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Mayston MJ, Saloojee GM, Foley SE. ボバースフレームワーク:をむのにするシステマチックサイエンスのアプローチ. Dev Med Child Neurol 2024; 66:e112-e119. [PMID: 38239103 DOI: 10.1111/dmcn.15851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
要旨現在、発達領域で推奨されているボバース臨床推論フレームワーク(Bobath Clinical Reasoning Framework: BCRF)によるボバース実践を、システム科学のレンズによって概念化し、小児期発症の障害に関連する様々な変数の相互関係・相関依存に対する全人的観点を提供する。BCRFはICFの各領域間の関係性を理解し、それぞれがどのように影響を与え、どのように影響を受けるのかを理解する助けとなる臨床推論の詳細なフレームワークである。BCRFは介入計画へとつながる観察に基づく学際的なシステムであり、実践的な推論のアプローチである。BCRFにより脳性麻痺(Cerebral Palsy: CP)などの障害における複雑な状況を全人的に理解し、神経学的障害がある人々の生涯にわたるマネジメントおよびハビリテーションの基盤を持つことができる。BCRFが用いる臨床推論は、個々人およびその社会的環境、とくに家族単位で見られる重要な文脈的要因を重視している。定型発達・非定型発達、病態生理(感覚運動・認知・行動)、神経科学の相互関連性、および、心身機能・身体構造レベルの構成要素がどのように活動・参加レベルに影響を与えるのか、BCRFはその理解に根差している。BCRFにとって不可欠なシステム科学system science※1)のモデルはCPの複雑性を理解および対応を進める有用な方法であり、何よりも大切な目標とはあらゆる文脈であらゆる個々人の生きた経験を最適化することである。.
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Affiliation(s)
| | - Gillian M Saloojee
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Australia
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Murugasen S, Springer P, Olusanya BO, Gladstone M, Newton C, Kakooza-Mwesige A, Donald KA. Cerebral palsy in African paediatric populations: A scoping review. Dev Med Child Neurol 2024; 66:990-1012. [PMID: 38351549 DOI: 10.1111/dmcn.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 07/05/2024]
Abstract
AIM To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21-year period. METHOD The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021. RESULTS A total of 1811 articles underwent review against explicit criteria; 93 articles were selected for inclusion in the scoping review. The reported prevalence of CP ranged from 0.8 to 10 per 1000 children. Almost half had perinatal risk factors, but up to 26% had no identifiable risk factor. At least one-third of children with CP had one or more comorbidities, most commonly epilepsy, intellectual disability, and malnutrition. African children with CP demonstrated excess premature mortality approximately 25 times that of the general population, predominantly from infections. Hospital-based and younger populations had larger proportions of children with severe impairments. African children with CP had inadequate access to care and education, yet showed functional improvements compared to controls for all evaluated interventions. INTERPRETATION The prevalence of CP in Africa remains uncertain. African children with CP have different risk profiles, greater premature mortality, and more severe functional impairments and comorbidities compared to the Global North. Several barriers prevent access to optimal care. Larger African studies on validated and effective interventions are needed.
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Affiliation(s)
- Serini Murugasen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Priscilla Springer
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Melissa Gladstone
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Charles Newton
- Department of Psychiatry, University of Oxford, Oxford, UK
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Mayston MJ, Saloojee GM, Foley SE. Le cadre de raisonnement clinique Bobath: un modèle de science des systèmes pour aborder la complexité des troubles neurodéveloppementaux, y compris la paralysie cérébrale. Dev Med Child Neurol 2024; 66:e84-e92. [PMID: 38351502 DOI: 10.1111/dmcn.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
RésuméLa pratique Bobath actuelle telle qu'elle est recommandée dans le cadre du Bobath Clinical Reasoning Framework (BCRF) se base sur une application clinique de la science des systèmes. Elle offre une perspective holistique des relations entre les variables qui sont associées à l'apparition d'un handicap chez l'enfant. Le BCRF est un cadre de raisonnement clinique qui peut aider à comprendre les relations entre les domaines de la Classification Internationale du Fonctionnement, du Handicap et de la Santé. C'est un système d'observation transdisciplinaire de raisonnement pratique qui vise à proposer un plan d'intervention. Plus généralement, le BCRF permet une compréhension holistique de la complexité des situations associées à des troubles tels que la paralysie cérébrale et indique des choix d'adaptation et de prise en charge tout au long de la vie des personnes vivant avec des troubles neurologiques. Ce raisonnement clinique se base sur les facteurs contextuels importants de l'individu et de son environnement social, principalement la cellule familiale, et sur une compréhension des relations entre le développement typique et atypique, la physiopathologie (sensorimotrice, cognitive, comportementale) et les neurosciences, ainsi que sur l'impact des fonctions et des structures corporelles sur les activités et la participation. Le modèle de la science des systèmes du BCRF permet d'aborder la complexité de la paralysie cérébrale, avec l'objectif global d'optimiser l'expérience vécue par chaque individu dans chaque contexte.
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Affiliation(s)
- Margaret J Mayston
- Division des biosciences, University College London, Londres, Royaume-Uni
| | - Gillian M Saloojee
- Département de physiothérapie, Faculté des sciences de la santé, Université des Pays-Bas, Londres, Royaume-Uni. des sciences de la santé, Université du Witwatersrand, Johannesburg, Afrique du Sud
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Australie
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Mayston MJ, Saloojee GM, Foley SE. El marco de razonamiento clínico de Bobath: Un modelo de ciencia de sistemas para abordar la complejidad de los trastornos del neurodesarrollo incluida la parálisis cerebral. Dev Med Child Neurol 2024; 66:e120-e129. [PMID: 38113324 DOI: 10.1111/dmcn.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 07/31/2023] [Indexed: 12/21/2023]
Abstract
ResumenLa actual práctica de desarrollo Bobath recomendada dentro del Marco de Razonamiento Clínico Bobath (BCRF) puede conceptualizarse utilizando la visión de la ciencia de los sistemas. Proporciona, así, una perspectiva holística de la interrelación e interconexión de las variables asociadas con la discapacidad aparecida durante la infancia. El BCRF se define como un marco exhaustivo de razonamiento clínico que puede aplicarse para ayudar a comprender las relaciones entre los dominios de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud, cómo se puede influir en esos dominios y cómo influyen entre sí. El BCRF es un sistema de observación transdisciplinario y de razonamiento práctico que da lugar a un plan de intervención. Esto proporciona una comprensión holística de la complexidad de las situaciones asociadas a trastornos como la parálisis cerebral (PC) y la base para la gestión y habilitación a lo largo de la vida de personas que viven con trastornos neurológicos. El razonamiento clínico utilizado por el BCRF se basa en los importantes factores contextuales del individuo y su entorno social, principalmente la unidad familiar. Se basa en la comprensión de las interrelaciones entre el desarrollo típico y atípico, la fisiopatología (sensoriomotora, cognitiva, conductual) y la neurociencia, así como el impacto de funciones y estructuras corporales sobre la actividad y la participación. El modelo de ciencia de sistemas del BCRF es una forma útil de comprender y responder a la complejidad de la parálisis cerebral, con el objetivo global de optimizar la experiencia vivida de todo individuo en cualquier contexto.
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Affiliation(s)
| | - Gillian M Saloojee
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Australia
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Mayston MJ, Saloojee GM, Foley SE. O Quadro de Raciocínio Clínico Bobath: Uma abordagem de ciência de sistemas para a complexidade das condições do neurodesenvolvimento, incluindo a paralisia cerebral. Dev Med Child Neurol 2024; 66:e102-e111. [PMID: 38303632 DOI: 10.1111/dmcn.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Esta revisão descreve um modelo de prática pediátrica recomendada do Bobath, o Quadro de Raciocínio Clínico Bobath (QRCB), e explica como esse conhecimento contribui para a área de habilitação em distúrbios pediátricos. A ciência de sistemas proporciona uma nova maneira de concetualizar a paralisia cerebral como uma condição complexa. Ela foi aplicada ao QRCB para ilustrar uma perspetiva holística sobre a inter-relação e interconexão das variáveis associadas à PC. O modelo de ciência de sistemas adotado pelo QRCB é uma forma promissora de construir uma estrutura abrangente que engloba a complexidade da PC e possibilitará pesquisas mais robustas.
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Affiliation(s)
- Margaret J Mayston
- Divisão de Ciências Biológicas, University College London, Londres, Reino Unido
| | - Gillian M Saloojee
- Departamento de Fisioterapia, Faculdade de Ciências da Saúde, University of the Witwatersrand, Joanesburgo, África do Sul
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Austrália
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Mayston MJ, Saloojee GM, Foley SE. Bobath Klinik Gerekçelendirme Çerçevesi: Serebral palsi dahil nörogelişimsel durumların karmaşıklığında sistemler bilimi yaklaşımı. Dev Med Child Neurol 2024; 66:e93-e101. [PMID: 38343079 DOI: 10.1111/dmcn.15876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
ÖzetBobath Klinik Gerekçelendirme Çerçevesi (BKGÇ) içerisindeki önerilen güncel gelişimsel Bobath uygulaması sistemler bilimi merceği kullanılarak kavramsallaştırılabilir ve bunu çocukluk çağı engelliliği ile ilişkilendirilen değişkenlerin birbirine bağlılığı ve etkileşimine bütüncül bir bakış açısıyla sağlar. BKGÇ, İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF)’nın alt boyutları arasındaki ilişkiyi ve bu alt boyutların birbirini nasıl etkilediğini anlamak için uygulanabilen derinlemesine bir klinik gerekçelendirme çerçevesi olarak tanımlanmaktadır. BKGÇ, bir tedavi planı ile sonuçlanan klinik gerekçelendirme ve transdisipliner gözlemsel bir sistemdir. Bu sistem ise, serebral palsi (SP) gibi bozuklukların karmaşıklığını anlamak için bütüncül bir anlayış sunar ve nörolojik bozukluğu olan bireylerin yaşam boyu tedavisi ve rehabilitasyonu için temel oluşturur. BKGÇ tarafından kullanılan klinik gerekçelendirme, başta aile birimi olmak üzere bireyin ve sosyal çevresinin önemli bağlamsal faktörlerine dayanmaktadır. Tipik ve atipik gelişim, patofizyoloji (sensorimotor, bilişsel, davranışsal) ve sinirbilim arasındaki karşılıklı ilişkilerin ve bu vücut yapı ve fonksiyonlarının aktivite ve katılım üzerindeki etkisinin anlaşılmasına dayanır. BKGÇ'nin ayrılmaz bir parçası olan sistemler bilimi modeli, SP'nin karmaşıklığını anlamak ve buna yanıt vermek için yararlı bir yoldur; kapsayıcı hedef, herhangi bir bağlamda herhangi bir bireyin yaşadığı deneyimi optimize etmektir.
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Affiliation(s)
- Margaret J Mayston
- Biyobilimler Bölümü, Londra College Üniversitesi, Londra, Birleşik Krallık
| | - Gillian M Saloojee
- Fizyoterapi Bölümü, Sağlık Bilimleri Fakültesi, Witwatersrand Üniversitesi, Johannesburg, Güney Afrika
| | - Sarah E Foley
- Kids Plus Vakfı, Deakin Üniversitesi, Melbourne, VIC, Avustralya
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Maronga-Feshete F, Pilusa S, Dreyer A. 'I'm proud of my son with CP': Cerebral palsy caregivers' experiences, Gauteng province. Afr J Disabil 2024; 13:1357. [PMID: 38962747 PMCID: PMC11219972 DOI: 10.4102/ajod.v13i0.1357] [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: 10/19/2023] [Accepted: 02/14/2024] [Indexed: 07/05/2024] Open
Abstract
Background Caregivers of children with cerebral palsy (CP) are critical in the survival and well-being of their children. Despite the caregivers' particularly demanding responsibilities, literature on their experiences is limited. Objectives This study explored the caregivers' experiences of providing care to children with CP. Method An explorative qualitative study design using semi-structured interviews was employed. All interviews were audio-recorded, transcribed verbatim and analysed guided by Colaizzi's seven-step methodology. Results Two themes emerged: the challenges in caregiving and positive experiences of providing care. Caregivers faced financial, psychological, social and physical challenges such as stigmatisation, a lack of work accommodations, time constraints due to demands of providing care, strained family relations, isolation, exclusion, emotional and physical exhaustion in their caregiving role. Despite the challenges, they also had fulfilling, positive experiences. Caregivers became more resilient, some relationships were strengthened and awareness of the CP condition increased over time. Conclusion Caring for a child with CP is challenging. Cerebral palsy is a permanent disability; therefore, a holistic, long-term perspective to supporting caregivers is necessary to ensure they can care for their children adequately. Contribution There is a need for various support structures for caregivers to lessen the burden of care. It is necessary to establish the relationships between the support structures available and the way that these structures are viewed and consequently utilised by the caregivers. This study highlights the experiences and needs of caregivers to inform stakeholders on intervention strategies.
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Affiliation(s)
- Faith Maronga-Feshete
- Department of Rural Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonti Pilusa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail Dreyer
- Department of Rural Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abate BB, Tegegne KM, Zemariam AB, Wondmagegn Alamaw A, Kassa MA, Kitaw TA, Abebe GK, Azmeraw Bizuayehu M. Magnitude and clinical characteristics of cerebral palsy among children in Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003003. [PMID: 38905321 PMCID: PMC11192420 DOI: 10.1371/journal.pgph.0003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
Cerebral palsy (CP) is the most common motor disability in childhood which causes a child's behavioral, feeding, and sleep difficulties. It remains a poorly studied health problem in Africa. The main aim of this study was assessing the pooled prevalence of Cerebral Palsy (CP) and its clinical characteristics in Africa context. Systematic review and meta-analysis were conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search articles from electronic databases (Cochrane library, Ovid platform) (Medline, Embase, and Emcare), Google Scholar, CINAHL, PubMed, Maternity and Infant Care Database (MIDIRS). The last search date was on 12/05/ 2023 G. C. A weighted inverse variance random-effects model was used to estimate the pooled estimates of cerebral palsy and its types. The subgroup analysis, publication bias and sensitivity analysis were done. Studies on prevalence and clinical characteristics of cerebral palsy were included. The primary and secondary outcomes were prevalence and clinical characteristics of cerebral palsy respectively. A total of 15 articles with (n = 498406 patients) were included for the final analysis. The pooled prevalence of cerebral palsy in Africa was found to be 3·34 (2·70, 3·98). The most common type is spastic cerebral palsy accounting 69·30% (66·76, 71·83) of all cases. The second one is quadriplegic cerebral palsy which was found to be 41·49% (33·16, 49·81). Ataxic cerebral palsy accounted 5·36% (3·22, 7·50). On the other hand, dyskinetic cerebral palsy was found to be 10.88% (6·26, 15·49). About 32·10% (19·25, 44.95) of cases were bilateral while 25·17% (16·84, 33·50) were unilateral. The incidence of cerebral palsy in Africa surpasses the reported rates in developed nations. Spastic and quadriplegic subtypes emerge as the most frequently observed. It is recommended to channel initiatives toward the strategic focus on preventive measures, early detection strategies, and comprehensive management protocols.
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Affiliation(s)
- Biruk Beletew Abate
- Assistant Professor in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | | | - Alemu Birara Zemariam
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Addis Wondmagegn Alamaw
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Mulat Awoke Kassa
- MSc in Psychiatry, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Tegene Atamenta Kitaw
- MSc in Adult Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Gebremeskel Kibret Abebe
- MSc in Emergency Medicine and Critical Care Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Molla Azmeraw Bizuayehu
- MSc in Pediatrics and Child Health Nursing, College of Health Science, Woldia University, Weldiya, Ethiopia
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Mayston MJ, Saloojee GM, Foley SE. The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy. Dev Med Child Neurol 2024; 66:564-572. [PMID: 37653669 DOI: 10.1111/dmcn.15748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
The current recommended developmental Bobath practice within the Bobath Clinical Reasoning Framework (BCRF) can be conceptualized using the lens of systems science, thereby providing a holistic perspective on the interrelatedness and interconnectedness of the variables associated with childhood-onset disability. The BCRF is defined as an in-depth clinical reasoning framework that can be applied to help understand the relationships between the domains of the International Classification of Functioning, Disability and Health, how those domains can be influenced, and how they impact each other. The BCRF is a transdisciplinary observational system and practical reasoning approach that results in an intervention plan. This provides a holistic understanding of the complexity of situations associated with disorders such as cerebral palsy (CP) and the basis for the lifelong management and habilitation of people living with neurological disorders. The clinical reasoning used by the BCRF draws on the important contextual factors of the individual and their social environment, primarily the family unit. It is rooted in an understanding of the interrelationships between typical and atypical development, pathophysiology (sensorimotor, cognitive, behavioural), and neuroscience, and the impact of these body structure and function constructs on activity and participation. The systems science model integral to the BCRF is a useful way forward in understanding and responding to the complexity of CP, the overarching goal being to optimize the lived experience of any individual in any context.
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Affiliation(s)
| | - Gillian M Saloojee
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah E Foley
- Kids Plus Foundation, Deakin University, Melbourne, VIC, Australia
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Yuan J, Cui M, Liang Q, Zhu D, Liu J, Hu J, Ma S, Li D, Wang J, Wang X, Ma D, Himmelmann K, Wang X, Xu Y, Zhu C. Cerebral Palsy Heterogeneity: Clinical Characteristics and Diagnostic Significance from a Large-Sample Analysis. Neuroepidemiology 2024:1-11. [PMID: 38636464 DOI: 10.1159/000539002] [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: 12/14/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is a nonprogressive movement disorder resulting from a prenatal or perinatal brain injury that benefits from early diagnosis and intervention. The timing of early CP diagnosis remains controversial, necessitating analysis of clinical features in a substantial cohort. METHODS We retrospectively reviewed medical records from a university hospital, focusing on children aged ≥24 months or followed up for ≥24 months and adhering to the International Classification of Diseases-10 for diagnosis and subtyping. RESULTS Among the 2012 confirmed CP cases, 68.84% were male and 51.44% had spastic diplegia. Based on the Gross Motor Function Classification System (GMFCS), 62.38% were in levels I and II and 19.88% were in levels IV and V. Hemiplegic and diplegic subtypes predominantly fell into levels I and II, while quadriplegic and mixed types were mainly levels IV and V. White matter injuries appeared in 46.58% of cranial MRI findings, while maldevelopment was rare (7.05%). Intellectual disability co-occurred in 43.44% of the CP cases, with hemiplegia having the lowest co-occurrence (20.28%, 58/286) and mixed types having the highest co-occurrence (73.85%, 48/65). Additionally, 51.67% (697/1,349) of the children with CP aged ≥48 months had comorbidities. CONCLUSIONS This study underscores white matter injury as the primary CP pathology and identifies intellectual disability as a common comorbidity. Although CP can be identified in infants under 1 year old, precision in diagnosis improves with development. These insights inform early detection and tailored interventions, emphasizing their crucial role in CP management.
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Affiliation(s)
- Junying Yuan
- Henan Pediatric Clinical Research Center and Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital and of Zhengzhou University, Zhengzhou, China
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengli Cui
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiongqiong Liang
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dengna Zhu
- Henan Pediatric Clinical Research Center and Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital and of Zhengzhou University, Zhengzhou, China
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Liu
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiefeng Hu
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shijie Ma
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Li
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Wang
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuejie Wang
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Deyou Ma
- Cerebral Palsy Rehabilitation Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kate Himmelmann
- Pediatric Neurology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Xiaoyang Wang
- Henan Pediatric Clinical Research Center and Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital and of Zhengzhou University, Zhengzhou, China
- Centre of Perinatal Medicine and Health, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
| | - Yiran Xu
- Henan Pediatric Clinical Research Center and Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital and of Zhengzhou University, Zhengzhou, China
| | - Changlian Zhu
- Henan Pediatric Clinical Research Center and Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital and of Zhengzhou University, Zhengzhou, China
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Sogbossi ES, Baba-Tadja A, Nouatin E, Agbetou M, Adoukonou T, Kossi O. Estimating the Prevalence of Cerebral Palsy in a Semi-Urban City in Benin: A Door-to-Door Community-Based Study. Neuroepidemiology 2024:1-8. [PMID: 38631310 DOI: 10.1159/000538799] [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: 02/02/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common cause of pediatric motor disability. While epidemiological data are widespread in high-income countries, corresponding data in low-income countries in sub-Saharan Africa are still rare. This study aimed to estimate the prevalence of CP in Northern Benin, a French-speaking low-income country in sub-Saharan Africa. METHODS This study was a community-based door-to-door study involving children younger than 18 years old, in Parakou, a semi-urban city in Benin. We used a two-stage procedure. The first one consisted on children screening to identify potential cases of CP. During the second stage, suspected children were examined by neurologists with high experience with CP. RESULTS In total, 2,630 children were screened with 10 confirmed cases of CP, resulting in a crude prevalence (95% confidence interval) of 3.8 (1.4, 6.15) per 1,000 children. Of the 10 confirmed cases, six were younger than 5 years old, and five were male. Eight children over ten were spastic with six bilateral spastic subtype according to the Surveillance of Cerebral Palsy in Europe classification system. Seven children had a Gross Motor Function Classification System level III-V, and six were classified level III to V of the manual ability classification system. CONCLUSION CP is highly prevalent in semi-urban area in Northern Benin. Large studies on potential risk factors are needed for the development of effective preventive strategies.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Department of Physical Medicine and Rehabilitation, National Teaching Hospital, Cotonou, Benin
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Adjoua Baba-Tadja
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - Emilienne Nouatin
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - Mendinatou Agbetou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Thierry Adoukonou
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Oyéné Kossi
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
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Maimin D, Mentz A, Thomas M, Van Heerden TM, Horn A. The Etiologic Risk Factors for Cerebral Palsy at an Orthopedic Surgery Clinic in South Africa. Pediatr Neurol 2024; 153:175-178. [PMID: 38412782 DOI: 10.1016/j.pediatrneurol.2024.01.022] [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: 08/14/2023] [Revised: 01/07/2024] [Accepted: 01/25/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cerebral palsy (CP) is a group of disorders that affect movement and posture caused by injury to the developing brain. Although prematurity and low birth weight are common causes in developed countries, birth asphyxia, kernicterus, and infections have been identified as predominant etiologies in Africa. There is, however, very little information on the etiology of CP in South Africa. We aimed to determine the etiology, severity, and topographic distribution of CP in children undergoing orthopedic surgery at our tertiary pediatric unit. METHOD A retrospective folder review was performed for patients with CP who underwent orthopedic surgery from July 2018 to June 2022. Data were collected on perinatal circumstances, etiologic risk factors for developing CP, severity of disability as classified by the Gross Motor Function Classification Scale (GMFCS), and topographic distribution. Descriptive analysis was performed. RESULTS A total of 202 patients were included in the analysis. Prematurity (gestational age less than 37 weeks) was noted in 41.6% of the cohort and was the most common risk factor. Hypoxic-ischemic encephalopathy (30.7%), postnatal infections (13.4%), congenital brain malformations (10.4%), and cerebral infections were the next most common etiologic risk factors. Forty-eight percent of patients were classified as GMFCS IV or V. There was a predominance of bilateral (69.5%) compared with unilateral (21.3%) subtypes. CONCLUSION Most patients undergoing orthopedic surgery for musculoskeletal sequelae of CP had GMFCS levels of IV or V and were bilateral subtypes, emphasizing the need for intervention at a primary care level to decrease the incidence of this frequently preventable condition.
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Affiliation(s)
- Dane Maimin
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Anlume Mentz
- Medical Student, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michaela Thomas
- Medical Student, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tao-Mae Van Heerden
- Medical Student, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anria Horn
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Gong C, Liu A, Lian B, Wu X, Zeng P, Hao C, Wang B, Jiang Z, Pang W, Guo J, Zhou S. Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Front Pediatr 2023; 11:1189648. [PMID: 37576141 PMCID: PMC10416728 DOI: 10.3389/fped.2023.1189648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups. Method We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias. Results Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP. Conclusion Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.
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Affiliation(s)
- Chao Gong
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Annan Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Beibei Lian
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xixi Wu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Pei Zeng
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Chaoli Hao
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Bobo Wang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Zhimei Jiang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Wei Pang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Jin Guo
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Shaobo Zhou
- School of Science, Faculty of Engineering and Science, University of Greenwich, Medway Campus Central Avenue, Chatham Maritime, Kent, England
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Africa LE, Human A, Tshabalala MD. Participation patterns of children with cerebral palsy: A caregiver's perspective. Afr J Disabil 2023; 12:1058. [PMID: 36756463 PMCID: PMC9900282 DOI: 10.4102/ajod.v12i0.1058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Participation in activities of daily living (ADL), education, leisure and play in children living with cerebral palsy (CP) may be affected by various factors, as outlined in the International Classification of Functioning, Disability and Health Framework (ICF). The aim of this study was to describe the participation patterns of a group of these children. Objectives This study aimed to describe participation patterns in ADL, education, leisure and play activities of children living with CP in Modimolle. Method An exploratory-descriptive qualitative (EDQ) study design was used. A researcher-constructed bio-demographic data sheet and a semi-structured interview schedule were used to collect data from the primary caregivers of children (5-17 years) living with CP in Modimolle. Interviews were transcribed verbatim, translated from Sepedi to English and analysed using the content analysis approach and NVivo software. Results The findings of this study indicated that children living with CP in Modimolle require set-up and assistance to participate in various ADL such as self-care, family and community activities. They also participate in formal and informal educational programmes as well as active and passive leisure and play activities. However, at the moment, they have limited opportunities to participate because of resource constraints and inaccessible infrastructure. Conclusion Although children with CP in Modimolle perform some ADL, and participate in educational, leisure and play activities, they are not fully integrated into their community. Legislative support and policy implementation are required to improve participation and integration of children living with CP. Further studies on community-specific integrative strategies to enhance participation among children living with disabilities are recommended. Contribution This paper provides valuable information on the participation patterns of children with CP living in a rural area of South Africa. The findings can assist with development and implementation of community-specific, integrative health and social care strategies to enhance participation among children living with disabilities.
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Affiliation(s)
- Lethabo E. Africa
- Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Healthcare Sciences University, Pretoria, South Africa
| | - Anri Human
- Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Healthcare Sciences University, Pretoria, South Africa,Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Muziwakhe D. Tshabalala
- Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Healthcare Sciences University, Pretoria, South Africa
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Tegegne KT. Determinants of cerebral palsy in children: systematic review. Sudan J Paediatr 2023; 23:126-144. [PMID: 38380410 PMCID: PMC10876278 DOI: 10.24911/sjp.106-1670589241] [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: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 02/22/2024]
Abstract
Cerebral palsy (CP) is a group of disorders of movement and postural control caused by a nonprogressive defect or lesion of the developing brain. Several prepregnancy risk factors have been described including maternal age, parity and maternal diseases including epilepsy, diabetes and thyroid disease. There are few in-depth studies on the causes of CP. In the present systematic review, databases searched were Google Scholar and PubMed to identify data on determinants of CP in the world. Studies were included if they specifically mentioned CP as an outcome, the study objective is to identify factors associated with CP in children and all quantitative observational studies. JBI Critical Appraisal Tools were used to assess the methodological quality of a study. Papers that meet the inclusion criteria were rigorously appraised by two critical appraisers. 40 consistent determinants of CP in children from 95 research articles that meet inclusion criteria are included in the review. The majority of studies (24 articles) showed that premature babies and low weight were determinants of CP in children, whereas 15 studies showed that low Apgar scores were determinants of CP in children. The commonest determinants of CP in children are premature babies and low weight, low Apgar scores, intrauterine infection, congenital brain malformations, thyroid disease, premature rupture of membrane (PROM) and placental abruption. Preventing preterm delivery, low birth weight and intrauterine infection as well as immediate neonatal resuscitation for newborns with low Apgar scores may help to prevent CP in children.
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Affiliation(s)
- Kaleab Tesfaye Tegegne
- Department of Public Health, College of Health Science, Debark University, Debark, Ethiopia
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Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties. Pediatr Phys Ther 2023; 35:66-73. [PMID: 36638031 DOI: 10.1097/pep.0000000000000971] [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 This study evaluated gross motor outcomes between children with cerebral palsy from non-Appalachian and Appalachian counties in the United States. METHODS For this retrospective, matched-case controlled study, data were sourced from electronic medical record and compared between groups. Groups were matched by age and Gross Motor Function Classification System (GMFCS) level. RESULTS Children from Appalachian counties had significantly higher Gross Motor Function Measure, 66 (GMFM-66) scores and had a cerebral palsy diagnosis reported in the electronic medical record significantly later compared with children from non-Appalachian counties, controlling for age and GMFCS level. CONCLUSION Although it has been documented that families and children from Appalachian counties have poorer overall health outcomes, motor development may not be affected. Our study found that children with cerebral palsy from Appalachian counties scored significantly higher on the GMFM-66 across GMFCS levels.
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Waight E, McIntyre S, Woolfenden S, Watson L, Reid S, Scott H, Martin T, Webb A, Badawi N, Smithers‐Sheedy H. Temporal trends, clinical characteristics, and sociodemographic profile of post-neonatally acquired cerebral palsy in Australia, 1973-2012: A population-based observational study. Dev Med Child Neurol 2023; 65:107-116. [PMID: 35665921 PMCID: PMC10952665 DOI: 10.1111/dmcn.15293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022]
Abstract
AIM To describe post-neonatally acquired (PNN) cerebral palsy (CP) in terms of temporal trends in prevalence, clinical and sociodemographic profiles, known causes and associations between causes, and sociodemographic variables. METHOD Numerator data, a count of children with PNN-CP confirmed at 5 years of age (n = 523), was drawn from two Australian state CP registers (birth years 1973-2012). Poisson regression was used to investigate temporal trends in the prevalence of PNN-CP by 5-year intervals, calculated per 10 000 live births. Using data from all state and territory Australian CP registers (n = 469), distributions of clinical characteristics, PNN-CP causes, and sociodemographic factors were tabulated (birth years 1995-2012). χ2 and logistic regression analyses were used to assess associations between sociodemographic profile, Australian reference data, and known causes. RESULTS A significant temporal decline in PNN-CP in Victoria (p = 0.047) and Western Australia (p = 0.033) was observed. The most common proximal causes of PNN-CP were cerebrovascular accidents (34%, n = 158), infection (25%, n = 117), and non-accidental injuries (12%, n = 58). Children born to teenage mothers, Aboriginal and/or Torres Strait Islander mothers, or children born in remote areas were over-represented in this cohort compared with reference data (all p ≤ 0.001). Infectious causes were strongly associated with teenage motherhood (odds ratio 3.0 [95% confidence interval 1.1-8.2], p = 0.028) and remote living (odds ratio 4.5 [95% confidence interval 2.0-10.2], p < 0.001). INTERPRETATION Although prevalence of PNN-CP has declined, the over-representation of priority populations, and the relative severity of a condition that is largely preventable, suggest the need for more specific primary preventive measures and support. WHAT THIS PAPER ADDS Prevalence of post-neonatally acquired (PNN) cerebral palsy (CP) in Australia significantly declined between 1973 and 2012. Cerebrovascular accidents are the most common proximal cause of PNN-CP. Children born in remote areas are at greater risk of PNN-CP.
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Affiliation(s)
- Emma Waight
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNSWAustralia
| | - Sarah McIntyre
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNSWAustralia
| | - Susan Woolfenden
- Faculty of Medicine, School of Women's and Children's HealthUniversity of New South WalesSydneyNSWAustralia
| | - Linda Watson
- Western Australian Register of Developmental AnomaliesPerthWAAustralia
| | - Susan Reid
- Murdoch Children's Research Institute and Department of PaediatricsUniversity of MelbourneMelbourneVICAustralia
| | - Heather Scott
- Women's and Children's Health NetworkAdelaideSAAustralia
| | - Tanya Martin
- School of Nursing and MidwiferyThe University of SydneyCamperdownNSWAustralia
| | - Annabel Webb
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNSWAustralia
| | - Nadia Badawi
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNSWAustralia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Specialty of Child & Adolescent HealthThe University of SydneyWestmeadNSWAustralia
| | - Hayley Smithers‐Sheedy
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNSWAustralia
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The Profile of Epilepsy and its characteristics in Children with Cerebral Palsy. Seizure 2022; 101:190-196. [DOI: 10.1016/j.seizure.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
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Paker N, Yavuz Mollavelioglu T, Bugdaycı D, Ones K, Bardak AN, Karacan I, Yıkıcı I, Kesiktas FN. Vitamin D levels in children with cerebral palsy. J Pediatr Rehabil Med 2022; 16:163-169. [PMID: 36031913 DOI: 10.3233/prm-190622] [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: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to assess serum vitamin D levels and related factors in children with cerebral palsy (CP). METHODS One hundred and nineteen children with CP between the ages of 1 year to 10 years 9 months who were admitted to the children's inpatient rehabilitation unit of a tertiary rehabilitation hospital between January 1, 2017, and December 31, 2018, were included in this study. Demographic and clinical characteristics were obtained from the patient files. CP types and serum 25 hydroxyvitamin D (25OHD) levels were recorded. Gross Motor Function Classification System (GMFCS) was used to assess the functional level. RESULTS Mean age was 5.1±2.9 years. Forty-two (35.3%) were girls, 105 (88.3%) were spastic, and 14 (11.7%) were ataxic and mixed type CP. Mean GMFCS level was 4 (IQR:2). Thirty-one (26.1%) were getting extra liquid feed while the rest were eating a normal diet. Mean serum 25OHD level was 27.4±15.7 (3-79) ng/mL. Vitamin D levels were normal in 68 children (57.1%), whereas 36 (30.3%) had vitamin D insufficiency and 15 (12.6%) showed vitamin D deficiency. Those whose serum vitamin D levels were within a normal range had a median age of 3.8 (IQR:4.2) years. On the other hand, mean age was 6.4 (4.3) years for those with low vitamin D level (p < 0.0001). Vitamin D level was 19.8 (21.4) ng/mL in those (n = 88) who had regular diets, whereas it was 31.0 [16] ng/mL in those (n = 31) who were getting extra liquid feed (p = 0.015). There was no statistically significant correlation between vitamin D level and gender, GMFCS, CP type, season or antiepileptic drug treatment. A binary logistic regression model showed that older age and having only regular meals were significant risk factors for low vitamin D. CONCLUSION In this study, 42.9% of the children with CP had low vitamin D. Older children with CP or those who had regular diets were higher risk groups in terms of low vitamin D.
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Affiliation(s)
- Nurdan Paker
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | | | - Derya Bugdaycı
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Kadriye Ones
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Ayse Nur Bardak
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Ilhan Karacan
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | | | - Fatma Nur Kesiktas
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
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de Gutierrez GM, Marin LM, Xiao Y, Escalante-Herrera A, Santos MTBR, Siqueira WL. Detection of periodontal disease activity based on histatin degradation in individuals with cerebral palsy. Heliyon 2022; 8:e10134. [PMID: 36046535 PMCID: PMC9421316 DOI: 10.1016/j.heliyon.2022.e10134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This proof-of-concept study aimed at evaluating the proteolytic profile of histatin 1 and 5 in saliva of adolescents with spastic cerebral palsy (CP) with gingivitis. Methods This cross-sectional study included 24 individuals allocated into three groups: G1 (CP with gingivitis; n = 8), G2 (without CP and without gingivitis; n = 8), and G3 (without CP and with gingivitis; n = 8). The gingival index (GI) and simplified oral hygiene index (OHI–S) were evaluated. Whole saliva was collected and used to assess the rate and mode of histatin 1 and 5 at different times. The degradation products were visualized after cationic PAGE and the protein band densities (BDs) were compared with a protein standard. Fragmentation products were collected from the gel, pooled by group and characterized by mass spectrometry. BDs and gingival health parameters were analyzed by One-Way ANOVA or Kruskal Wallis tests, whereas poisson multilevel regression was used to the factors that influenced histatin degradation (α = 5%). Results Groups G1 and G3 differed significantly on OHI–S, visible biofilm, oral calculus and GI (p < 0.001). Poisson Regression showed that: 1) CP and gingivitis influenced the degradation of histatin 1 and 5 (p < 0.05); 2) The degradation of histatin 5 was influenced by age and male sex (p < 0.05); and 3) GI influenced significantly the degradation of histatin 1 (p < 0.001). Unique histatin degradation peptides were identified in individuals with gingivitis. Conslusions These data demonstrated that both the kinetics and pattern of histatins degradation differ according to the gingival health or disease conditions.
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Affiliation(s)
- Gabriela M de Gutierrez
- College of Dentistry, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.,University of Cruzeiro do Sul, Rua Galvão Bueno, 868 - Liberdade, São Paulo, SP, 01506-000, Brazil
| | - Lina M Marin
- College of Dentistry, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Yizhi Xiao
- College of Dentistry, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Andrea Escalante-Herrera
- College of Dentistry, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Maria T B R Santos
- University of Cruzeiro do Sul, Rua Galvão Bueno, 868 - Liberdade, São Paulo, SP, 01506-000, Brazil
| | - Walter L Siqueira
- College of Dentistry, University of Saskatchewan, 105 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
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Saloojee G. Just how internationally relevant can evidence-based cerebral palsy clinical practice guidelines be? Dev Med Child Neurol 2022; 64:530. [PMID: 34632568 DOI: 10.1111/dmcn.15086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Gillian Saloojee
- Physiotherapist and independent researcher, Johannesburg, South Africa
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Abdallah MA, Abdelaziem F, Soliman M. Prevalence of the need for adaptive seating systems among children with cerebral palsy in Egypt. Prosthet Orthot Int 2022; 46:7-11. [PMID: 34840277 DOI: 10.1097/pxr.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries. OBJECTIVES To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system. STUDY DESIGN Observational cross-sectional study. METHODS One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently. RESULTS Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system. CONCLUSIONS There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation.
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Affiliation(s)
- Mohamed Adel Abdallah
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Mangamba DCK, Enyama D, Foko LPK, Tankou J, Njinkui DN, Essome H, Mangamba LME, Eposse Ekoube C, Betoko RM, Eboumbou PE, Njankoua YM, Penda CI. Epidemiological, clinical, and treatment-related features of children with cerebral palsy in Cameroon: A hospital-based study. Arch Pediatr 2022; 29:219-224. [PMID: 35094907 DOI: 10.1016/j.arcped.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/14/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric cerebral palsy (CP) remains a poorly studied public health problem in sub-Saharan Africa, especially in Cameroon. This study aimed at determining the epidemiological, clinical, and treatment-related characteristics of CP in Cameroonian children. METHODS A cross-sectional study was conducted at the pediatric department of the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH). Medical records of children attending the department during the study period were reviewed. Only medical records of children aged from 3 months to 15 years and diagnosed with CP were included. Parents/guardians of children presenting with CP were contacted and invited to come with their children to the DGOPH where they were examined by a pediatric neurologist. A questionnaire designed for the study was used to collect sociodemographic, clinical, paraclinical, and treatment data for each child. RESULTS Out of the 4064 medical records reviewed, CP was diagnosed in 198 children (4.86%). These children were predominantly male (53.6%), aged 3-24 months (54.0%). Perinatal disorders were the main CP etiologies, especially neonatal asphyxia (55.1%), jaundice (32.8%), and neonatal infections (25.8%). Most of the children were born at term (81.6%) and by vaginal delivery (62.6%), with a normal birth weight (83.2%). Several comorbidities were found including speech delay (74.2%) and epilepsy (34.4%). The patients with CP presented predominantly with the spastic form of the disease, especially spastic quadriplegia (44.3%). Less than half of the children were managed at hospital, while the majority of parents were following various traditional treatments. CONCLUSION Addressing preventable causes of CP and improving awareness in the population will be of great help to reduce CP in Cameroon.
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Affiliation(s)
- D C Kedy Mangamba
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - D Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon.
| | - L P Kojom Foko
- Faculty of Science, University of Douala, Douala, Cameroon
| | - J Tankou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - D Noukeu Njinkui
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - H Essome
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - L M Endale Mangamba
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - C Eposse Ekoube
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - R Mbono Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - P Epée Eboumbou
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Y Mapoure Njankoua
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - C I Penda
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Andrews C, Namaganda L, Eliasson AC, Kakooza-Mwesige A, Forssberg H. Functional development in children with cerebral palsy in Uganda: population-based longitudinal cohort study. Dev Med Child Neurol 2022; 64:70-79. [PMID: 34346507 DOI: 10.1111/dmcn.14996] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/29/2023]
Abstract
AIM To follow the functional development of a population-based cohort of children with cerebral palsy (CP) in rural Uganda and compare their development with the developmental trajectories of children from high-income countries (HIC). METHOD Eighty-one children (33 females, 48 males) aged 2 to 17 years (mean 8y 6mo, SD 4y 6mo) with CP were initially assessed in 2015 and then 4 years later using the 66-item Gross Motor Function Measure (GMFM-66), Pediatric Evaluation of Disability Inventory, Ugandan version (PEDI-UG), and functional classification systems. We calculated actual and reference scores (level of deviation from the developmental trajectories in HIC). A Wilcoxon signed-rank test was used for statistical analyses. RESULTS Children and young people with CP in Uganda exhibited no differences in scores between the first and second assessments for the GMFM-66 and PEDI-UG mobility skills, whereas they exhibited increased PEDI-UG social function (p<0.001) and self-care skills scores (p<0.001). Reference scores were more negative at the second assessment than at the first for the GMFM-66 (p=0.002) and PEDI-UG mobility (p=0.036) but not for PEDI-UG self-care. The increased difference in reference scores over the 4 years was primarily driven by younger children (2-5y) and children with milder impairments. INTERPRETATION The increased difference in reference scores between assessments suggests that children with CP in Uganda develop motor skills at a slower rate than peers in HIC. Limited access to health care and rehabilitation likely contributed to the lower scores and slower rate of development.
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Affiliation(s)
- Carin Andrews
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lukia Namaganda
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Angelina Kakooza-Mwesige
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study. Neurol Res Int 2021; 2021:9993912. [PMID: 34966561 PMCID: PMC8712143 DOI: 10.1155/2021/9993912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/07/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country. Objective To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019. Methods An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27. Results Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31-68.88), central nervous system infections (AOR: 0.02, 95% CI: 0-0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03-0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15-161.73). Conclusion Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.
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Tsige S, Moges A, Mekasha A, Abebe W, Forssberg H. Cerebral palsy in children: subtypes, motor function and associated impairments in Addis Ababa, Ethiopia. BMC Pediatr 2021; 21:544. [PMID: 34861837 PMCID: PMC8641229 DOI: 10.1186/s12887-021-03026-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/24/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although, there is no population-level data in Ethiopia, a previous retrospective hospital-based study identified CP as the most common developmental disability in children. The overall aim of this study is to describe the clinical spectrum of CP in Tikur Anbessa Specialized Hospital in Addis Ababa, including CP subtype, gross and fine motor function, presence and pattern of associated impairments, and possible risk factors in children aged 2 to 18 years. METHODS A hospital-based descriptive cross-sectional study conducted- July - September of 2018 among 207 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as a guideline for inclusion and evaluation was by standardized questionnaire and clinical examination. Descriptive, bivariate and multivariate statistical analyses, Chi-square test, crudes association and adjusted odds ratio with 95% confidence interval employed. RESULT One hundred seventy four children who fulfilled the clinical criteria were included. Half (50.6%) were under the age of 5 years with a mean age of 5.6 (SD 3.6) years; 55.2 were male. The majority had bilateral spastic CP (60.4%) followed by unilateral spastic CP 21.8%, dyskinetic CP 10.4%, and ataxic CP 3.4%; 4% were unclassifiable. Of the children, 95.4% had speech difficulty, 87.4% learning disabilities, 60.9% epilepsy, 24.7% visual impairment and 8.6% hearing impairment. On gross motor function (GMFCS) and manual ability (MACS) classification systems, 75.3% of the children had level IV and V functional impairment. More than 80% of the mothers had complications during delivery Half of the neonates did not cry immediately after birth,44% were resuscitated with bag mask ventilation at birth and 64% immediately admitted to NICU. During the first month of life, 50% had infection, 62% had trouble feeding, 49.4% had difficulty breathing, 35% had seizure and 13.8% had jaundice. CONCLUSION The severe forms of CP predominate; most children are dependent on their parents for routine activities of daily living and cannot communicate well. Multidisciplinary care approaches and focused functional habilitation services are needed. Causal relationships cannot be drawn from these data but findings make a strong argument for improving maternal and child health care.
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Affiliation(s)
- Selamenesh Tsige
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ayalew Moges
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Mekasha
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institute and Astrid Lindgren Children's Hospital, Stockholm, Sweden
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Sogbossi ES, Sotindjo Adon S, Adjagodo L, Dossou S, Dakè H, Ebner-Karestinos D, Araneda R, Saussez G, Paradis J, Kpadonou TG, Bleyenheuft Y. Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial. BMJ Open 2021; 11:e050958. [PMID: 34610941 PMCID: PMC8493925 DOI: 10.1136/bmjopen-2021-050958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children's access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa. METHODS AND ANALYSIS Forty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01-2019/MS/CNHU-HKM/CEI/CUMPR). All participants' parents/caregivers will provide their written informed consent. Data will be managed with confidentiality. TRIAL REGISTRATION NUMBER PACTR201911894444879.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Solange Sotindjo Adon
- Service de Kinésithérapie et d'Appareillage Orthopédique, Centre Hospitalier Universitaire Départemental de Borgou/Alibori, Parakou, Benin
| | | | - Solange Dossou
- Centre Medico-social Sainte Elisabeth de la Trinité, Calavi, Benin
| | - Hyppolite Dakè
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | | | - Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
| | - Geoffroy Saussez
- Physical and Occupational Therapy, Haute Ecole Louvain en Hainaut - Montignies-sur-Sambre, Montignies-sur-Sambre, Belgium
| | - Julie Paradis
- Département Ergothérapie, HE Vinci, Italia, Vinci, Italy
| | - Toussaint G Kpadonou
- School of Physiotherapy, Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Benin
- Clinique universitaire de médecine physique et réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou Maga de Cotonou, Cotonou, Benin
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Bruxelles, Belgium
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Ferreira ACFM, Eveloff RJ, Freire M, Santos MTBR. The Impact of Oral-Gut Inflammation in Cerebral Palsy. Front Immunol 2021; 12:619262. [PMID: 33717115 PMCID: PMC7953843 DOI: 10.3389/fimmu.2021.619262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy. Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis. Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292). Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.
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Affiliation(s)
| | - Ryan J Eveloff
- Department of Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States
| | - Marcelo Freire
- Department of Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States.,Department of Infectious Diseases, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Maria Teresa Botti Rodrigues Santos
- Postgraduate Program in Dentistry, Department of Individuals With Special Needs, Cruzeiro do Sul University, São Paulo, Brazil.,Department of Dentistry, Association for Assistance to Disabled Children, São Paulo, Brazil
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Zhang H, Zhi J, Ning B, Zhang S. Research progress on limb spasmolysis, orthopedics and functional reconstruction of brain-derived paralysis. JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Brain-derived paralysis is a disease dominated by limb paralysis caused by various brain diseases. The damage of upper motor neurons can lead to spastic paralysis of the limbs in different parts. If it cannot be treated in time and effectively, it will severely affect the motor function and ability of daily living. Treating limb spastic dysfunction in patients with brain-derived paralysis is a global problem. Presently, there are many alternative surgical methods. This article mainly reviews the treatment of limb spastic dysfunction with brain-derived paralysis, focusing on three aspects: limb spasmolysis, orthopedics, and functional reconstruction. Among them, the transposition of the peripheral nerve helps limb function with spastic paralysis and can effectively alleviate limb spasticity.
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Ekanem PE, Nyaga ACK, Imbusi EA, Ekanem R, Mebrahte B, Gebreslasie A, Peter N. Neuroimaging patterns of anatomical features in pediatric cerebral palsy patients at Ayder hospital, Mekelle, Ethiopia. PLoS One 2020; 15:e0241436. [PMID: 33147254 PMCID: PMC7641380 DOI: 10.1371/journal.pone.0241436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background Neuroradiological studies have greatly improved the knowledge and diagnoses of cerebral palsy with its underlying pathology, types and accompanying changes in brain morphology. However, there is no published study on cerebral palsy neuroimaging patterns in Ethiopia. Methods Retrospective chart and neuroimaging reviews were conducted among pediatric patients, who attended Ayder Comprehensive Specialized Hospital between January 2016 and August 2019, fulfilling the study criteria. The magnetic resonance images and computed tomography scans reviewed by a neuroradiologist and/or pediatric neurologist were included. Data was collected using a structured checklist and analyzed using SPSS statistical software version 22. Results were represented using tables, graphs and images. Results The median age at neuroimaging was 2 years. There were more males (54.5%) than females (45.5%) with a male: female ratio of 1.2:1. Majority of the patients had magnetic resonance (81.8%) as opposed to computed tomography scans (18.2%). Most of the patients (69.7%) had been born at term with spastic quadriplegia (33.3%) found to be the leading type of cerebral palsy. 30.3% of the patients had normal neuroimaging studies whereas 69.7% had neuroimaging abnormalities. Anomalies included pathologies of the white matter (18.2%), basal ganglia (15.2%), cortex and lobes (27.3%), corpus callosum (6.1%), lateral ventricles (12.1%), cysts (18.2%) and cerebellum (3%), respectively. Other findings were seen in 45.5% of the patients. Conclusion Severe forms of cerebral palsy (spastic quadriplegia) were most common with majorly cortical and subcortical brain involvement.
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Affiliation(s)
- Peter Etim Ekanem
- Department of Anatomy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- * E-mail:
| | - Anne Caroline Kendi Nyaga
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Elizabeth Akitsa Imbusi
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Regina Ekanem
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhanu Mebrahte
- Department of Anatomy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Adhanom Gebreslasie
- Department of Anatomy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Nissi Peter
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Abstract
Cerebral palsy is a group of neuromuscular diseases that is primarily common in the pediatric population and is the most common cause of neurological and motor disability in children. Cerebral palsy is comprised of various subtypes with the most common type being spastic cerebral palsy. It is highly associated with prematurity and affects nerve function, motor function, and intellectual capacity. It is also associated with nutritional deficiencies and gastrointestinal dysfunction. Cerebral palsy is diagnosed via clinical evaluation and does not have specific laboratory or image findings, but certain imaging findings are positively correlated with it. There are numerous interventions and treatment modalities that are aimed at ensuring the highest quality of life for the patient and their families. This article was compiled with peer-reviewed publications from the PubMed database in which various keywords were utilized in the search engine. These peer-reviewed articles were selected without geographical restrictions and selected based on the use of the English language. These articles were also selected on the restriction of publication within the last 10 years. This review article on cerebral palsy will serve as a medium of education for the physician, healthcare team, and family involved in the management of children or adults with cerebral palsy. It is important because it discusses the possible etiologies, diagnostic and assessment techniques, prevention methods, and possible rehabilitation interventions. This article aims to broaden the reader's understanding of cerebral palsy and answer any questions that may arise during the management of this disease. The management of cerebral palsy is often plagued with frustration, depression, and anxiety. The main goal of treatment is to attain the highest quality of life for the family and the child.
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Nogueira BR, Silva AM, de Castelo Branco Araújo T, Ferreira MC, Mendes RF, Prado Júnior RR. Exploring the association of predisposing factors of Cerebral Palsy and developmental defects of enamel: a case-control study. Eur Arch Paediatr Dent 2020; 22:367-374. [PMID: 32860616 DOI: 10.1007/s40368-020-00558-2] [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: 04/22/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022]
Abstract
AIM To evaluate the occurrence of developmental defects of enamel (DDE) in children and adolescents with Cerebral Palsy (CP) and to analyze the effect of common factors in the etiology of CP on the occurrence of DDE. METHODS A case-control study was carried out using the modified DDE index to classify enamel defects. The study group (SG) consisted of 45 participants with CP aged between three and 14 years. The control group (CG) consisted of 88 normotypical schoolchildren, paired by gender and age group. Caregivers answered a questionnaire on their socioeconomic status and medical history. The Chi-square tests, bivariate and multivariate analysis were performed (level significance < 0.05). RESULTS The occurrence of DDE in SG and CG was 60% and 64.8%, respectively (p value = 0.726). The most frequent defect observed in SG was diffuse opacity (44.4%), followed by demarcated opacity (26.7%) and enamel hypoplasia (2.2%). No difference was observed in the defect's distribution among both groups (p value = 0.083). For SG, the bivariate analysis revealed a statically significant association between the presence of DDE and age group 7-14 years old and maternal schooling below 11 years. After adjusting for confounding variables, age, family income and maternal schooling were not associated with DDE. CONCLUSION In conclusion, the occurrence of DDE was high and similar in both groups. The pre, peri or post-natal factors associated with CP were not significant for the presence of DDE.
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Affiliation(s)
- B R Nogueira
- Postgraduate Program in Dentistry, Federal University of Piauí - UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, Piauí, 64049-550, Brasil
| | - A M Silva
- Postgraduate Program in Dentistry, Federal University of Piauí - UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, Piauí, 64049-550, Brasil.
| | - T de Castelo Branco Araújo
- Postgraduate Program in Dentistry, Federal University of Piauí - UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, Piauí, 64049-550, Brasil
| | - M C Ferreira
- Postgraduate Program in Dentistry, Ceuma University, São Luís, MA, Brazil
| | - R F Mendes
- Postgraduate Program in Dentistry, Federal University of Piauí - UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, Piauí, 64049-550, Brasil
| | - R R Prado Júnior
- Postgraduate Program in Dentistry, Federal University of Piauí - UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, Piauí, 64049-550, Brasil
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Duke R, Torty C, Nwachukwu K, Ameh S, Kim M, Eneli N, Onyedikachi A, Aghaji A, Burton K, Dyet L, Bowman R. Clinical features and aetiology of cerebral palsy in children from Cross River State, Nigeria. Arch Dis Child 2020; 105:625-630. [PMID: 31959596 DOI: 10.1136/archdischild-2019-317932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria. DESIGN A population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4-15 years were clinically assessed for CP. RESULTS The estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1-3 and 88 (22.7%) of level 4-5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP. CONCLUSION The profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.
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Affiliation(s)
- Roseline Duke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom .,Department of Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Chimaeze Torty
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kennedy Nwachukwu
- Department of Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Soter Ameh
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Min Kim
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nnena Eneli
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ani Onyedikachi
- Department of Physiotherapy, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ada Aghaji
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Leigh Dyet
- Neonatology, University College London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bakuwa TC, Pilusa S, Saloojee G. The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa. Afr J Disabil 2020; 9:610. [PMID: 32391247 PMCID: PMC7203206 DOI: 10.4102/ajod.v9i0.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 11/28/2019] [Indexed: 11/16/2022] Open
Abstract
Background Cerebral palsy (CP) is the most common and most complex disabling disorder in children. Newly qualified therapists are expected to manage CP despite feeling inexperienced and inadequately prepared. Short postgraduate practical training courses could potentially help bridge this readiness gap. However, the value of these short courses in addressing the knowledge and experience gap is unknown. Objectives To establish the value of a short practical training course on the self-perceived readiness of newly qualified South African trained therapists to work with children with CP. Method Secondary analysis of records on therapists’ immediate evaluation of a short practical training course on CP management was completed. The analysis included records from 11 courses collected over a 2-years period (2015–2017). Paired t-tests were used to determine the change in knowledge in the quantitative questionnaire. Qualitative data were analysed inductively to determine themes. Results The majority of therapists had their expectations met by the course. Therapists’ self-perceived level of knowledge about various aspects of CP after the course changed significantly. Therapists appreciated the adult teaching and learning methods, conducive learning environment, the relevant and organised content and holistic approach of the course. They demonstrated readiness to adopt positive attitudes, perceptions and practice following the course. Conclusion A short practical postgraduate training course in CP is valuable in addressing the self-perceived lack of readiness amongst therapists with little experience in this area. It is capable of improving the knowledge and changing attitudes, perceptions and practice intentions positively, and thereby potentially improving the quality of service offered to children with CP.
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Affiliation(s)
- Takondwa C Bakuwa
- Department of Physiotherapy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sonti Pilusa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Sogbossi ES, Houekpetodji D, Kpadonou TG, Bleyenheuft Y. A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country. J Child Neurol 2019; 34:842-850. [PMID: 31339409 DOI: 10.1177/0883073819864516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children's mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.
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Affiliation(s)
- Emmanuel Segnon Sogbossi
- Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Damienne Houekpetodji
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Toussaint G Kpadonou
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.,Clinique Universitaire de Médecine Physique et Réadaptation du Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA (CNHU-HKM) de Cotonou, Benin
| | - Yannick Bleyenheuft
- Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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Alvarenga ÉDSL, Silva AM, da Silva TAE, de Araújo RF, Prado Júnior RR, Mendes RF. Oral health-related quality of life in caregivers of individuals with Cerebral Palsy: a case-control study. Eur Arch Paediatr Dent 2019; 21:193-202. [PMID: 31471856 DOI: 10.1007/s40368-019-00472-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
Abstract
AIM The object of this study is to evaluate the oral health-related quality of life (OHRQoL) of caregivers of individuals with Cerebral Palsy (CP). METHODS Ninety-eight caregivers of individuals with CP (SG) and 196 caregivers of individuals without special needs (CG) completed the reduced version of the Oral Health Impact Profile (OHIP-14). In addition, a questionnaire with demographic and socioeconomic questions was used. Groups were matched according to gender, schooling and family income. Fisher's exact tests, Chi square and Mann-Whitney, and bi/multivariate logistic regression were used (p < 0.05). RESULTS The impact on OHRQoL was similar for SG and CG (OHIP-14 total score). For SG, the high negative impact was in the following OHIP domains: "Functional limitation", "Physical disability", "Psychological incapacity" and "Disadvantages". For SG, a higher number of caregivers was single, unemployed, received government financial aid. There was a statistically significant association between the number of children a caregiver has and a negative impact on OHRQoL. CONCLUSIONS Being a caregiver of children with or without CP had a negative impact of similar magnitude on ORHQoL. The negative impact on OHRQoL of caregivers of children with CP was associated with having a high number of children; the higher the number of children, the greater the negative impact on their OHRQoL.
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Affiliation(s)
- É da S L Alvarenga
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil
| | - A M Silva
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil.
| | - T A E da Silva
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil
| | - R F de Araújo
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil
| | - R R Prado Júnior
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil
| | - R F Mendes
- Postgraduate Program in Dentistry, Federal University of Piauí, UFPI, Campus Universitário Ministro Petrônio Portella, Bloco 5, Bairro Ininga, Teresina, PI, CEP: 64049-550, Brazil
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Ferreira ACFM, Mayer MPA, Kawamoto D, Santos MTBR. Constipation, antiepileptic drugs, and gingivitis in children and adolescents with cerebral palsy. Int J Paediatr Dent 2019; 29:635-641. [PMID: 30817037 DOI: 10.1111/ipd.12488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cerebral palsy (CP) individuals present with epilepsy, which requires the use of antiepileptic drug (AED). HYPOTHESIS Since an inflammatory response may contribute to epileptogenesis, the hypothesis tested was that constipation would be associated with gingivitis and the use of AED in children and adolescents (CA) with CP. DESIGN A comparative study was conducted with 101 CA aged 5-17 years (10.8 ± 4.9), classified as constipated (G1; n = 57) or not constipated (G2; n = 44). Clinical patterns, AED used, body mass index (BMI), fluid intake, toilet transfer, and gingival condition were evaluated. Student's t test, chi-squared test, and logistic regression analysis were performed (α = 0.05). RESULTS There were no differences between groups regarding gender (P = 0.531), age (P = 0.227), BMI (P = 0.437), and fluid intake (P = 0.346). G1, however, presented a higher percentage of quadriplegic individuals (P < 0.001), dependency for toilet transfer (P < 0.001), the presence of gingivitis (P = 0.020), and the use of AED polytherapy (P < 0.001) compared to G2. Constipation was associated with quadriplegic CA, using GABA as AED (P = 0.002). CONCLUSIONS Mucosal inflammation evidenced by constipation and gingivitis is associated with the most neurologically compromised CAs under the use of GABA AED.
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Affiliation(s)
| | - Marcia Pinto Alves Mayer
- Department of Microbiology, Oral Microbiology Laboratory, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Dione Kawamoto
- Department of Microbiology, Oral Microbiology Laboratory, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Duke R, Eyong K, Burton K, MacLeod D, Dutton GN, Gilbert C, Bowman R. The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: study protocol for a randomized controlled trial. Trials 2019; 20:417. [PMID: 31291989 PMCID: PMC6617659 DOI: 10.1186/s13063-019-3527-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
Abstract
Background Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child’s environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial. Methods/design This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4–9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1–3 and 4–5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision. Discussion This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting. Trial registration Pan African Clinical Trials Registration, PACTR201612001886396. Registered on 3 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3527-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roseline Duke
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT, UK. .,Calabar Childrens' Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
| | - Komomo Eyong
- Paediatric Neurology Unit, Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | | | - David MacLeod
- Calabar Childrens' Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | | | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT, UK
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT, UK
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Socioeconomic Status Influences Functional Severity of Untreated Cerebral Palsy in Nepal: A Prospective Analysis and Systematic Review. Clin Orthop Relat Res 2019; 477:10-21. [PMID: 30179955 PMCID: PMC6345316 DOI: 10.1097/corr.0000000000000476] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cerebral palsy (CP) comprises a heterogeneous group of disorders whose clinical manifestations and epidemiologic characteristics vary across socioeconomic and geographic contexts. The functional severity of untreated CP in low-income countries has been insufficiently studied; a better understanding of how these children present for care in resource-constrained environments is important because it will better characterize the natural history of CP, guide clinical decision-making, and aid in the prognostication of children with untreated CP. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the etiologies, motor subtypes, topographic distributions, and functional classifications of a large cohort of Nepali children with untreated CP presenting to a large pediatric rehabilitation center in Nepal; and (2) to compare the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) scores of a subset of patients with spastic CP in the Nepali cohort with control subjects from high-income countries. METHODS A cross-sectional study was conducted at the Hospital and Rehabilitation Centre for Disabled Children in Nepal. Two hundred six consecutive Nepali children (76 girls; median age 4.0 years [interquartile range {IQR}, 2.5-9.0 years]) were evaluated to determine the demographic, clinical, and functional characteristics of a cohort of Nepali children with untreated CP. A systematic review of the Medline and Cochrane databases was then performed to obtain reference classification scores from high-income countries. Cross-sectional, noninterventional studies reporting at least one functional classification system with a sample size of at least 50 participants were included. Only studies of patients with spastic CP were included to allow for compatible comparisons with a subset of our study sample with spastic CP. A random-effects analysis was used to pool functional scores from participants in the included studies. Among the 206 children in our sample, 102 had spastic CP (35 girls; median age 5.5 years [IQR, 3.5-9.0 years]). Functional scores from these children were compared with pooled scores obtained from the systematic review by assessing the proportions of children in each sample with GMFCS, MACS, and CFCS score categories of I or II versus III to V. RESULTS Children with spastic hemiplegia from high-income countries were more likely to have a GMFCS score of I or II (96% [95% confidence interval {CI}, 92%-99%] versus 78% [95% CI, 62%-89%]) and a MACS score of I or II (83% [95% CI, 77%-88%] versus 50% [95% CI, 32%-68%]) relative to those from Nepal, but they were less likely to have a CFCS score of I or II (67% [95% CI, 51%-80%] versus 97% [95% CI, 87%-99%]). No differences were seen in children with spastic diplegia or quadriplegia. CONCLUSIONS Children in Nepal with hemiplegic CP display less difficulty in communicating and social engagement (CFCS) despite more-severe upper- and lower-extremity impairments in gross motor function (GMFCS) and manual ability (MACS) than do children with hemiplegic CP from high-income countries. Targeted interventions, including perhaps simple orthopaedic interventions to treat soft-tissue contractures, may therefore provide more-substantial improvements in function and quality of life to Nepali children than could be achieved for the same deployment of resources in more-affluent settings. LEVEL OF EVIDENCE Level II, prognostic study.
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Bitta M, Kariuki SM, Abubakar A, Newton CR. Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.13540.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques. Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques. Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia-Pacific (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for any NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD. Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.
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Bitta M, Kariuki SM, Abubakar A, Newton CRJC. Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis. Wellcome Open Res 2017. [PMID: 29881784 DOI: 10.12688/wellcomeopenres.13540.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques. Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques. Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for all NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD. Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.
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Affiliation(s)
- Mary Bitta
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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Risk Factors for Cerebral Palsy in Children in Botswana. Pediatr Neurol 2017; 77:73-77. [PMID: 29074060 DOI: 10.1016/j.pediatrneurol.2017.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although cerebral palsy is reported to have a higher prevalence in low-resource settings, there are few studies describing risk factors for cerebral palsy in these settings. A better understanding of the unique risk factors affecting children with cerebral palsy in low-resource settings could optimize both resource allocation and preventative strategies. METHODS A case-control study comparing children with cerebral palsy at ages two to 18 years with age-matched healthy control subjects was conducted between 2013 and 2014 at a referral center in Gaborone, Botswana. Study participants were enrolled from inpatient and outpatient settings, and data were collected through caregiver interviews, review of medical records, and physical examination of subjects. Risk factors were evaluated using conditional logistic regression models. RESULTS We studied 56 subjects with cerebral palsy and 56 age-matched control subjects. Significant risk factors for cerebral palsy included a history of serious neonatal infection (odds ratio 15.0, P = 0.009), complications during delivery (odds ratio 13.5, P < 0.001), and maternal human immunodeficiency virus (HIV) infection (odds ratio 3.5, P = 0.03). Maternal HIV infection remained a significant risk factor after adjusting for potential confounders and covariates (adjusted odds ratio 13.2, P = 0.05). CONCLUSIONS Major risk factors for cerebral palsy in Botswana differ from those described in high-resource settings. Modifiable risk factors such as maternal HIV infection should be targeted as a potential strategy to reduce the incidence of cerebral palsy in Botswana. Further studies are necessary to determine optimal preventative and treatment strategies in this population.
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Patel P, Baier J, Baranov E, Khurana E, Gambrah-Sampaney C, Johnson A, Monokwane B, Bearden DR. Health beliefs regarding pediatric cerebral palsy among caregivers in Botswana: A qualitative study. Child Care Health Dev 2017; 43:861-868. [PMID: 28744889 DOI: 10.1111/cch.12490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common motor disability worldwide with an incidence of 2.5 per 1,000 births globally. Health beliefs among caregivers may be major drivers of health-related behaviours and service utilization, but little is known regarding health beliefs around CP in Africa. METHODS Between July 2013 and September 2015, children with CP were identified in Gaborone, Botswana, and their caregivers were invited to participate in a qualitative study utilizing semistructured in-person one-on-one interviews. Interview questions addressed their understanding of CP, challenges of caring for a handicapped child, and community response to children with CP. RESULTS Sixty-two caregivers participated in the study. Common themes elicited were variable knowledge about CP, financial and physical burden, lack of therapies and educational resources, and the impact of stigma. Caregivers in Botswana generally subscribed to a biomedical explanation of CP but expressed concerns regarding more stigmatizing folks beliefs expressed in the community. CONCLUSION Health beliefs regarding CP in Botswana likely have a significant impact on utilization of healthcare resources. Information from this study should inform future educational interventions for caregivers of children with CP.
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Affiliation(s)
- P Patel
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Baier
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - E Baranov
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - E Khurana
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C Gambrah-Sampaney
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A Johnson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - B Monokwane
- Department of Pediatrics, University of Botswana School of Medicine, Gaborone, Botswana
| | - D R Bearden
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Botswana School of Medicine, Gaborone, Botswana.,Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA
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Johnson A, Gambrah-Sampaney C, Khurana E, Baier J, Baranov E, Monokwane B, Bearden DR. Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana. Pediatr Neurol 2017; 70:50-55. [PMID: 28363511 DOI: 10.1016/j.pediatrneurol.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there are few available data on specific risk factors for malnutrition among children with cerebral palsy in the developing world. METHODS We performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared with subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition. RESULTS We identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Nonambulatory status (odds ratio 13.8, 95% confidence interval [CI] 3.8-50.1, P < 0.001) and a composite measure of socioeconomic status (odds ratio 1.6, 95% CI 1.0-2.5, P = 0.03) were the strongest risk factors for malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and receiver operating characteristic curve analysis demonstrated excellent performance characteristics of this score (area under the curve 0.92, 95% CI 0.89-0.94). CONCLUSIONS Malnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population.
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Affiliation(s)
- Allison Johnson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Esha Khurana
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - James Baier
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Esther Baranov
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - David R Bearden
- Department of Pediatrics, University of Botswana, Gaborone, Botswana; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York.
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46
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Abas O, Abdelaziem F, Kilany A. Clinical Spectrum of Cerebral Palsy and Associated Disability in South Egypt: A Local Survey Study. Open Access Maced J Med Sci 2017; 5:37-41. [PMID: 28293314 PMCID: PMC5320905 DOI: 10.3889/oamjms.2017.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common cause of motor disability in children with a prevalence of 2-10/1,000 live births in the developing areas. AIM The epidemiology, clinical picture, and associated comorbidities in CP have been extensively studied in high-resource countries, but in low-resource areas, including Africa, those studies are still lacking. METHODS Cerebral palsy cases were prospectively recruited from every physiotherapy centre in Bani-Mazar city, Egypt, in a cross-sectional study from May 2015 to November 2015. RESULTS Two hundred cases were enrolled with a prevalence of 1 per 1000 live births. Within the study population, 72.5% were the spastic type, 16% were dyskinetic, 7% were ataxic, and 4.5% were hypotonic. The most common comorbidities were cognitive impairment and epilepsy affecting 77% and 38%, respectively. CONCLUSION Cerebral palsy in developing countries has a higher prevalence and different clinical profile regarding severity and associated disability. The perinatal and high-quality neonatal care together with physical therapy and rehabilitation programs is still lacking in developing countries.
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Affiliation(s)
- Osama Abas
- Physical Therapy, Ministry of Health, Cairo, Egypt
| | - Faten Abdelaziem
- Department of Physical Therapy for Growth and Development Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Ayman Kilany
- Department of Research on Children with Special Needs, National Research Centre, Cairo, Egypt
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Bitta M, Kariuki SM, Abubakar A, Newton CRJC. Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis. Wellcome Open Res 2017; 2:121. [PMID: 29881784 PMCID: PMC5964629 DOI: 10.12688/wellcomeopenres.13540.3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques. Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques. Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for all NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD. Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.
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Affiliation(s)
- Mary Bitta
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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