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Cangussu AI, Lucarini B, Melo IDF, Diniz PA, Mancini M, Viana BDM, Romano-Silva MA, Miranda DMD. Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2024; 13:e52922. [PMID: 38687586 PMCID: PMC11094605 DOI: 10.2196/52922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/20/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. OBJECTIVE This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. METHODS This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children's quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child's baseline Gross Motor Function Measure results. The participants' changes will be evaluated and compared in both groups. Intervenient features will be tested. RESULTS Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. CONCLUSIONS A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. TRIAL REGISTRATION Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52922.
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Affiliation(s)
- Anna Izabel Cangussu
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horinzote, Brazil
| | - Beatriz Lucarini
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Igor de Freitas Melo
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paula Araújo Diniz
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marisa Mancini
- Departament of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Mattos Viana
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Dobler F, Mayr R, Lengnick H, Federolf P, Alexander N. Efficacy of hinged and carbon fiber ankle-foot orthoses in children with unilateral spastic cerebral palsy and drop-foot gait pattern. Prosthet Orthot Int 2024:00006479-990000000-00239. [PMID: 38579167 DOI: 10.1097/pxr.0000000000000337] [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: 05/23/2023] [Accepted: 12/21/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND In children with unilateral spastic cerebral palsy (USCP), ankle-foot orthoses (AFOs) are widely used to correct common gait deviations such as a drop-foot pattern. Most studies on this topic have investigated specific time points while omitting other parts of the gait cycle. OBJECTIVES This study investigated the separate effects of prefabricated carbon fiber AFOs and custom-made hinged AFOs compared with barefoot walking in children with USCP with a drop-foot gait pattern using statistical parametric mapping. STUDY DESIGN Retrospective, cross-sectional, repeated measures study. METHODS Twenty ambulatory children (9.9 ± 2.5 years) with USCP and a drop-foot gait pattern were included. Kinematics, kinetics, and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking. Statistical parametric mapping was used to compare joint angles and moment waveforms. Kinematics, kinetics and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking for each AFO type but not between the 2 AFO types. RESULTS Compared with barefoot walking, there was a steeper sole angle at initial contact, corresponding to a heel strike pattern, and an increased ankle dorsiflexion in swing with the use of both AFOs. The ankle plantar flexion moment during loading response increased. Ankle power generation during pre-swing decreased in the carbon fiber AFO group when walking with AFOs. CONCLUSIONS Both AFOs were beneficial for improving a drop-foot gait pattern in these small patient groups and can, therefore, be recommended to treat this gait deviation in patients with unilateral cerebral palsy. However, the reduction in ankle power generation during push-off and additional goals targeted by AFOs, such as correction of structural or flexible foot deformities, should be considered for prescription.
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Affiliation(s)
- Florian Dobler
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Robin Mayr
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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García-Castro MI, Menor J, Alvarez-Carriles JC. Differential neuropsychological profiles in children and adolescents with motor disability in an inclusive educational setting. Child Neuropsychol 2024:1-25. [PMID: 38221861 DOI: 10.1080/09297049.2024.2304377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
The aim of this study was to determine the potential cognitive impairment associated with motor disability in a group of children attending regular schools and to analyze whether there were different cognitive profiles according to the type of motor disability they presented. The study had 87 participants, 31 healthy and 56 with three types of motor disability: Neuromuscular Diseases (NMD Group), Cerebral Palsy-Hemiparesis (CP- HPx Group) and Cerebral Palsy-Diplegia (CP-DP). Ages ranged from 6 to 18 years and they had medium and medium-high socioeconomic and cultural levels. All participants attended regular state-funded and independent schools in an inclusive modality. The neuropsychological assessment included the following cognitive domains: processing speed, working memory, verbal and visual episodic memory, language, visuo-perception and constructive praxis and executive functioning. A second analysis was performed with the groups with CP: one based on the severity of gross motor impairment (GMFCS-E&R scale) and the other based on the levels of manual dexterity (MACS scale). ANCOVAs were performed controlling for age and processing speed in the three analyses. The group with CP-HPx was shown to be the most cognitively impaired of the three groups, with significant deficits in visuo-perception, verbal working memory, and visuo-spatial memory. Subjects with greater gross motor dysfunction (GMFCS-E&R) did not show the greatest cognitive impairment, while those with worse manual dexterity (MACS) exhibited greater cognitive impairment. Children and adolescents with motor disabilities, a priori cognitively normal, present different levels of cognitive impairment. This should be considered when planning educational adaptations for this infant-juvenile population.
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Affiliation(s)
- M Isabel García-Castro
- Physical Disability Unit, Regional Team of Attention to Students with Specific, Educational Support Needs, Regional Ministry of Education of the Principality of Asturias, Oviedo, Spain
| | - Julio Menor
- Department of Psychology, University of Oviedo, Spain
| | - Juan C Alvarez-Carriles
- Department of Psychology, University of Oviedo, Spain
- Clinical Neuropsychology Unit, Liaison Psychiatry Service, Central University Hospital of Asturias, Oviedo, Spain
- Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
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Basoya S, Kumar S, Wanjari A. Cerebral Palsy: A Narrative Review on Childhood Disorder. Cureus 2023; 15:e49050. [PMID: 38116360 PMCID: PMC10728574 DOI: 10.7759/cureus.49050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
Cerebral palsy, one of the most common reasons for infirmity in children and young people in developed countries, refers to several neurological diseases that impact movement and coordination. Central nervous system damage received during the first stages of brain development can cause cerebral palsy, a non-progressive condition that manifests as impairments of movement and posture. Two cases per 1000 are reported, and the causes include those mentioned for high-risk infants. Mental retardation, sensory deficiencies, failure to thrive, seizures, and behavioral or emotional issues are some of the associated difficulties. To enable interdisciplinary intervention, early identification is crucial. The result varies depending on the topography, severity, and presence of concomitant abnormalities in cerebral palsy. Cerebral palsy is caused by a static injury to the cerebral motor cortex that happens before, during, or within five years after birth. Various circumstances can influence the disease, including cerebral anoxia, cerebral hemorrhage, infection, and hereditary disorders. Interventions for children are typically provided as part of multidisciplinary rehabilitation programs. Musculoskeletal complaints are common, and pain is a significant underreported symptom.
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Affiliation(s)
- Sakshi Basoya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Gómez-Pérez C, Vidal Samsó J, Puig Diví A, Medina Casanovas J, Font-Llagunes JM, Martori JC. Relationship between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy: Clinical interpretation proposal. J Orthop Sci 2023; 28:1136-1142. [PMID: 36216726 DOI: 10.1016/j.jos.2022.08.011] [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: 04/17/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Understanding the links between gait disorders, impairments, and activity limitations is essential for correctly interpreting the instrumented gait analysis. We aimed to evaluate the relationships between spatiotemporal parameters and clinical outcomes in children with bilateral spastic cerebral palsy, and find out whether spatiotemporal parameters provide clinical information regarding gait pattern and walking. METHODS Data from 19 children with bilateral spastic cerebral palsy (nine males, ten females, 9.6 ± 2.8 years old) were collected retrospectively. All children underwent an instrumented gait analysis and a standardized clinical assessment. Seven spatiotemporal parameters were calculated: non-dimensional cadence, stride length, step width, gait speed, first double support, single support, and time of toe off. Clinical outcomes included measures of two different components of the International Classification of Functioning, Disability and Health - Children and Youth version: body functions and structures (spasticity, contractures and range of motion, and deformities), and activities and participation (gross motor function, and walking capacity). Pearson correlation, ANOVA, Student's t, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze relationships. Spatiotemporal parameters related to clinical outcomes of body functions and structures were interpreted as outcome measures of gait pattern, while those related to clinical outcomes of activities and participation were interpreted as outcome measures of walking. RESULTS Non-dimensional cadence, stride length, and gait speed showed relationships (p < 0.05) with hip flexors spasticity and hindfoot deformity, ankle plantar flexors spasticity, and hindfoot deformity, respectively. All spatiotemporal parameters except non-dimensional cadence showed correlation (p < 0.05) with gross motor function and walking capacity. CONCLUSIONS Spatiotemporal parameters provide clinical information regarding both gait pattern and walking.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, Barcelona, Spain
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Henríquez M, Sabido R, Barbado D, Roldan A, Elvira JLL, Yanci J, Reina R. Differences in kinetic characteristics during countermovement jump of football players with cerebral palsy according to impairment profiles. Front Physiol 2023; 14:1121652. [PMID: 37179834 PMCID: PMC10169619 DOI: 10.3389/fphys.2023.1121652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Objectives: The purpose of this study was 1) to determine and compare kinetic parameters during the realization of a countermovement jump (CMJ) between footballers with cerebral palsy (CP) and non-impaired footballers, and 2) to analyze the differences in this action between different players' impairment profiles and a group of non-impaired footballers. Methods: This study involved 154 participants comprising 121 male footballers with CP from 11 national teams and 33 male non-impaired football players recruited as the control group (CG). The footballers with CP were described according to the different impairment profiles (bilateral spasticity = 10; athetosis or ataxia = 16; unilateral spasticity = 77; minimum impairment = 18). All participants performed three CMJs on a force platform to record kinetic parameters during the test. Results: The group of para-footballers presented significantly lower values than the CG in the jump height (p < 0.01, d = -1.28), peak power (p < 0.01, d = -0.84), and the net concentric impulse (p < 0.01, d = -0.86). Concerning the pairwise comparisons between CP profiles and the CG, significant differences were found for the bilateral spasticity, athetosis or ataxia, and unilateral spasticity subgroups compared to the non-impaired players for jump height (p < 0.01; d = -1.31 to -2.61), power output (p < 0.05; d = -0.77 to -1.66), and concentric impulse of the CMJ (p < 0.01; d = -0.86 to -1.97). When comparing the minimum impairment subgroup with the CG, only significant differences were found for jump height (p = 0.036; d = -0.82). Footballers with minimum impairment presented higher jumping height (p = 0.002; d = -1.32) and concentric impulse (p = 0.029; d = -1.08) compared to those with bilateral spasticity. Also, the unilateral spasticity subgroup reports a higher jump height performance than the bilateral group (p = 0.012; d = -1.12). Conclusion: These results suggest that the variables related to power production during the concentric phase of the jump are crucial for the performance differences between groups with and without impairment. This study provides a more comprehensive understanding of kinetic variables that would differentiate CP and non-impaired footballers. However, more studies are necessary to clarify which parameters better differentiate among different profiles of CP. The findings could help to prescribe effective physical training programs and support the classifier's decision-making for class allocation in this para-sport.
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Affiliation(s)
- Matías Henríquez
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Providencia, Chile
| | - Rafael Sabido
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - David Barbado
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Alba Roldan
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - Jose L. L. Elvira
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - Javier Yanci
- Society, Sports, and Physical Exercise Research Group (GIKAFIT), Physical Education and Sport Department, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
| | - Raúl Reina
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University, Elche, Spain
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Factors Associated With Short-Term Recovery Following Single-Event Multilevel Surgery for Children With Cerebral Palsy. Pediatr Phys Ther 2023; 35:93-99. [PMID: 36638036 DOI: 10.1097/pep.0000000000000976] [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] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine the role of multiple factors, including therapy dose, on recovery of mobility function during post-single-event multilevel surgery (SEMLS) rehabilitation in youth with cerebral palsy. METHODS Several factors expected to influence postoperative change in Gross Motor Function Measure (GMFM) were examined: age, Gross Motor Function Classification System (GMFCS) level, cognition, number of osteotomies, surgical complications, medical comorbidities, number of therapy sessions, and preoperative measures of gait, balance, and gross motor function. RESULTS Sixty-nine youth with cerebral palsy, GMFSC levels I-IV, who had undergone SEMLS and rehabilitation had on average 2.6 osteotomies and 89 postoperative therapy sessions. Fewer osteotomies, higher therapy dose, higher preoperative GMFM, and lower GMFM at postoperative admission were significant in determining GMFM change. CONCLUSIONS The most relevant factors on post-SEMLS recovery were therapy dose, surgical burden, and level of gross motor function immediately before and after surgery.
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Barnett BS, Balaji D, Weleff J, Carroll BT. Catatonia and Neuroleptic Malignant Syndrome in Patients With Cerebral Palsy: Two Case Reports and a Systematic Review of the Literature. J Acad Consult Liaison Psychiatry 2022; 64:277-293. [PMID: 36586471 DOI: 10.1016/j.jaclp.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with cerebral palsy, a group of movement disorders with motor, communication, and behavioral features that can mimic catatonic signs, could benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high. OBJECTIVE This study aimed to systematically review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia. METHODS We used the terms "cerebral palsy" in combination with "catatoni∗," related terms for catatonia, and "neuroleptic malignant syndrome" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched. RESULTS In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management. CONCLUSIONS Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.
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Affiliation(s)
- Brian S Barnett
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | - Dhiksha Balaji
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Ahmed AH, Hanna AA, Arafa AS, El-Sherbini MH, Omran AA. Prospective Comparison of Subtalar Arthroereisis With Calcaneal Lengthening in the Management of Planovalgus Feet of Ambulatory Children With Spastic Cerebral Palsy?. Foot Ankle Spec 2022; 15:515-527. [PMID: 33269639 DOI: 10.1177/1938640020974886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pes planovalgus (PPV) deformity is common among cerebral palsy (CP) patients. There is no true consensus about the best way of treating this common deformity, especially when surgical interference is required. Treatment options range from orthotics to complex surgical procedures. The purpose of this prospective study was to evaluate and compare the effectiveness of 2 different procedures in the correction of symptomatic flexible PPV in ambulatory CP patients. METHODS A total of 57 feet in 35 patients were divided into 2 groups: group 1, subtalar arthroereisis group, using the calcaneostop technique; group 2, lateral column lengthening group, using Evans osteotomy. Patients were assessed clinically by the clinical score proposed by Yoo et al and radiologically by measuring 7 weight-bearing angles, both preoperatively and 12 months postoperatively. Patients' (or parents') satisfaction and their tolerance to braces or shoes were assessed 12 months after surgery as secondary outcome parameters. RESULTS There was a statistically significant improvement in both primary and secondary outcome parameters after both procedures in comparison to the preoperative parameters. No statistically significant differences were observed between the 2 groups regarding the outcomes of both procedures except for the greater power of arthroereisis in the correction of hindfoot valgus, which was statistically significant both clinically and radiographically. CONCLUSION Both procedures are valid options for the surgical management of PPV in ambulatory children with spastic CP. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis is appropriate for some patients, especially in the context of single-event multilevel surgery. LEVELS OF EVIDENCE Level II: Prospective, comparative study.
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Affiliation(s)
- Amr H Ahmed
- Department of Orthopaedics, National Institute of Neuromotor System (NINMS, GOTHI), Imbaba, Giza, Egypt
| | - Atef A Hanna
- Department of Paediatric Orthopaedics, Cairo University, Egypt
| | - Amr S Arafa
- Department of Paediatric Orthopaedics, Cairo University, Egypt
| | - Mostafa H El-Sherbini
- Department of Orthopaedics, National Institute of Neuromotor System (NINMS, GOTHI), Imbaba, Giza, Egypt
| | - Ahmed A Omran
- Department of Orthopaedics, National Institute of Neuromotor System (NINMS, GOTHI), Imbaba, Giza, Egypt
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A cross-sectional study determining the relationship between eating and drinking skills and functional independence levels of patients with cerebral palsy. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/Aim: In cerebral palsy (CP), drinking/eating disorders are considered common. To evaluate these disorders, a very detailed and lengthy evaluation is required. Few tools are available to identify children who need to be evaluated. This study determined whether the functional independence level of children with CP is sufficient to predict their drinking/eating skills and to determine the relationship between this functional level and these skills.
Methods: A total of 105 children with CP aged 4–8 years participated in a cross-sectional study in our outpatient clinic. Functional classification was assigned using the Gross Motor Function Classification System and Manuel Ability Classification System (GMFCS and MACS, respectively). For a functional assessment of daily life, the Pediatric Evaluation of Disability Inventory (PEDI) was performed by asking a relative of the child. The Eating and Drinking Abilities Classification System (EDACS) level was added to the study after asking the caregivers of the patients for eating/drinking evaluations.
Results: According to the current results, we found a negative correlation between EDACS and PEDI scores. As the EDACS grade increased, the PEDI subscale and total scores decreased in a statistically significant manner (P < 0.001), while the GMFCS and MACS scale increased statistically (P < 0.001). As the PEDI subscale and total scores increased, the levels of GMFCS and MACS decreased statistically significantly (P < 0.001).
Conclusions: The performances of children with CP in terms of activities of daily living are closely related to their performance in eating/drinking activities. If children are independent in their mobility, social functions, and daily self-care, they are also more independent in terms of eating/drinking.
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Pagaki-Skaliora M, Morrow E, Theologis T. Telehealth and remote interventions for children with cerebral palsy: A scoping review. JMIR Rehabil Assist Technol 2022; 9:e36842. [PMID: 36041012 PMCID: PMC9629344 DOI: 10.2196/36842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.
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Affiliation(s)
- Marina Pagaki-Skaliora
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar CentreWindmill Road, Oxford, GB
| | - Eileen Morrow
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar CentreWindmill Road, Oxford, GB.,Oxford University Hospitals NHS Foundation Trust, Oxford, GB
| | - Tim Theologis
- Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Sciences, University of Oxford, Botnar CentreWindmill Road, Oxford, GB.,Oxford University Hospitals NHS Foundation Trust, Oxford, GB
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Thomé Teixeira da Silva LV, Vegas M, Aquaroni Ricci N, Cardoso de Sá CS, Alouche SR. Selecting assessment tools to characterize upper limb function of children with cerebral palsy: A mega-review of systematic reviews. Dev Neurorehabil 2022; 25:378-391. [PMID: 35282778 DOI: 10.1080/17518423.2022.2046656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM A mega-review of published systematic reviews without restriction on year of publication was implemented to summarize available assessment tools of upper limb (UL) function in children with Cerebral Palsy (CP). METHOD A multi-prong search strategy was used to identify 12 systematic literature reviews for inclusion in the mega-review. Included reviews were coded by descriptive analyses, which included methodological and reported measurement property description. Methodological quality of the selected systematic reviews was evaluated with the AMSTAR-2. We synthetized the measurement properties of the revised assessment tools and their coverage within the International Classification of Functioning, Disability and Health (ICF) domains. RESULTS The 12 systematic reviews addressed 84 assessment tools. Systematic reviews' methodological quality varied between critically low to moderate. Suggested assessment tools covered ICF domains of body structure and function, and activities and participation. Measurement property data analysis was based mostly on reliability and validity. INTERPRETATION Based on the findings of the mega-review, the ABILHAND-Kids, Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function (MUUL) are the most suitable tools to evaluate children between 6 and 12 years of age with unilateral CP.
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Affiliation(s)
| | - Milena Vegas
- School of Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Natalia Aquaroni Ricci
- Master's and Doctoral Program in Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Sandra Regina Alouche
- Master's and Doctoral Program in Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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13
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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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Carman KB, Aydın K, Kilic Aydin B, Cansu A, Direk MC, Durmus S, Dündar NO, Gencpinar P, Gungor S, Gurkas E, Hur O, Karadag M, Karademir CN, Ozkan Kart P, Okuyaz C, Oz NA, Peduk Y, Per H, Serin MH, Tekgul H, Unay B, Yarar C, Yildirim GK. Evaluation of micronutrient levels in children with cerebral palsy. Pediatr Int 2022; 64:e15005. [PMID: 34585809 DOI: 10.1111/ped.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). METHODS This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. RESULTS The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers. CONCLUSIONS Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.
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Affiliation(s)
- Kursat Bora Carman
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kursad Aydın
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Betul Kilic Aydin
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Selver Durmus
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Nihal Olgaç Dündar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Serdal Gungor
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Esra Gurkas
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Ozgen Hur
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Meral Karadag
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Cefa Nil Karademir
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pinar Ozkan Kart
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Nefise Arıbas Oz
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Yakup Peduk
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | | | - Hasan Tekgul
- Department of Pediatric Neurology, Ege University, Izmir, Turkey
| | - Bulent Unay
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Coskun Yarar
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gonca Kilic Yildirim
- Pediatric Metabolic Diseases and Nutrition, Eskisehir Osmangazi University, Eskisehir, Turkey
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Logosu D, Tagoe TA, Adjei P. Transcutaneous electrical nerve stimulation in the management of calf muscle spasticity in cerebral palsy: A pilot study. IBRO Neurosci Rep 2021; 11:194-199. [PMID: 34939065 PMCID: PMC8664700 DOI: 10.1016/j.ibneur.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
This study sets out to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of calf muscle spasticity in children with cerebral palsy. The study follows a one group pre-test–post-test design involving fifteen children with spastic cerebral palsy, presenting with calf muscle spasticity. Spasticity was assessed before and after a 30 min application of TENS to the bilateral calf muscles. The H-reflex (electromyography) of the calf muscles and Modified Ashworth Scale (MAS) served as a measure of spasticity. A goniometer was used to measure the range of motion (ROM) angles for ankle dorsiflexion. We report here no significant difference (p > 0.05) between the left and right H-reflex responses, MAS scores, and ROM scores recorded at baseline (pre-test). Correlation analysis show no correlation (p > 0.05) between the pre-test HA Max (maximum H-reflex amplitude)/MA Max (maximum M-Wave Amplitude) ratio and MAS scores of both the left and right calf muscles. However, TENS significantly reduced (p < 0.05) the HA of the left calf muscle and MAS scores of the left and right calf muscles. Additionally, TENS significantly increased the ROM scores of the left and right calf muscles. Our findings lend support to existing evidence that TENS is effective in reducing spasticity. The potential mechanism underlying this effect is a reduction in neuron excitability. The application of TENS in children with spastic Cerebral palsy is well tolerated. H-reflex is an effective tool in measuring spasticity objectively. TENS may be effective as an adjunct treatment option in the management of spasticity.
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Affiliation(s)
- Delali Logosu
- Department of Physiology, University of Ghana, Accra, Ghana
| | - Thomas A Tagoe
- Department of Physiology, University of Ghana, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine and Therapeutics, University of Ghana, Accra, Ghana.,Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
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Gómez-Pérez C, Martori JC, Puig Diví A, Medina Casanovas J, Vidal Samsó J, Font-Llagunes JM. Gait event detection using kinematic data in children with bilateral spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2021; 90:105492. [PMID: 34627071 DOI: 10.1016/j.clinbiomech.2021.105492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ground reaction forces are the gold standard for detecting gait events, but they are not always applicable in cerebral palsy. Ghoussayni's algorithm is an event detection method based on the sagittal plane velocity of heel and toe markers. We aimed to evaluate whether Ghoussayni's algorithm, using two different thresholds, was a valid event detection method in children with bilateral spastic cerebral palsy. We also aimed to define a new adaptation of Ghoussayni's algorithm for detecting foot strike in cerebral palsy, and study the effect of event detection methods on spatiotemporal parameters. METHODS Synchronized kinematic and kinetic data were collected retrospectively from 16 children with bilateral spastic cerebral palsy (7 males and 9 females; age 8.9 ± 2.7 years) walking barefoot at self-selected speed. Gait events were detected using methods: 1) ground reaction forces, 2) Ghoussayni's algorithm with a threshold of 0.5 m/s, and 3) Ghoussayni's algorithm with a walking speed dependent threshold. The new adaptation distinguished how foot strikes were performed (heel and/or toe) comparing the timing when the foot markers velocities fell below the threshold. Differences between the three methods, and between spatiotemporal parameters calculated from the two Ghoussayni's thresholds were analyzed. FINDINGS There were statistically significant (P < 0.05) differences between methods 1 and 3, and between some spatiotemporal parameters calculated from methods 2 and 3. Ghoussayni's algorithm showed better performance for foot strike than for toe off. INTERPRETATION Ghoussayni's algorithm using 0.5 m/s is valid in children with bilateral spastic cerebral palsy. Event detection methods affect spatiotemporal parameters.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família 7, 08500 Vic, Spain.
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia (UVic-UCC), C. Sagrada Família 7, 08500 Vic, Spain.
| | - Albert Puig Diví
- Blanquerna School of Health Sciences - Ramon Llull University, C. Padilla 326, 08025 Barcelona, Spain.
| | - Josep Medina Casanovas
- Institut Guttmann, Hospital de Neurorehabilitació, Camí de Can Ruti, 08916 Badalona, Spain; Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera Canyet, 08916 Badalona, Spain.
| | - Joan Vidal Samsó
- Institut Guttmann, Hospital de Neurorehabilitació, Camí de Can Ruti, 08916 Badalona, Spain; Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera Canyet, 08916 Badalona, Spain.
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Av. Diagonal 647, 08028 Barcelona, Spain; Institut de Recerca Sant Joan de Déu, C. Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain.
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Bingol H, Kerem Gunel M. The effects of hand deformity on upper-limb function and health-related quality of life in children with spastic hemiplegic cerebral palsy. HAND SURGERY & REHABILITATION 2021; 40:722-728. [PMID: 34454162 DOI: 10.1016/j.hansur.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the effect of hand deformity on upper-limb function and health-related quality of life (HRQOL) in children with hemiplegic cerebral palsy (CP). The study included 44 children with hemiplegic CP between the ages of 6 and 14 years (mean age, 10.04 years; SD, 3.1; 23 males, 21 females). The Manual Ability Classification System (MACS) and Gross Motor Function Classification System (GMFCS) were used, with the Zancolli classification to characterize hand deformities on the more affected side. Upper-limb function was assessed in terms of unilateral capacity (Quality of Upper Extremity Skills Test: QUEST) and bimanual performance (Children's Hand-use Experience Questionnaire: CHEQ), while HRQOL was evaluated on the KIDSCREEN-27 questionnaire. Comparison of bimanual performance and unilateral capacity in children with Zancolli level 1 and 2a hemiplegic CP found statistically significant differences (p < 0.01). There was also a significant difference on the HRQOL 'physical activities and health' subdomain, in favor of Zancolli level I deformity (p = 0.003), but not on the other HRQOL domains (p > 0.05). Upper-limb function and the HRQOL physical health domain were poorer with greater hand deformity in children with hemiplegic CP.
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Affiliation(s)
- H Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Service, Muş Alparslan University, 49250, Güzeltepe/Mus, Turkey; Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100, Samanpazarı/Ankara, Turkey.
| | - M Kerem Gunel
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100, Samanpazarı/Ankara, Turkey.
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18
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Gugała B. Caregiver burden versus intensity of anxiety and depression symptoms in parents of children with cerebral palsy as well as factors potentially differentiating the level of burden: a cross-sectional study (Poland). BMJ Open 2021; 11:e036494. [PMID: 34145003 PMCID: PMC8215253 DOI: 10.1136/bmjopen-2019-036494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the relationship between caregiver burden and severity of symptoms of anxiety/depression in parents of children with cerebral palsy (CP), and to identify factors differentiating the level of caregiver burden. SETTING Regional rehabilitation centres in South-Eastern Poland. PARTICIPANTS The study involved 190 parents of children with CP, that is, 138 women and 52 men. PRIMARY AND SECONDARY OUTCOME MEASURES Caregiver burden was assessed using Caregiver Burden Scale (CBS), while the intensity of anxiety and depression symptoms was measured using Hospital Anxiety and Depression Scale (HADS). Potential predictors were examined using Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Barthel Index (BI) as well as a questionnaire focusing on the characteristics of the child, the parent and the family. The analyses applied Pearson's linear correlation coefficient as well as multiple regression analysis. RESULTS All the CBS measures are significantly correlated to HADS-A (anxiety) and HADS-D (depression). Intensity of anxiety is most visibly linked to CBS measures of disappointment and environment (p<0.0001), while severity of depression is related to emotional involvement and general strain (p<0.0001). The factors differentiating caregiver burden measure in the subscales of general strain (p<0.0001) and social isolation (p<0.0001) include the child's age and BI, and the parent's health status; in the subscale of disappointment (p<0.0001)-the child's age, BI, GMFCS, as well as the parent's age and health status; in the subscale of emotional involvement (p=0.0007)-BI, and the parent's health status; in the subscale of environment (p=0.0002)-the child's age and BI. CONCLUSIONS There is a positive linear relationship between the caregiver burden measures and severity of anxiety and depression. Effort should be made to relieve caregiver burden in parents of children with CP.
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Intramuscular psoas lengthening at the pelvic brim plus proximal lengthening of the rectus femoris as a treatment for fixed knee flexion deformity in cerebral palsy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Abstract
PURPOSE In myelomeningocele, several classifications have been used. The present manuscript proposes a new functional classification to better assess the prognosis and management of these patients. METHODS The manual muscle test is what defines the actual group in which the patient should be included. Furthermore, this new classification brings information about the bracing and external supports recommended to each functional level. We also recommend that the patient's Functional Mobility Scale should always be mentioned together with their functional level. RESULTS The four levels in this classification are MMFC1, MMFC2, MMFC3 and MMFC4. The MMFC1 group includes patients with significant muscle weakness. They need to use high braces crossing the hip joint with a walker to achieve some ambulation. The MMFC2 group includes patients who have functional hip flexors, knee extensors and knee flexors. However, the hip abductors are quite weak. These patients usually need to use a walker - or crutches - and Ankle-Foot Orthosis (AFOs). The MMFC3 group includes patients with functional hip flexors, knee extensors, knee flexors and hip abductors. However, the ankle plantar flexion function is absent. Most of them are able to walk independently, only using AFOs without any external support. The MMFC4 group includes patients who have preserved function in the entire lower limb musculature. These patients don't need any assistive devices to achieve an adequate ambulation pattern. CONCLUSIONS We hope that this new classification is a system that is simple to understand, serves as a gait prognosis guide and facilitates communication among healthcare professionals. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Luciano S. Dias
- Shirley Ryan Ability Laboratory, Chicago, Illinois, USA,Correspondence should be sent to Luciano S. Dias, 680 N. Lakeshore Dr. #1621, Chicago, IL 60611, USA. E-mail:
| | - Vineeta T. Swaroop
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Luiz R. A. de Angeli
- Department of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jill E. Larson
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
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21
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Intramuscular psoas lengthening at the pelvic brim plus proximal lengthening of the rectus femoris as a treatment for fixed knee flexion deformity in cerebral palsy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:216-222. [PMID: 33461940 DOI: 10.1016/j.recot.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
Although the correction of knee flexion by lengthening the hamstring musculature is traditionally contemplated in cerebral palsy, literature suggests that treatment of hip flexion also improves knee extension. The aim of the study was to first show the efficacy of the sequence of intrapelvic tenotomy of the psoas followed by intramuscular lengthening of the proximal rectus anterior and, later, that of both surgical soft tissue surgeries separately. For this, a prospective study was carried out in 10 patients with a mean age of 14 years, which presented 16 fixed knee flexes with a mean of deformity of 22°. The data was analyzed through means of an ANOVA of repeated measures and to determine the effect separately of each one of the techniques, the improvements obtained with respect to the previous level were contrasted. The mean extension achieved was 12°, 7° corresponding to the intrapelvic tenotomy of the psoas and, on the remaining knee flexion, a correction of 5° after intramuscular lengthening of the anterior rectus at the proximal level. Both the sequence of proposed gestures and those that form separately, showed statistically significant differences (P <0.001) in the correction of the deformity. In conclusion, the proposed techniques applied sequentially or separately are effective in reducing knee flexion in predominantly spastic cerebral palsy, facilitating or even being able to avoid the treatment that is directly needed.
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22
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The effect of trunk kinesio taping on static and dynamic balance and functional mobility in children with cerebral palsy. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00660-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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de Andrade E Souza Mazuchi F, Mochizuki L, Hamill J, Franciulli PM, Bigongiari A, de Almeida Martins IT, Ervilha UF. Joint-Position Sense Accuracy Is Equally Affected by Vision among Children with and without Cerebral Palsy. J Mot Behav 2020; 53:209-216. [PMID: 32340568 DOI: 10.1080/00222895.2020.1756732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We compared the effect of visual information on the dominant upper limb position sense of children with diplegic cerebral palsy (n = 10) and normally developing children (n = 10). An isokinetic dynamometer passively moved the dominant forearm in 120° of elbow flexion/extension until the volunteers stopped the machine to indicate that the elbow joint was positioned in the predetermined target angle. Participants performed this task five times in sequence with and without visual feedback of the elbow angle. We calculated the absolute and the relative position errors related to the final elbow position and the target angle. In both groups, absolute error was significantly higher when vision was occluded. Relative error was not affected by cerebral palsy or visual feedback. When vision was occluded, accuracy on this task was similarly impaired in both groups and precision was not disturbed.
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Affiliation(s)
| | - Luis Mochizuki
- School of Arts Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - Aline Bigongiari
- Biomechanics Laboratory, Sao Judas Tadeu University, Sao Paulo, Brazil
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Więch P, Ćwirlej-Sozańska A, Wiśniowska-Szurlej A, Kilian J, Lenart-Domka E, Bejer A, Domka-Jopek E, Sozański B, Korczowski B. The Relationship Between Body Composition and Muscle Tone in Children with Cerebral Palsy: A Case-Control Study. Nutrients 2020; 12:nu12030864. [PMID: 32213841 PMCID: PMC7146599 DOI: 10.3390/nu12030864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 01/10/2023] Open
Abstract
The monitoring of children with cerebral palsy (CP) should include a precise assessment of the nutritional status to identify children and adolescents at risk of nutrition disorders. Available studies assessing the nutritional status of children with CP mainly focus on the relationship between body composition and the coexistence of motor dysfunctions, frequently overlooking the role of muscle tone. Therefore, the aim of this study was to assess the relationship between body composition and muscle tone in children with CP. In a case-control study (n = 118; mean age 11 y; SD = 3.8), the children with CP presented various stages of functional capacities, corresponding to all the levels in gross motor function classification system (GMFSC), and muscle tone described by all the grades in Ashworth scale. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. The children with CP were found with significantly lower mean values of fat-free mass (FFM kg = 29.2 vs. 34.5, p < 0.001), muscle mass (MM kg = 18.6 vs. 22.6, p < 0.001), body cell mass (BCM kg = 15.1 vs. 18.3, p < 0.001), and total body water (TBW L = 23.0 vs. 26.7, p < 0.001). The same differences in body composition were identified with respect to gender (p < 0.01 respectively). Moreover, children with higher muscle tone (higher score in Ashworth scale) were found with significantly lower values of fat mass (FM), FFM, MM, BCM, and TBW (p < 0.05). The findings showed lower parameters of body composition in the children with CP compared to the healthy children, and a decrease in the parameters coinciding with higher muscle tone in the study group. This observation suggests that it is necessary to measure muscle tone while assessing nutritional status of children with CP.
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Affiliation(s)
- Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Correspondence: ; Tel.: +48667192696
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Agnieszka Wiśniowska-Szurlej
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Justyna Kilian
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Ewa Lenart-Domka
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Clinical Regional Rehabilitation and Education Centre for Children and Adolescents in Rzeszow, 35-301 Rzeszow, Poland
| | - Agnieszka Bejer
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Elżbieta Domka-Jopek
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bernard Sozański
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bartosz Korczowski
- Institute of Medical Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland;
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Krzhizhanovskaya VV, Závodszky G, Lees MH, Dongarra JJ, Sloot PMA, Brissos S, Teixeira J. Gait Abnormality Detection in People with Cerebral Palsy Using an Uncertainty-Based State-Space Model. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7303699 DOI: 10.1007/978-3-030-50423-6_40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Assessment and quantification of feature uncertainty in modeling gait pattern is crucial in clinical decision making. Automatic diagnostic systems for Cerebral Palsy gait often ignored the uncertainty factor while recognizing the gait pattern. In addition, they also suffer from limited clinical interpretability. This study establishes a low-cost data acquisition set up and proposes a state-space model where the temporal evolution of gait pattern was recognized by analyzing the feature uncertainty using Dempster-Shafer theory of evidence. An attempt was also made to quantify the degree of abnormality by proposing gait deviation indexes. Results indicate that our proposed model outperformed state-of-the-art with an overall \documentclass[12pt]{minimal}
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\begin{document}$$100\%$$\end{document}). In a gait cycle of a Cerebral Palsy patient, first double limb support and left single limb support were observed to be affected mainly. Incorporation of feature uncertainty in quantifying the degree of abnormality is demonstrated to be promising. Larger value of feature uncertainty was observed for the patients having higher degree of abnormality. Sub-phase wise assessment of gait pattern improves the interpretability of the results which is crucial in clinical decision making.
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Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rao AP, Shah H, Guruvare S, Guddattu V. Growth, sexual development and menstrual issues among girls with cerebral palsy – A cross sectional study in a tertiary care centre. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Diaphragmatic mobility in children with spastic cerebral palsy and differing motor performance levels. Respir Physiol Neurobiol 2019; 266:163-170. [DOI: 10.1016/j.resp.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/24/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022]
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Gómez-Pérez C, Font-Llagunes JM, Martori JC, Vidal Samsó J. Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials. Dev Med Child Neurol 2019; 61:770-782. [PMID: 30484877 DOI: 10.1111/dmcn.14108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Abstract
AIM To identify the gait parameters used to assess gait disorders in children with bilateral spastic cerebral palsy (CP) and evaluate their responsiveness to treatments. METHOD A systematic search within PubMed, Web of Science, and Scopus (in English, 2000-2016) for randomized controlled trials of children with bilateral spastic CP who were assessed by instrumented gait analysis (IGA) was performed. Data related to participants and study characteristics, risk of bias, and outcome measures were collected. A list of gait parameters responsive to clinical interventions was obtained. RESULTS Twenty-one articles met the inclusion criteria. Eighty-nine gait parameters were identified, 56 of which showed responsiveness to treatments. Spatiotemporal and kinematic parameters were widely used compared to kinetic and surface electromyography data. The majority of responsive gait parameters were joint angles at the sagittal plane (flexion-extension). INTERPRETATION The IGA yields responsive outcome measures for the gait assessment of children with bilateral spastic CP. Spatiotemporal and kinematic (at sagittal plane) parameters are the gait parameters used most frequently. Further research is needed to establish the relevant gait parameters for each clinical problem. WHAT THIS PAPER ADDS Fifty-six responsive gait parameters for children with bilateral spastic cerebral palsy were identified. Most responsive gait parameters belong to joint angles time-series at sagittal plane. Spatiotemporal and kinematic parameters are widely used compared to kinetic and surface electromyography parameters.
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Affiliation(s)
- Cristina Gómez-Pérez
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences, Faculty of Health Science and Welfare, Centre for Health and Social Care Research, University of Vic - Central University of Catalonia, Vic, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain.,Biomedical Engineering, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, Faculty of Business and Communication Studies, University of Vic - Central University of Catalonia, Vic, Spain
| | - Joan Vidal Samsó
- Institut Guttmann, Neurorehabilitation Institute, Badalona, Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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[Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy]. An Pediatr (Barc) 2019; 91:317-327. [PMID: 30795881 DOI: 10.1016/j.anpedi.2018.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/05/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. METHODS This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. RESULTS Of the 124 patients included in the study, 56 (45.2%) experienced a pain level ≤2. In the Group III a significantly greater proportion of patients were classified with a pain level score ≤2, P<.001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). CONCLUSION The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP.
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Vargus-Adams J. Transformative journeys in childhood-onset disability with the AACPDM. Dev Med Child Neurol 2018; 60:967. [PMID: 30187467 DOI: 10.1111/dmcn.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abd-Elmonem AM, Elhady HSA. Effect of rebound exercises on balance in children with spastic diplegia. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018; 25:467-474. [DOI: 10.12968/ijtr.2018.25.9.467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Background/Aims: Rebound exercises using a trampoline and BOSU ball provides proprioceptive and vestibular stimulation and improve postural control and balance. Although there is no evidence to support the benefits of using rebound exercises, it is widely used in rehabilitation. The current study aimed to investigate the effect of a rebound exercises on balance in children with spastic diplegia. Methods: Forty children with spastic diplegia from both sexes, age ranged from 6 to 10 years participated in this study. They were allocated randomly into two groups of equal numbers, one was the control group and the other was the study group. The control group received a designed physical therapy programme for 1 hour and balance training for 1 hour. The study group received the same physical therapy programme as the control group in addition to rebound exercises for one hour. The treatment programmes of both groups were conducted 3 days a week for 2 successive months. The assessments of dynamic balance were conducted pre, post treatment and 1 month after the end of the treatment using the Biodex balance system. Results: Baseline and post treatment comparisons showed a statistically significant improvement of balance in the two groups. There was no significant difference between post treatment and post 1 month follow-up in the control group, while a significant difference was recorded in the study group. Conclusions: Rebound exercises conducted with a designed physical therapy programme is beneficial and has a significant effect in improving balance.
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Affiliation(s)
- Amira Mahmoud Abd-Elmonem
- Lecturer, Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hebatallah S Abd Elhady
- Researcher, Department of Audio-vestibular Medicine, National Research Center, Giza, Cairo, Egypt
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Kim GM. Validation of the Fullerton Advanced Balance Scale in children with cerebral palsy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.9.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background/Aims: Cerebral palsy is classified by the type of motor impairment. The ability to balance differs depending on the level of disability. The aim of this research was to investigate the item fit and item difficulty of the Fullerton Advanced Balance Scale in children with cerebral palsy, and to compare item fit and difficulty in individuals with diplegia and hemiplegia. Methods: Forty children with cerebral palsy completed the 10-item Fullerton Advanced Balance Scale questionnaire. Rasch analysis was used to identify the psychometric properties of the Fullerton Advanced Balance Scale and compare item fit and difficulty in two groups: children with diplegia and children with hemiplegia. Findings: Item 2 showed misfit statistics for all participants. Items 1 and 2 showed misfit statistics in hemiplegia, whereas no items showed misfit in diplegia. Conclusions: Item fit and difficulty need to be considered in relation to the level of disability when evaluating balance in children with cerebral palsy.
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Affiliation(s)
- Gyoung-mo Kim
- Professor, Department of Physical Therapy, Daejeon Health Institute of Technology, Republic of Korea
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Mu X, Wang Z, Nie B, Duan S, Ma Q, Dai G, Wu C, Dong Y, Shan B, Ma L. Altered regional and circuit resting-state activity in patients with occult spastic diplegic cerebral palsy. Pediatr Neonatol 2018; 59:345-351. [PMID: 29066071 DOI: 10.1016/j.pedneo.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/12/2017] [Accepted: 10/03/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Very few studies have been made to investigate functional activity changes in occult spastic diplegic cerebral palsy (SDCP). The purpose of this study was to analyze whole-brain resting state regional brain activity and functional connectivity (FC) changes in patients with SDCP. METHODS We examined 12 occult SDCP and 14 healthy control subjects using resting-state functional magnetic resonance imaging. The data were analyzed using Resting-State fMRI Data Analysis Toolkit (REST) software. The regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), and whole brain FC of the motor cortex and thalamus were analyzed and compared between the occult SDCP and control groups. RESULTS Compared with the control group, the occult SDCP group showed decreased ReHo regions, including the bilateral frontal, parietal, and temporal lobes, the cerebellum, right cingulate gyrus, and right lenticular nucleus, whereas an increased ReHo value was observed in the left precuneus, calcarine, fusiform gyrus, and right precuneus. Compared with the control group, no significant differences in ALFF were noted in the occult SDCP group. With the motor cortex as the region of interest, the occult SDCP group showed decreased connectivity regions in the bilateral fusiform and lingual gyrus, but increased connectivity regions in the contralateral precentral and postcentral gyrus, supplementary motor area, and the ipsilateral postcentral gyrus. With the thalamus being regarded as the region of interest, the occult SDCP group showed decreased connectivity regions in the bilateral basal ganglia, cingulate, and prefrontal cortex, but increased connectivity regions in the bilateral precentral gyrus, the contralateral cerebellum, and inferior temporal gyrus. CONCLUSIONS Resting-state regional brain activities and FC changes in the patients with occult SDCP exhibited a special distribution pattern, which is consistent with the pathology of the disease.
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Affiliation(s)
- Xuetao Mu
- Department of MRI, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China.
| | - Zhiqun Wang
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Binbin Nie
- Key Laboratory of Nuclear Analysis Techniques, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
| | - Shaofeng Duan
- Key Laboratory of Nuclear Analysis Techniques, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
| | - Qiaozhi Ma
- Department of MRI, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Guanghui Dai
- Neurosurgical Institute, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Chunnan Wu
- Department of MRI, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Yuru Dong
- Department of MRI, The General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis Techniques, Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China
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Angelin AC, Sposito AM, Pfeifer LI. Influence of functional mobility and manual function on play in preschool children with cerebral palsy. Hong Kong J Occup Ther 2018; 31:46-53. [PMID: 30186086 PMCID: PMC6091981 DOI: 10.1177/1569186118783889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/21/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction This study analysed the differences in play performance between preschool children with cerebral palsy and those with typical development and investigated the factors influencing functional mobility and manual dexterity on play in children with cerebral palsy. Method Sixty preschool children (30 with cerebral palsy; 30 with typical development), were assessed by the revised Knox Preschool Play Scale, being that children with cerebral palsy were also classified according to their functional mobility and manual dexterity. Results On average, all measures were significantly smaller in the cerebral palsy group than the typical development group (p≤ .002). Manual function and functional mobility were negatively correlated with material (r = −.456, p = .011; r = −.487, p = .006) and space (r = −.494, p = .006; r = −.784, p = .000). Also the results pointed out a significant correlation with topography and manual function (r = .404, p = .027) and functional mobility (r = .718, p = .000). Pretend play and participation showed no correlation with topography (r = −.051, p = .788; r = −.312, p = .093), manual function (r = −.019, p = .921; r = −.322, p = .083) and functional mobility (r = −.085, p = .657; r = −.308, p = .097). Conclusion Play performance of children with typical development was superior to those with cerebral palsy. The degree of impairment of functional mobility and manual function negatively was negatively associated with play exploration but did not relate to pretend play or social interaction in play.
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Santos RMD, Massi G, Willig MH, Carnevale LB, Berberian AP, Freire MHDS, Tonocchi R, Carvalho TPD. Children and adolescents with cerebral palsy in the perspective of familial caregivers. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171969817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze family caregivers’ perceptions on care delivered to children and adolescents presented with cerebral palsy. Methods: a quantitative, qualitative study developed with 50 family caregivers of children and adolescents diagnosed with cerebral palsy. Data collection was carried out by means of an interview with semi-open questions whose answers were analyzed based on the Content Analysis. Results: family members’ accounts on care delivered to children and adolescents with cerebral palsy are mostly connected with positive feelings, such as love, happiness, privilege and overcoming. However, for a significant share of these family members, their own quality of life depends on the cared subject’s health condition, blurring the distinction between their own needs and those of the cared subjects. Conclusions: health professionals need to recognize the importance of caregivers’ health promotion as a major condition to keep caring. In this dimension, they may contribute by helping caregivers identify their own health needs.
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Mutlu A, Büğüşan S, Kara ÖK. Impairments, activity limitations, and participation restrictions of the international classification of functioning, disability, and health model in children with ambulatory cerebral palsy. Saudi Med J 2017; 38:176-185. [PMID: 28133691 PMCID: PMC5329630 DOI: 10.15537/smj.2017.2.16079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: To examine the impairments, activity limitations, and participation restrictions in children with spastic unilateral and bilateral cerebral palsy (CP). We investigated the relationship between these factors according to the international classification of functioning, disability, and health (ICF) model. Methods: This prospective cross sectional study included 60 children aged between 4-18 years with spastic CP (30 unilateral, 30 bilateral involvement) classified as Levels I and II on the gross motor function classification system. Children had been referred to the Pediatric Rehabilitation Unit in the Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey between March 2014 and March 2015. The Physician Rating scale was used to assess body functions and structures. The Gillette Functional Assessment Questionnaire 22-item skill set, Pediatric Functional Independence Measure, and Pediatric Outcomes Data Collection Instrument were used to assess activity and participation levels. Results: There was a significant positive correlation between impairments and activity limitations (r=0.558; p=0.000), as well as between activity limitations and participation restrictions (r=0.354, p=0.005). Conclusion: These results show that activity limitations in children with unilateral and bilateral ambulatory CP may be related to their impairments and participation restrictions, although the sample size of our study is not large enough for generalizations. Overall, our study highlights the need for up-to-date, practical evaluation methods according to the ICF model.
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Affiliation(s)
- Akmer Mutlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. E-mail.
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Lampe R, Blumenstein T, Turova V, Alves-Pinto A. Mobile communication jacket for people with severe speech impairment. Disabil Rehabil Assist Technol 2017; 13:280-286. [PMID: 28447491 DOI: 10.1080/17483107.2017.1319427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Cerebral palsy is a movement disorder caused by damage to motor control areas of the developing brain during early childhood. Motor disorders can also affect the ability to produce clear speech and to communicate. The aim of this study was to develop and to test a prototype of an assistive tool with an embedded mobile communication device to support patients with severe speech impairments. METHODS A prototype was developed by equipping a cycling jacket with a display, a small keyboard, a LED and an alarm system, all controlled by a microcontroller. Functionality of the prototype was tested in six participants (aged 7-20 years) with cerebral palsy and global developmental disorder and three healthy persons. A patient questionnaire consisting of seven items was used as an evaluation tool. RESULTS A working prototype of the communication jacket was developed and tested. The questionnaire elicited positive responses from participants. Improvements to correct revealed weaknesses were proposed. Enhancements like voice output of pre-selected phrases and enlarged display were implemented. CONCLUSIONS Integration in a jacket makes the system mobile and continuously available to the user. The communication jacket may be of great benefit to patients with motor and speech impairments. Implications for Rehabilitation The communication jacket developed can be easily used by people with movement and speech impairment. All technical components are integrated in a garment and do not have to be held with the hands or transported separately. The system is adaptable to individual use. Both expected and unexpected events can be dealt with, which contributes to the quality of life and self-fulfilment.
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Affiliation(s)
- Renée Lampe
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany.,b Markus Würth Professor Fellowship , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Tobias Blumenstein
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Varvara Turova
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
| | - Ana Alves-Pinto
- a Research Unit of the Buhl-Strohmaier-Foundation for Paediatric Neuro-Orthopaedics and Cerebral Palsy of the Clinic for Orthopaedics and Sports Orthopaedics , Clinic 'rechts der Isar' of the Technical University of Munich , Munich , Germany
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Abstract
Cerebral palsy (CP) is the most common movement disorder of childhood. Parents recognized the symptoms of CP at mean age of 13 months. However there was a mean delay of going to a doctor by 23 months and the mean age of diagnosis was 5½ years. Less than half of the CP children were diagnosed by a pediatrician and were receiving treatment methods with weak evidence base of efficacy. Delay in recognition of symptoms and help seeking due to lack of awareness and access to proper medical care and prevalent false beliefs were the leading reason for late diagnosis of CP in Nepal and thus children loose valuable time for intervention in their early developmental stage.
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Alves-Pinto A, Turova V, Blumenstein T, Hantuschke C, Lampe R. Implicit Learning of a Finger Motor Sequence by Patients with Cerebral Palsy After Neurofeedback. Appl Psychophysiol Biofeedback 2017; 42:27-37. [PMID: 28176012 DOI: 10.1007/s10484-017-9349-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Facilitation of implicit learning of a hand motor sequence after a single session of neurofeedback training of alpha power recorded from the motor cortex has been shown in healthy individuals (Ros et al., Biological Psychology 95:54-58, 2014). This facilitation effect could be potentially applied to improve the outcome of rehabilitation in patients with impaired hand motor function. In the current study a group of ten patients diagnosed with cerebral palsy trained reduction of alpha power derived from brain activity recorded from right and left motor areas. Training was distributed in three periods of 8 min each. In between, participants performed a serial reaction time task with their non-dominant hand, to a total of five runs. A similar procedure was repeated a week or more later but this time training was based on simulated brain activity. Reaction times pooled across participants decreased on each successive run faster after neurofeedback training than after the simulation training. Also recorded were two 3-min baseline conditions, once with the eyes open, another with the eyes closed, at the beginning and end of the experimental session. No significant changes in alpha power with neurofeedback or with simulation training were obtained and no correlation with the reductions in reaction time could be established. Contributions for this are discussed.
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Affiliation(s)
- Ana Alves-Pinto
- Research Unit of the Buhl-Strohmaier Foundation for Pediatric Neuroorthopaedics and Cerebral Palsy, Orthopaedic Department, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Varvara Turova
- Research Unit of the Buhl-Strohmaier Foundation for Pediatric Neuroorthopaedics and Cerebral Palsy, Orthopaedic Department, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Tobias Blumenstein
- Research Unit of the Buhl-Strohmaier Foundation for Pediatric Neuroorthopaedics and Cerebral Palsy, Orthopaedic Department, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany
| | - Conny Hantuschke
- Münchner Förderzentrum, St.-Quirin-Straße 19, 81549, Munich, Germany
| | - Renée Lampe
- Research Unit of the Buhl-Strohmaier Foundation for Pediatric Neuroorthopaedics and Cerebral Palsy, Orthopaedic Department, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, Munich, Germany. .,Markus Würth Professorship, Technische Universität München, Munich, Germany.
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Jung SH, Song SH, Kim DR, Kim SG, Park YJ, Son YJ, Lee G. Effects of kinesio taping on the gait parameters of children with cerebral palsy: a pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.14474/ptrs.2016.5.4.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sun-Hye Jung
- JungWoo Children Development Center, Changwon, Republic of Korea
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Sun-Hae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - Da-Rye Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Seul-Gi Kim
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Ye-Jin Park
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - Yeon-Jung Son
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea
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Motta F, Antonello CE. Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications. J Neurosurg Pediatr 2016; 18:493-498. [PMID: 27341610 DOI: 10.3171/2016.4.peds15646] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this single-center study the authors investigated the complications occurring before and after the introduction of the new Ascenda intrathecal catheter (Medtronic Inc.) in pediatric patients treated with intrathecal baclofen therapy (ITB) for spasticity and/or dystonia. METHODS This was a retrospective review of 508 children who had received ITB, 416 with silicone catheters in the 13 years between September 1998 and September 2011 and 92 with Ascenda catheters in the 3 years between September 2011 and August 2014. The authors evaluated major complications such as infections, CSF leaks treated, and problems related to the catheter or pump, and they compared the 2 groups of patients who had received either a silicone catheter or an Ascenda catheter implant. RESULTS One hundred twenty patients in the silicone group (29%) and 1 patient in the Ascenda group (1.1%; p < 0.001) had a major complication. In the silicone group 23 patients (5.5%) were affected by CSF leakage and 75 patients (18%) experienced 82 catheter-related events, such as occlusion, dislodgment, disconnection, or breakage, which required catheter replacement. In the Ascenda group, only 1 patient (1.1%) was affected by CSF leakage. CONCLUSIONS To the authors' knowledge, this study is the first in the literature to compare the performance of the new Ascenda catheter, introduced in 2011, with the traditional silicone catheter for intrathecal drug infusion. In their analysis, the authors found that the Ascenda catheter can reduce major complications related to the catheter after ITB pump implantation. Further investigation is necessary to expand on and confirm their results.
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Affiliation(s)
- Francesco Motta
- Department of Paediatric Orthopaedics, "V. Buzzi" Children's Hospital, Milan, Italy
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Rumajogee P, Bregman T, Miller SP, Yager JY, Fehlings MG. Rodent Hypoxia-Ischemia Models for Cerebral Palsy Research: A Systematic Review. Front Neurol 2016; 7:57. [PMID: 27199883 PMCID: PMC4843764 DOI: 10.3389/fneur.2016.00057] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/03/2016] [Indexed: 12/28/2022] Open
Abstract
Cerebral palsy (CP) is a complex multifactorial disorder, affecting approximately 2.5-3/1000 live term births, and up to 22/1000 prematurely born babies. CP results from injury to the developing brain incurred before, during, or after birth. The most common form of this condition, spastic CP, is primarily associated with injury to the cerebral cortex and subcortical white matter as well as the deep gray matter. The major etiological factors of spastic CP are hypoxia/ischemia (HI), occurring during the last third of pregnancy and around birth age. In addition, inflammation has been found to be an important factor contributing to brain injury, especially in term infants. Other factors, including genetics, are gaining importance. The classic Rice-Vannucci HI model (in which 7-day-old rat pups undergo unilateral ligation of the common carotid artery followed by exposure to 8% oxygen hypoxic air) is a model of neonatal stroke that has greatly contributed to CP research. In this model, brain damage resembles that observed in severe CP cases. This model, and its numerous adaptations, allows one to finely tune the injury parameters to mimic, and therefore study, many of the pathophysiological processes and conditions observed in human patients. Investigators can recreate the HI and inflammation, which cause brain damage and subsequent motor and cognitive deficits. This model further enables the examination of potential approaches to achieve neural repair and regeneration. In the present review, we compare and discuss the advantages, limitations, and the translational value for CP research of HI models of perinatal brain injury.
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Affiliation(s)
- Prakasham Rumajogee
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network , Toronto, ON , Canada
| | - Tatiana Bregman
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network , Toronto, ON , Canada
| | - Steven P Miller
- Department of Pediatrics, Hospital for Sick Children , Toronto, ON , Canada
| | - Jerome Y Yager
- Division of Pediatric Neurosciences, Stollery Children's Hospital, University of Alberta , Edmonton, AB , Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Pavone V, Testa G, Restivo DA, Cannavò L, Condorelli G, Portinaro NM, Sessa G. Botulinum Toxin Treatment for Limb Spasticity in Childhood Cerebral Palsy. Front Pharmacol 2016; 7:29. [PMID: 26924985 PMCID: PMC4759702 DOI: 10.3389/fphar.2016.00029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/03/2016] [Indexed: 12/18/2022] Open
Abstract
CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles.
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Affiliation(s)
- Vito Pavone
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Gianluca Testa
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Domenico A Restivo
- Neurologic Unit, Department of Internal Medicine, Nuovo "Garibaldi" Hospital Catania, Italy
| | - Luca Cannavò
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Giuseppe Condorelli
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
| | - Nicola M Portinaro
- Humanitas Clinical and Research Center, Clinica Ortopedica e Traumatologica Milan, Italy
| | - Giuseppe Sessa
- Dipartimento di Chirurgia Generale e Specialità Medico-chirurgiche, Sez. Ortopedia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele Catania, Italy
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Methods and Procedures for Measuring Comorbid Disorders: Medical. COMORBID CONDITIONS AMONG CHILDREN WITH AUTISM SPECTRUM DISORDERS 2016. [DOI: 10.1007/978-3-319-19183-6_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
A 9-year-old boy presented to our outpatient specialized sport and exercise medicine clinic complaining of a subacute onset of unilateral knee pain, after an increased level of soccer training. His knee examination was unremarkable. However, he demonstrated significant tenderness on palpation of his ipsilateral hip flexor and adductor tendons. Abnormalities in muscle tone and difficulty in relaxing and resisting the examiner properly were noted and lead to a complete neurological examination. It demonstrated multiple abnormalities such as increased tone and deep tendon reflexes, greater in lower than upper extremities, and abnormal patterning. A mild form of spastic diplegia was suspected and the patient was referred to a pediatric neurologist who confirmed our initial diagnosis. This case draws attention to the importance of maintaining a high level of suspicion for milder forms of diseases that can go unnoticed for years.
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Kim MR, Lee BH, Park DS. Effects of combined Adeli suit and neurodevelopmental treatment in children with spastic cerebral palsy with gross motor function classification system levels I and II. Hong Kong Physiother J 2015; 34:10-18. [PMID: 30931022 PMCID: PMC6385137 DOI: 10.1016/j.hkpj.2015.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Children with cerebral palsy (CP) exhibit diverse gait patterns depending on their neurological deficits and musculoskeletal problems. The Adeli suit treatment (AST) has been proposed as an intensive exercise protocol in the management of CP. Objectives: The aim of this study was to compare the effects of a 6-week programme of combined AST and neurodevelopment treatment (NDT) with those of NDT alone on Gross Motor Function Measure (GMFM), balance, and gait in children with CP. Methods: Twenty children with CP of Gross Motor Function Classification System levels I and II were randomly assigned to one of the following two groups: (1) NDT or (2) AST/NDT. The participants were assessed using the GMFM, Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and spatiotemporal gait parameters. Results: The GMFM, PBS, and TUG test for both groups showed a statistically significant increase (p < 0.05). Three children were excluded. Compared to the NDT group (n = 9), the AST/NDT group (n = 8) demonstrated a significant increase in spatiotemporal gait parameters (p < 0.05). Conclusion: These results provide evidence for the greater effectiveness of combined AST/NDT than NDT alone in improving spatiotemporal gait parameters but not GMFM, PBS, and TUG test.
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Affiliation(s)
- Mi-Ra Kim
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Dae-Sung Park
- Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea
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Martín Lorenzo T, Lerma Lara S, Martínez-Caballero I, Rocon E. Relative fascicle excursion effects on dynamic strength generation during gait in children with cerebral palsy. Med Hypotheses 2015; 85:385-90. [PMID: 26138625 DOI: 10.1016/j.mehy.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/17/2015] [Indexed: 02/06/2023]
Abstract
Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation which is significantly altered in children with cerebral palsy (CP). While most muscle structure parameters have shown to be significantly correlated to different expressions of strength development in children with CP and typically developing (TD) children, conflicting results are found for muscle fascicle length. Muscle fascicle length determines muscle excursion and velocity, and contrary to what might be expected, correlations of fascicle length to rate of force development have not been found for children with CP. The lack of correlation between muscle fascicle length and rate of force development in children with CP could be due, on the one hand, to the non-optimal joint position adopted for force generation on the isometric strength tests as compared to the position of TD children. On the other hand, the lack of correlation could be due to the erroneous assumption that muscle fascicle length is representative of sarcomere length. Thus, the relationship between muscle architecture parameters reflecting sarcomere length, such as relative fascicle excursions and dynamic power generation, should be assessed. Understanding of the underlying mechanisms of weakness in children with CP is key for individualized prescription and assessment of muscle-targeted interventions. Findings could imply the detection of children operating on the descending limb of the sarcomere length-tension curve, which in turn might be at greater risk of developing crouch gait. Furthermore, relative muscle fascicle excursions could be used as a predictive variable of outcomes related to crouch gait prevention treatments such as strength training.
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Affiliation(s)
- T Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
| | - S Lerma Lara
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain; CSEU La Salle-UAM, Madrid, Spain
| | - I Martínez-Caballero
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - E Rocon
- Centro de Automática y Robótica CSIC, Madrid, Spain
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Bisneto EDNF, Rizzi N, Setani EO, Casagrande L, Fonseca J, Fortes G. Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer. ACTA ORTOPEDICA BRASILEIRA 2015. [PMID: 26207093 PMCID: PMC4503608 DOI: 10.1590/1413-785220152303145550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Analize data on patients submitted to transfer of the pronator teres (PT) or the flexor carpi ulnaris (FCB) to the extensor carpi radialis longus/brevis (ECRL/B) in order to correct flexed wrist deformity in patients with cerebral palsy. METHOD Patients were divided into two groups: PT group and FCU group to ECRL/B. The results were evaluated by goniometry and by the functional hand test (FHT). RESULTS Goniometry showed a statistically significant difference in favor of FCU transfer. There was no statistically significant difference regarding FHT. CONCLUSION Both transfers PT and FCU to ECRB are good options to correct wrist flexion deformity in cerebral palsy. Level of Evidence III, Non-randomized Controlled Cohort/Follow-Up Study.
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Affiliation(s)
| | - Nivea Rizzi
- Associação de Assistência à Criança Deficiente, Brazil
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