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Lyons-Warren AM, Guez-Barber D, Thomas SP, Tantry EK, Mahat A, Aravamuthan B. Sensory Symptoms Across the Lifespan in People With Cerebral Palsy. Pediatr Neurol 2024; 157:157-166. [PMID: 38924827 PMCID: PMC11257800 DOI: 10.1016/j.pediatrneurol.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND To estimate the prevalence of sensory symptoms in people with cerebral palsy (CP) across the lifespan. METHODS In this cross-sectional study, the self-reported Sensory Processing Scale Inventory (SPS-I) was administered via Research Electronic Data Capture (REDCap) between February 1, 2022, and August 15, 2022, to people with CP or their caregivers enrolled in the online MyCP Community Registry. We determined the association between SPS-I scores and age (Pearson correlation) and functional status as assessed using five validated functional classification systems for CP (analysis of variance [ANOVA]). We hypothesized that sensory symptoms would differ between younger and older individuals with CP. RESULTS Of 155 responses (28% response rate, age one to 76 years, 34% male), 97% reported at least one bothersome sensory symptom. Total sensory symptoms decreased with age (R2 = 0.12, P < 0.0001), driven by decreases in hyposensitivity symptoms (R2 = 0.32, P < 0.0001), primarily tactile hyposensitivity (R2 = 0.29, P < 0.0001). Sensory symptoms increased with greater functional impairment across all functional domains (ANOVA, P < 0.0001). However, the age-specific decrease in hyposensitivities was most pronounced in people with the greatest gross motor functional impairment (R2 = 0.70, P = 0.0004). CONCLUSION Our findings suggest that hyposensitivity, primarily tactile sensitivity, decreases with age in people with CP. Future work should assess whether decreased hyposensitivity contributes to other age-related changes in CP like increased pain.
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Affiliation(s)
- Ariel M Lyons-Warren
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Danielle Guez-Barber
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sruthi P Thomas
- H. Ben Taub Department of Physical Medicine and Rehabilitation and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Evelyne K Tantry
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Aditya Mahat
- Department of Pediatric-Neurology, Children's Mercy Hospital, Kansas City, Missouri
| | - Bhooma Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
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Huang CH, Wong LC, Chu YJ, Hsu CJ, Wang HP, Tsai WC, Lee WT. The sleep problems in individuals with Rett syndrome and their caregivers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241254620. [PMID: 38853381 DOI: 10.1177/13623613241254620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
LAY ABSTRACT Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.
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Affiliation(s)
- Cheng-Hsien Huang
- Department of Pediatrics, Sleep Center, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan
- University of Taipei, Taiwan
| | - Lee-Chin Wong
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ju Chu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hsin-Pei Wang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital YunLin Branch, Yun-Lin, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University Children's Hospital, Taipei, Taiwan
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Jarlman E, Hägglund G, Alriksson-Schmidt AI. Foot and lower leg pain in children and adults with cerebral palsy: a population-based register study on 5,122 individuals. BMC Musculoskelet Disord 2024; 25:391. [PMID: 38762469 PMCID: PMC11102238 DOI: 10.1186/s12891-024-07486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Pain is common in individuals with cerebral palsy (CP) and the most reported pain site is the foot/lower leg. We analyzed the prevalence of pain in the foot/lower leg and the associations with age, sex, gross motor function, and clinical findings in individuals with CP. METHOD This was a cross-sectional register-study, based on data reported to the Swedish Cerebral Palsy Follow-up Program (CPUP). All participants in CPUP, four years-of-age or older, were included. Pearson chi-square tests and logistic regression were used to analyze the prevalence and degree of pain in the foot/lower leg. RESULTS In total, 5,122 individuals were included from the CPUP database: 58% were males and 66% were under 18 years-of-age. Overall, 1,077 (21%) reported pain in the foot/lower leg. The odds ratios (ORs) of pain were higher in females (OR 1.31, 95% confidence interval (CI) 1.13-1.53), individuals who could ambulate (Gross Motor Function Classification System Level I (OR 1.84, CI 1.32-2.57) and II (OR 2.01, CI 1.46-2.79) compared to level V), and in individuals with decreased range of motion of the ankle (dorsiflexion 1-10 degrees (OR 1.43, CI 1.13-1.83) and ≤ 0 degrees (OR 1.46, CI 1.10-1.93) compared to ≥ 20 degrees). With increasing age the OR of pain increased (OR 1.02, CI 1.01-1.03) as well as the reported pain intensity (p < 0.001). CONCLUSIONS Pain in the foot and lower leg appears to be a significant problem in individuals with CP, particularly in those who walk. As with pain in general in this population, both pain intensity and frequency increase with age. The odds of pain in the foot and lower leg were increased in individuals with limited dorsiflexion of the ankle. Given the cross-sectional design causality cannot be inferred and it is unknown if pain causes decreased range of motion of the ankle or if decreased range of motion causes pain. Further research is needed on causal pathways and importantly on prevention.
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Affiliation(s)
- Ebba Jarlman
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
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Steiner L, Tscherter A, Henzi B, Branca M, Carda S, Enzmann C, Fluss J, Jacquier D, Neuwirth C, Ripellino P, Scheidegger O, Schlaeger R, Schreiner B, Stettner GM, Klein A. Chronic Pain in Patients with Spinal Muscular Atrophy in Switzerland: A Query to the Spinal Muscular Atrophy Registry. J Clin Med 2024; 13:2798. [PMID: 38792340 PMCID: PMC11122245 DOI: 10.3390/jcm13102798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/01/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background and Objectives: Chronic pain is a common symptom in various types of neuromuscular disorders. However, for patients with spinal muscular atrophy (SMA), the literature regarding chronic pain is scarce. Thus, this study assessed the prevalence of chronic pain in children, adolescents, and adults with SMA and investigated the influence of clinical characteristics on chronic pain. Materials and Methods: This study used data from 141 patients, which were collected by the Swiss Registry for Neuromuscular Disorders. Extracted data included information on pain (present yes/no, pain location, and pain medication) and clinical characteristics, such as SMA type, motor function, wheelchair use, scoliosis, and contractures. Results: The analyses revealed that the highest prevalence of chronic pain was observed in adolescents with 62%, followed by adults with 48%, children (6-12 years) with 39%, and children < 6 years with 10%. The legs, back, and hips were most frequently reported as pain locations. Sex (females), age (adolescents), and the presence of contractures and scoliosis (with surgery) were factors that were associated with chronic pain. Conclusions: These findings contribute to a better understanding of pain in SMA, shedding light on its prevalence and characteristics in different age groups, which underscores the importance of assessing and managing pain in patients with SMA.
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Affiliation(s)
- Leonie Steiner
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, 3010 Bern, Switzerland
| | - Bettina Henzi
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Mattia Branca
- Department of Clinical Research, University of Bern, 3010 Bern, Switzerland
| | - Stefano Carda
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), 1005 Lausanne, Switzerland
| | - Cornelia Enzmann
- Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital Basel (UKBB), University of Basel, 4001 Basel, Switzerland
| | - Joël Fluss
- Neuropediatric Unit, Children’s Hospital, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - David Jacquier
- Pediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Olivier Scheidegger
- Centre for Neuromuscular Diseases, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Regina Schlaeger
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Bettina Schreiner
- Department of Neurology, University Hospital Zurich, 8032 Zurich, Switzerland
| | - Georg M. Stettner
- Neuromuscular Center Zurich, Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Andrea Klein
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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Sabater-Gárriz Á, Gaya-Morey FX, Buades-Rubio JM, Manresa-Yee C, Montoya P, Riquelme I. Automated facial recognition system using deep learning for pain assessment in adults with cerebral palsy. Digit Health 2024; 10:20552076241259664. [PMID: 38846372 PMCID: PMC11155325 DOI: 10.1177/20552076241259664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients.The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models' sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Department of Research and Training, Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - F Xavier Gaya-Morey
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - José María Buades-Rubio
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Cristina Manresa-Yee
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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Bell BG, Shah S, Coulson N, McLaughlin J, Logan P, Luke R, Avery AJ. The impact of ageing on adults with cerebral palsy: the results of a national online survey. BJGP Open 2023; 7:BJGPO.2023.0028. [PMID: 37591553 PMCID: PMC11176684 DOI: 10.3399/bjgpo.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is one of the most common neurological disorders in children and results in lifelong physical impairments. Adults with CP have approximately the same life expectancy as their non-disabled peers, so helping them to stay healthy throughout the life course will have long-term cost benefits via reductions in hospital admissions, long-term care, and unemployment rates. AIM To explore how adults with CP experience ageing. DESIGN & SETTING National online survey given to adults with CP in the UK. METHOD The participants were adults with CP. Items for the online survey were taken from existing self-report measures, with additional items developed for the survey. Several domains of functioning were assessed including mobility, dexterity, fatigue, pain, speech, mental health, swallowing and health maintenance/self-care as well as healthcare usage. Data were analysed using χ2 to examine the relationships between the demographic variables and the survey responses. RESULTS The survey was completed by 395 participants, of whom 74.2% were female and approximately 59.3% aged <45 years. Responders reported having problems with mobility, pain, and fatigue with older participants reporting higher levels of pain and more mobility problems, although the correlations were fairly small. Healthcare usage was surprisingly low. CONCLUSION The study found that age was associated with a decline in mobility and a higher level of pain, although the relationships were weak. It is possible that the low healthcare usage among the responders is owing to services not being available to respond to their needs.
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Affiliation(s)
- Brian G Bell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sonali Shah
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Coulson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Janice McLaughlin
- School of Geography, Politics, and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Anthony J Avery
- School of Medicine, University of Nottingham, Nottingham, UK
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Trevarrow MP, Dukkipati SS, Baker SE, Wilson TW, Kurz MJ. Reduced brainstem volume is associated with mobility impairments in youth with cerebral palsy. J Clin Neurosci 2023; 117:114-119. [PMID: 37801875 PMCID: PMC10841759 DOI: 10.1016/j.jocn.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in mobility by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. RESEARCH QUESTION We used high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP and if these alterations relate to the mobility impairments within this population. METHODS A cohort study was conducted to assess the volume of the whole brainstem, pons, midbrain, medulla, and superior cerebellar peduncle in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 years; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 years, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. RESULTS We found a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. SIGNIFICANCE The structural changes in the brainstems of persons with CP may contribute to the mobility impairments that are ubiquitous within this population.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Saihari S Dukkipati
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Sarah E Baker
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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Gottlieb REW, Panzer KV, Wang M, Leis AM, Whitney DG. Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy. Phys Ther 2023; 103:pzad090. [PMID: 37440438 PMCID: PMC10471154 DOI: 10.1093/ptj/pzad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. METHODS This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. RESULTS Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55-1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57-1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. CONCLUSION Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. IMPACT Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6 months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3 years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.
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Affiliation(s)
- Rachel E W Gottlieb
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate V Panzer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mia Wang
- School of Public Health, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleda M Leis
- Epidemiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Asuman D, Gerdtham UG, Alriksson-Schmidt AI, Rodby-Bousquet E, Andersen GL, Jarl J. Pain and labor outcomes: A longitudinal study of adults with cerebral palsy in Sweden. Disabil Health J 2023:101479. [PMID: 37149449 DOI: 10.1016/j.dhjo.2023.101479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP). OBJECTIVES To estimate the association between pain and labor outcomes for adults with CP in Sweden. METHODS A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings. RESULTS Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement. CONCLUSION Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.
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Affiliation(s)
- Derek Asuman
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden.
| | - Ulf-G Gerdtham
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden; Department of Economics, Lund University, Lund, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Orthopaedics, Department of Clinical Sciences (Lund), Lund University, Lund, Sweden; Centre for Clinical Research, Uppsala University-Region Västmanland, Västeräs, Sweden
| | - Guro L Andersen
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Jarl
- Health Economics, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden
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Trevarrow MP, Dukkipati SS, Baker SE, Wilson TW, Kurz MJ. Reduced Brainstem Volume is Associated with Mobility Impairments in Youth with Cerebral Palsy. RESEARCH SQUARE 2023:rs.3.rs-2566073. [PMID: 36824764 PMCID: PMC9949252 DOI: 10.21203/rs.3.rs-2566073/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in locomotion by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. The objective of this investigation was to use high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP, and if these alterations relate to the mobility impairments within this population. We assessed the volume of the pons, midbrain, medulla, and superior cerebellar peduncle (SCP) in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 yrs; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 yrs, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. Our MRI results revealed that there was a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. These results suggest that there are structural changes in the brainstems of persons with CP that may contribute to the mobility impairments that are ubiquitous within this population.
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11
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Peterson MD, Kamdar N, Haapala HJ, Brummett C, Hurvitz EA. Opioid prescription patterns among adults with cerebral palsy and spina bifida. Heliyon 2022; 8:e09918. [PMID: 35847615 PMCID: PMC9284449 DOI: 10.1016/j.heliyon.2022.e09918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pain is the most common symptom of cerebral palsy and spina bifida (CP/SB). The objective of this study was to compare the opioid prescription patterns for differing pain types and overlapping pain among adults living with and without CP/SB. Methods Privately-insured beneficiaries were included if they had CP/SB (n = 22,647). Adults without CP/SB were also included as controls (n = 931,528). Oral morphine equivalents (OMEs) were calculated. A multivariable logistic regression was used to analyze the association between CP/SB and OMEs, across the three pain categories: (1) no pain, (2) isolated pain, and (3) pain multimorbidity. Results Adults living with CP/SB had a higher OME prescription pattern per year than adults without CP or SB (8,981.0 ± 5,183.0 vs. 4,549.1 ± 2,988.0), and for no pain (4,010.8 ± 828.1 vs. 1,623.53 ± 47.5), isolated pain (7,179.9 ± 378.8 vs. 3,531.0 ± 131.0), and pain multimorbidity (15,752.4 ± 1,395.5 vs. 8,492.9 ± 398.0) (all p < 0.001), and differences were to a clinically meaningful extent. Adjusted odds ratios (OR) for prescribed OMEs were higher for adults with CP/SB vs. control and (1) no pain (OR: 1.51; 95%CI: 1.46, 1.56), (2) isolated pain (OR: 1.48; 95%CI: 1.44, 1.52), and (3) pain multimorbidity (OR: 1.79; 95%CI: 1.72, 1.86). Conclusions Adults with CP/SB obtain significantly higher prescription of OMEs than adults without CP/SB.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, USA.,Department of Emergency Medicine, Michigan Medicine, University of Michigan, USA.,Department of Surgery, Michigan Medicine, University of Michigan, USA
| | - Heidi J Haapala
- Department of Anesthesiology, Michigan Medicine, University of Michigan, USA
| | - Chad Brummett
- Department of Anesthesiology, Michigan Medicine, University of Michigan, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Trevarrow MP, Reelfs A, Ott LR, Penhale SH, Lew BJ, Goeller J, Wilson TW, Kurz MJ. Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy. Brain Commun 2022; 4:fcac087. [PMID: 35441137 PMCID: PMC9014448 DOI: 10.1093/braincomms/fcac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/13/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all pFWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.
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Affiliation(s)
- Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brandon J. Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jessica Goeller
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J. Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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13
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Noten S, Rodby-Bousquet E, Limsakul C, Tipchatyotin S, Visser F, Grootoonk A, Thorpe DE, van der Slot WMA, Selb M, Roebroeck ME, Roebroeck ME, Noten S, van den Berg-Emons RJG, van der Slot WMA, Hilberink SR, Limsakul C, Konijnenbelt M, van den Borne K, de Groot V, Grootoonk A, Selb M. An international clinical perspective on functioning and disability in adults with cerebral palsy. Disabil Health J 2022; 15:101318. [DOI: 10.1016/j.dhjo.2022.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
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14
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Peterson MD, Haapala HJ, Kratz A. Pain Phenotypes in Adults Living With Cerebral Palsy. Neurol Clin Pract 2022; 11:e848-e855. [PMID: 34992968 DOI: 10.1212/cpj.0000000000001113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives To identify pain phenotypes among adults living with cerebral palsy (CP) and compare phenotypes of pain intensity, anxiety and depressive symptoms, and self-reported perceived stress. Methods Seventy-one adults with CP presented to the University of Michigan (mean age = 39.3 ± 16.2; 43 women, 28 men). The median of 6 on the American College of Rheumatology fibromyalgia survey was used to classify patients for nociplastic pain centralization. The painDETECT Score was used to classify patients for neuropathic pain. These measures were then used to cross-classify each patient into 1 of 4 possible pain categories: neuropathic, nociplastic, mixed neuropathic/noclipastic, or nociceptive pain (-neuropathic/-nociplastic pain). Results Twenty-eight adults with CP (39.4%) were classified as nociceptive, 24 (33.8%) as nociplastic, 8 (11.3%) as neuropathic, and 11 (15.5%) as mixed neuropathic/nociplastic. Subgroups differed significantly on average scores on the Brief Pain Inventory pain intensity scale, the Perceived Stress Scale, and on the Patient-Reported Outcomes Measurement Information System measures of anxiety and depression; the nociceptive pain subgroup reported lower pain and emotional distress compared with the other groups. Discussion Findings suggest that type of pain is variable among adults with CP and may arise through multiple mechanisms.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine and Rehabilitation (MDP, HJH, AK), Michigan Medicine, University of Michigan, Ann Arbor; and Institute for Healthcare Policy and Innovation (MDP), Michigan Medicine, University of Michigan, Ann Arbor
| | - Heidi J Haapala
- Department of Physical Medicine and Rehabilitation (MDP, HJH, AK), Michigan Medicine, University of Michigan, Ann Arbor; and Institute for Healthcare Policy and Innovation (MDP), Michigan Medicine, University of Michigan, Ann Arbor
| | - Anna Kratz
- Department of Physical Medicine and Rehabilitation (MDP, HJH, AK), Michigan Medicine, University of Michigan, Ann Arbor; and Institute for Healthcare Policy and Innovation (MDP), Michigan Medicine, University of Michigan, Ann Arbor
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15
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Jersak T, Noritz G. Evaluation of Pain in Adults With Childhood-Onset Disabilities and Communication Difficulties. Front Neurol 2021; 12:722971. [PMID: 34675866 PMCID: PMC8523837 DOI: 10.3389/fneur.2021.722971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
Adults with childhood-onset disabilities, particularly those with central nervous system impairment, commonly experience pain. Because many such individuals have difficulties in communication, caregivers and medical professionals must identify and interpret non-verbal behaviors as indicators of pain. This process is challenging and can lead to poor outcomes through delayed or incorrect diagnosis and treatment. Most research in the evaluation of pain in individuals with neurologic impairment has focused on the pediatric population, and evidence-based guidelines do not exist for adults. The purpose of this paper is to review current recommendations for pain assessment in adults with communication impairment. This approach includes guidance for history-taking, pharmacologic review, physical examination, and the judicious use of laboratory and imaging tests. Finally, we discuss adult-specific diagnoses to consider when evaluating pain in adults with childhood-onset disabilities and communication difficulties.
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Affiliation(s)
- Taylor Jersak
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
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16
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Hurvitz EA, Whitney DG, Waldron-Perrine B, Ryan D, Haapala HJ, Schmidt M, Gray C, Peterson MD. Navigating the Pathway to Care in Adults With Cerebral Palsy. Front Neurol 2021; 12:734139. [PMID: 34603186 PMCID: PMC8482767 DOI: 10.3389/fneur.2021.734139] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
As individuals with cerebral palsy (CP) age, they face unique challenges which complicate their ability to access and receive appropriate health care. These problems exist at the level of the health care system, the clinician, and the individual. At the system level, there is an inadequate number of professionals who are informed of and interested in the care of adults with CP. Pediatric clinicians prefer treating children, and adult caregivers are not knowledgeable about and may feel less competent about CP. Pediatric care does not translate well to the adult population, and information about best practices for adults is just starting to develop. Differences in the physiologic development of individuals with CP render well-established clinical protocols for risk screening of chronic diseases less effective. Moreover, lack of supportive resources decreases a caregiver's sense of self-efficacy in treating this population. The patient's ability to navigate these barriers is complicated by the high prevalence of comorbid cognitive impairment and mental health issues including anxiety, depression, and other psychiatric disorders; a bidirectional relationship between challenges in navigating care/needs and comorbid mental health conditions appears likely. Many patients have additional barriers related to social determinants of health, such as access to transportation, accessible health care facilities, and other personal and environmental factors that may impede health maintenance and wellness. Increasing and disseminating knowledge, harnessing the power of new technologies such as telemedicine, and addressing mental health issues are some of the methods that are available to help adults with CP navigate this road.
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Affiliation(s)
- Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brigid Waldron-Perrine
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Dayna Ryan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Heidi J. Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Cathryn Gray
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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17
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Smith SE, Gannotti M, Hurvitz EA, Jensen FE, Krach LE, Kruer MC, Msall ME, Noritz G, Rajan DS, Aravamuthan BR. Adults with Cerebral Palsy Require Ongoing Neurologic Care: A Systematic Review. Ann Neurol 2021; 89:860-871. [PMID: 33550625 DOI: 10.1002/ana.26040] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022]
Abstract
Cerebral palsy (CP) neurologic care and research efforts typically focus on children. However, most people with CP are adults. Adults with CP are at increased risk of new neurologic conditions, such as stroke and myelopathy, that require ongoing neurologic surveillance to distinguish them from baseline motor impairments. Neurologic factors could also contribute to the motor function decline, chronic pain, and chronic fatigue that are commonly experienced by adults with CP. Based on a systematic literature review, we suggest (1) guidelines for neurologic surveillance and neurologist referral and (2) clinical research questions regarding the evolving neurologic risks for adults with CP. ANN NEUROL 2021;89:860-871.
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Affiliation(s)
- Sarah E Smith
- Washington University School of Medicine, St Louis, MO, USA
| | - Mary Gannotti
- Shriners Hospitals for Children, Cerebral Palsy Network, University of Hartford, West Hartford, CT, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine/University of Michigan, Ann Arbor, MI, USA
| | - Frances E Jensen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda E Krach
- Gillette Children's Specialty Healthcare, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael C Kruer
- Cerebral Palsy & Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA.,Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine-Phoenix Children's Hospital, Tucson, AZ, USA
| | - Michael E Msall
- University of Chicago Kennedy Research Center on Neurodevelopmental Disabilities, Chicago, IL, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
| | - Deepa S Rajan
- Department of Pediatrics, Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhooma R Aravamuthan
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, St Louis, MO, USA
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