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Bykova KM. Measurement of surface electromyography activity during swallowing in paediatrics: a scoping literature review. Eur J Pediatr 2024:10.1007/s00431-024-05685-2. [PMID: 39037451 DOI: 10.1007/s00431-024-05685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
Surface electromyography (sEMG) could be used for diagnostic and therapeutic purposes in various health conditions. For example, sEMG biofeedback is shown to be beneficial in adults with swallowing disorders (dysphagia), whereas there are no easily identifiable studies to support such evidence in paediatrics. The current review aimed to evaluate the feasibility of implementing sEMG during swallowing tasks in paediatric populations with various diagnoses. Additionally, the review aimed to describe findings in publications involving participants with cerebral palsy (CP) and dysphagia. Paediatric-related publications were sourced using English keywords and phrases across the following seven databases: PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, and ProQuest Dissertations and Theses Global. The search included all available publications without language and date restrictions. Publications using sEMG during chewing tasks were also accepted in the review as chewing is considered to be part of the act of swallowing. The feasibility of measuring sEMG during swallowing in children with various health conditions was supported by 116 publications (n = 6 literature reviews) that met the inclusion criteria for the final full-text review. However, a few publications described some difficulties occurring directly during the sEMG data collection sessions. The review identified 15 publications involving 177 participants with CP who underwent sEMG while swallowing (n = 1 publication focused solely on the assessment of chewing). Ten publications described studies that recruited children with dysphagia. Children with CP who had dysphagia were recruited in five of these studies. CONCLUSIONS The acquisition of sEMG measurements while performing swallowing tasks was shown to be feasible in children with various diagnoses including those who have CP and dysphagia. Future studies should investigate the implementation of sEMG as a part of paediatric dysphagia therapy alongside biofeedback swallowing skill training. WHAT IS KNOWN • Surface electromyography (sEMG) could be implemented for diagnostic and therapeutic purposes in various health conditions. • Biofeedback using sEMG is beneficial in adults with swallowing disorders (dysphagia). WHAT IS NEW • Implementation of sEMG was shown to be feasible during swallowing tasks in paediatric populations with various diagnoses, including dysphagia and cerebral palsy. • The usage of sEMG biofeedback as a part of paediatric dysphagia management should be investigated in future studies.
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Affiliation(s)
- Ksenia M Bykova
- Rose Centre for Stroke Recovery and Research, School of Psychology Speech and Hearing, University of Canterbury, 249 Papanui Road, Christchurch, 8052, New Zealand.
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Tillberg E, Persson JKE. Hemiplegic (unilateral) cerebral palsy in northern Stockholm: Intellectual disability and epilepsy. Seizure 2024; 120:110-115. [PMID: 38941801 DOI: 10.1016/j.seizure.2024.06.012] [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: 11/14/2023] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024] Open
Abstract
PURPOSE The purpose of this study was to describe intellectual disability and its association with epilepsy and brain imaging, in a population-based group of children with hemiplegic (unilateral) cerebral palsy, previously investigated and published in 2020. MATERIALS AND METHODS Forty-seven children of school age in northern Stockholm, fulfilling the Surveillance of Cerebral Palsy in Europe-criteria of hemiplegic (unilateral spastic) cerebral palsy, were invited to participate in the study. Twenty-one children consented to participate. A WISC (Wechsler Intelligence Scale for Children)-test was performed by an experienced psychologist. RESULTS In the study population of twenty-one children, 57 % (n 12) displayed uneven cognitive profiles, 38 % (n 8) intellectual disability and 62 % (n 13) had a normal IQ. 43 % (n 9) developed epilepsy. Children with extensive brain lesions had more severe intellectual disability. CONCLUSIONS In this study intellectual disability and/or epilepsy were associated with the type and extent of the underlying brain lesion. Intellectual disability and uneven cognitive profiles were common. We therefore recommend individual cognitive assessment to ensure an optimal school start.
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Affiliation(s)
- Elsa Tillberg
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
| | - Jonas K E Persson
- Department of Clinical Neurophysiology, Karolinska University Hospital, Eugeniavägen 11 SE-171 76 Stockholm, Sweden
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Feroze N, Karim T, Ostojic K, Mcintyre S, Barnes EH, Lee BC, Dale RC, Gill D, Kothur K. Clinical features associated with epilepsy occurrence, resolution, and drug resistance in children with cerebral palsy: A population-based study. Dev Med Child Neurol 2024; 66:793-803. [PMID: 38059324 DOI: 10.1111/dmcn.15807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 12/08/2023]
Abstract
AIM To investigate clinicoradiological features associated with epilepsy, its resolution, and drug resistance in children with cerebral palsy (CP). METHOD Data were gathered from the New South Wales/Australian Capital Territory CP Register, encompassing children with CP born between 2003 and 2015 (n = 1916). Clinical features and the severity of impairments were compared among three groups: children with current epilepsy (n = 604), those with resolved epilepsy by age 5 years (n = 109), and those without epilepsy (n = 1203). Additionally, a subset of the registry cohort attending Children's Hospital Westmead (n = 256) was analysed to compare epilepsy and treatment characteristics between drug-responsive (n = 83) and drug-resistant groups (n = 147) using logistic regression and hierarchical cluster analysis. RESULTS Manual Ability Classification System levels IV and V, intellectual impairment, and vision impairment were found to be associated with epilepsy in children with CP on multivariable analysis (p < 0.01). Moderate to severe intellectual impairment and bilateral spastic CP were independent positive and negative predictors of epilepsy persistence at the age of 5 years respectively (p < 0.05). Microcephaly and multiple seizure types were predictors of drug-resistant epilepsy (area under the receiver operating characteristic curve of 0.83; 95% confidence interval 0.77-0.9). Children with a known genetic cause (14%) and CP epilepsy surgery group (4.3%) formed specific clinical subgroups in CP epilepsy. INTERPRETATION Our study highlights important clinical associations of epilepsy, its resolution, and treatment response in children with CP, providing valuable knowledge to aid in counselling families and identifying distinct prognostic groups for effective medical surveillance and optimal treatment. WHAT THIS PAPER ADDS Severe motor and non-motor impairments in cerebral palsy (CP) increase epilepsy risk. Epilepsy more likely resolves in bilateral spastic and milder CP impairments. Epilepsy in CP often manifests at an early age with multiple seizure types and high drug resistance. Children with a known genetic cause and CP epilepsy surgery group represent distinct clinical subgroups.
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Affiliation(s)
- Nimra Feroze
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Tasneem Karim
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia
| | - Katarina Ostojic
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, NSW, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Byoung Chan Lee
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Deepak Gill
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kavitha Kothur
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Martin T, McIntyre S, Waight E, Baynam G, Watson L, Langdon K, Woolfenden S, Smithers‐Sheedy H, Sherwood J. Prevalence and trends for Aboriginal and Torres Strait Islander children living with cerebral palsy: A birds-eye view. Dev Med Child Neurol 2023; 65:1475-1485. [PMID: 37147854 PMCID: PMC10952932 DOI: 10.1111/dmcn.15617] [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: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/07/2023]
Abstract
AIM To provide a birds-eye view of the trends of cerebral palsy (CP) for Australian Aboriginal and Torres Strait Islander children and young adults. METHOD Data were obtained for this population-based observational study from the Australian Cerebral Palsy Register (ACPR), birth years 1995 to 2014. The Indigenous status of children was classified by maternal Aboriginal and Torres Strait Islander or non-Indigenous status. Descriptive statistics were calculated for socio-demographic and clinical characteristics. Prenatal/perinatal and post-neonatal birth prevalence was calculated per 1000 live births and per 10 000 live births respectively, and Poisson regression used to assess trends. RESULTS Data from the ACPR were available for 514 Aboriginal and Torres Strait Islander individuals with CP. Most children could walk independently (56%) and lived in urban or regional areas (72%). One in five children lived in socioeconomically disadvantaged remote/very remote areas. The birth prevalence of prenatal/perinatal CP declined after the mid-2000s from a high of 4.8 (95% confidence interval 3.2-7.0) to 1.9 per 1000 live births (95% confidence interval 1.1-3.2) (2013-2014), with marked declines observed for term births and teenage mothers. INTERPRETATION The birth prevalence of CP in Aboriginal and Torres Strait Islander children in Australia declined between the mid-2000s and 2013 to 2014. This birds-eye view provides key stakeholders with new knowledge to advocate for sustainable funding for accessible, culturally safe, antenatal and CP services. WHAT THIS PAPER ADDS Birth prevalence of cerebral palsy (CP) is beginning to decline for Aboriginal and Torres Strait Islanders. Recent CP birth prevalence for Aboriginal and Torres Strait Islanders is 1.9 per 1000 live births. Most children with CP live in more populated areas rather than remote or very remote areas. One in five Aboriginal and Torres Strait Islander children with CP live in socioeconomically disadvantaged remote areas.
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Affiliation(s)
- Tanya Martin
- School of Nursing and MidwiferyThe University of SydneyCamperdownNew South WalesAustralia
| | - Sarah McIntyre
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Emma Waight
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Gareth Baynam
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | - Linda Watson
- Department of Health, Western Australian Register of Developmental AnomaliesGovernment of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Susan Woolfenden
- Discipline of Paediatrics, School of Clinical MedicineUNSW SydneySydneyNew South WalesAustralia
- Sydney Institute of Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Hayley Smithers‐Sheedy
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Juanita Sherwood
- Jumbunna Institute for Indigenous Education and ResearchUniversity of Technology SydneySydneyNew South WalesAustralia
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Gong C, Liu X, Fang L, Liu A, Lian B, Qi X, Chen S, Li H, Zhao M, Guo J, Zhou S. Prevalence of cerebral palsy comorbidities in China: a systematic review and meta-analysis. Front Neurol 2023; 14:1233700. [PMID: 37840931 PMCID: PMC10568468 DOI: 10.3389/fneur.2023.1233700] [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: 06/02/2023] [Accepted: 08/25/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives This systematic review aimed to comprehensively understand the comorbidity of cerebral palsy (CP) in China. Methods We searched through databases in both Chinese and English until December 2022 to gather cross-sectional studies on the comorbidity of CP in China. After two reviewers independently screened the articles, collected the data, and assessed the bias risk, a meta-analysis was conducted using the Stata 17.0 software. Results A total of 73 articles were included. Of these, 16 articles reported total comorbidity, with a prevalence of 79.7% (95% CI: 73.8-85.7%); 56 articles reported epilepsy, with a prevalence of 17.9% (95% CI: 15.4-20.4%); 48 articles reported intellectual disability, with a prevalence of 58.0% (95% CI: 51.8-64.3%); 32 articles reported speech disorders, with a prevalence of 48.0% (95% CI: 41.6-54.4%); 41 articles reported hearing disorders, with a prevalence of 17.2% (95% CI: 13.0-21.4%); and 35 articles reported vision disorders, with a prevalence of 23.1% (95% CI: 16.3-29.8%). The topographical type of CP was the primary source of heterogeneity in the prevalence of epilepsy. Diagnostic criteria for CP, clinical type of CP, GMFCS, publishing time, and topographical type of CP were the primary sources of heterogeneity in the prevalence of intellectual disability. Clinical type of CP and topographical type were the primary sources of heterogeneity in the prevalence of speech disorders. Finally, the region was the primary source of heterogeneity in the prevalence of hearing disorders. Conclusion The prevalence of comorbidities in CP is high in China. Comorbidities are related to the characteristics, severity, and risk factors of brain insult and have a particular relationship with regional economic development and medical and health levels.
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Affiliation(s)
- Chao Gong
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xiaopei Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No. 3 Hospital, Jiamusi, China
| | - Liya Fang
- 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
| | - Xunzhong Qi
- Jiamusi University Affiliated No. 1 Hospital, Jiamusi, China
| | - Shuyue Chen
- College of Basic Medicine, Jiamusi University, Jiamusi, China
| | - Huiqing Li
- College of Basic Medicine, Jiamusi University, Jiamusi, China
| | - Ming Zhao
- College of Public Health, Jiamusi University, 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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van Eyk CL, Fahey MC, Gecz J. Redefining cerebral palsies as a diverse group of neurodevelopmental disorders with genetic aetiology. Nat Rev Neurol 2023; 19:542-555. [PMID: 37537278 DOI: 10.1038/s41582-023-00847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
Cerebral palsy is a clinical descriptor covering a diverse group of permanent, non-degenerative disorders of motor function. Around one-third of cases have now been shown to have an underlying genetic aetiology, with the genetic landscape overlapping with those of neurodevelopmental disorders including intellectual disability, epilepsy, speech and language disorders and autism. Here we review the current state of genomic testing in cerebral palsy, highlighting the benefits for personalized medicine and the imperative to consider aetiology during clinical diagnosis. With earlier clinical diagnosis now possible, we emphasize the opportunity for comprehensive and early genomic testing as a crucial component of the routine diagnostic work-up in people with cerebral palsy.
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Affiliation(s)
- Clare L van Eyk
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
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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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Asano D, Takeda M, Nobusako S, Morioka S. Error analysis of Raven's Coloured Progressive Matrices in children and adolescents with cerebral palsy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:655-667. [PMID: 37016552 DOI: 10.1111/jir.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Analysis of the errors in the Raven's Coloured Progressive Matrices (RCPM) has been previously performed for children with intellectual disabilities but has not been investigated for those with cerebral palsy (CP). This study aimed to investigate whether the types and positions of errors made by individuals with CP differed from those made by typically developing (TD) controls. METHODS Forty-five participants with CP aged 4-18 years and 30 TD children aged 3-9 years underwent RCPM testing. We first compared the RCPM performance and error characteristics between the groups and then examined the association between RCPM and the severity of CP and receptive vocabulary in the CP group. RESULTS The results showed that while mean total scores in the two groups were comparable, the types and positions of errors made by individuals with CP differed from those of TD controls. The development of non-verbal intelligence in children with CP increased with age; when controlling for age, non-verbal intelligence was significantly correlated with all three functional levels of CP severity and receptive vocabulary. CONCLUSIONS This study provides valuable insights into the problem-solving strategies employed by children with CP.
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Affiliation(s)
- D Asano
- Department of Rehabilitation, Japan Baptist Hospital, Kyoto, Japan
| | - M Takeda
- Department of Rehabilitation, Beppu Developmental Medical Center, Oita, Japan
| | - S Nobusako
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - S Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
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Ostojic K, Paget S, Martin T, Dee-Price BJ, McIntyre S, Smithers Sheedy H, Mimmo L, Burnett H, Scott T, Berg A, Masi A, Scarcella M, Calderan J, Azmatullah S, Mohamed M, Woodbury M, Wilkinson A, Zwi K, Dale R, Eapen V, Lingam R, Strnadová I, Woolfenden S. Codesigning a social prescribing pathway to address the social determinant of health concerns of children with cerebral palsy and their families in Australia: a protocol for a mixed-methods formative research study. BMJ Open 2023; 13:e066346. [PMID: 37024248 PMCID: PMC10083805 DOI: 10.1136/bmjopen-2022-066346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDH) are contributors to health inequities experienced by some children with cerebral palsy and pose barriers to families engaging with complex and fragmented healthcare systems. There is emerging evidence to support 'social prescribing' interventions that systematically identify SDH concerns and refer patients to non-medical social care support and services to address their needs. To date, social prescribing has not been trialled specifically for children with neurodevelopmental disabilities, including cerebral palsy, in Australia. This study aims to codesign a social prescribing programme to address SDH concerns of children with cerebral palsy and their families who attend one of the three tertiary paediatric rehabilitation services in New South Wales, Australia. METHODS AND ANALYSIS This is a qualitative multi-site study conducted at the three NSW paediatric hospitals' rehabilitation departments using a codesign approach. Children aged 12-18 years with cerebral palsy, parents/caregivers of children (aged 0-18 years) with cerebral palsy, and clinicians will be involved in all stages to codesign the social prescribing programme. The study will consist of three components: (1) 'what we need', (2) 'creating the pathways' and (3) 'finalising and sign off'. This project is overseen by two advisory groups: one group of young adults with cerebral palsy and one group of parents of young people with cerebral palsy. The study will be guided by the biopsychosocial ecological framework, and analysis will follow Braun and Clark's thematic approach. ETHICS AND DISSEMINATION The study protocol was approved by the human research ethics committee of the Sydney Children's Hospitals Network. This codesign study will inform a future pilot study of feasibility and acceptability, then if indicated, a pilot clinical trial of efficacy. We will collaborate with all project stakeholders to disseminate findings and undertake further research to build sustainable and scalable models of care. TRIAL REGISTRATION NUMBER ACTRN12622001459718.
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Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Paget
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tanya Martin
- Sydney Medical School, University of Sydney Poche Centre for Indigenous Health, Camperdown, New South Wales, Australia
| | - Betty-Jean Dee-Price
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurel Mimmo
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Nursing Research Unit, The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Heather Burnett
- John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
| | - Timothy Scott
- Rehab2Kids, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Alison Berg
- Kids Rehab, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anne Masi
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michele Scarcella
- Aboriginal Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Jack Calderan
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Sheikh Azmatullah
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Masyitah Mohamed
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Mackenzie Woodbury
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Alunya Wilkinson
- EPIC-CP Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Russell Dale
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Kids Neuroscience Centre, Kids Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
| | - Iva Strnadová
- School of Education, University of New South Wales, Sydney, New South Wales, Australia
- Disability Innovation Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Camperdown, New South Wales, Australia
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Hinwood GL, Loftus H, Shepherd DA, Guzys A, Reddihough DS, Reid SM. Survival of individuals with cerebral palsy in Victoria, Australia: A longitudinal cohort study spanning four decades. Dev Med Child Neurol 2023; 65:580-587. [PMID: 36161450 DOI: 10.1111/dmcn.15420] [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: 03/17/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022]
Abstract
AIM To provide an updated description of the rates, trends, and predictors of mortality of individuals with cerebral palsy (CP), born in the Australian state of Victoria between 1970 and 2012. METHOD Data were extracted for 4807 individuals (2091 females; 2716 males). The probability of survival to 30th June 2017 was calculated using the Kaplan-Meier method. Mortality rates were calculated per 1000 person-years using age strata and compared with population mortality rates to produce mortality ratios. Cox proportional hazards regression was used to calculate hazard ratios for selected demographic and clinical characteristics and to estimate the effect of birth epoch on 15-year survival. RESULTS There were 666 recorded deaths. Compared to the general population, mortality was higher for all persons with CP and highest for children aged 1 to 15 years (45-62 times). We observed 35% improvement in the probability of survival to 15 years for births in the 2000s relative to the 1970s (hazard ratio 0.65, 95% confidence interval [CI] 0.49, 0.86), but only 4% improvement for the subgroup with complex CP (hazard ratio 0.96, 95% CI 0.69, 1.33). INTERPRETATION The observed improvements in survival for those born in the 2000s is likely related predominantly to a proportional reduction in complex CP within the cohort. WHAT THIS PAPER ADDS Length of survival improved for Australians with cerebral palsy (CP) born this millennium. Improved survival was mainly because of a proportional reduction in complex CP. A small improvement in length of survival was seen for children with complex CP.
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Affiliation(s)
- Gina L Hinwood
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Hayley Loftus
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Angela Guzys
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Parkville, Victoria, Australia
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11
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Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh-Findings from the Bangladesh Cerebral Palsy Register. J Clin Med 2023; 12:jcm12041597. [PMID: 36836130 PMCID: PMC9966186 DOI: 10.3390/jcm12041597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND We aimed to describe the burden, severity, and underlying factors of associated impairments among children with cerebral palsy (CP) in rural Bangladesh. METHODS This study reports findings from the Bangladesh Cerebral Palsy Register-the first population-based surveillance of children with CP in any LMIC, where children with confirmed CP aged < 18 years are registered by a multidisciplinary team following a standard protocol. Associated impairments were documented based on clinical assessment, available medical records, and a detailed clinical history provided by the primary caregivers. Descriptive analysis, as well as unadjusted and adjusted logistic regression, were completed using R. RESULTS Between January 2015 and February 2022, 3820 children with CP were registered (mean (SD) age at assessment: 7.6 (5.0) y; 39% female). Overall, 81% of children had ≥1 associated impairment; hearing: 18%, speech: 74%, intellectual: 40%, visual: 14%, epilepsy: 33%. The presence of a history of CP acquired post-neonatally and having a gross motor function classification system levels III-V significantly increased the odds of different types of associated impairments in these children. Most of the children had never received any rehabilitation services and were not enrolled in any mainstream or special education system. CONCLUSIONS The burden of associated impairments was high among children with CP, with comparatively low receipt of rehabilitation and educational services in rural Bangladesh. Comprehensive intervention could improve their functional outcome, participation, and quality of life.
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12
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Cooper MS, Mackay MT, Dagia C, Fahey MC, Howell KB, Reddihough D, Reid S, Harvey AS. Epilepsy syndromes in cerebral palsy: varied, evolving and mostly self-limited. Brain 2023; 146:587-599. [PMID: 35871494 DOI: 10.1093/brain/awac274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/25/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022] Open
Abstract
Seizures occur in approximately one-third of children with cerebral palsy. This study aimed to determine epilepsy syndromes in children with seizures and cerebral palsy due to vascular injury, anticipating that this would inform treatment and prognosis. We studied a population-based cohort of children with cerebral palsy due to prenatal or perinatal vascular injuries, born 1999-2006. Each child's MRI was reviewed to characterize patterns of grey and white matter injury. Children with syndromic or likely genetic causes of cerebral palsy were excluded, given their inherent association with epilepsy and our aim to study a homogeneous cohort of classical cerebral palsy. Chart review, parent interview and EEGs were used to determine epilepsy syndromes and seizure outcomes. Of 256 children, 93 (36%) had one or more febrile or afebrile seizures beyond the neonatal period and 87 (34%) had epilepsy. Children with seizures were more likely to have had neonatal seizures, have spastic quadriplegic cerebral palsy and function within Gross Motor Function Classification System level IV or V. Fifty-six (60%) children with seizures had electroclinical features of a self-limited focal epilepsy of childhood; we diagnosed these children with a self-limited focal epilepsy-variant given the current International League Against Epilepsy classification precludes a diagnosis of self-limited focal epilepsy in children with a brain lesion. Other epilepsy syndromes were focal epilepsy-not otherwise specified in 28, infantile spasms syndrome in 11, Lennox-Gastaut syndrome in three, genetic generalized epilepsies in two and febrile seizures in nine. No epilepsy syndrome could be assigned in seven children with no EEG. Twenty-one changed syndrome classification during childhood. Self-limited focal epilepsy-variant usually manifested with a mix of autonomic and brachio-facial motor features, and occipital and/or centro-temporal spikes on EEG. Of those with self-limited focal epilepsy-variant, 42/56 (75%) had not had a seizure for >2 years. Favourable seizure outcomes were also seen in some children with infantile spasms syndrome and focal epilepsy-not otherwise specified. Of the 93 children with seizures, at last follow-up (mean age 15 years), 61/91 (67%) had not had a seizure in >2 years. Children with cerebral palsy and seizures can be assigned specific epilepsy syndrome diagnoses typically reserved for normally developing children, those syndromes commonly being age-dependent and self-limited. Compared to typically developing children with epilepsy, self-limited focal epilepsy-variant occurs much more commonly in children with cerebral palsy and epilepsy. These findings have important implications for treatment and prognosis of epilepsy in cerebral palsy, and research into pathogenesis of self-limited focal epilepsy.
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Affiliation(s)
- Monica S Cooper
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Mark T Mackay
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Charuta Dagia
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia
| | - Katherine B Howell
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Dinah Reddihough
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Susan Reid
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - A Simon Harvey
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
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13
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Blasco M, García-Galant M, Berenguer-González A, Caldú X, Arqué M, Laporta-Hoyos O, Ballester-Plané J, Miralbell J, Jurado MÁ, Roser Pueyo. Interventions with an Impact on Cognitive Functions in Cerebral Palsy: a Systematic Review. Neuropsychol Rev 2022; 33:551-577. [PMID: 35972712 DOI: 10.1007/s11065-022-09550-7] [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: 09/03/2021] [Accepted: 06/18/2022] [Indexed: 10/15/2022]
Abstract
This systematic review aimed at investigating those interventions that impact on cognitive functioning in children and adults with cerebral palsy (CP). A systematic database search was conducted and twenty-eight studies suitable for inclusion were identified, of which only nine were randomized controlled trials (RCTs). Among all the studies included, ten were multi-modal (cognitive and physical tasks), eleven physical, five cognitive, and two alternative and augmentative communication interventions. The evidence suggests that multi-modal and physical interventions improve general cognitive functioning. Multi-modal and cognitive interventions have an impact on visual perception. Both interventions, together with physical interventions have an effect on a specific executive function domain (inhibitory control), and only cognitive interventions improved other executive function domains such as working memory. However, no RCT assessed the effects of all executive function domains. Few studies have looked at interventions to improve memory and language, and there is a scarcity of long-term research. Future RCTs must be of higher quality and better account for age and sex differences, as well as the clinical heterogeneity of CP. To date, there is evidence that multi-modal, cognitive or physical interventions have an impact on general cognitive functioning, visual perception and executive functions in children with CP, which may support their cognitive development.The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42020152616.
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Affiliation(s)
- Montse Blasco
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - María García-Galant
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Alba Berenguer-González
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain
| | - Xavier Caldú
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Miquel Arqué
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain
| | - Olga Laporta-Hoyos
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Júlia Ballester-Plané
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Júlia Miralbell
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - María Ángeles Jurado
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Roser Pueyo
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain. .,Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
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14
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Coceski M, Stargatt R, Sherwell S, Abu-Rayya HM, Reid SM, Reddihough DS, Wrennall J, Hocking DR. 10-year follow-up study found that motor-free intelligence quotient declined in children with mild to moderate cerebral palsy. Acta Paediatr 2022; 111:1899-1906. [PMID: 35735126 PMCID: PMC9543839 DOI: 10.1111/apa.16463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Aim This 10‐year follow‐up study examined cognitive change in a cohort of children with cerebral palsy from preschool to adolescence at the group and individual levels. Methods The Wechsler Preschool and Primary Scale of Intelligence was administered to 80 children with cerebral palsy (mean = 4 years 6 months, standard deviation = 7 months) at baseline (Time 1). At 10‐year follow‐up (Time 2), 28 adolescents (mean = 14 years 6 months, standard deviation = 9 months) returned for assessment with the Wechsler Intelligence Scale for Children. Motor‐free intelligence quotient (IQ) scores were calculated and paired‐samples t‐tests and the Reliable Change Index (RCI) were used to investigate change in IQ over time. Results At the group level, nonverbal IQ scores declined significantly. At the individual level, RCI indicated nine and 11 children showed a clinically significant decline in Full Scale IQ (FSIQ) and nonverbal IQ scores, respectively. Decline in FSIQ was related to a history of seizures whereas decline in nonverbal IQ was associated with higher initial IQ. Conclusion Cognitive abilities in children with cerebral palsy evolve over time and selective deficits may not be observable until a later age, highlighting the importance of repeated cognitive assessment throughout childhood and adolescence.
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Affiliation(s)
- Monika Coceski
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Robyn Stargatt
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sarah Sherwell
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hisham M Abu-Rayya
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,School of Social Work, University of Haifa, Haifa, Israel
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neurodevelopmental & Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jacquie Wrennall
- Mental Health, Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Darren R Hocking
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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15
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Rosenthal M. Life expectancy and its adjustment in cerebral palsy with severe impairment: Are we doing this right? Dev Med Child Neurol 2022; 64:709-714. [PMID: 34897672 DOI: 10.1111/dmcn.15120] [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: 03/01/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
In children with very severe cerebral palsy, an adversarial legal process for medical negligence, when liability is admitted, requires an estimate of life expectancy. Medical experts using the same cohort data and the same clinical facts can produce quite different life expectancies, leading to arguments in legal conferences and courts. The issues that commonly arise include between-country comparisons, projected and therapy-induced advanced life expectancies, and the contribution of epilepsy, scoliosis, and especially cognition to life expectancy. In this review, these factors are discussed from an arithmetic, statistical, and medical viewpoint to initiate debate on the issue, including whether median survival should be advocated.
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Affiliation(s)
- Mark Rosenthal
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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16
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Laporta-Hoyos O, Pannek K, Pagnozzi AM, Whittingham K, Wotherspoon J, Benfer K, Fiori S, Ware RS, Boyd RN. Cognitive, academic, executive and psychological functioning in children with spastic motor type cerebral palsy: Influence of extent, location, and laterality of brain lesions. Eur J Paediatr Neurol 2022; 38:33-46. [PMID: 35381411 DOI: 10.1016/j.ejpn.2022.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/14/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate, in spastic motor-type cerebral palsy, the association between 1) the location and extent of brain lesions and numerous psychological outcomes; 2) the laterality of brain lesions and performance of verbal-related cognitive functions. METHODS The semi-quantitative scale for MRI (sqMRI) was scored for 101 children with cerebral palsy. Non-verbal and verbal proxy intelligence quotients (IQ), word reading, spelling, numerical operations skills, executive functioning, and psychological adjustment were assessed. Relationships between global and regional sqMRI scores and clinical scores were examined. The best multivariable linear regression model for each outcome was identified using the Bayesian Information Criteria. Regional sqMRI scores, gross motor functioning, manual ability, and epilepsy status were considered for inclusion as covariables. Where sqMRI scores made statistically significant contributions to models of verbal-related functioning, data were reanalysed including these sqMRI scores' laterality index. Verbal-related outcomes were compared between participants with left-sided versus bilateral brain lesions. RESULTS Medial dorsal thalamus and parietal lobe lesions significantly accounted for poorer verbal proxy-IQ. Left-hemisphere lateralization of temporal lobe lesions was associated with poorer verbal proxy-IQ. Participants with bilateral lesions performed significantly better than those with unilateral left-sided lesions in verbal cognitive functions. Controlling for epilepsy diagnosis, participants with ventral posterior lateral thalamus lesions presented with better Behaviour Rating Inventory of Executive Function scores, although within the normal range. sqMRI scores were not significantly associated with some psychological outcomes or these only bordered on significance after accounting for relevant control variables. CONCLUSION The laterality of early-life lesions influences the development of verbal-related cognitive functions.
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Affiliation(s)
- Olga Laporta-Hoyos
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Kerstin Pannek
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Alex M Pagnozzi
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jane Wotherspoon
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Kath Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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17
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Chollat C, Bertrand E, Petit-Ledo A, de Vansay C, Voisin C, Dabaj I, Gillibert A, Marret S. Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center. J Pediatr 2021; 237:183-189.e6. [PMID: 34144033 DOI: 10.1016/j.jpeds.2021.06.018] [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: 02/06/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the prevalence of cerebral palsy (CP) at age 2 years in infants born before 33 weeks of gestation and to analyze the fetal neuroprotective effect of the antenatal administration of magnesium sulfate (MgSO4) treatment on CP. STUDY DESIGN Preterm infants born before 33 weeks of gestation and discharged from the Rouen University Hospital's Neonatal Intensive Care Unit between 2007 and 2015 were included. At age 2 years, pediatricians of the perinatal network of Eure and Seine-Maritime counties administered standardized questionnaires analyzing motor, cognitive, and behavioral items, derived from the Denver and Amiel-Tison scales. A routine protocol based on MgSO4 infusion was introduced in 2010. The primary outcome measure was the occurrence of CP according to the Surveillance of Cerebral Palsy in Europe network definition. RESULTS A total of 1759 very preterm infants were included, among whom 138 (7.8%) died and 148 (9.1%) were lost to follow-up. Assuming that those lost to follow-up had no CP, at 2 years, 55 of 1621 infants (3.4%; 95% CI, 2.6%-4.4%) had CP. After statistical adjustment for birth term and antenatal corticosteroid use, a significant decrease in CP was observed after implementation of a protocol of MgSO4 administration in mothers before imminent preterm birth at <33 weeks of gestation (aOR, 0.53; 95% CI, 0.29-0.98; P = .04). CONCLUSIONS The prevalence of CP at 2 years after very preterm birth was low. The implementation of a neuroprotective protocol with MgSO4 was associated with reduced CP occurrence; however, several relevant limitations must be considered for interpretation.
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Affiliation(s)
- Clément Chollat
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Neonatal Intensive Care Unit, Port-Royal, Paris Center University Hospitals, APHP, Paris Descartes University, Paris, France
| | - Emmanuelle Bertrand
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Alice Petit-Ledo
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Caroline Voisin
- Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | - Ivana Dabaj
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France
| | | | - Stéphane Marret
- INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders Team, Institute of Research and Innovation in Biomedicine, Faculty of Medicine, Normandy University, Caen, France; Department of Neonatal Pediatrics and Intensive Care-Neuropediatrics, CHU Rouen, Rouen, France.
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18
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Scott K, Lewis J, Pan X, Heathcock J. Parent-Reported PEDI-CAT Mobility and Gross Motor Function in Infants With Cerebral Palsy. Pediatr Phys Ther 2021; 33:156-161. [PMID: 34086623 PMCID: PMC8217157 DOI: 10.1097/pep.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to determine the relationship between the Pediatric Evaluation of Disability Index-Computer Adapted Test (PEDI-CAT), a parent-reported outcome measure, and therapist-administered measures of motor function for infants with cerebral palsy (CP) with moderate to severe motor impairments. METHODS A prospective, cohort study included 54 infants, ages 6 to 24 months, with CP or high risk of CP, Gross Motor Function Classification System (GMFCS) levels III to V. Measures included the Gross Motor Function Measure (GMFM) and the mobility domain of the PEDI-CAT (PEDI-mob). RESULTS A significant correlation was found between PEDI-mob and GMFM scores. Significant differences were found in PEDI-mob scores as a function of GMFCS level. CONCLUSIONS The PEDI-mob adds value to motor evaluations of infants with CP. Parents can accurately contribute information about daily motor performance for goal setting and treatment planning. The PEDI-mob offers a practical solution when longer assessments cannot be completed.
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Affiliation(s)
- Kimberley Scott
- The Ohio State University (Drs Scott, Pan, and Heathcock), Columbus, Ohio; Nationwide Children's Hospital (Dr Lewis), Columbus, Ohio
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19
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Coceski M, Hocking DR, Abu-Rayya HM, Sherwell S, Reid SM, Reddihough DS, Wrennall J, Stargatt R. WISC-V motor-free cognitive profile and predictive factors in adolescents with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 113:103934. [PMID: 33740670 DOI: 10.1016/j.ridd.2021.103934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The most commonly used intelligence tests - the Wechsler Scales - do not provide standardised procedures for assessing children with motor impairment, and as a result, may underestimate the intelligence quotient (IQ) of young people with CP. AIMS To characterise a motor-free cognitive profile of adolescents with CP using the Wechsler Intelligence Scale for Children - Fifth edition (WISC-V) and explore the influence of clinical factors on cognitive abilities. METHODS AND PROCEDURE The WISC-V was used to assess cognitive abilities in 70 adolescents (M = 14 years 6 months, SD = 10 months). Sixty-six adolescents (Gross Motor Function Classification System (GMFCS) Level I, n = 26 ; II, n = 23; III, n = 15; IV, n = 1; V, n = 1) obtained either a Motor-free IQ or index score using the motor-free method. OUTCOMES AND RESULTS MFIQ and index scores fell below the normative data and rates of borderline and impaired cognitive abilities were significantly higher in the CP group. Scores showed an uneven cognitive profile with a relative strength in verbal abilities. Severity of motor impairment and small for gestational age (SGA) were associated with lower IQ scores. A history of seizures was related to lower verbal abilities. CONCLUSIONS AND IMPLICATIONS Cognitive abilities of adolescents with CP are significantly below expectation compared to normative data. Severity of motor impairment, SGA, and seizures need to be recognised by health professionals as risk factors for cognitive impairment. A substantial proportion of adolescents showed borderline cognitive abilities, constituting a group with CP which are relatively neglected in the literature.
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Affiliation(s)
- Monika Coceski
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Darren R Hocking
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Hisham M Abu-Rayya
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia; Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Sarah Sherwell
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Neurodevelopmental & Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Neurodevelopmental & Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jacquie Wrennall
- Mental Health, Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Robyn Stargatt
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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20
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Arnaud C, Ehlinger V, Delobel-Ayoub M, Klapouszczak D, Perra O, Hensey O, Neubauer D, Hollódy K, Virella D, Rackauskaite G, Greitane A, Himmelmann K, Ortibus E, Dakovic I, Andersen GL, Papavasiliou A, Sellier E, Platt MJ, Krägeloh-Mann I. Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol 2021; 12:624884. [PMID: 34093391 PMCID: PMC8173253 DOI: 10.3389/fneur.2021.624884] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups. Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models. Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks. Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.
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Affiliation(s)
- Catherine Arnaud
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France.,Clinical Epidemiology Unit, University Hospital of Toulouse, Toulouse, France
| | - Virginie Ehlinger
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Malika Delobel-Ayoub
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Dana Klapouszczak
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Oliver Perra
- School of Nursing & Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, United Kingdom
| | | | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Katalin Hollódy
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Daniel Virella
- Neonatology Intensive Care Unit/Research Center, Central Lisbon Hospital, Lisbon, Portugal
| | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ivana Dakovic
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Guro L Andersen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Elodie Sellier
- Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, France
| | - Mary Jane Platt
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Inge Krägeloh-Mann
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Eberhard Karls Universität Tübingen, Tübingen, Germany
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Chen A, Dyck Holzinger S, Oskoui M, Shevell M. Cerebral palsy in Canadian Indigenous children. Dev Med Child Neurol 2021; 63:614-622. [PMID: 33314061 DOI: 10.1111/dmcn.14776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
AIM To determine whether inequities in health outcomes for Indigenous Canadians are also present in cerebral palsy (CP) by comparing CP profiles between Indigenous and non-Indigenous children. METHOD Using the Canadian Cerebral Palsy Registry, we conducted a cross-sectional study. CP motor subtype, gross motor severity, comorbidities, perinatal adversity, preterm birth, and parental education were compared between 94 Indigenous (53 males, 41 females) and 1555 non-Indigenous (891 males, 664 females) children (all >5y). Multivariate analysis was done to analyze adverse CP factors, defined as CP gross motor severity and comorbidities. CP etiologies, either prenatal/perinatal or postnatal, were also compared. RESULTS Indigenous children with CP have higher odds of having low parental education (odds ratio [OR] 6.15, 95% confidence interval [CI] 3.36-11.3) and comorbidities (OR 4.46, 95% CI 1.62-12.3), especially cognitive (OR 4.52, 95% CI 2.27-9.05), communication (OR 2.66, 95% CI 1.54-4.61), and feeding (OR 2.25, 95% CI 1.33-3.83) impairment. Indigenous children also have higher CP gross motor severity (p=0.03). Indigenous children are also more likely to have non-accidental head injury (n=4; OR 8.18, 95% CI 1.86-36.0) as the cause of their postnatal CP. INTERPRETATION Indigenous populations have worse health outcomes as a result of intergenerational impacts of colonization. Our study shows that Indigenous children with CP have increased comorbidities and higher CP gross motor severity, reinforcing the need for a multidisciplinary approach to management. Furthermore, targeted prevention programs against preventable causes of CP, such as non-accidental head injury, may be beneficial. WHAT THIS PAPER ADDS Indigenous children with cerebral palsy (CP) have more severe motor impairment and more comorbidities. Non-accidental head injury is a significant cause of postnatal CP.
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Affiliation(s)
- Anjellica Chen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sasha Dyck Holzinger
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
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Papadimitriou I, Dalivigka Z, Outsika C, Scarmeas N, Pons R. Dystonia assessment in children with cerebral palsy and periventricular leukomalacia. Eur J Paediatr Neurol 2021; 32:8-15. [PMID: 33743389 DOI: 10.1016/j.ejpn.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/15/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the frequency, motor phenotype, clinical patterns and functional consequences of dystonia in patients with cerebral palsy (CP) in the setting of periventricular leukomalacia. METHODS Retrospective analysis of a cohort of 31 patients with CP and periventricular leukomalacia. Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were used to classify functional ability. Spasticity was rated using the Modified Ashworth Scale. Presence of dystonia was assessed by reviewing video recordings, and its severity by using the Burke-Fahn-Marsden Dystonia Rating Scale. RESULTS All patients showed evidence of dystonia involving upper and/or lower limbs, neck, trunk, mouth and eyes in order of frequency. In 29% of patients dystonia involved only the limbs and in 71% it was multifocal. Dystonia severity ranged from slight to severe. Severity and distribution of dystonia did not correlate with gender, age, weeks of gestation or duration of neonatal unit stay. GMFCS and MACS correlated with dystonia but not with spasticity. CONCLUSIONS Severity of dystonia, but not spasticity is associated with the severity of motor functional disability in CP patients with periventricular leukomalacia and demonstrates the key role of dystonia in the motor function of these patients.
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Affiliation(s)
- Ioanna Papadimitriou
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece
| | - Zoi Dalivigka
- Pediatric Rehabilitation Unit, Pan & Aglaia's Kyriakou Children's Hospital, Leof. Andrea Siggrou 290, Kallithea, 17673, Greece.
| | - Chrysa Outsika
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Leof. Vasilissis Sofias 72, Athens, 11528, Greece; Department of Neurology, Columbia University, New York, 710 W 168th St, New York, NY, 10032, USA.
| | - Roser Pons
- 1st Department of Pediatrics, Aghia Sofia Children's Hospital, National and Kapodistrian University of Athens, Thivon and Levadias, Athens, 11527, Greece.
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23
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Jarl J, Alriksson‐Schmidt A. School outcomes of adolescents with cerebral palsy in Sweden. Dev Med Child Neurol 2021; 63:429-435. [PMID: 33325036 PMCID: PMC7986710 DOI: 10.1111/dmcn.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 12/01/2022]
Abstract
AIM To study school outcomes of adolescents with cerebral palsy (CP) compared with a matched comparison group from the general population, and to observe to what extent sociodemographic and disability-specific factors are associated with school outcomes. METHOD This was a register study of persons with CP in Sweden, born between 1990 and 1999, with a matched comparison group. Logistic regressions were used to estimate the associations between CP and disability-specific factors and school outcomes (receiving final grades, grade scores, fulfilling the requirements for progressing to secondary school/university, and attending secondary school). RESULTS Children with CP had substantially lower school achievement compared with a general population sample. Much of the difference can be attributed to intellectual disability; however, CP remained strongly negatively associated with school outcomes. Ability to communicate in an effective manner explained most of the variation in children with CP, whereas motor function played a smaller role. INTERPRETATION The results suggest that school achievements might be improved if the communication barrier could be reduced, for example by ascertaining access to appropriate communication devices and by educators being aware that communicative difficulties do not necessarily imply intellectual disability. This might enhance the school experience and create an environment where children with CP can reach their full potential. WHAT THIS STUDY ADDS There are reduced educational outcomes associated with cerebral palsy. Negative outcomes are mainly driven by reduced communicative and intellectual ability. Gross motor function is associated with outcomes, but plays a smaller part.
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Affiliation(s)
- Johan Jarl
- Department of Clinical Sciences MalmöHealth Economics UnitLund UniversityLundSweden
| | - Ann Alriksson‐Schmidt
- Department of Clinical Sciences LundOrthopedicsSkåne University HospitalLund UniversityLundSweden
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24
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Holmes C, Brock K, Morgan P. Progression of Postural Asymmetry in Young Adults With Cerebral Palsy Who Are Not Walking: An Exploratory Study. Pediatr Phys Ther 2021; 33:E94-E98. [PMID: 33770801 DOI: 10.1097/pep.0000000000000787] [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: 11/26/2022]
Abstract
PURPOSE Young adults with cerebral palsy (CP) who are not walking are at risk of developing or increasing musculoskeletal asymmetries affecting the rib cage, spine, pelvis, and hips. This longitudinal study aimed to explore postural change using the Goldsmith Indices of Body Symmetry (GIofBS) over an 18-month period in adults with CP who are not walking. METHODS Demographic and medical data were accessed from participant's history. Posture was recorded using the GIofBS to collect data during an 18-month period following skeletal maturity. RESULTS All participants had postural asymmetry at study onset with evidence of minimal change in some GIofBS outcome measures and fluctuations in other outcomes over 18 months. CONCLUSIONS Physical therapists may use the GIofBS across the lifespan to screen for deterioration in musculoskeletal status or in assessing longer-term outcomes of interventions impacting posture in this complex population. VIDEO ABSTRACT For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A314.
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Affiliation(s)
- Carlee Holmes
- Young Adult Complex Disability Service (Ms Holmes), St Vincent's Hospital Melbourne, Australia; Physiotherapy Department (Dr Brock), St. Vincent's Hospital Melbourne; Physiotherapy Department (Ms Holmes and Dr Morgan), Monash University, Frankston, Australia
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25
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Deramore Denver B, Froude E, Rosenbaum P, Imms C. Measure of early vision use: initial validation with parents of children with cerebral palsy. Disabil Rehabil 2021; 44:4066-4074. [PMID: 33651960 DOI: 10.1080/09638288.2021.1890243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To report initial psychometric evidence on the Measure of Early Vision Use. METHOD Data on performance of the Measure of Early Vision Use scale were collected from 100 parents of children with cerebral palsy aged 0-12 years via online survey. Psychometric evaluation included assessment of scale dimensionality using Classical Test Theory and hypothesis testing for evidence of construct validity. RESULTS Principal components analysis of the 14-item parent-rated Measure of Early Vision Use revealed one component with an eigenvalue of 9.343, explaining 66.7% of variance; internal consistency was high (Cronbach's α = 0.96). Total scores ranged from 15-56 (Mean 42.8, standard deviation = 10.6). The results support seven pre-defined hypotheses including statistically significant differences in MEVU-total scores between children with and without parent-reported cerebral visual impairment. CONCLUSIONS Measure of Early Vision Use is the first assessment tool to describe 'how vision is used' in children with cerebral palsy. Results provide preliminary evidence that the measure comprises a unidimensional construct, sufficient construct validity, and feasibility as a parent-completed online assessment. Findings on internal structure provide foundational evidence and require further testing with Confirmatory Factor Analysis or Rasch Analysis.IMPLICATIONS FOR REHABILITATIONThe Measure of Early Vision Use is a new instrument to describe the use of basic visual abilities and is feasible to use as a parent-completed online questionnaire.The Measure of Early Vision Use is a unidimensional scale with sufficient construct validity to supports its use as a measure of 'how vision is used' without confounding visual ability with the reason why it might be impaired (e.g., cerebral vision impairment, motor limitations, or cognition).There is potential for the Measure of Early Vision Use to support early intervention planning for children with (or at high risk of) cerebral palsy.
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Affiliation(s)
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Canada
| | - Christine Imms
- Department of Paediatrics,University of Melbourne, Parkville, Australia
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26
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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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27
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Hoffman RM, Trevarrow MP, Bergwell HR, Embury CM, Heinrichs-Graham E, Wilson TW, Kurz MJ. Cortical oscillations that underlie working memory are altered in adults with cerebral palsy. Clin Neurophysiol 2021; 132:938-945. [PMID: 33636609 DOI: 10.1016/j.clinph.2020.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This investigation used magnetoencephalography (MEG) to identify the neurophysiological mechanisms contributing to the altered cognition seen in adults with cerebral palsy (CP). METHODS Adults with CP (GMFCS levels I-IV) and demographically-matched controls completed a Sternberg-type working memory task during MEG. Secondarily, they completed the National Institutes of Health (NIH) cognitive toolbox. Beamforming was used to image the significant MEG oscillatory responses and the resulting images were examined using statistical parametric mapping to identify cortical activity that differed between groups. RESULTS Both groups had a left-lateralized decrease in alpha-beta (11-16 Hz) power across the occipital, temporal, and prefrontal cortices during encoding, as well as an increase in alpha (9-13 Hz) power across the occipital cortices during maintenance. The strength of alpha-beta oscillations in the prefrontal cortices were weaker in those with CP during encoding. Weaker alpha-beta oscillation within the prefrontal cortex was associated with poorer performance on the NIH toolbox and a higher GMFCS level. CONCLUSIONS Alpha-beta aberrations may impact the basic encoding of information in adults with CP, which impacts their overall cognition. Altered alpha-beta oscillation might be connected with gross motor function. SIGNIFICANCE This experimental work highlights the aberrant alpha-beta during encoding as possible neurophysiological mechanism of the cognitive deficiencies.
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Affiliation(s)
- Rashelle M Hoffman
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA; Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Hannah R Bergwell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA.
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Karlsson P, Griffiths T, Clarke MT, Monbaliu E, Himmelmann K, Bekteshi S, Allsop A, Pereksles R, Galea C, Wallen M. Stakeholder consensus for decision making in eye-gaze control technology for children, adolescents and adults with cerebral palsy service provision: findings from a Delphi study. BMC Neurol 2021; 21:63. [PMID: 33568101 PMCID: PMC7874479 DOI: 10.1186/s12883-021-02077-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited research exists to guide clinical decisions about trialling, selecting, implementing and evaluating eye-gaze control technology. This paper reports on the outcomes of a Delphi study that was conducted to build international stakeholder consensus to inform decision making about trialling and implementing eye-gaze control technology with people with cerebral palsy. METHODS A three-round online Delphi survey was conducted. In Round 1, 126 stakeholders responded to questions identified through an international stakeholder Advisory Panel and systematic reviews. In Round 2, 63 respondents rated the importance of 200 statements generated by in Round 1. In Round 3, 41 respondents rated the importance of the 105 highest ranked statements retained from Round 2. RESULTS Stakeholders achieved consensus on 94 of the original 200 statements. These statements related to person factors, support networks, the environment, and technical aspects to consider during assessment, trial, implementation and follow-up. Findings reinforced the importance of an individualised approach and that information gathered from the user, their support network and professionals are central when measuring outcomes. Information required to support an application for funding was obtained. CONCLUSION This Delphi study has identified issues which are unique to eye-gaze control technology and will enhance its implementation with people with cerebral palsy.
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Affiliation(s)
- Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Frenchs Forest, PO Box 6427, Sydney, NSW, 2086, Australia.
| | - Tom Griffiths
- Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Michael T Clarke
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Elegast Monbaliu
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences Campus Bruges, Bruges, Belgium
| | - Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Saranda Bekteshi
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences Campus Bruges, Bruges, Belgium
| | - Abigail Allsop
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Frenchs Forest, PO Box 6427, Sydney, NSW, 2086, Australia
| | | | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Frenchs Forest, PO Box 6427, Sydney, NSW, 2086, Australia
| | - Margaret Wallen
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med 2020; 63:447-456. [DOI: 10.1016/j.rehab.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
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Sadowska M, Sarecka-Hujar B, Kopyta I. Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy. Brain Sci 2020; 10:brainsci10080481. [PMID: 32722475 PMCID: PMC7463548 DOI: 10.3390/brainsci10080481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 01/14/2023] Open
Abstract
Cerebral palsy (CP) is a set of etiologically diverse symptoms that change with the child's age. It is one of the most frequent causes of motor disability in children. CP occurs at a frequency of 1.5 to 3.0 per 1000 live-born children. CP often coexists with epilepsy, which is drug-resistant in a high number of cases. The aim of the present study was to analyze the associations between preconception, prenatal, perinatal, neonatal, and infancy risk factors for epilepsy in a group of pediatric patients with CP. We retrospectively analyzed 181 children with CP (aged 4-17 years at diagnosis), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008-2016. Division into particular types of CP was based on Ingram's classification. Data were analyzed using STATISTICA 13.0 (STATSOFT; Statistica, Tulsa, OK, USA). Epilepsy was diagnosed in 102 children (56.35%), of whom 44 (43%) had drug-resistant epilepsy; only in 15 cases (14.71%) was epilepsy susceptible to treatment. The incidence of epilepsy varied between the types of CP. It occurred significantly more often in children with tetraplegia (75%), ataxic form (83%), and mixed form (80%) in comparison to diplegia (32%) and hemiplegia (38%). Maternal hypertension was found to be a risk factor for epilepsy in CP patients (OR = 12.46, p < 0.001) as well as for drug-resistant epilepsy (the odds ratio (OR) = 9.86, p = 0.040). Delivery by cesarean section increased the risk of epilepsy in the CP patients over two-fold (OR = 2.17, p = 0.012). We observed also that neonatal convulsions significantly increased the risk for epilepsy (OR = 3.04, p = 0.011) as well as drug-resistant epilepsy (OR = 4.02, p = 0.002). In conclusion, maternal hypertension, neonatal convulsions, and delivery by cesarean section were the most important factors increasing the risk of epilepsy as well as drug-resistant epilepsy in the analyzed group of patients with CP.
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Affiliation(s)
- Małgorzata Sadowska
- Department of Pediatrics and Developmental Age Neurology, Upper Silesian Center for Child’s Health, 40-752 Katowice, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-322-699-830
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
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Crichton A, Ditchfield M, Gwini S, Wallen M, Thorley M, Bracken J, Harvey A, Elliott C, Novak I, Hoare B. Brain magnetic resonance imaging is a predictor of bimanual performance and executive function in children with unilateral cerebral palsy. Dev Med Child Neurol 2020; 62:615-624. [PMID: 31965572 DOI: 10.1111/dmcn.14462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 12/24/2022]
Abstract
AIM To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). METHOD Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). RESULTS From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. INTERPRETATION Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.
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Affiliation(s)
- Alison Crichton
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Stellamay Gwini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Margaret Wallen
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Jenny Bracken
- Department of Diagnostic Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, Frenchs Forest, New South Wales, Australia
| | - Brian Hoare
- Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,School of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
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Tillberg E, Isberg B, Persson JKE. Hemiplegic (unilateral) cerebral palsy in northern Stockholm: clinical assessment, brain imaging, EEG, epilepsy and aetiologic background factors. BMC Pediatr 2020; 20:116. [PMID: 32164572 PMCID: PMC7069041 DOI: 10.1186/s12887-020-1955-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 02/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe clinical presentation, epilepsy, EEG, extent and site of the underlying cerebral lesion with special reference towards aetiologic background factors in a population-based group of children with hemiplegic cerebral palsy. METHODS Forty-seven children of school- age, fulfilling the SPCE (Surveillance of Cerebral palsy in Europe)-criteria of hemiplegic cerebral palsy, identified via the Swedish cerebral palsy register, were invited and asked to participate in the study. RESULTS Fifteen boys and six girls participated. Of the sixteen children born at term, five had no risk factors for cerebral palsy. Two out of five preterm children presented additional risk factors. Debut of motor impairment was observed in the first year of life in sixteen children. Age at diagnosis varied from 2 months to 6 years. Epilepsy was common and associated with grey- and white matter injury. CONCLUSIONS Recognizing the importance of risk factors for cerebral palsy, any child with these risk factors should be offered a check-up by a paediatrician or a paediatric neurologist. Thereby reducing diagnostic delay. Epilepsy is common in hemiplegic cerebral palsy and associated with grey- and white matter injury in this cohort.
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Affiliation(s)
- Elsa Tillberg
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Bengt Isberg
- Läkarhuset Odenplan, Odengatan 69, 113 22, Stockholm, Sweden
| | - Jonas K E Persson
- Department of Clinical Neurophysiology, Karolinska University Hospital, Eugeniavägen 11, 171 76, Stockholm, Sweden
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Endo W, Ikemoto S, Togashi N, Miyabayashi T, Nakajima E, Hamano SI, Shibuya M, Sato R, Takezawa Y, Okubo Y, Inui T, Kato M, Sengoku T, Ogata K, Hamanaka K, Mizuguchi T, Miyatake S, Nakashima M, Matsumoto N, Haginoya K. Phenotype-genotype correlations in patients with GNB1 gene variants, including the first three reported Japanese patients to exhibit spastic diplegia, dyskinetic quadriplegia, and infantile spasms. Brain Dev 2020; 42:199-204. [PMID: 31735425 DOI: 10.1016/j.braindev.2019.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/19/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
We report the first three Japanese patients with missense variants in the GNB1 gene. Patients exhibited severe dyskinetic quadriplegia with cortical blindness and epileptic spasms, West syndrome (but with good outcomes), and hypotonic quadriplegia that later developed into spastic diplegia. Whole-exome sequencing revealed two recurrent GNB1 variants (p.Leu95Pro and p.Ile80Thr) and one novel variant (p.Ser74Leu). A recent investigation revealed large numbers of patients with GNB1 variants. Functional studies of such variants and genotype-phenotype correlation are required to enable future precision medicine.
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Affiliation(s)
- Wakaba Endo
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Satoru Ikemoto
- Division of Neurology, Saitama Children's Medical Center, Saitama 330-8777, Japan
| | - Noriko Togashi
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Takuya Miyabayashi
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Erika Nakajima
- Division of Neurology, Saitama Children's Medical Center, Saitama 330-8777, Japan
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama 330-8777, Japan
| | - Moriei Shibuya
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Ryo Sato
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Yusuke Takezawa
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo 152-8555, Japan
| | - Toru Sengoku
- Department of Biochemistry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazuhiro Ogata
- Department of Biochemistry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kohei Hamanaka
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Mitsuko Nakashima
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital Hospital, Sendai 989-3126, Japan.
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Lewis J, Scott K, Pan X, Heathcock J. The Relationship between Parent-reported PEDI-CAT Mobility and Gross Motor Function in Children with Cerebral Palsy: Brief Report. Dev Neurorehabil 2020; 23:140-144. [PMID: 31726912 DOI: 10.1080/17518423.2019.1687601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The PEDI-CAT mobility domain (PEDI-mob) is a parent-reported measure of mobility for children up to 21 years of age. The purpose of this research is to investigate the relationship between the PEDI-mob and Gross Motor Function Measure (GMFM)-66 and Gross Motor Function Classification Scale (GMFCS) levels.Methods: Fifty-seven children (N = 57), ages 2-8.8 years participated. PEDI-mob and GMFM were administered and GMFCS was confirmed during the same session. A Pearson correlation coefficient was calculated for PEDI-mob and GMFM-66 scores to evaluate the association between these two measures. An ANOVA was used to analyze PEDI-mob across GMFCS levels.Results: Large, statistically significant correlation was found between PEDI-mob and GMFM-66 scores (r = 0.894, p-value<0.001). Differences in PEDI-mob scores were found across GMFCS levels (p-value <0.001), where patients with higher GMFCS levels had lower PEDI-mob scores.Conclusion: These results support a strong relationship between parent-reported and clinically measured motor function.
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Baranello G, Signorini S, Tinelli F, Guzzetta A, Pagliano E, Rossi A, Foscan M, Tramacere I, Romeo DMM, Ricci D, Fazzi E, Cioni G, Mercuri E. Visual Function Classification System for children with cerebral palsy: development and validation. Dev Med Child Neurol 2020; 62:104-110. [PMID: 31180136 DOI: 10.1111/dmcn.14270] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate the Visual Function Classification System (VFCS), which was created to classify how children with cerebral palsy (CP) use visual abilities in daily life. METHOD The process of development and validation of the VFCS involved four phases: (1) drafting of the five levels from the analysis of literature and clinical experience; (2) validation of constructs and revision of the levels for concept meaningfulness, using nominal group process; (3) refinement by international Delphi survey; and(4) assessment of interrater reliability among professionals and with caregivers, and of test-retest reliability. RESULTS Five nominal groups involved 29 participants; 65 people completed the first round and 51 the second round of the Delphi survey. Construct validity was demonstrated within an expert group and external validation through several stakeholders, with the involvement of patients and families to ensure meaningfulness of the concept. Discussions continued until consensus was reached about the construct and content of the five levels. Participants in the reliability study included 29 professionals, 39 parents, and a total sample of 160 children with CP (mean age [SD] 6y 6mo [3y 4mo]; median 5y 7mo, range 1-19y). Absolute interrater agreement among professionals was 86% (weighted κ=0.88; 95% confidence interval [CI] 0.83-0.93). Test-retest reliability was high (weighted κ=0.97; 95% CI 0.95-0.99). Parent-professional interrater reliability on 39 children was moderate (weighted κ=0.51; 95% CI 0.39-0.63). INTERPRETATION The VFCS has been appropriately constructed and provides a reliable system to classify visual abilities of children with CP both in clinical and in research settings. WHAT THIS PAPER ADDS The Visual Function Classification System is a valid and reliable system. It classifies visual abilities of children with cerebral palsy in clinical and research settings. At a clinical level, it can be used to harmonize communication among professionals and identify patients' strengths and weaknesses. In research settings, it can be used to stratify patients, define natural history evolution, and interpret intervention studies.
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Affiliation(s)
- Giovanni Baranello
- UO Neurologia Dello Sviluppo, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,The Dubowitz Neuromuscular Centre, UCL NIHR GOSH Biomedical Research Centre, Great Ormond Street Institute of Child Health, London, UK
| | - Sabrina Signorini
- Centre of Child Neuro-Ophthalmology, Unit of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Tinelli
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Emanuela Pagliano
- UO Neurologia Dello Sviluppo, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Rossi
- Child and Adolescent Neurology and Psychiatry Unit, Children Hospital, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maria Foscan
- UO Neurologia Dello Sviluppo, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico M M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for Prevention of Blindness and Rehabilitation of Visually Impaired, Rome, Italy
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Mineyko A, Kirton A. Long-Term Outcome After Bilateral Perinatal Arterial Ischemic Stroke. Pediatr Neurol 2019; 101:39-42. [PMID: 31495662 DOI: 10.1016/j.pediatrneurol.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
AIM We aimed to characterize the phenotype and outcome of children with bilateral, large vessel perinatal arterial ischemic stroke. METHODS Patients with bilateral, large vessel perinatal arterial ischemic stroke were identified from a large, population-based cohort (Alberta Perinatal Stroke Project). Subjects were included if stroke involving a major cerebral artery territory was documented in both cerebral hemispheres on magnetic resonance imaging. Standardized variables were extracted from charts including clinical presentations, associated potential risk factors, and outcomes. Outcome measures included the Pediatric Stroke Outcome Measure, Gross Motor Function Classification System, and epilepsy frequency score. Electroencephalographies were reviewed for sleep, epileptiform activity, and background. RESULTS Of 174 children with perinatal arterial ischemic stroke, eight (5%) had bilateral large artery infarcts. Patients were followed for a mean of 9.7 years (range 1.8 to 14.6 years). One child died. All children had a total Pediatric Stroke Outcome Measure of ≥2 (median 8, range 2 to 10) and Gross Motor Function Classification System ≥ II. Seven of eight (88%) children had a history of epilepsy. CONCLUSIONS Children with bilateral, large vessel perinatal stroke are at high risk of severe cognitive and motor sequelae. Epilepsy may also be more common than unilateral strokes. Cautious discussions with families regarding prognosis are recommended.
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Affiliation(s)
- Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Adam Kirton
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Aguayo V, Verdugo MA, Arias VB, Guillen VM, Amor AM. Assessing support needs in children with intellectual disability and motor impairments: measurement invariance and group differences. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1413-1427. [PMID: 31486142 DOI: 10.1111/jir.12683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/18/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study assessed the equivalence of the measurement of support needs between children with intellectual disability (ID) and children with intellectual and motor disabilities (IMD) and compared both groups in the different domains of support. METHOD The Supports Intensity Scale-Children's Version was used to assess the support needs of 713 children with ID and 286 children with IMD, mainly associated with cerebral palsy. RESULTS The results supported measurement invariance between the group of ID and IMD, which allowed to conduct comparison between them. Children with IMD scored higher on support needs than did children without IMD, suggesting that children with IMD needed more support than their peers without motor impairments. Furthermore, the ID levels interacted with motor impairments: at the highest levels of ID, groups tended to be similar in support needs, with high scores and low variability. The greatest differences were found in the domains of Home and Community activities. CONCLUSIONS This study points to the across-condition of the construct of support needs in populations with intellectual and developmental disabilities. However, additional mobility impairments should be considered during the evaluation and planning of systems of support. In this regard, the Supports Intensity Scale-Children's Version might have limitations when discriminating between samples with high support needs.
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Affiliation(s)
- V Aguayo
- Institute on Community Integration, Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - M A Verdugo
- Institute on Community Integration, Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - V B Arias
- Institute on Community Integration, Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - V M Guillen
- Institute on Community Integration, Department of Education, Faculty of Education, University of Cantabria, Santander, Spain
| | - A M Amor
- Institute on Community Integration, Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of Salamanca, Salamanca, Spain
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Levy JP, Oskoui M, Ng P, Andersen J, Buckley D, Fehlings D, Kirton A, Koclas L, Pigeon N, van Rensburg E, Wood E, Shevell M. Ataxic-hypotonic cerebral palsy in a cerebral palsy registry: Insights into a distinct subtype. Neurol Clin Pract 2019; 10:131-139. [PMID: 32309031 DOI: 10.1212/cpj.0000000000000713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022]
Abstract
Objective To specifically report on ataxic-hypotonic cerebral palsy (CP) using registry data and to directly compare its features with other CP subtypes. Methods Data on prenatal, perinatal, and neonatal characteristics and gross motor function (Gross Motor Function Classification System [GMFCS]) and comorbidities in 35 children with ataxic-hypotonic CP were extracted from the Canadian Cerebral Palsy Registry and compared with 1,804 patients with other subtypes of CP. Results Perinatal adversity was detected significantly more frequently in other subtypes of CP (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.5-11.7). The gestational age at birth was higher in ataxic-hypotonic CP (median 39.0 weeks vs 37.0 weeks, p = 0.027). Children with ataxic-hypotonic CP displayed more intrauterine growth restriction (OR 2.6, 95% CI 1.0-6.8) and congenital malformation (OR 2.4, 95% CI 1.2-4.8). MRI was more likely to be either normal (OR 3.8, 95% CI 1.4-10.5) or to show a cerebral malformation (OR 4.2, 95% CI 1.5-11.9) in ataxic-hypotonic CP. There was no significant difference in terms of GMFCS or the presence of comorbidities, except for more frequent communication impairment in ataxic-hypotonic CP (OR 4.2, 95% CI 1.5-11.6). Conclusions Our results suggest a predominantly genetic or prenatal etiology for ataxic-hypotonic CP and imply that a diagnosis of ataxic-hypotonic CP does not impart a worse prognosis with respect to comorbidities or functional impairment. This study contributes toward a better understanding of ataxic-hypotonic CP as a distinct nosologic entity within the spectrum of CP with its own pathogenesis, risk factors, clinical profile, and prognosis compared with other CP subtypes.
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Affiliation(s)
- Jake P Levy
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Maryam Oskoui
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Pamela Ng
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - John Andersen
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - David Buckley
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Darcy Fehlings
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Adam Kirton
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Louise Koclas
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Nicole Pigeon
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Esias van Rensburg
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Ellen Wood
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
| | - Michael Shevell
- Faculty of Medicine (JPL), McGill University, Montreal, QC; Department of Pediatrics and Neurology and Neurosurgery (MO, MS), McGill University, Montreal, QC; Centre for Outcomes Research and Evaluation (MO, PN, MS), Research Institute of the McGill University Health Centre, Montreal, QC; Department of Pediatrics (JA), University of Alberta, Edmonton, AB; Janeway Children's Hospital (DB), St. John's, NL; Department of Paediatrics (DF), University of Toronto, Bloorview Research Institute, Toronto, ON; Departments of Pediatrics and Clinical Neurosciences (AK), Cumming School of Medicine, University of Calgary, AB; Centre de réadaptation Marie Enfant du CHU Sainte-Justine (LK), Montreal, QC; Centre hospitalier universitaire de Sherbrooke (NP), Sherbrooke, QC; BC Children's Hospital (EvR), Vancouver, BC; and IWK Health Centre (EW), Halifax, NS, Canada
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Caynes K, Rose TA, Theodoros D, Burmester D, Ware RS, Johnston LM. The Functional Communication Classification System: extended reliability and concurrent validity for children with cerebral palsy aged 5 to 18 years. Dev Med Child Neurol 2019; 61:805-812. [PMID: 30613944 DOI: 10.1111/dmcn.14135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
AIM To examine psychometric properties and clinical utility of the Functional Communication Classification System (FCCS) for classifying observable communication function in children with cerebral palsy (CP) aged 5 to 18 years. METHOD Eighty-two children (38 males, 44 females) with CP in six age groups (5y [n=15], 8y [n=14], 10y [n=14], 12y [n=14], 15y [n=11], and 17y [n=14]) were assessed by a speech-language pathologist (SLP) and parent for FCCS ratings. Data were compared with: (1) everyday communication function, assessed using the Clinical Evaluation of Language Fundamentals - Fourth Edition Pragmatics Profile (CELF-4 PP) for familiar and unfamiliar partners; (2) motor speech, gross and fine motor function; and (3) associated impairments, including epilepsy, intelligence, hearing, and vision. Interrater agreement was calculated for FCCS ratings using kappa (κ) statistics. Relationships between FCCS ratings and other measures were examined using Spearman's correlation coefficient. RESULTS Almost perfect interrater agreement was demonstrated between SLP and parent FCCS ratings (κw =0.96). Correlations were excellent between FCCS ratings with CELF-4 PP ratings, motor speech, and intellect; moderate with gross and fine motor function; and fair with other associated impairments (hearing, visual, and epilepsy). There was no correlation between age and FCCS. INTERPRETATION The FCCS is a reliable and valid communication classification system for children with CP aged 5 to 18 years, and highly suitable for surveillance, research, and clinical purposes. WHAT THIS PAPER ADDS The Functional Communication Classification System (FCCS) is valid and reliable for communication classification in children with cerebral palsy. Excellent agreement is present between speech language pathologists and parents. The FCCS shows excellent correlation with pragmatics, motor speech, and intelligence. The FCCS is moderately correlated with gross and fine motor function. The FCCS has fair correlation with epilepsy, hearing, and vision.
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Affiliation(s)
- Katy Caynes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Leanne M Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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40
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Woolfenden S, Galea C, Smithers-Sheedy H, Blair E, Mcintyre S, Reid S, Delacy M, Badawi N. Impact of social disadvantage on cerebral palsy severity. Dev Med Child Neurol 2019; 61:586-592. [PMID: 30221759 DOI: 10.1111/dmcn.14026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 12/27/2022]
Abstract
AIM To investigate the impact of socio-economic disadvantage on indicators of cerebral palsy (CP) severity - motor impairment, intellectual disability, and the presence of severe comorbidities - in children with CP in Australia. METHOD Data from the Australian Cerebral Palsy Register were analysed. Socio-economic disadvantage was assessed using maternal age, maternal country of birth, and a measure of neighbourhood socio-economic status (SES) at the time of the child's birth. Descriptive bivariate analysis, trend analysis, risk ratios, and mediation analysis were undertaken to examine the impact of disadvantage on the indicators of CP severity. RESULTS A socio-economic gradient was demonstrated with an increasing proportion of children with non-ambulant status, at least moderate intellectual disability, and the presence of severe comorbidities (having epilepsy, functional blindness, bilateral deafness, and/or no verbal communication) with decreasing neighbourhood SES, adolescent motherhood, and maternal minority ethnicity. INTERPRETATION In Australia, socio-economic disadvantage at birth impacts adversely on CP severity at age 5 years. By identifying that socio-economically disadvantaged children with CP are at greater risk of more severe functional outcomes, we can inform targeted interventions at the family and neighbourhood level to reduce these inequities for children with CP. WHAT THIS PAPER ADDS Socio-economic disadvantage is associated with increased severity of cerebral palsy functional outcomes. This encompasses low neighbourhood socio-economic status, adolescent motherhood, and maternal minority ethnicity.
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Affiliation(s)
- Sue Woolfenden
- Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Claire Galea
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sue Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Delacy
- Queensland Cerebral Palsy Register, CPL - Choice, Passion, Life, Brisbane, QLD, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia
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41
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Corbett MA, van Eyk CL, Webber DL, Bent SJ, Newman M, Harper K, Berry JG, Azmanov DN, Woodward KJ, Gardner AE, Slee J, Pérez-Jurado LA, MacLennan AH, Gecz J. Pathogenic copy number variants that affect gene expression contribute to genomic burden in cerebral palsy. NPJ Genom Med 2018; 3:33. [PMID: 30564460 PMCID: PMC6294788 DOI: 10.1038/s41525-018-0073-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
Cerebral palsy (CP) is the most frequent movement disorder of childhood affecting 1 in 500 live births in developed countries. We previously identified likely pathogenic de novo or inherited single nucleotide variants (SNV) in 14% (14/98) of trios by exome sequencing and a further 5% (9/182) from evidence of outlier gene expression using RNA sequencing. Here, we detected copy number variants (CNV) from exomes of 186 unrelated individuals with CP (including our original 98 trios) using the CoNIFER algorithm. CNV were validated with Illumina 850 K SNP arrays and compared with RNA-Seq outlier gene expression analysis from lymphoblastoid cell lines (LCL). Gene expression was highly correlated with gene dosage effect. We resolved an additional 3.7% (7/186) of this cohort with pathogenic or likely pathogenic CNV while a further 7.7% (14/186) had CNV of uncertain significance. We identified recurrent genomic rearrangements previously associated with CP due to 2p25.3 deletion, 22q11.2 deletions and duplications and Xp monosomy. We also discovered a deletion of a single gene, PDCD6IP, and performed additional zebrafish model studies to support its single allele loss in CP aetiology. Combined SNV and CNV analysis revealed pathogenic and likely pathogenic variants in 22.7% of unselected individuals with CP.
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Affiliation(s)
- Mark A. Corbett
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Clare L. van Eyk
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Dani L. Webber
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Stephen J. Bent
- Data61, Commonwealth Scientific and Industrial Research Organisation, Ecosciences Precinct, Dutton Park, Brisbane, QLD 4102 Australia
| | - Morgan Newman
- School of Biological Sciences, University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Kelly Harper
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Jesia G. Berry
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Dimitar N. Azmanov
- Department of Diagnostic Genomics, Queen Elizabeth II Medical Centre, PathWest, Nedlands, WA 6009 Australia
| | - Karen J. Woodward
- Department of Diagnostic Genomics, Queen Elizabeth II Medical Centre, PathWest, Nedlands, WA 6009 Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA 6009 Australia
| | - Alison E. Gardner
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Jennie Slee
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA 6008 Australia
| | - Luís A. Pérez-Jurado
- Genetics Unit, Universitat Pompeu Fabra, Barcelona, 08003 Spain
- Hospital del Mar Research Institute (IMIM) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, 08003 Spain
- SA Clinical Genetics, Women’s and Children’s Hospital & University of Adelaide, Adelaide, South Australia 5006 Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia 5000 Australia
| | - Alastair H. MacLennan
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
| | - Jozef Gecz
- Robinson Research Institute & Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5000 Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia 5000 Australia
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Grychtol R, Chan EY. Use of non-invasive ventilation in cerebral palsy. Arch Dis Child 2018; 103:1170-1177. [PMID: 29886412 DOI: 10.1136/archdischild-2017-313959] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 11/04/2022]
Abstract
Patients with cerebral palsy (CP), especially those at the severe end of the spectrum (Gross Motor Function Classification System levels IV-V equivalent), frequently suffer from sleep disturbance and sleep-disordered breathing (SDB). Non-invasive ventilation (NIV) is increasingly used in this patient group, albeit with little published evidence of its effectiveness in CP. This article aims to review the current evidence in the use of NIV in children with CP, highlighting areas of uncertainties, as well as the balance of potential risks, challenges and benefits. We would also share our experience and practical considerations in using NIV to manage SDB in this group of patients. Between January 2010 and December 2016, 21 patients (median age 11.1 (range 1.7-16.1) years) with CP were initiated on NIV at Great Ormond Street Hospital for Children following diagnosis of moderate to severe SDB on cardiorespiratory polygraphy. Over half of our patients with CP (n=11) failed to establish on NIV either due to intolerance of mask and/or ventilation pressure at the initial trial in hospital, or poor adherence during follow-up, in contrast to the overall failure rate of 8.7% among total patient population commenced on NIV. Children with CP constitute a relatively small but challenging group of patients. Decision to undertake NIV should be individualised, based on benefit outweighing the risk and burden of the treatment.
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Affiliation(s)
- Ruth Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Elaine Y Chan
- Respiratory Unit, Great Ormond St Hospital for Children, London, UK
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43
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Reid SM, Meehan EM, Reddihough DS, Harvey AR. Dyskinetic vs Spastic Cerebral Palsy: A Cross-sectional Study Comparing Functional Profiles, Comorbidities, and Brain Imaging Patterns. J Child Neurol 2018; 33:593-600. [PMID: 29808776 DOI: 10.1177/0883073818776175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors aimed to describe the distribution of predominant and secondary motor types and compare functional profiles, comorbidities, and brain imaging patterns between dyskinetic and spastic cerebral palsy. Children recruited from a cerebral palsy register were assessed at age 5, 10, or 15. Motor types, topography, functional classifications, and comorbidities were recorded. Univariable logistic regression was used to compare dyskinesia with spasticity, with and without adjustment for topography. Neuroimaging classifications were extracted from the register. Of 243 children with spasticity or dyskinesia, the predominant motor type was spastic in 183 and dyskinetic in 56. Dyskinesia was associated with comparatively poorer function, total body involvement, and gray matter injury. After adjustment for topography, dyskinesia was associated with similar or better function. The study suggests that practical tools routinely incorporated into clinical practice would facilitate accurate and reliable classification of predominant and secondary motor types, topography, and functional abilities.
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Affiliation(s)
- Susan M Reid
- 1 Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,2 Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,3 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine M Meehan
- 1 Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,2 Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,3 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- 1 Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,2 Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,3 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrienne R Harvey
- 1 Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,2 Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,3 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Reid SM, Meehan EM, Arnup SJ, Reddihough DS. Intellectual disability in cerebral palsy: a population-based retrospective study. Dev Med Child Neurol 2018; 60:687-694. [PMID: 29667705 DOI: 10.1111/dmcn.13773] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/26/2022]
Abstract
AIM A population-based observational study design was used to describe the epidemiology of intellectual disability in cerebral palsy (CP) in terms of clinical and neuroimaging associations, and to report the impact of intellectual disability on utilization of health services and length of survival. METHOD Population CP registry data were used to retrospectively assess the frequency of intellectual disability and strength of associations between intellectual disability and mobility, epilepsy, vision, hearing, communication, and neuroimaging patterns (n=1141). Data linkage was undertaken to assess usage of hospital inpatient and emergency department services. Survival analysis was performed in a 30-year birth cohort (n=3248). RESULTS Intellectual disability, present in 45% of the cohort, was associated with non-ambulation (47% vs 8%), later walking (mean 2y 7mo vs 1y 9mo), hypotonic (8% vs 1%) or dyskinetic (9% vs 5%) CP, a quadriplegic pattern of motor impairment (42% vs 5%), epilepsy (52% vs 12%), more emergency and multi-day hospital admissions, and reduced 35-year survival (96% vs 71%). Grey matter injuries (13% vs 6%), malformations (18% vs 6%), and miscellaneous neuroimaging patterns (12% vs 4%) were more common in people with intellectual disability. INTERPRETATION Intellectual disability adds substantially to the overall medical complexity in CP and may increase health and mortality disparities. WHAT THIS STUDY ADDS Cerebral maldevelopments and grey matter injuries are associated with higher intellectual disability rates. Health care is more 'crisis-driven' and 'reactive' in children with co-occurring intellectual disability. Length of survival is reduced in individuals with CP and co-occurring intellectual disability.
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Affiliation(s)
- Susan M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elaine M Meehan
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah J Arnup
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
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45
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Gillies MB, Bowen JR, Patterson JA, Roberts CL, Torvaldsen S. Educational outcomes for children with cerebral palsy: a linked data cohort study. Dev Med Child Neurol 2018; 60:397-401. [PMID: 29278268 DOI: 10.1111/dmcn.13651] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Abstract
AIM To identify a cohort of children with cerebral palsy (CP) from hospital data; determine the proportion that participated in standardized educational testing and attained a score within the normal range; and describe the relationship between test results and motor symptoms. METHOD This population-based retrospective cohort study used data from New South Wales, Australia. We linked hospital data for children younger than 16 years of age admitted between 1st July 2000 and 31st March 2014 to education data from 2009 to 2014. Hospital diagnosis codes were used to identify a cohort of children with CP (n=3944) and describe their motor symptoms. Educational outcomes in the CP cohort were compared with those among children without CP. RESULTS Of those with educational data (n=1770), 46% were exempt from reading assessment because of intellectual or functional disability, 7% were absent or withdrawn from testing and 47% participated in testing. About 30% of all children with educational data had test scores in the normal range. The proportion was greatest among those with hemiplegia (>40%) and lowest among those with tetraplegia (<10%). INTERPRETATION One-third of children with CP participated in standardized testing and achieved a result in the normal range. The proportions were lower in children with more severe motor symptoms. WHAT THIS PAPER ADDS From 2009 to 2014, most Australian children with cerebral palsy (CP) attended a mainstream school. The rate of disability-related exemption from standardized educational testing was almost 50%. Thirty per cent of children with CP achieved educational scores in the normal range.
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Affiliation(s)
- Malcolm B Gillies
- Centre for Epidemiology and Evidence, NSW Ministry of Health, North Sydney, NSW, Australia.,Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jennifer R Bowen
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Siranda Torvaldsen
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,School of Public Health and Community Medicine, UNSW, Sydney, NSW, Australia
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Computerised Tracking Training for Coordination in Children with Hemiplegic Cerebral Palsy: A Case Series. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2017.35] [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]
Abstract
Objective: To examine whether elbow coordination training can improve elbow coordination in cerebral palsy and whether any benefit carries over to upper limb activity.Methods: A case series A–B–C multiple baseline study was carried out. Two weeks of no intervention (A) was followed by 2 weeks of computerised tracking (B), which was followed by 2 weeks of no intervention (C). Six children (age range 7–12 years) with hemiplegic cerebral palsy (Level I–III of the Manual Ability Classification System) participated. Coordination training consisted of 10 × 1-min trials of computerised tracking each session for 10 sessions over a 2-week period. Coordination was measured as tracking performance using a different target from the training target. Upper limb activity was measured using the 9-Hole Peg Test. Data were analysed using the 2-SD band method.Results: None of the participants appeared to improve tracking performance or 9-Hole Peg Test (9HPT) scores (p > 0.05) after the 2 weeks of intervention. On withdrawal of the intervention, visual analysis showed that tracking performance and 9HPT scores remained at the same level as the intervention phase.Conclusions: Ten minutes of computerised elbow tracking daily for 10 sessions did not improve coordination in six children with cerebral palsy.
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Cognitive functioning in dyskinetic cerebral palsy: Its relation to motor function, communication and epilepsy. Eur J Paediatr Neurol 2018; 22:102-112. [PMID: 29108712 DOI: 10.1016/j.ejpn.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/25/2017] [Accepted: 10/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a disorder of motor function often accompanied by cognitive impairment. There is a paucity of research focused on cognition in dyskinetic CP and on the potential effect of related factors. AIM To describe the cognitive profile in dyskinetic CP and to assess its relationship with motor function and associated impairments. METHOD Fifty-two subjects with dyskinetic CP (28 males, mean age 24 y 10 mo, SD 13 y) and 52 typically-developing controls (age- and gender-matched) completed a comprehensive neuropsychological assessment. Gross Motor Function Classification System (GMFCS), Communication Function Classification System (CFCS) and epilepsy were recorded. Cognitive performance was compared between control and CP groups, also according different levels of GMFCS. The relationship between cognition, CFCS and epilepsy was examined through partial correlation coefficients, controlling for GMFCS. RESULTS Dyskinetic CP participants performed worse than controls on all cognitive functions except for verbal memory. Milder cases (GMFCS I) only showed impairment in attention, visuoperception and visual memory. Participants with GMFCS II-III also showed impairment in language-related functions. Severe cases (GMFCS IV-V) showed impairment in intelligence and all specific cognitive functions but verbal memory. CFCS was associated with performance in receptive language functions. Epilepsy was related to performance in intelligence, visuospatial abilities, visual memory, grammar comprehension and learning. CONCLUSION Cognitive performance in dyskinetic CP varies with the different levels of motor impairment, with more cognitive functions impaired as motor severity increases. This study also demonstrates the relationship between communication and epilepsy and cognitive functioning, even controlling for the effect of motor severity.
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Hafström M, Källén K, Serenius F, Maršál K, Rehn E, Drake H, Ådén U, Farooqi A, Thorngren-Jerneck K, Strömberg B. Cerebral Palsy in Extremely Preterm Infants. Pediatrics 2018; 141:peds.2017-1433. [PMID: 29222398 DOI: 10.1542/peds.2017-1433] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The risk of cerebral palsy (CP) is high in preterm infants and is often accompanied by additional neurodevelopmental comorbidities. The present study describes lifetime prevalence of CP in a population-based prospective cohort of children born extremely preterm, including the type and severity of CP and other comorbidities (ie, developmental delay and/or cognitive impairment, neurobehavioral morbidity, epilepsy, vision and hearing impairments), and overall severity of disability. In this study, we also evaluate whether age at assessment, overall severity of disability, and available sources of information influence outcome results. METHODS All Swedish children born before 27 weeks' gestation from 2004 to 2007 were included (the Extremely Preterm Infants in Sweden Study). The combination of neonatal information, information from clinical examinations and neuropsychological assessments at 2.5 and 6.5 years of age, original medical chart reviews, and extended chart reviews was used. RESULTS The outcome was identified in 467 (94.5%) of eligible children alive at 1 year of age. Forty-nine (10.5%) children had a lifetime diagnosis of CP, and 37 (76%) were ambulatory. Fourteen (29%) had CP diagnosed after 2.5 years of age, 37 (76%) had at least 1 additional comorbidity, and 27 (55%) had severe disability. The probability for an incomplete evaluation was higher in children with CP compared with children without CP. CONCLUSIONS Children born extremely preterm with CP have various comorbidities and often overall severe disability. The importance of long-term follow-up and of obtaining comprehensive outcome information from several sources in children with disabilities is shown.
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Affiliation(s)
- Maria Hafström
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; .,Department of Pediatrics, St Olav's Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden
| | | | - Eva Rehn
- Queen Silvia Children's Hospital, Gothenburg, Sweden; and
| | - Helen Drake
- Queen Silvia Children's Hospital, Gothenburg, Sweden; and
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Aijaz Farooqi
- Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden
| | | | - Bo Strömberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Montgomery C, Johansen K, Lucas S, Strömberg B, Persson K. The Structured Observation of Motor Performance in Infants can detect cerebral palsy early in neonatal intensive care recipients. Early Hum Dev 2017; 113:31-39. [PMID: 28728014 DOI: 10.1016/j.earlhumdev.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/23/2017] [Accepted: 07/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The detection of motor problems in infancy requires a detailed assessment method that measures both the infants' level of motor development and movement quality. AIMS To evaluate the ability of the Structured Observation of Motor Performance in Infants (SOMP-I) to detect cerebral palsy (CP) in neonatal intensive care recipients. STUDY DESIGN Prospective cohort study analyzed retrospectively. SUBJECTS 212 (girls: 96) neonatal intensive care recipients (mean gestational age 34weeks, range: 23-43). Twenty infants were diagnosed with CP. OUTCOME MEASURES The infants were assessed using SOMP-I at 2, 4, 6 and 10months' corrected age. Accuracy measures were calculated for level of motor development, quality of motor performance and a combination of the two to detect CP at single and repeated assessments. RESULTS At 2months, 17 of 20 infants with CP were detected, giving a sensitivity of 85% (95% CI 62-97%) and a specificity of 48% (95% CI 40-55%), while the negative likelihood ratio was 0.3 (95% CI 0.1-0.9) and the positive likelihood ratio was 1.6 (95% CI 1.3-2.0). At 6months all infants with CP were detected using SOMP-I, and all infants had repeatedly been assessed outside the cut-offs. Specificity was generally lower for all assessment ages, however, for repeated assessments sensitivity reached 90% (95% CI 68-99%) and specificity 85% (95% CI 79-90%). CONCLUSIONS SOMP-I is sensitive for detecting CP early, but using the chosen cut-off can lead to false positives for CP. Assessing level and quality in combination and at repeated assessments improved predictive ability.
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Affiliation(s)
- Cecilia Montgomery
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala University, Sweden.
| | - Kine Johansen
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala University, Sweden.
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala University, Sweden
| | - Bo Strömberg
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala University, Sweden
| | - Kristina Persson
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala University, Sweden
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Deramore Denver B, Adolfsson M, Froude E, Rosenbaum P, Imms C. Methods for conceptualising 'visual ability' as a measurable construct in children with cerebral palsy. BMC Med Res Methodol 2017; 17:46. [PMID: 28320348 PMCID: PMC5359986 DOI: 10.1186/s12874-017-0316-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 03/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Vision influences functioning and disability of children with cerebral palsy, so there is a growing need for psychometrically robust tools to advance assessment of children’s vision abilities in clinical practice and research. Vision is a complex construct, and in the absence of clarity about this construct it is challenging to know whether valid, reliable measures exist. This study reports a method for conceptualising ‘visual ability’ as a measurable construct. Methods Using the items from 19 assessment tools previously identified in a systematic review, this study used a two-phase process: first, deductive content analysis linked items to the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY), and second, vision-specific ‘Activity’-level items were explored using inductive thematic analysis. Results The linking and content analysis identified that existing assessment tools are measuring vision across the ICF-CY domains of Body Functions, Activities and Participation, and Environmental and Personal Factors. Items specifically coded to vision at the Activity level were defined as measuring ‘how vision is used’, and these items form the basis of the conceptualisation that ‘visual ability’ is measurable as a single construct. The thematic analysis led to the identification of 3 categories containing 13 themes that reflect a child’s observable visual behaviours. Seven abilities reflect how a child uses vision: responds or reacts, initiates, maintains or sustains looking, changes or shifts looking, searches, locates or finds, and follows. Four interactions reflect the contexts in which a child uses their vision to purposefully interact: watches and visually interacts with people and faces, objects, over distance, and with hands. Finally, two themes reflect a child’s overall use of vision in daily activities: frequency of use, and efficiency of use. Conclusions This study demonstrates an approach to exploring and explaining a complex topic utilising World Health Organization language and building on existing research. Despite the complexity of vision, the concept of ‘how vision is used’ can be clearly defined as a measurable construct at the Activity level of the ICF-CY. This study has identified observable visual behaviours that may be developed into items assessing how vision is used in daily activities. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0316-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Belinda Deramore Denver
- Australian Catholic University, School of Allied Health, Level 9, 33 Berry Street, North Sydney, NSW, 2060, Australia.
| | - Margareta Adolfsson
- Jönköping University, CHILD, School of Education and Communication, Box 1026, 551 11, Jönköping, Sweden
| | - Elspeth Froude
- Australian Catholic University, School of Allied Health, Level 9, 33 Berry Street, North Sydney, NSW, 2060, Australia
| | - Peter Rosenbaum
- McMaster University, IAHS Building, Room 408, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Christine Imms
- Australian Catholic University, School of Allied Health, Level 2, Daniel Mannix Building, 17 Young Street, Fitzroy, VIC, 3065, Australia
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