Level IV-this is a case-series.
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21
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Aylward GP. Commentary: An Important Problem but a "Probably Don't Do It" Solution. J Pediatr Psychol 2019; 44:253-255. [PMID: 30192959 DOI: 10.1093/jpepsy/jsy072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Glen P Aylward
- Developmental-Behavioral Pediatrics/Psychology, Southern Illinois University School of Medicine
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Synowiec S, Lu J, Yu L, Goussakov I, Lieber R, Drobyshevsky A. Spinal Hyper-Excitability and Altered Muscle Structure Contribute to Muscle Hypertonia in Newborns After Antenatal Hypoxia-Ischemia in a Rabbit Cerebral Palsy Model. Front Neurol 2019; 9:1183. [PMID: 30705663 PMCID: PMC6344443 DOI: 10.3389/fneur.2018.01183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/21/2018] [Indexed: 12/17/2022] Open
Abstract
Rabbit kits after global antenatal hypoxic-ischemic injury exhibit motor deficits similar to humans with cerebral palsy. We tested several mechanisms previously implicated in spinal hyper-excitability after perinatal brain injury that may explain muscle hypertonia in newborns. Stiffness of hind limb muscles during passive stretch, electromyogram, and spinal excitability by Hoffman reflex, were assessed in rabbit kits with muscle hypertonia after global hypoxic-ischemic brain injury and naïve controls. Affected muscle architecture, motoneuron morphology, primary afferents density, gliosis, and KCC2 expression transporter in the spinal cord were also examined. Decrease knee stiffness after anesthetic administration was larger, but residual stiffness was higher in hypertonic kits compared to controls. Hypertonic kits exhibited muscle shortening and atrophy, in both agonists and antagonists. Sarcomere length was longer in tibialis anterior in hypertonic kits than in controls. Hypertonic kits had decreased rate dependent depression and increased Hmax/Mmax in H-reflex. Motor neuron soma sizes, primary afferent density were not different between controls and hypertonic kits. Length of dendritic tree and ramification index were lower in hypertonic group. Gene expression of KCC2 was lower in hypertonic kits, but protein content was not different between the groups. In conclusion, while we found evidence of decreased supraspinal inhibitory control and increased excitability by H-reflex that may contribute to neuronal component in hypertonia, increased joint resistance to stretch was explained predominantly by changes in passive properties of muscles and joints. We did not find structural evidence of increased sensory afferent input or morphological changes in motoneurons that might explain increased excitability. Gliosis, observed in spinal gray matter, may contribute to muscle hypertonia.
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Affiliation(s)
- Sylvia Synowiec
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Jing Lu
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Lei Yu
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Ivan Goussakov
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
| | - Richard Lieber
- Department of Physical Medicine and Rehabilitation, Northwestern University and the Shirley Ryan Ability Lab, Chicago, IL, United States
| | - Alexander Drobyshevsky
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, United States
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23
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Brooks JT, Yaszay B, Bartley CE, Bastrom TP, Sponseller PD, Shah SA, Samdani A, Cahill PJ, Miyanji F, Newton PO. Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion? Spine Deform 2019; 7:112-117. [PMID: 30587303 DOI: 10.1016/j.jspd.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Retrospective review of a prospective cohort. OBJECTIVE To identify patient and surgical factors that alter the length of postoperative intensive care unit (ICU) stays after spinal fusion/instrumentation in patients with neuromuscular scoliosis secondary to cerebral palsy (CP). SUMMARY OF BACKGROUND DATA High perioperative complication rates in patients with CP contribute to the practice of utilizing the ICU postoperatively for monitoring. However, this is costly and little is known regarding which patients truly need this increased acuity of care. METHODS A prospective, multicenter database was queried for patients with CP who underwent spinal fusion and instrumentation. Patients with an ICU length of stay (LOS) ≤1 day were assumed to not have required postoperative ICU admission. Demographic and surgical characteristics were compared between those with ICU LOS of ≤1 day versus >1 day. A classification and regression tree (CART) analysis was utilized to create a decision algorithm for postoperative ICU admission. RESULTS Three hundred twenty-four patients were identified with a mean ICU LOS of 4.7 days (range 0-47). Sixty-eight patients (21%) had an ICU LOS ≤1 day and 256 patients (79%) had an ICU LOS >1 day. CART analysis demonstrated that the institution where the surgery was performed was the primary predictor with two groups: sites that almost routinely had ICU stay >1 day (92%) and those that were split (50.5% >1 day). In the latter group, an operative time greater than 4 hours was a risk factor for a longer ICU stay. CONCLUSION Because of their heterogeneous makeup, CP patients should be evaluated individually and their postoperative disposition should not be based on institutional tradition but instead on objective surgical factors. For those patients with surgical times less than 4 hours, discussions should be held regarding the safety of a postoperative disposition to a regular floor. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jaysson T Brooks
- Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Burt Yaszay
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
| | - Carrie E Bartley
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Tracey P Bastrom
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Paul D Sponseller
- The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Suken A Shah
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Amer Samdani
- Shriners Hospitals for Children, 3551 N. Broad St., Philadelphia, PA 19140, USA
| | - Patrick J Cahill
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, PA 19104, USA
| | - Firoz Miyanji
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, Vancouver, BC, Canada
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
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Abstract
Perinatal brain injury may lead to long-term morbidity and neurodevelopmental impairment. Improvements in perinatal care have resulted in the survival of more infants with perinatal brain injury. The effects of hypoxia-ischemia, inflammation, and infection during critical periods of development can lead to a common pathway of perinatal brain injury marked by neuronal excitotoxicity, cellular apoptosis, and microglial activation. Various interventions can prevent or improve the outcomes of different types of perinatal brain injury. The objective of this article is to review the mechanisms of perinatal brain injury, approaches to prevention, and outcomes among children with perinatal brain injury.
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Hoare B, Ditchfield M, Thorley M, Wallen M, Bracken J, Harvey A, Elliott C, Novak I, Crichton A. Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study. BMC Neurol 2018; 18:63. [PMID: 29739443 PMCID: PMC5938804 DOI: 10.1186/s12883-018-1070-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 05/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child’s ability to use their two hands to perform bimanual tasks. Methods/Design This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6–12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain – lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive – standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. Discussion This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy. Trial registration ACTRN12614000631606; Date of retrospective registration 29/05/2014.
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Affiliation(s)
- Brian Hoare
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia. .,School of Occupational Therapy, La Trobe University, Bundoora, VIC, 3168, Australia. .,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Margaret Wallen
- School of Allied Health, Australian Catholic University, North Sydney, NSW, 2060, Australia
| | - Jenny Bracken
- Department of Diagnostic Imaging, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Bentley, 6102, Western Australia, Australia.,Department of Paediatric Rehabilitation, Princess Margaret Hospital, Washington, WA, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, PO Box 6427, Frenchs Forest, NSW, 2086, Australia
| | - Ali Crichton
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
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Abstract
PURPOSE To explore factors contributing to variability in cognitive functioning in children with cerebral palsy (CP). METHOD A geographical cohort of 70 children with CP was assessed with tests of language comprehension, visual-spatial reasoning, attention, working memory, memory, and executive functioning. Mean age was 9;9 years (range 5;1-17;7), 54.3% were girls, and 50.0% had hemiplegic, 25.7% diplegic, 12.9% quadriplegic, and 11.4% dyskinetic CP. For the participants with severe motor impairments, assessments were adapted for gaze pointing. A cognitive quotient (CQ) was computed. RESULTS Mean CQ was 78.5 (range 19-123). Gross motor functioning, epilepsy, and type of brain injury explained 35.5% of the variance in CQ (F = 10.643, p = .000). CONCLUSION Twenty-four percent had an intellectual disability, most of them were children with quadriplegic CP. Verbal comprehension and perceptual reasoning scores did only differ for the 21% with an uneven profile, of whom two-thirds had challenges with perceptual reasoning.
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Affiliation(s)
- Kristine Stadskleiv
- a Department of Clinical Neurosciences for Children, Oslo University Hospital , Oslo , Norway
| | - Reidun Jahnsen
- a Department of Clinical Neurosciences for Children, Oslo University Hospital , Oslo , Norway.,b Department of Research, Sunnaas Rehabilitation Hospital , Nesodden , Norway
| | - Guro L Andersen
- c Vestfold Hospital Trust, The Cerebral Palsy Register of Norway , Tønsberg , Norway.,d Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Rodríguez Mariblanca M, Cano de la Cuerda R. Mobile applications in children with cerebral palsy. Neurologia 2017; 36:135-148. [PMID: 29275969 DOI: 10.1016/j.nrl.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is one of the most common developmental disorders. Technological development has enabled a transformation of the healthcare sector, which can offer more individualised, participatory, and preventive services. Within this context of new technology applied to the healthcare sector, mobile applications, or apps, constitute a very promising tool for the management of children with CP. OBJECTIVE The purpose of this article is to perform a systematic review of the information published about various mobile applications either directly related to CP or with potential to be useful in the context of the disease, and to describe, analyse, and classify these applications. MATERIAL AND METHODS A literature search was carried out to gather articles published in English or Spanish between 2011 and 2017 which presented, analysed, or validated applications either specifically designed or potentially useful for CP. Furthermore, a search for mobile applications was conducted in the main mobile application markets. CONCLUSIONS A total of 63 applications were found in biomedical databases and mobile application markets, of which 40 were potentially useful for CP and 23 were specifically designed for the condition (11 for information, 3 for evaluation, and 9 for treatment). There are numerous mobile applications either specifically designed for or with potential to be useful in the field of CP. However, despite the existing scientific evidence, the low methodological quality of scientific articles makes it impossible to generalise the use of these tools.
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Affiliation(s)
- M Rodríguez Mariblanca
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
| | - R Cano de la Cuerda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España.
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Zhang H, Gao J, Wang M, Yu X, Lv X, Deng H, Fan X, Chen K. Effects of scalp electroacupuncture on the PI3K/Akt signalling pathway and apoptosis of hippocampal neurons in a rat model of cerebral palsy. Acupunct Med 2017; 36:96-102. [PMID: 29102966 DOI: 10.1136/acupmed-2016-011335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 07/14/2017] [Accepted: 08/13/2017] [Indexed: 11/03/2022]
Abstract
Background Substantial evidence from clinical reports has established that most cerebral palsy (CP) patients benefit from a comprehensive rehabilitation exercise training programme. Such advances are enhanced when scalp electroacupuncture (EA), applied at a location corresponding to the projection of the motor area, is combined with rehabilitation exercise training. However, little information exists regarding the mechanistic basis for these effects. Objective To examine whether EA stimulation within the scalp projection location of the motor area can inhibit apoptosis of hippocampal neurons by regulating the PI3k/Akt signalling pathway in a rat model of CP. Methods Fifty male Sprague-Dawley rats underwent surgical modelling of CP. Five were used to confirm successful establishment of the model and the remaining 45 rats were randomly divided into one of three groups that remained untreated (CP group, n=15) or received EA treatment alone (CP+EA group, n=15) or EA in combination with a PI3K/Akt inhibitor (CP+EA+LY294002 group, n=15)). An otherwise healthy negative control group of rats undergoing sham surgery was also included (Control group, n=15). In the CP+EA and CP+EA+LY294002 groups, EA was applied to the scalp surface at alocation corresponding to the projection of the motor area. Basso, Beattie and Bresnahan (BBB) locomotor scores, hippocampal protein expression of Akt and p-Akt (by Western blot analysis) and neuronal apoptosis in hippocampal tissue (by histopathology) were assessed at 7, 14 and 21 days post-CP induction. Results CP rats receiving scalp EA treatment demonstrated improved behavioural scores, less hippocampal neuronal apoptosis and higher expression levels of Akt and p-Akt (p<0.05) at all time points studied compared with untreated CP rats. There were no significant differences observed between CP+EA+LY294002 and untreated CP model groups. Conclusions The effects of scalp EA on the PI3K/ Akt signalling pathway may represent one of the mechanisms involved in the inhibition of hippocampal neuronal apoptosis and improvement of deficits associated with CP in a rat model.
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Affiliation(s)
- Hanhong Zhang
- The Fourth Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Gao
- Huai'an Maternity and Child Care Hospital, Huan'an, Jiangsu, China
| | - Mengmeng Wang
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xuefeng Yu
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiuhua Lv
- Life Science and Bioengineering of Beijing Agricultural University, Beijing, China
| | - Huan Deng
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiangwei Fan
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kaiyun Chen
- The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Velasco MA, Raya R, Muzzioli L, Morelli D, Otero A, Iosa M, Cincotti F, Rocon E. Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games. Biomed Eng Online 2017; 16:74. [PMID: 28830552 PMCID: PMC5568605 DOI: 10.1186/s12938-017-0364-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. MATERIALS The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. METHODS Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. RESULTS The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. CONCLUSIONS Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.
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Affiliation(s)
- Miguel A Velasco
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.
| | - Rafael Raya
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.,Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Luca Muzzioli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Daniela Morelli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Abraham Otero
- Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Marco Iosa
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Febo Cincotti
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain
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Lotfian M, Kharazi MR, Mirbagheri A, Dadashi F, Nourian R, Mirbagheri MM. Therapeutic effects of an anti-gravity treadmill (AlterG) training on gait and lower limbs kinematics and kinetics in children with cerebral palsy. IEEE Int Conf Rehabil Robot 2017; 2017:170-174. [PMID: 28813813 DOI: 10.1109/icorr.2017.8009241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We aimed to investigate the effects of the lower body weight support treadmill (AlterG) training on kinetics and kinematics of the lower extremities in children with cerebral palsy (CP). We provided a 45-minute training program, 3 times a week for 8 weeks. AlterG can support the subject's weight up to 70% so that the subject will be able to walk more comfortably to reach a more correct walking pattern. The kinematics and kinetics were evaluated using an isokinetic dynamometer. The locomotion parameters were assessed in the gait laboratory. Subjects performance was evaluated at four time points: baseline (prior to training), 1 and 2 months after the beginning of training, and one month after the end of the training (as a follow-up evaluation). The results showed that the major gait, kinematic, and kinetic parameters improved after the AlterG training and were persistent. These findings suggest that the AlterG training can be considered as a therapeutic tool for improving the lower limb performance and locomotion in children with CP.
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Lotfian M, Mirbagheri MM, Kharazi MR, Dadashi F, Nourian R, Irani A, Mirbagheri A. Pendulum test measure correlates with gait parameters in children with cerebral palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1708-1711. [PMID: 28268656 DOI: 10.1109/embc.2016.7591045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Individuals with cerebral palsy (CP) usually suffer from different impairments including gait impairment and spasticity. Spastic hypertonia is a defining feature of spasticity and manifests as a mechanical abnormality. The objective of this study was to determine the relationship between spastic hypertonia and gait impairments in spastic children with CP, addressing an important controversial issue. Spastic hypertonia was quantified using the pendulum test. The gait impairments were evaluated using the motion capture system in a gait laboratory. Our results showed significant correlations among gait parameters; i.e. walking speed, step length, and the pendulum test measures. This indicates that neuromuscular abnormalities are associated with spasticity and may contribute to gait impairments. The clinical implication is that the impaired gait in children with CP may be improved with the treatment of neuromuscular abnormalities.
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Drobyshevsky A, Quinlan KA. Spinal cord injury in hypertonic newborns after antenatal hypoxia-ischemia in a rabbit model of cerebral palsy. Exp Neurol 2017; 293:13-26. [PMID: 28347765 DOI: 10.1016/j.expneurol.2017.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 12/25/2022]
Abstract
While antenatal hypoxia-ischemia (H-I) is a well-established cause of brain injury, the effects of H-I on the spinal cord remain undefined. This study examined whether hypertonia in rabbits was accompanied by changes in spinal architecture. Rabbit dams underwent global fetal H-I at embryonic day 25 for 40min. High resolution diffusion tensor imaging was performed on fixed neonatal CNS. Fractional anisotropy (FA) and regional volumetric measurements were compared between kits with and without hypertonia after H-I and sham controls using Tract Based Spatial Statistics. Hypertonic kits showed evidence of damage from hypoxia not only in the brain, but in spinal cord as well. Hypertonic kits showed reduced FA and thickness in corticospinal tracts, external capsule, fimbria, and in white and gray matter of both cervical and lumbar spinal cord. Dorsal white matter of the spinal cord was the exception, where there was thickening and increased FA in hypertonic kits. Direct damage to the spinal cord was demonstrated in a subset of dams imaged during H-I with a 3T magnetic resonance scanner, where apparent diffusion coefficient in fetal spinal cords acutely decreased during hypoxia. Hypertonic kits showed subsequent decreases in lumbar motoneuron counts and extensive TUNEL- and Fluoro-Jade C-positive labeling was present in the spinal cord 48h after H-I, demonstrating spinal neurodegeneration. We speculate that global H-I causes significant loss of both spinal white and gray matter in hypertonic newborns due to direct H-I injury to the spinal cord as well as due to upstream brain injury and consequent loss of descending projections.
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Affiliation(s)
- Alexander Drobyshevsky
- Department of Pediatric, NorthShore University HealthSystem Research Institute, Evanston, IL, United States.
| | - Katharina A Quinlan
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Garbellini S, Robert Y, Randall M, Elliott C, Imms C. Rationale for prescription, and effectiveness of, upper limb orthotic intervention for children with cerebral palsy: a systematic review. Disabil Rehabil 2017; 40:1361-1371. [PMID: 28286982 DOI: 10.1080/09638288.2017.1297498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore (i) reasons for upper limb orthosis prescription for children with cerebral palsy (CP), (ii) the link between reason and effect according to intended outcome and outcome measure utilized and (iii) to classify the prescribed orthoses using standard terminology. METHOD A prospectively registered (center for reviews and dissemination: 42015022067) systematic review searched for experimental and observational studies investigating rigid/thermoplastic upper limb orthotic intervention for children aged 0-18 with CP. The Cochrane central register, MEDLINE, CINAHL, Embase, SCOPUS and Web of Science databases were searched. Included studies were assessed for risk of bias. RESULTS Sixteen studies met selection criteria. Two studies described a specific reason for orthosis prescription, six prescribed orthoses to manage a clinical symptom and eight did not describe a reason. Eight studies were analyzed for effect according to intended outcome with no clear connection found between reasons for prescription, outcome measures utilized and effect reported. INTERPRETATION The lack of evidence for upper limb orthotic intervention for children with CP leads to uncertainty when considering this treatment modality. Future research is needed to evaluate the effect of orthosis wear in relation to intended outcome utilizing robust methods and valid and reliable outcome measures. Implications for rehabilitation: Insufficient evidence exists about the reason for prescription of upper limb orthoses. The connection between reason for orthosis prescription, intended outcome, outcome measure utilized and observed effect is unclear. Recommend orthosis prescription to be accompanied by clear documentation of the aim of the orthosis and description using orthosis classification system terminology. Outcome measures consistent with the reason for orthosis prescription and intended outcome of the intervention are essential to measure effectiveness of the intervention.
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Affiliation(s)
- Simon Garbellini
- a Centre for Disability and Development Research , Australian Catholic University , Melbourne , VIC , Australia.,b Department of Pediatric Rehabilitation , Princess Margaret Hospital , Perth , WA , Australia
| | - Yvette Robert
- b Department of Pediatric Rehabilitation , Princess Margaret Hospital , Perth , WA , Australia
| | - Melinda Randall
- a Centre for Disability and Development Research , Australian Catholic University , Melbourne , VIC , Australia
| | - Catherine Elliott
- b Department of Pediatric Rehabilitation , Princess Margaret Hospital , Perth , WA , Australia.,c School of Occupational Therapy and Social Work , Curtin University , Perth , WA , Australia
| | - Christine Imms
- a Centre for Disability and Development Research , Australian Catholic University , Melbourne , VIC , Australia
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Kurmanaviciute R, Stadskleiv K. Assessment of verbal comprehension and non-verbal reasoning when standard response mode is challenging: A comparison of different response modes and an exploration of their clinical usefulness. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2016.1275416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ramune Kurmanaviciute
- Labour and Service Department, Norwegian Labour and Welfare Organisation (NAV), P.O. 308, Alnabru, N-0614 Oslo, Norway
| | - Kristine Stadskleiv
- Department of Child Neurology, Oslo University Hospital, PO 4956, Nydalen, N–0424 Oslo, Norway
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Eliasson AC, Ullenhag A, Wahlström U, Krumlinde-Sundholm L. Mini-MACS: development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Dev Med Child Neurol 2017; 59:72-78. [PMID: 27273427 DOI: 10.1111/dmcn.13162] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Abstract
AIM To develop the Mini-Manual Ability Classification System (Mini-MACS) and to evaluate the extent to which its ratings are valid and reliable when children younger than 4 years are rated by their parents and therapists. METHOD The Mini-MACS was created by making adjustments to the MACS. The development involved a pilot project, consensus discussions within an expert group, and the creation of a test version of the Mini-MACS that was evaluated for content validity and interrater reliability. A convenience sample of 61 children with signs of cerebral palsy aged 12 to 51 months (mean age 30.2mo [SD 10.1]) were classified by one parent and two occupational therapists across a total of 64 assessments. Agreement between the parents' and therapists' ratings was evaluated using the intraclass correlation coefficient (ICC) and the percentage of agreement. RESULTS The first sentence of the five levels in the MACS was kept, but other descriptions within the Mini-MACS were adjusted to be more relevant for the younger age group. The ICC between parents and therapists was 0.90 (95% confidence interval [CI] 0.79-0.92), and for the two therapists it was 0.97 (95% CI 0.78-0.92). Most parents and therapists found the descriptions in the Mini-MACS suitable and easy to understand. INTERPRETATION The Mini-MACS seems applicable for children from 1 to 4 years of age.
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Affiliation(s)
- Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ullenhag
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Wahlström
- Children and Youth's Habilitation Centre, Linköping, Sweden
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Matsui MY, Giannasi LC, Batista SRF, Amorim JBO, Oliveira CS, Oliveira LVF, Gomes MF. Differences between the activity of the masticatory muscles of adults with cerebral palsy and healthy individuals while at rest and in function. Arch Oral Biol 2017; 73:16-20. [DOI: 10.1016/j.archoralbio.2016.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/17/2016] [Accepted: 08/31/2016] [Indexed: 02/04/2023]
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Silva KOGD, Pereira SDC, Portovedo M, Milanski M, Galindo LCM, Guzmán‐Quevedo O, Manhães‐de‐Castro R, Toscano AE. Effects of maternal low‐protein diet on parameters of locomotor activity in a rat model of cerebral palsy. Int J Dev Neurosci 2016; 52:38-45. [DOI: 10.1016/j.ijdevneu.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
| | | | - Mariana Portovedo
- Faculty of Applied SciencesUniversity of Campinas13084‐970CampinasBrazil
| | - Marciane Milanski
- Faculty of Applied SciencesUniversity of Campinas13084‐970CampinasBrazil
| | | | | | | | - Ana Elisa Toscano
- Department of Nursing, CAVFederal University of Pernambuco55608‐680Vitória de Santo AntãoBrazil
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Zafer H, Amjad I, Malik AN, Shaukat E. Effectiveness of Constraint induced movement therapy as compared to bimanual therapy in Upper motor function outcome in child with hemiplegic Cerebral palsy. Pak J Med Sci 2016; 32:181-4. [PMID: 27022371 PMCID: PMC4795864 DOI: 10.12669/pjms.321.8491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study aims at determining the effectiveness of constraint induced movement therapy as compared to bimanual therapy for improving functional status in children with hemiplegic cerebral palsy. Methods: This study was a randomized control trial, children (n = 20) with spastic hemiplegic cerebral palsy was randomly allocated to CIMT (constraint induced movement therapy) and BMT (bimanual therapy) group. The children with spastic hemiplegia, age between 1.5 and 12 year and having 10 degrees of wrist extension and 10 degrees of finger extension were included in study. Treatment regime was two hours of daily training six days a week for two weeks. Constraint was applied to CIMT group for six hours. The outcome tool QUEST was used for baseline and post treatment assessment. Result: CIMT had superior outcome as compared to BMT in improving functional status (p=0.007). On QUEST tool grasp and dissociated movements results were significant (p=0.005) and (p=0.028) respectively. Weight bearing and protective extension resulted in no significant outcome (p=0.080) and (p=0.149) respectively. Dissociated movements and grasp are significantly improved but there is no difference for weight bearing and protective extension in CIMT treated group as compared to BMT treated group. Conclusion: CIMT approach is better in improving functional status of child with cerebral palsy as compared to BMT. Significant improvement in grasp and dissociated movement is noted in group of CIMT while there was no significant improvement in weight bearing and protective extension in CIMT group when compared to BMT. CIMT is considered the appropriate treatment approach for unilateral conditions while BMT for bilateral conditions.
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Affiliation(s)
- Hira Zafer
- Dr. Hira Zafer, DPT, Riphah College of rehabilitation sciences, Riphah International University, Islamabad, Pakistan
| | - Imran Amjad
- Dr. Imran Amjad, DPT, Riphah College of rehabilitation sciences, Riphah International University, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Dr. Arshad Nawaz Malik, DPT, Riphah College of rehabilitation sciences, Riphah International University, Islamabad, Pakistan
| | - Enfall Shaukat
- Dr. Enfall Shaukat, DPT, Riphah College of rehabilitation sciences, Riphah International University, Islamabad, Pakistan
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Giannasi LC, Matsui MY, Freitas SRB, Caldas BF, Grossmann E, Amorim JBO, dos Santos IDR, Oliveira LVF, Oliveira CS, Gomes MF. Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach. PLoS One 2015; 10:e0128959. [PMID: 26247208 PMCID: PMC4527754 DOI: 10.1371/journal.pone.0128959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP.
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Affiliation(s)
- Lilian Chrystiane Giannasi
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
- * E-mail:
| | - Miriam Yumi Matsui
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | - Bruna F. Caldas
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | - Eduardo Grossmann
- Anatomy Laboratory, Federal University of Rio Grande do Sul- UFRGS, Porto Alegre, RS, Brazil
| | - José Benedito O. Amorim
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
| | | | | | - Claudia Santos Oliveira
- Rehabilitation Sciences Master and PhD Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
| | - Monica Fernandes Gomes
- Bioscience, State of São Paulo University “Julio de Mesquita Filho”, UNESP/SJC, São José dos Campos, Brazil
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40
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Golding J, Emmett P, Iles-Caven Y, Steer C, Lingam R. A review of environmental contributions to childhood motor skills. J Child Neurol 2014; 29:1531-47. [PMID: 24170258 PMCID: PMC4004720 DOI: 10.1177/0883073813507483] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although much of children's motor skills have a heredity component, at least half of the variance is likely to be influenced by the environment. It is important to ascertain features of the environment that are responsible so that toxins can be avoided, children at risk can be identified, and beneficial interventions initiated. This review outlines the results of published studies and recommends the areas where further research is required. We found much confusion with little comparability concerning the ages or measures used. Few studies had sufficient power and few allowed for confounders. We found that research to date implicates associations with prenatal drinking ≥4 drinks of alcohol per day; diabetes; taking antidepressant drugs; being deficient in iodine or iron; dietary fish; and postnatal depression. The child appearing to be most at risk was born of low birth weight (but not due to preterm delivery) or with neonatal problems.
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Affiliation(s)
- Jean Golding
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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41
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Smithers-Sheedy H, Raynes-Greenow C, Badawi N, McIntyre S, Jones CA. Congenital cytomegalovirus is associated with severe forms of cerebral palsy and female sex in a retrospective population-based study. Dev Med Child Neurol 2014; 56:846-52. [PMID: 24749557 DOI: 10.1111/dmcn.12467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/30/2022]
Abstract
AIM Congenital cytomegalovirus (cCMV) infection can result in poor outcomes including cerebral palsy (CP). The aim of this study was to describe the incidence and comorbidities of CP reported to the Australian Cerebral Palsy Register (ACPR) as attributed to cCMV infection. METHOD This was a retrospective population-based study. Cases were drawn from Australian state CP registers with population level ascertainment, 1993 to 2003 (n=2265; 56.4% males, Gross Motor Function Classification System [GMFCS] ratings available for Victorian cases only: 70% GMFCS levels I to III and 30% GMFCS levels IV to V). Clinical data were extracted and cases with cCMV reported as a known cause were compared with cases where cCMV was not reported. RESULTS Children with cCMV (n=34; 12 males, 22 females; mean [SD] gestational age, 36.4 wk [4.4], range 24-41 wk) accounted for 1.5% of CP cases; 2.9 per 100,000 live births, (95% confidence intervals 1.9-3.9). When compared with CP cases where cCMV was not reported, proportionally, more CP cases with cCMV were born to younger mothers (p<0.001), were female (64% vs 43%, p=0.014), had spastic quadriplegia (73% vs 21%, p<0.001), required wheeled mobility i.e. GMFCS IV or V (78% vs 28%, p<0.001), had epilepsy (70% vs 30%, p<0.001), deafness (40% vs 2%, p<0.001), functional blindness (20% vs 5%, p<0.001), and severe communication impairment (71% vs 25%, p<0.001). INTERPRETATION cCMV is an important potentially preventable cause of CP and is associated with severe disability and female sex in cases reported to the ACPR. Future studies utilising prospective sample collection for cCMV testing are needed to confirm these findings.
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Affiliation(s)
- Hayley Smithers-Sheedy
- Discipline of Paediatrics & Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Centre for Perinatal Infection Research or Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia; Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia
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Vincer MJ, Allen AC, Allen VM, Baskett TF, O'Connell CM. Trends in the prevalence of cerebral palsy among very preterm infants (<31 weeks' gestational age). Paediatr Child Health 2014; 19:185-9. [PMID: 24855414 DOI: 10.1093/pch/19.4.185] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The birth prevalence of cerebral palsy varies over time among very preterm infants, and the reasons are poorly understood. OBJECTIVE To describe the variation in the prevalence of cerebral palsy among very preterm infants over time, and to relate these differences to other maternal or neonatal factors. METHODS A population-based cohort of very preterm infants was evaluated over a 20-year period (1988 to 2007) divided into four equal epochs. RESULTS The prevalence of cerebral palsy peaked in the third epoch (1998 to 2002) while mortality rate peaked in the second epoch (1993 to 1997). Maternal anemia, tocolytic use and neonatal need for home oxygen were highest in the third epoch. CONCLUSIONS Lower mortality rates did not correlate well with the prevalence of cerebral palsy. Maternal risk factors, anemia and tocolytic use, and the newborn need for home oxygen were highest during the same epoch as the peak prevalence of cerebral palsy.
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Affiliation(s)
- Michael J Vincer
- The Perinatal Follow-Up Program, IWK Health Centre; ; Department of Pediatrics; Dalhousie University, Halifax, Nova Scotia ; Department of Obstetrics and Gynaecology; Dalhousie University, Halifax, Nova Scotia
| | - Alexander C Allen
- Department of Pediatrics; Dalhousie University, Halifax, Nova Scotia ; Department of Obstetrics and Gynaecology; Dalhousie University, Halifax, Nova Scotia ; The Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology; Dalhousie University, Halifax, Nova Scotia
| | - Thomas F Baskett
- Department of Obstetrics and Gynaecology; Dalhousie University, Halifax, Nova Scotia
| | - Colleen M O'Connell
- Department of Pediatrics; Dalhousie University, Halifax, Nova Scotia ; Department of Obstetrics and Gynaecology; Dalhousie University, Halifax, Nova Scotia ; The Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia
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Ketelaar M, Gorter JW, Westers P, Hanna S, Verhoef M. Developmental trajectories of mobility and self-care capabilities in young children with cerebral palsy. J Pediatr 2014; 164:769-774.e2. [PMID: 24418472 DOI: 10.1016/j.jpeds.2013.11.070] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 11/04/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe development of mobility and self-care capabilities in young children (aged 1-4 years) with cerebral palsy, and to examine whether the development of mobility and self-care capabilities differs by cerebral palsy severity in terms of 5 distinct Gross Motor Function Classification System (GMFCS) levels. STUDY DESIGN This prospective longitudinal cohort study included 100 children with cerebral palsy (aged 1.5 or 2.5 years at baseline) and their parents. Mobility and self-care capabilities were assessed by the Pediatric Evaluation of Disability Inventory during yearly assessments from inclusion up to age 4.5 years. Longitudinal data for 92 children were available for analysis. Repeated-measures analyses with random coefficient analysis were performed using linear mixed models. RESULTS Despite large variations among individuals in the development of mobility and self-care capabilities in young children with cerebral palsy, distinct developmental trajectories were found for children in different GMFCS levels. The estimated change per month differed significantly by GMFCS level for both outcomes. CONCLUSIONS This longitudinal study provides an evidence base for prognosis in daily mobility and self-care skills in young children with cerebral palsy. The developmental trajectories for GMFCS levels can be helpful in communication between professionals and also in discussions of expectations and goal setting with families regarding mobility and self-care in the daily life of young children with cerebral palsy in neonatal follow-up and pediatric practice.
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Affiliation(s)
- Marjolijn Ketelaar
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands.
| | - Jan Willem Gorter
- Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Paul Westers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven Hanna
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Marjolein Verhoef
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands
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Coppus AMW. People with intellectual disability: what do we know about adulthood and life expectancy? ACTA ACUST UNITED AC 2014; 18:6-16. [PMID: 23949824 DOI: 10.1002/ddrr.1123] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 12/03/2012] [Accepted: 12/20/2012] [Indexed: 12/13/2022]
Abstract
Increases in the life expectancy of people with Intellectual Disability have followed similar trends to those found in the general population. With the exception of people with severe and multiple disabilities or Down syndrome, the life expectancy of this group now closely approximates with that of the general population. Middle and old age, which until 30 years ago were not recognized in this population, are now important parts of the life course of these individuals. Older adults with Intellectual Disabilities form a small, but significant and growing proportion of older people in the community. How these persons grow older and how symptoms and complications of the underlying cause of the Intellectual Disability will influence their life expectancy is of the utmost importance.
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Affiliation(s)
- A M W Coppus
- Dichterbij, Center for the Intellectually Disabled, Medical Center, Gennep, The Netherlands.
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José Luis Bacco R, Fanny Araya C, Esteban Flores G, Natalia Peña J. Trastornos de la alimentación y deglución en niños y jóvenes portadores de parálisis cerebral: abordaje multidisciplinario. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70044-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Shimmell LJ, Gorter JW, Jackson D, Wright M, Galuppi B. "It's the participation that motivates him": physical activity experiences of youth with cerebral palsy and their parents. Phys Occup Ther Pediatr 2013; 33:405-20. [PMID: 23663137 DOI: 10.3109/01942638.2013.791916] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Youth with cerebral palsy (CP) face significant barriers to participation in physical activity (PA). There is little information available about the nature of these barriers. Seventeen (17) youth and/or their parents participated in focus groups and individual interviews to identify factors that make it easy or hard to be physically active. Four themes emerged across functional levels: environmental and personal factors, limitations related to impairment in body structure and function, the perception that health benefits alone do not motivate youth to be physically active, and variable preferences for activity delivery. Dialogue with participants revealed that interventions to promote PA in youth should mitigate the interactions between personal and environmental factors that act as barriers to PA, and enhance the interactions that facilitate PA. Partnerships between researchers, policy makers, service providers, and families must be developed to address system barriers and build capacity in youth with CP and their communities.
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Affiliation(s)
- Lorie J Shimmell
- 1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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47
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Antecedents of Cerebral Palsy and Perinatal Death in Term and Late Preterm Singletons. Obstet Gynecol 2013; 122:869-877. [DOI: 10.1097/aog.0b013e3182a265ab] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Msall ME. Promoting function and participation to improve living a life with cerebral palsy. Dev Med Child Neurol 2013; 55:877-8. [PMID: 24016331 DOI: 10.1111/dmcn.12271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michael E Msall
- University of Chicago Comer Children's Hospital, Chicago, IL, USA
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49
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Review of Fractures and Low Bone Mass in Children with Cerebral Palsy. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2012. [DOI: 10.1016/j.jotr.2012.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Luan Z, Liu W, Qu S, Du K, He S, Wang Z, Yang Y, Wang C, Gong X. Effects of neural progenitor cell transplantation in children with severe cerebral palsy. Cell Transplant 2012; 21 Suppl 1:S91-8. [PMID: 22507684 DOI: 10.3727/096368912x633806] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cerebral palsy (CP) is a chronic nervous system disease that severely damages the physical and developmental health of children. Traditional treatment brings about only improvement of mild to moderate CP, but severe CP still lacks effective interventions. To explore safety and efficacy of using neural progenitor cells (NPCs) to treat CP in children, we performed NPC transplantation in 45 patients with severe CP by injecting NPCs derived from aborted fetal tissue into the lateral ventricle. Gross motor function measures (GMFM), the Peabody Developmental Motor Scale-Fine Motor (PDMS-FM) test, and a unified survey questionnaire designed specifically for children with CP were used to evaluate neurological function of the patients. Motor development was significantly accelerated within the first month after cell transplantation, but the rate of improvement gradually slowed to preoperative levels. However, after 1 year, the developmental level in each functional sphere (gross motor, fine motor, and cognition) of the treatment group was significantly higher compared to the control group. No delayed complications of this therapy were noted. These results suggest that NPC transplantation is a safe and effective therapeutic method for treating children with severe CP.
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Affiliation(s)
- Zuo Luan
- Department of Pediatrics, Navy General Hospital, No. 6 Fucheng Road, Beijing, P.R. China.
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