Antecedents of cerebral palsy according to severity of motor impairment

Pre-pregnancy and pregnancy disorders, pre-term birth and the risk of cerebral palsy: a population-based study

BACKGROUND

Cerebral palsy (CP) is the most common cause of childhood physical disability whose aetiology remains unclear in most cases. Maternal pre-existing and pregnancy complications are recognized risk factors of CP but the extent to which their effects are mediated by pre-term birth is unknown.

METHODS

Population-based cohort study in Sweden including 2 055 378 singleton infants without congenital abnormalities, born between 1999 and 2019. Data on maternal and pregnancy characteristics and diagnoses of CP were obtained by individual record linkages of nationwide Swedish registries. Exposure was defined as maternal pre-pregnancy and pregnancy disorders. Inpatient and outpatient diagnoses were obtained for CP after 27 days of age. Adjusted rate ratios (aRRs) were calculated, along with 95% CIs.

RESULTS

A total of 515 771 (25%) offspring were exposed to maternal pre-existing chronic disorders and 3472 children with CP were identified for a cumulative incidence of 1.7 per 1000 live births. After adjusting for potential confounders, maternal chronic cardiovascular or metabolic disorders, other chronic diseases, mental health disorders and early-pregnancy obesity were associated with 1.89-, 1.24-, 1.26- and 1.35-times higher risk (aRRs) of CP, respectively. Most notably, offspring exposed to maternal antepartum haemorrhage had a 6-fold elevated risk of CP (aRR 5.78, 95% CI, 5.00-6.68). Mediation analysis revealed that ∼50% of the effect of these associations was mediated by pre-term delivery; however, increased risks were also observed among term infants.

CONCLUSIONS

Exposure to pre-existing maternal chronic disorders and pregnancy-related complications increases the risk of CP in offspring. Although most infants with CP were born at term, pre-term delivery explained 50% of the overall effect of pre-pregnancy and pregnancy disorders on CP.

Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study

We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the “Shishu Shorgo” (Bengali title, which translates to ‘Children’s Heaven’) Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.

Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy

The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [N = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: r_s = 0.404, p ≤ 0.001; bCP: r_s = 0.335, p ≤ 0.05; uCP: r_s = 0.493, p ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: r_s = 0.392, p ≤ 0.001; bCP: r_s = 0.316, p ≤ 0.05; uCP: r_s = 0.331, p ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level (r_s = −0.523, p ≤ 0.001) and the GVS-knee sagittal (r_s = −0.311, p ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS (r_s = 0.321, p ≤ 0.001) and between periventricular layer damage and the GMFCS (r_s = 0.348, p ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: r_pb = 0.495, p ≤ 0.001; bCP: r_pb = 0.357, p ≤ 0.05; uCP: r_pb = 0.641, p ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension (p ≤ 0.001 and p ≤ 0.001) and flexion (p = 0.016 and p = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.

Systematic review on gait classifications in children with cerebral palsy: An update

BACKGROUND

Gait classification systems (GCSs) aim to aid clinicians and researchers in categorizing the gait of pathological populations, with the intent to improve the communication between them, to support treatment planning and enable the evaluation of patients over time. Throughout the years, various GCSs have been defined for children with cerebral palsy (CP), which were first summarized in a systematic review published in 2007.

RESEARCH QUESTION

The current systematic review aimed to: a) identify GCSs that have been more recently developed, b) appraise their methodological quality and c) specify the most commonly used multiple joint gait patterns for children with CP reported in literature.

METHODS

Four databases (Medline, EMBASE, CINAHL, Web of Science) were searched until July 2017. Several forms of validity and the reliability of these studies were assessed according to the principles of the consensus-based standards for the selection of health measurement instruments checklist or criteria defined in the original review. All published GCSs were also scrutinized in order to identify multiple joint patterns that have reached a predefined level of consensus.

RESULTS

Thirty-six studies were considered in this review, 15 of them being GCSs that were not included in the original review. The validity, reliability and clinical applicability of all GCSs was reported, including 3 studies from the original review. Six multiple joint patterns for children with CP reached a consensus in literature.

CONCLUSION

Since the previous review, obvious progress has been made in the field of GCSs for CP, resulting in improved methodological quality of the majority of published GCSs. This encouraged the applicability of GCSs in clinical or research settings. The six reliable, valid and commonly used multiple joint patterns, emerging from this systematic review, may aid clinical and research applications and create a common language among healthcare providers.

The complex aetiology of cerebral palsy

Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.