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Presedo A, Rutz E, Howard JJ, Shrader MW, Miller F. The Etiology of Neuromuscular Hip Dysplasia and Implications for Management: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:844. [PMID: 39062293 PMCID: PMC11275045 DOI: 10.3390/children11070844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
This study summarizes the current knowledge of the etiology of hip dysplasia in children with neuromuscular disease and the implications for management. This article is based on a review of development of the hip joint from embryology through childhood growth. This knowledge is then applied to selective case reviews to show how the understanding of these developmental principles can be used to plan specific treatments. The development of the hip joint is controlled by genetic shape determination, but the final adult shape is heavily dependent on the mechanical environment experienced by the hip joint during growth and development. Children with neuromuscular conditions show a high incidence of coxa valga, hip dysplasia, and subluxation. The etiology of hip pathology is influenced by factors including functional status, muscular tone, motor control, child's age, and muscle strength. These factors in combination influence the development of high neck-shaft angle and acetabular dysplasia in many children. The hip joint reaction force (HJRF) direction and magnitude determine the location of the femoral head in the acetabulum, the acetabular development, and the shape of the femoral neck. The full range of motion is required to develop a round femoral head. Persistent abnormal direction and/or magnitude of HJRF related to the muscular tone can lead to a deformed femoral head and a dysplastic acetabulum. Predominating thigh position is the primary cause defining the direction of the HJRF, leading to subluxation in nonambulatory children. The magnitude and direction of the HJRF determine the acetabular shape. The age of the child when these pathomechanics occur acts as a factor increasing the risk of hip subluxation. Understanding the risk factors leading to hip pathology can help to define principles for the management of neurologic hip impairment. The type of neurologic impairment as defined by functional severity assessed by Gross Motor Function Classification System and muscle tone can help to predict the risk of hip joint deformity. A good understanding of the biomechanical mechanisms can be valuable for treatment planning.
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Affiliation(s)
- Ana Presedo
- Department of Pediatric Orthopaedics, Robert Debré University Hospital, 75019 Paris, France;
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital, Melbourne 3052, Australia;
- Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne 3010, Australia
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Jason J. Howard
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
| | - Michael Wade Shrader
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
| | - Freeman Miller
- Department of Orthopaedics, Nemours Children’s Health, Wilmington, DE 19803, USA; (J.J.H.); (M.W.S.)
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Cloodt E, Lindgren A, Rodby-Bousquet E. Knee and ankle range of motion and spasticity from childhood into adulthood: a longitudinal cohort study of 3,223 individuals with cerebral palsy. Acta Orthop 2024; 95:200-205. [PMID: 38708569 PMCID: PMC11072397 DOI: 10.2340/17453674.2024.40606] [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: 10/05/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND AND PURPOSE Reduced range of motion (ROM) and spasticity are common secondary findings in cerebral palsy (CP) affecting gait, positioning, and everyday functioning. These impairments can change over time and lead to various needs for intervention. The aim of this study was to analyze the development path of the changes in hamstring length, knee extension, ankle dorsiflexion, and spasticity in hamstrings and gastrosoleus from childhood into adulthood in individuals with CP at the Gross Motor Function Classification System (GMFCS) levels I-V. METHODS A longitudinal cohort study was undertaken of 61,800 measurements in 3,223 individuals with CP, born 1990-2017 and followed for an average of 8.7 years (range 0-26). The age at examination varied between 0 and 30 years. The GMFCS levels I-V, goniometric measurements, and the modified Ashworth scale (MAS) were used for repeated assessments of motor function, ROM, and spasticity. RESULTS Throughout the follow-up period, knee extension and hamstring length exhibited a consistent decline across all individuals, with more pronounced decreases evident in those classified at GMFCS levels III-V. Ankle dorsiflexion demonstrated a gradual reduction from 15° to 5° (GMFCS I-IV) or 10° (GMFCS V). Spasticity levels in the hamstrings and gastrosoleus peaked between ages 5 and 7, showing a propensity to increase with higher GMFCS levels. CONCLUSION Passive ROM continues to decrease to 30 years of age, most pronouncedly for knee extension. Conversely, spasticity reached its peak at a younger age, with a more notable occurrence observed in the gastrosoleus compared with the hamstrings. Less than 50% of individuals had spasticity corresponding to MAS 2-4 at any age.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Department of Research and Development, Region Kronoberg, Växjö.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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De Beukelaer N, Vandekerckhove I, Molenberghs G, Naulaers G, Thewissen L, Costamagna D, Van Campenhout A, Desloovere K, Ortibus E. Longitudinal trajectory of medial gastrocnemius muscle growth in the first years of life. Dev Med Child Neurol 2024; 66:531-540. [PMID: 37786988 DOI: 10.1111/dmcn.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
AIM To define the longitudinal trajectory of gastrocnemius muscle growth in 6- to 36-month-old children with and without spastic cerebral palsy (SCP) and to compare trajectories by levels of gross motor function (Gross Motor Function Classification System, GMFCS) and presumed brain-lesion timing. METHOD Twenty typically developing children and 24 children with SCP (GMFCS levels I-II/III-IV = 15/9), were included (28/16 females/males; mean age at first scan 15.4 months [standard deviation 4.93, range 6.24-23.8]). Three-dimensional freehand ultrasound was used to repeatedly assess muscle volume, length, and cross-sectional area (CSA), resulting in 138 assessments (mean interval 7.9 months). Brain lesion timing was evaluated with magnetic resonance imaging classification. Linear mixed-effects models defined growth rates, adjusted for GMFCS levels and presumed brain-lesion timing. RESULTS At age 12 months, children with SCP showed smaller morphological muscle size than typically developing children (5.8 mL vs 9.8 mL, p < 0.001), while subsequently no differences in muscle growth were found between children with and without SCP (muscle volume: 0.65 mL/month vs 0.74 mL/month). However, muscle volume and CSA growth rates were lower in children classified in GMFCS levels III and IV than typically developing children and those classified in GMFCS levels I and II, with differences ranging from -56% to -70% (p < 0.001). INTERPRETATION Muscle growth is already hampered during infancy in SCP. Muscle size growth further reduces with decreasing functional levels, independently from the brain lesion. Early monitoring of muscle growth combined with early intervention is needed.
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Affiliation(s)
- Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | | | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), KU Leuven, Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Thewissen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Domiziana Costamagna
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Lenhart RL, Goodbody CM. Symptomatic flatfoot in cerebral palsy. Curr Opin Pediatr 2024; 36:98-104. [PMID: 37872808 DOI: 10.1097/mop.0000000000001300] [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: 10/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the current literature and best practices in the evaluation and treatment of symptomatic flatfoot in cerebral palsy. RECENT FINDINGS While techniques to reconstruct the neuromuscular flatfoot and reestablish bony levers have remained similar over time, the concept of surgical dosing has helped guide appropriate interventions based on the magnitude of disease and functional level of the child. Moreover, the utilization of multisegment foot modeling in motion analysis has allowed quantitative description of such deformities and their impact on gait. SUMMARY Future research should focus on refining operative indications and interventions with larger, multicenter, prospective cohorts to provide more robust evidence in surgical decision making. Long-term data are needed to confirm and compare efficacy of procedures. Radiographic data alone are not sufficient for describing functional foot position. Gait analysis with foot modeling and pedobarography along with patient-centered subjective outcomes will be needed in such investigations to make conclusive recommendations.
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Shahid J, Kashif A, Shahid MK. Enhancing Post-Operative Recovery in Spastic Diplegia through Physical Therapy Rehabilitation following Selective Dorsal Rhizotomy: A Case Report and Thorough Literature Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050842. [PMID: 37238390 DOI: 10.3390/children10050842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Spasticity is a common issue among children, especially those with bilateral spastic cerebral palsy (CP). Selective dorsal rhizotomy (SDR) is a surgical procedure that is often used to decrease lower limb rigidity, alongside other treatment options such as intrathecal medication, peripheral nerve surgery, and deep brain stimulation (DBS). The objective of these therapies is to improve the standard of living for young individuals. This article intends to explain the motor deficits observed in spastic diplegia and a rehabilitation program using physical therapy after SDR. The information can help with counseling parents about the prognosis and developing a clinical treatment plan. The article presents a case study of a 12-year-old girl who recently underwent L3, L4, and L5 nerve root rhizotomy in the physical therapy department. It highlights the importance of long-term physical therapy follow-up and orthotic usage in the management of spastic diplegia.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu-si 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
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De Beukelaer N, Vandekerckhove I, Huyghe E, Molenberghs G, Peeters N, Hanssen B, Ortibus E, Van Campenhout A, Desloovere K. Morphological Medial Gastrocnemius Muscle Growth in Ambulant Children with Spastic Cerebral Palsy: A Prospective Longitudinal Study. J Clin Med 2023; 12:jcm12041564. [PMID: 36836099 PMCID: PMC9963346 DOI: 10.3390/jcm12041564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Only cross-sectional studies have demonstrated muscle deficits in children with spastic cerebral palsy (SCP). The impact of gross motor functional limitations on altered muscle growth remains unclear. This prospective longitudinal study modelled morphological muscle growth in 87 children with SCP (age range 6 months to 11 years, Gross Motor Function Classification System [GMFCS] level I/II/III = 47/22/18). Ultrasound assessments were performed during 2-year follow-up and repeated for a minimal interval of 6 months. Three-dimensional freehand ultrasound was applied to assess medial gastrocnemius muscle volume (MV), mid-belly cross-sectional area (CSA) and muscle belly length (ML). Non-linear mixed models compared trajectories of (normalized) muscle growth between GMFCS-I and GMFCS-II&III. MV and CSA growth trajectories showed a piecewise model with two breakpoints, with the highest growth before 2 years and negative growth rates after 6-9 years. Before 2 years, children with GMFCS-II&III already showed lower growth rates compared to GMFCS-I. From 2 to 9 years, the growth rates did not differ between GMFCS levels. After 9 years, a more pronounced reduction in normalized CSA was observed in GMFCS-II&III. Different trajectories in ML growth were shown between the GMFCS level subgroups. These longitudinal trajectories highlight monitoring of SCP muscle pathology from early ages and related to motor mobility. Treatment planning and goals should stimulate muscle growth.
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Affiliation(s)
- Nathalie De Beukelaer
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-474033110
| | | | - Ester Huyghe
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), KU Leuven, 3000 Leuven, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Department of Orthopedics, University Hospitals Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3000 Leuven, Belgium
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Peeters N, Hanssen B, Bar-On L, De Groote F, De Beukelaer N, Coremans M, Van den Broeck C, Dan B, Van Campenhout A, Desloovere K. Associations between muscle morphology and spasticity in children with spastic cerebral palsy. Eur J Paediatr Neurol 2023; 44:1-8. [PMID: 36706682 DOI: 10.1016/j.ejpn.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/03/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Due to the heterogeneous clinical presentation of spastic cerebral palsy (SCP), which makes spasticity treatment challenging, more insight into the complex interaction between spasticity and altered muscle morphology is warranted. AIMS We studied associations between spasticity and muscle morphology and compared muscle morphology between commonly observed spasticity patterns (i.e. different muscle activation patterns during passive stretches). METHODS Spasticity and muscle morphology of the medial gastrocnemius (MG) and semitendinosus (ST) were defined in 74 children with SCP (median age 8 years 2 months, GMFCS I/II/III: 31/25/18, bilateral/unilateral: 46/27). Using an instrumented assessment, spasticity was quantified as the difference in muscle activation recorded during passive stretches at low and high velocities and was classified in mixed length-/velocity-dependent or pure velocity-dependent activation patterns. Three-dimensional freehand ultrasound was used to assess muscle morphology (volume and length) and echogenicity intensity (as a proxy for muscle quality). Spearman correlations and Mann-Whitney-U tests defined associations and group differences, respectively. RESULTS A moderate negative association (r = -0.624, p < 0.001) was found between spasticity and MG muscle volume, while other significant associations between spasticity and muscle morphology parameters were weak. Smaller normalized muscle volume (MG p = 0.004, ST p=<0.001) and reduced muscle belly length (ST p = 0.015) were found in muscles with mixed length-/velocity-dependent patterns compared to muscles with pure velocity-dependent patterns. DISCUSSION Higher spasticity levels were associated with smaller MG and ST volumes and shorter MG muscles. These muscle morphology alterations were more pronounced in muscles that activated during low-velocity stretches compared to muscles that only activated during high-velocity stretches.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | | | - Bernard Dan
- Université Libre de Bruxelles (ULB), Faculty of Psychology and Education Science, Brussels, Belgium; Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopedic Surgery, University Hospitals Leuven, Belgium.
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Belgium.
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Abd-Elmonem AM, Ali HA, Saad-Eldien SS, Rabiee A, Abd El-Nabie WA. Effect of physical training on motor function of ambulant children with diplegia after selective dorsal rhizotomy: A randomized controlled study. NeuroRehabilitation 2023; 53:547-556. [PMID: 38143389 DOI: 10.3233/nre-230098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction.
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Affiliation(s)
- Amira M Abd-Elmonem
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hazem A Ali
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Sara S Saad-Eldien
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Center for Physical Medicine, Rehabilitation and Rheumatology, Al-Agouza Hospital, Giza, Egypt
| | - Ahmed Rabiee
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Walaa A Abd El-Nabie
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Ronchetti AB, Bertamino M, Tacchino CM, Moretti P, Pavanello M. Letter to the Editor. Intrathecal baclofen pump insertion versus selective dorsal rhizotomy. J Neurosurg Pediatr 2022; 30:634-635. [PMID: 36593674 DOI: 10.3171/2022.7.peds22276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Centorame D, Rawicki B, Hennel S, Hoare B. Upper Limb Onabotulinumtoxin A Injections in Children Under 2 Years with Cerebral Palsy: A Retrospective Chart Review. J Child Neurol 2022; 37:949-955. [PMID: 36113444 DOI: 10.1177/08830738221124365] [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: 11/17/2022]
Abstract
Aim: To report on the safety of using Onabotulinumtoxin A (OnaA) in the upper limb(s) of children <2 years of age with cerebral palsy and to describe a proactive clinical model of care in the management of upper limb impairment in children with cerebral palsy. Methods and procedures: Retrospective chart audit of 65 infants aged 13-23 months (mean 18.69) who received upper limb OnaA injections. Administration procedures, trends in muscle selection, and adverse events were examined. Results: Adverse events were reported in 6 (4%) of the 65 children. Across the study period, muscles that control thumb and forearm movements were most commonly injected. The number of OnaA injections to subscapularis and flexor digitorum profundus increased over this period. Conclusions and implications: OnaA is a safe treatment option for the short-term management of focal upper limb muscle overactivity in children under 2 years of age with cerebral palsy. In line with existing evidence, OnaA should always be considered as an adjunct to evidence-based therapy.
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Affiliation(s)
- Danni Centorame
- Department of Paediatrics, 2541Monash University, Clayton, Australia
| | - Barry Rawicki
- Department of Paediatrics, 2541Monash University, Clayton, Australia.,Victorian Paediatric Rehabilitation Service, 557360Monash Children's Hospital, Clayton, Australia
| | - Sabine Hennel
- Department of Paediatrics, 2541Monash University, Clayton, Australia.,Victorian Paediatric Rehabilitation Service, 557360Monash Children's Hospital, Clayton, Australia
| | - Brian Hoare
- Department of Paediatrics, 2541Monash University, Clayton, Australia.,School of Occupational Therapy, 2080La Trobe University, School of Occupational Therapy, Bundoora, Australia.,Department of Occupational Therapy, Cerebral Palsy Group, Carlton, Australia
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Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Reduced plantar-flexors extensibility but improved selective motor control associated with age in young children with unilateral cerebral palsy and equinovalgus gait. J Electromyogr Kinesiol 2022; 65:102665. [DOI: 10.1016/j.jelekin.2022.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
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MacWilliams BA, McMulkin ML, Duffy EA, Munger ME, Chen BPJ, Novacheck TF, Schwartz MH. Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy. Dev Med Child Neurol 2022; 64:561-568. [PMID: 34755903 DOI: 10.1111/dmcn.15075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 01/07/2023]
Abstract
AIM To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy. METHOD This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life. RESULTS Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design). INTERPRETATION Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.
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Affiliation(s)
- Bruce A MacWilliams
- Shriners Hospitals for Children, Salt Lake City, UT, USA.,Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Brian Po-Jung Chen
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, St. Paul, MN, USA
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, St. Paul, MN, USA
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Straathof EJM, Hamer EG, Hensens KJ, La Bastide-van Gemert S, Heineman KR, Hadders-Algra M. Development of muscle tone impairments in high-risk infants: Associations with cerebral palsy and cystic periventricular leukomalacia. Eur J Paediatr Neurol 2022; 37:12-18. [PMID: 35007848 DOI: 10.1016/j.ejpn.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
AIM To assess the prevalence and development of muscle tone impairments in infants at high risk of developmental disorders, and their associations with cerebral palsy (CP) and cystic periventricular leukomalacia (cPVL). METHOD Longitudinal exploration of muscle tone in 39 infants at high risk of CP (LEARN2MOVE 0-2 project) mostly due to an early lesion of the brain. Muscle tone was assessed ≥4 times between 0 and 21 months corrected age (CA) with the Touwen Infant Neurological Examination. Diagnosis of CP was determined at 21 months CA. Neonatal neuro-imaging was available. Developmental trajectories were calculated using generalized linear mixed effect models. RESULTS Infants showed atypical muscle tone in three or four body parts in 93% (172/185) of the assessments. The most prevalent muscle tone pattern was hypotonia of neck and trunk with hypertonia of the limbs (28%). From 7 months CA onwards hypertonia of the arms was associated with CP. Asymmetric arm tone during infancy was associated with unilateral CP. At 18-21 months CA ankle hypertonia was associated with CP at 21 months; leg hypertonia in infancy was not associated with CP. Leg hypertonia was associated with cPVL, regardless of age. INTERPRETATION High-risk infants due to an early lesion of the brain often present with muscle tone impairment. In these infants, hypertonia and asymmetric muscle tone of the arms were from 7 months onwards associated with the diagnosis of CP at 21 months; hypertonia of the legs was not.
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Affiliation(s)
- Elisabeth J M Straathof
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Elisa G Hamer
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands; Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands
| | - Kilian J Hensens
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Sacha La Bastide-van Gemert
- University of Groningen, Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands; Stichting Epilepsie Instellingen Nederland SEIN, Dokter Denekampweg 20, 8025, BV, Zwolle, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
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14
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De Beukelaer N, Weide G, Huyghe E, Vandekerckhove I, Hanssen B, Peeters N, Uytterhoeven J, Deschrevel J, Maes K, Corvelyn M, Costamagna D, Gayan-Ramirez G, Van Campenhout A, Desloovere K. Reduced Cross-Sectional Muscle Growth Six Months after Botulinum Toxin Type-A Injection in Children with Spastic Cerebral Palsy. Toxins (Basel) 2022; 14:toxins14020139. [PMID: 35202166 PMCID: PMC8876834 DOI: 10.3390/toxins14020139] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Botulinum Neurotoxin type-A (BoNT-A) injections are widely used as first-line spasticity treatment in spastic cerebral palsy (SCP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised. Yet, the risk of initiating BoNT-A to reduce muscle growth remains unclear. This study investigated medial gastrocnemius (MG) morphological muscle growth in children with SCP (n = 26, median age of 5.2 years (3.5)), assessed by 3D-freehand ultrasound prior to and six months post-BoNT-A injections. Post-BoNT-A MG muscle growth of BoNT-A naive children (n = 11) was compared to (a) muscle growth of children who remained BoNT-A naive after six months (n = 11) and (b) post-BoNT-A follow-up data of children with a history of BoNT-A treatment (n = 15). Six months after initiating BoNT-A injection, 17% decrease in mid-belly cross-sectional area normalized to skeletal growth and 5% increase in echo-intensity were illustrated. These muscle outcomes were only significantly altered when compared with children who remained BoNT-A naive (+4% and -3%, respectively, p < 0.01). Muscle length growth persevered over time. This study showed reduced cross-sectional growth post-BoNT-A treatment suggesting that re-injections should be postponed at least beyond six months. Future research should extend follow-up periods investigating muscle recovery in the long-term and should include microscopic analysis.
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Affiliation(s)
- Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Guido Weide
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 Amsterdam, The Netherlands
| | - Ester Huyghe
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ines Vandekerckhove
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Britta Hanssen
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Nicky Peeters
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Julie Uytterhoeven
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Marlies Corvelyn
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Unit of Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
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15
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Yucesoy CA, Pontén E, Valero-Cuevas FJ, Smeulders M, Simms CK. Editorial: Muscle Mechanics, Extracellular Matrix, Afferentation, Structural, and Neurological Coupling and Coordination in Health and Disease. Front Physiol 2021; 12:802202. [PMID: 34938207 PMCID: PMC8685432 DOI: 10.3389/fphys.2021.802202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Can A. Yucesoy
- Institute of Biomedical Engineering, Bogaziçi University, Istanbul, Turkey
| | - Eva Pontén
- Karolinska Institutet, Stockholm, Sweden
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16
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Sees JP, Miller F. The Foot in Cerebral Palsy. Foot Ankle Clin 2021; 26:639-653. [PMID: 34752232 DOI: 10.1016/j.fcl.2021.07.002] [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: 02/02/2023]
Abstract
Children with cerebral palsy frequently develop foot deformities, most commonly equinus contractures, which can be managed with orthotics up to age 5 to 7 years. Plantar flexor lengthening, typically around this age, should be restricted to the offending muscle only, usually with a fascia release of the gastrocnemius. Equinovarus, mainly a problem in children with unilateral cerebral palsy, often responds to plantar flexor lengthening. If further tendon transfers are needed, they should be done when the child is older to avoid overcorrection. Planovalgus mostly improves spontaneously up to age 5 years. Surgical correction is best done in adolescence.
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Affiliation(s)
- Julieanne P Sees
- Department of Orthopedics, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, BOX 269, Wilmington, DE 19899, USA.
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17
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Cloodt E, Wagner P, Lauge-Pedersen H, Rodby-Bousquet E. Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children. Acta Orthop 2021; 92:222-227. [PMID: 33228441 PMCID: PMC8158222 DOI: 10.1080/17453674.2020.1848154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP.Patients and methods - This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan-Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve.Results - Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V.Interpretation - Early interventions to prevent knee and foot contractures in children with CP should be considered.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Department of Research and Development, Region Kronoberg, Växjö;; ,Correspondence:
| | - Philippe Wagner
- Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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18
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Smith SE, Gannotti M, Hurvitz EA, Jensen FE, Krach LE, Kruer MC, Msall ME, Noritz G, Rajan DS, Aravamuthan BR. Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review. Ann Neurol 2021; 89:860-871. [PMID: 33550625 DOI: 10.1002/ana.26040] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022]
Abstract
Cerebral palsy (CP) neurologic care and research efforts typically focus on children. However, most people with CP are adults. Adults with CP are at increased risk of new neurologic conditions, such as stroke and myelopathy, that require ongoing neurologic surveillance to distinguish them from baseline motor impairments. Neurologic factors could also contribute to the motor function decline, chronic pain, and chronic fatigue that are commonly experienced by adults with CP. Based on a systematic literature review, we suggest (1) guidelines for neurologic surveillance and neurologist referral and (2) clinical research questions regarding the evolving neurologic risks for adults with CP. ANN NEUROL 2021;89:860-871.
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Affiliation(s)
- Sarah E Smith
- Washington University School of Medicine, St Louis, MO, USA
| | - Mary Gannotti
- Shriners Hospitals for Children, Cerebral Palsy Network, University of Hartford, West Hartford, CT, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine/University of Michigan, Ann Arbor, MI, USA
| | - Frances E Jensen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda E Krach
- Gillette Children's Specialty Healthcare, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael C Kruer
- Cerebral Palsy & Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine-Phoenix Children's Hospital, Tucson, AZ, USA
| | - Michael E Msall
- University of Chicago Kennedy Research Center on Neurodevelopmental Disabilities, Chicago, IL, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
| | - Deepa S Rajan
- Department of Pediatrics, Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhooma R Aravamuthan
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, St Louis, MO, USA
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19
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Straathof EJM, Heineman KR, Hamer EG, Hadders-Algra M. Patterns of atypical muscle tone in the general infant population - Prevalence and associations with perinatal risk and neurodevelopmental status. Early Hum Dev 2021; 152:105276. [PMID: 33220644 DOI: 10.1016/j.earlhumdev.2020.105276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Muscle tone is an indispensable element in motor development. Its assessment forms an integral part of the infant neurological examination. Knowledge on the prevalence of atypical tone in infancy is lacking. AIM To assess the prevalence of atypical muscle tone in infancy and of the most common atypical muscle tone patterns, and associations between atypical tone and perinatal risk and neurodevelopmental status. STUDY DESIGN Cross-sectional study. SUBJECTS 1100 infants (585 boys; gestational age 39.4 weeks (27.3-42.4)), 6 weeks-12 months corrected age, representative of the Dutch population. OUTCOME MEASURES Muscle tone and neurodevelopmental status were assessed with the Standardized Infant NeuroDevelopmental Assessment (SINDA). Perinatal information was obtained by questionnaire and medical records. Univariable and multivariable statistics were applied. RESULTS Ninety-two infants (8%) had atypical muscle tone in 3-4 body parts (impaired pattern), while atypical muscle tone in 1-2 body parts was observed in 50%. Isolated leg hypotonia and isolated arm hypertonia were most common. Isolated arm hypertonia and the impaired pattern were most clearly but only moderately associated with perinatal risk. These patterns were also most clearly associated with lower neurological scores. Only the impaired pattern was associated with lower developmental scores. CONCLUSION Atypical muscle tone in one or two body parts is common in infancy and has in general little clinical significance. This finding corresponds to the well-known high prevalence of a typical but non-optimal neurological condition. Eight percent of infants show atypical muscle tone in 3-4 body parts. This clinically relevant pattern is associated with perinatal risk and less favourable neurodevelopmental status.
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Affiliation(s)
- Elisabeth J M Straathof
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Dokter Denekampweg 20, 8025 BV Zwolle, the Netherlands
| | - Elisa G Hamer
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Department of Neurology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, Department of Paediatrics - Division of Developmental Neurology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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20
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Tedroff K, Hägglund G, Miller F. Long-term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2020; 62:554-562. [PMID: 31342516 PMCID: PMC7187377 DOI: 10.1111/dmcn.14320] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the long-term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). METHOD Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full-text original articles in English that described long-term follow-up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed-up, and the reported outcomes. RESULTS Of the 199 studies identified, 16 were included in this evaluation: 14 were case series and two studies reported a retrospectively assigned comparison group. Evidence concerning function was limited by study design differences, clinical variability, loss to follow-up, and heterogeneity across trials. INTERPRETATION At 10 years or more follow-up, available studies generate low-level evidence with considerable bias. No functional improvement of SDR over routine therapy is documented. Furthermore, the long-term effects of SDR with respect to spasticity reduction is unclear, with many studies reporting a high amount of add-on spasticity treatment. More long-term follow-up using robust scientific protocols is required before it can be decided whether the use of SDR as routine therapy for children with CP is to be recommended or not. WHAT THIS PAPER ADDS Ten years after selective dorsal rhizotomy, available studies supply inconclusive evidence on functional outcomes. The long-term effect on spasticity is uncertain, studies reported a substantial need for add-on treatment. Short- and long-term complications seem frequent but are not reported in a consistent manner.
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Affiliation(s)
- Kristina Tedroff
- Neuropaediatric Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Gunnar Hägglund
- Department of Clinical Sciences Lund, OrthopaedicsLund UniversityLundSweden
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21
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Photo-Based Range-of-Motion Measurement: Reliability and Concurrent Validity in Children With Cerebral Palsy. Pediatr Phys Ther 2020; 32:151-160. [PMID: 32150030 DOI: 10.1097/pep.0000000000000689] [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: 11/26/2022]
Abstract
PURPOSE To investigate intrarater and interrater reliability, agreement, and concurrent validity of a smartphone photography-based application compared with a universal goniometer in children with cerebral palsy. METHODS Range of motion of hip abduction, popliteal angle, and ankle dorsiflexion was measured with a universal goniometer and a photography-based application in children with cerebral palsy, Gross Motor Function Classification System levels I to V.A 2-way random-effects intraclass correlation coefficients and Bland-Altman plots, standard error of measurement, and smallest detectable change were used for analyses. RESULTS The application had good to excellent reliability and concurrent validity compared with a universal goniometer, while the large measurement error of both methods suggests that changes of 10° to 23° are needed to be certain that changes over time are not results of measurement error. CONCLUSIONS A photography-based goniometer can be a reliable and valid tool when measuring range of motion in children with cerebral palsy.
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22
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Więch P, Ćwirlej-Sozańska A, Wiśniowska-Szurlej A, Kilian J, Lenart-Domka E, Bejer A, Domka-Jopek E, Sozański B, Korczowski B. The Relationship Between Body Composition and Muscle Tone in Children with Cerebral Palsy: A Case-Control Study. Nutrients 2020; 12:nu12030864. [PMID: 32213841 PMCID: PMC7146599 DOI: 10.3390/nu12030864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 01/10/2023] Open
Abstract
The monitoring of children with cerebral palsy (CP) should include a precise assessment of the nutritional status to identify children and adolescents at risk of nutrition disorders. Available studies assessing the nutritional status of children with CP mainly focus on the relationship between body composition and the coexistence of motor dysfunctions, frequently overlooking the role of muscle tone. Therefore, the aim of this study was to assess the relationship between body composition and muscle tone in children with CP. In a case-control study (n = 118; mean age 11 y; SD = 3.8), the children with CP presented various stages of functional capacities, corresponding to all the levels in gross motor function classification system (GMFSC), and muscle tone described by all the grades in Ashworth scale. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. The children with CP were found with significantly lower mean values of fat-free mass (FFM kg = 29.2 vs. 34.5, p < 0.001), muscle mass (MM kg = 18.6 vs. 22.6, p < 0.001), body cell mass (BCM kg = 15.1 vs. 18.3, p < 0.001), and total body water (TBW L = 23.0 vs. 26.7, p < 0.001). The same differences in body composition were identified with respect to gender (p < 0.01 respectively). Moreover, children with higher muscle tone (higher score in Ashworth scale) were found with significantly lower values of fat mass (FM), FFM, MM, BCM, and TBW (p < 0.05). The findings showed lower parameters of body composition in the children with CP compared to the healthy children, and a decrease in the parameters coinciding with higher muscle tone in the study group. This observation suggests that it is necessary to measure muscle tone while assessing nutritional status of children with CP.
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Affiliation(s)
- Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Correspondence: ; Tel.: +48667192696
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Agnieszka Wiśniowska-Szurlej
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Justyna Kilian
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Ewa Lenart-Domka
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Clinical Regional Rehabilitation and Education Centre for Children and Adolescents in Rzeszow, 35-301 Rzeszow, Poland
| | - Agnieszka Bejer
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Elżbieta Domka-Jopek
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bernard Sozański
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bartosz Korczowski
- Institute of Medical Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland;
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Fosdahl MA, Jahnsen R, Pripp AH, Holm I. Change in popliteal angle and hamstrings spasticity during childhood in ambulant children with spastic bilateral cerebral palsy. A register-based cohort study. BMC Pediatr 2020; 20:11. [PMID: 31914961 PMCID: PMC6947838 DOI: 10.1186/s12887-019-1891-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Muscle contractures are developing during childhood and may cause extensive problems in gait and every day functioning in children with cerebral palsy (CP). The aim of the present study was to evaluate how the popliteal angle (PA) and hamstrings spasticity change during childhood in walking children with spastic bilateral CP. METHODS The present study was a longitudinal register-based cohort study including 419 children (1-15 years of age) with spastic bilateral CP, gross motor function classification system (GMFCS) level I, II and III included in the Norwegian CP Follow-up Program (CPOP). From 2006 to 2018 a total of 2193 tests were performed. The children were tested by trained physiotherapists yearly or every second year, depending on GMFCS level and age. The PA and the hamstrings spasticity (Modified Ashworth scale (MAS)) were measured at every time point. Both legs were included in the analysis. RESULTS There was an increase in PA with age for all three GMFCS levels with significant differences between the levels from 1 up to 8 years of age. At the age of 10 years there was no significant difference between GMFCS level II and III. At the age of 14 years all three GMFCS levels had a mean PA above 40° and there were no significant differences between the groups. The hamstrings spasticity scores for all the three GMFCS levels were at the lower end of the MAS (mean < 1+), however they were significantly different from each other until 8 years of age. The spasticity increased the first four years in all three GMFCS levels, thereafter the level I and II slightly increased, and level III slightly decreased, until the age of 15 years. CONCLUSION The present study showed an increasing PA during childhood. There were significantly different PAs between GMFCS level I, II and III up to 8 years of age. At the age of 14 years all levels showed a PA above 40°. The spasticity increased up to 4 years of age, but all the spasticity scores were at the lower end of the MAS during childhood.
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Affiliation(s)
- Merete Aarsland Fosdahl
- Department of Clinical Neuroscience for Children, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. .,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - Reidun Jahnsen
- Department of Clinical Neuroscience for Children, The Cerebral Palsy Follow-up Program (CPOP), Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Inger Holm
- Division of Orthopaedic Surgery, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Medical Faculty, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy. Toxins (Basel) 2019; 11:toxins11110651. [PMID: 31717282 PMCID: PMC6891294 DOI: 10.3390/toxins11110651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the use of botulinum toxin type A (BoNT-A) injections and their efficacy on gross motor function for lower limb spasticity in children with spastic cerebral palsy (CP). This retrospective study included 919 injection occasions from 591 children with CP who received a lower limb BoNT-A injection between 2006 and 2016. The Gross Motor Function Measure (GMFM-88), the Modified Ashworth Scale, and the Modified Tardieu Scale were administered before and after injections. Injections were predominantly administered to children under the age of 6 years. The most common muscle injection site was the calf muscle for dynamic foot deformity. The second most commonly injected muscle was the hip adductor among 2–3 year olds and the hamstring muscle among 4–6 year olds. Distal injections were predominantly administered to high-functioning children, whereas proximal injections were typically administered to low-functioning children. Multilevel injections were mostly administered to midfunctioning children. GMFM-88 scores significantly increased post-injection for both high- and low-functioning groups. Younger age at injection and distal injection type were associated with larger improvements on the GMFM-88 at both short- and midterm follow-up. The target muscles for injection varied depending on gross motor functioning and age. Younger age at injection and distal injection type were significantly related with greater gain in gross motor function.
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