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Brændvik SM, Ross Raftemo AE, Roeleveld K, Andersen GL, Ramstad K, Follestad T, Aarli Å, Bonikowski M, Vik T. Does botulinum neurotoxin A make walking easier in children with cerebral palsy? A randomized clinical trial. Dev Med Child Neurol 2024. [PMID: 39058740 DOI: 10.1111/dmcn.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 07/28/2024]
Abstract
AIM To assess the effect of single botulinum neurotoxin A (BoNT-A) injections into the calf muscles on the gross energy cost of walking in children with cerebral palsy (CP) and to evaluate the effect of BoNT-A on walking capacity, physical activity, perceived changes in mobility, and pain. METHOD This was an industry-independent, randomized, quadruple-blind, placebo-controlled, multicentre trial (ClinicalTrials.gov registration: NCT02546999). Sixty-one children (33 male, median age [range] = 8 years [4-16 years]) with spastic CP and classified in Gross Motor Function Classification System (GMFCS) levels I and II allocated to single injections of either BoNT-A or 0.9% saline into the calf muscles. The main outcome was gross energy cost (J/kg/m); secondary outcomes were walking capacity, habitual physical activity, perceived change in mobility tasks, and calf pain at baseline, 4 weeks (P1), 12 weeks (P2), and 24 weeks (P3) after the injection. RESULTS The mean change in energy cost did not differ significantly between groups at the primary time point P2 (-0.27 J/kg/m, 95% confidence interval - 0.91 to 0.36, p = 0.404), nor at P1 or P3. Regarding the secondary outcomes, there was some evidence of a larger reduction in pain intensity in the group given BoNT-A (p = 0.043). INTERPRETATION One treatment with BoNT-A was not superior to placebo in making walking easier in children with CP classified in GMFCS levels I and II, at least in the short term. BoNT-A may have a pain-reducing effect.
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Affiliation(s)
- Siri Merete Brændvik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Rehabilitation Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Anne Elisabeth Ross Raftemo
- Vestfold Hospital Trust, Tønsberg, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Karin Roeleveld
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Guro Lillemoen Andersen
- Vestfold Hospital Trust, Tønsberg, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Ånen Aarli
- Haukeland University Hospital, Bergen, Norway
| | - Marcin Bonikowski
- Mazovian Neuropsychiatry Center, Neuro Rehabilitation Department, Movement Analysis Laboratory, Poland
| | - Torstein Vik
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Page SJ, Levine P. Pediatric Constraint-Induced Therapy: Checking under the Hood Before Jumping on the Bandwagon. J Pediatr 2024; 270:113998. [PMID: 38431195 DOI: 10.1016/j.jpeds.2024.113998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Stephen J Page
- RehabLab™, Columbus, OH; Neurorecovery Unlimited, LLC™, Columbus, OH.
| | - Peter Levine
- Deceased; formerly affiliated with Synapse Together, LLC, Cincinnati, OH
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Kiapekos N, von Heideken J, Broström E, Hägglund G, Åstrand P. Treatment of Hip Displacement in Children With Cerebral Palsy: A 5-year Comparison of Proximal Femoral Osteotomy and Combined Femoral-Pelvic Osteotomy in 163 Children. J Pediatr Orthop 2024; 44:e536-e541. [PMID: 38477355 DOI: 10.1097/bpo.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND This study compared the 5-year outcomes of isolated proximal femoral varus osteotomy (FO) and combined proximal femoral varus and pelvic osteotomy (FPO) for the treatment of hip displacement in children with cerebral palsy (CP) in Sweden, focusing on the number of reoperations and residual hip displacement. METHODS The study included 163 children with a 5-year follow-up after FO or FPO in the national Swedish CP surveillance program, CPUP. Descriptive statistics and univariate and multivariate Cox regression analyses were used to identify whether the age at surgery, sex, Gross Motor Function Classification System level, CP dominant symptom, hip migration percentage (MP), type of surgery (unilateral/bilateral), and history of soft tissue hip surgery were related to the 5-year outcomes after surgery. Failure after hip surgery was defined as a skeletal reoperation involving the hip and/or MP >50%. RESULTS During the period 2001 to 2017, 163 children (65 girls) underwent 246 femoral and/or pelvic osteotomies (154 FO, 47 bilaterally; 92 FPO, 16 bilaterally) and had a 5-year follow-up; 95 and 74 children had ≥1 FO or FPO as the primary skeletal surgery, respectively. The mean preoperative MP (51%±18% for FO and 59%±17% for FPO, P =0.001) and age at surgery (6.2±2.5 years for FO and 7.3±2.8 years for FPO, P =0.014) differed between procedures. At the 5-year follow-up, 5 hips (5%) had reoperations and 5 hips (5%) had radiological failure among the 92 FPOs, and 33 (21%) had reoperations and 14 (9%) radiological failure among the 154 FOs. The difference in outcome failure rate was significant ( P <0.001). Multivariate Cox regression analysis showed a lower risk for failure with FPO [hazard ratio (HR)=0.32, 95% CI: 0.15-0.68] compared with FO. A higher preoperative MP increased the risk for outcome failure (HR=1.21, 95% CI: 1.15-1.36 for each 5% increment). CONCLUSIONS FPO had a higher mean preoperative MP but a lower 5-year outcome failure rate compared with FO. A higher preoperative MP was associated with an increased risk of failure. LEVEL OF EVIDENCE Level II-prospective comparative study.
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Affiliation(s)
- Nikolaos Kiapekos
- Department of Women's and Children's Health, Karolinska Institutet
- Department of Highly Specialized Pediatric Orthopedics and Medicine, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm
| | | | - Eva Broström
- Department of Women's and Children's Health, Karolinska Institutet
- Department of Highly Specialized Pediatric Orthopedics and Medicine, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden
| | - Per Åstrand
- Department of Women's and Children's Health, Karolinska Institutet
- Department of Highly Specialized Pediatric Orthopedics and Medicine, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm
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Romin E, Lindgren A, Rodby-Bousquet E, Cloodt E. Sit-to-stand performance in children with cerebral palsy: a population-based cross-sectional study. BMC Musculoskelet Disord 2024; 25:460. [PMID: 38862936 PMCID: PMC11165808 DOI: 10.1186/s12891-024-07557-0] [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: 02/01/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Sit-to-stand (STS) is one of the most commonly performed functional movements in a child's daily life that enables the child to perform functional activities such as independent transfer and to initiate walking and self-care. Children with cerebral palsy (CP) often have reduced STS ability. The aim of this study was to describe STS performance in a national based total population of children with CP and its association with age, sex, Gross Motor Function Classification System (GMFCS) level, and CP subtype. METHODS This cross-sectional study included 4,250 children (2,503 boys, 1,747 girls) aged 1-18 years from the Swedish Cerebral Palsy Follow-Up Program (CPUP). STS performance was classified depending on the independence or need for support into "without support," "with support," or "unable." "With support" included external support from, e.g., walls and furniture. Physical assistance from another person was classified as "unable" (dependent). Ordinal and binary logistic regression analyses were used to identify associations between STS and age, GMFCS level, and CP subtype. RESULTS 60% of the children performed STS without support, 14% performed STS with support, and 26% were unable or needed assistance from another person. STS performance was strongly associated with GMFCS level and differed with age and subtype (p < 0.001). For all GMFCS levels, STS performance was lowest at age 1-3 years. Most children with GMFCS level I (99%) or II (88%) performed STS without support at the age of 4-6 years. In children with GMFCS level III or IV, the prevalence of independent STS performance improved throughout childhood. CP subtype was not associated with STS performance across all GMFCS levels when adjusted for age. CONCLUSIONS Independent STS performance in children with CP is associated with GMFCS level and age. Children with CP acquire STS ability later than their peers normally do. The proportion of children with independent STS performance increased throughout childhood, also for children with GMFCS level III or IV. These findings suggest the importance of maintaining a focus on STS performance within physiotherapy strategies and interventions for children with CP, including those with higher GMFCS level.
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Affiliation(s)
- Elinor Romin
- Habilitation Centre Child and Youth, Region Kronoberg, Växjö, Sweden
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
- Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
| | - Erika Cloodt
- Habilitation Centre Child and Youth, Region Kronoberg, Växjö, Sweden.
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
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Paleg GS, Williams SA, Livingstone RW. Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:669. [PMID: 38928915 PMCID: PMC11203597 DOI: 10.3390/ijerph21060669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.
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Affiliation(s)
| | - Sian A. Williams
- School of Allied Health, Curtin University, Perth, WA 6009, Australia;
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Roslyn W. Livingstone
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
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Kristensen MA, Rich KK, Mogensen TC, Damsgaard Jensen AM, Fex Svenningsen Å, Zhang M. Focal Traumatic Brain Injury Impairs the Integrity of the Basement Membrane of Hindlimb Muscle Fibers Revealed by Extracellular Matrix Immunoreactivity. Life (Basel) 2024; 14:543. [PMID: 38792565 PMCID: PMC11121831 DOI: 10.3390/life14050543] [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: 02/12/2024] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Traumatic brain injury (TBI) stands as a prominent global cause of disability, with motor deficits being a common consequence. Despite its widespread impact, the precise pathological mechanisms underlying motor deficits after TBI remain elusive. In this study, hindlimb postural asymmetry (HL-PA) development in rats subjected to focal TBI was investigated to explore the potential roles of collagen IV and laminin within the extracellular matrix (ECM) of selected hindlimb muscles in the emergence of motor deficits following TBI. A focal TBI was induced by ablating the left sensorimotor cortex in rats and motor deficits were assessed by measuring HL-PA. The expression of laminin and collagen IV in eight selected muscles on each side of the hindlimbs from both TBI- and sham-operated rats were studied using immunohistochemistry and semi-quantitatively analyzed. The results indicated that the TBI rats exhibited HL-PA, characterized by flexion of the contralateral (right) hindlimb. In the sham-operated rats, the immunoreactive components of laminin and collagen IV were evenly and smoothly distributed along the border of the muscle fibers in all the investigated muscles. In contrast, in the TBI rats, the pattern was broken into aggregated, granule-like, immunoreactive components. Such a labeling pattern was detected in all the investigated muscles both from the contra- and ipsilateral sides of the TBI rats. However, in TBI rats, most of the muscles from the contralateral hindlimb showed a significantly increased expression of these two proteins in comparison with those from the ipsilateral hindlimb. In comparison to sham-operated rats, there was a significant increase in laminin and collagen IV expression in various contralateral hindlimb muscles in the TBI rats. These findings suggest potential implications of laminin and collagen IV in the development of motor deficits following a focal TBI.
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Affiliation(s)
- Mette Albæk Kristensen
- Department of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark; (M.A.K.); (K.K.R.); (T.C.M.); (Å.F.S.)
| | - Karen Kalhøj Rich
- Department of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark; (M.A.K.); (K.K.R.); (T.C.M.); (Å.F.S.)
| | - Tobias Christian Mogensen
- Department of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark; (M.A.K.); (K.K.R.); (T.C.M.); (Å.F.S.)
| | | | - Åsa Fex Svenningsen
- Department of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark; (M.A.K.); (K.K.R.); (T.C.M.); (Å.F.S.)
- Brain Research—Inter Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, DK-5230 Odense, Denmark
| | - Mengliang Zhang
- Department of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark; (M.A.K.); (K.K.R.); (T.C.M.); (Å.F.S.)
- Brain Research—Inter Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, DK-5230 Odense, Denmark
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Rinde ER, Anderzén-Carlsson A, Jahnsen RB, Andersen RD. "I have to obey my pain" - children's experiences of pain burden in cerebral palsy. Disabil Rehabil 2024; 46:1112-1120. [PMID: 36987867 DOI: 10.1080/09638288.2023.2191012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To explore pain experiences of children with cerebral palsy, and how it influences their everyday life. METHOD Fourteen children with CP between eight and seventeen years old were included, using a purposeful sampling strategy. They had different experiences of pain, and different degrees of physical and cognitive impairments. Sixteen individual semi-structured interviews were carried out, and analyzed using inductive thematic analysis. RESULTS Data analysis resulted in the main theme "I have to obey my pain" and four themes were identified. Experiences regarding pain varied ("My pain is mine alone"). Both pain itself and the use of cognitive strategies to cope with pain involved a mental struggle ("Pain brings me down"). The children had to make adjustments to manage their pain ("I want to participate, but I have to rest"). The most important help was to be understood, but adults also provided valuable help with interventions like stretching, medication and adjustment of activity levels ("Others can help me"). CONCLUSION Pain was a determining feature in the lives of these children with CP. The wide variety of experiences and challenges emphasized the need for tailored management strategies developed together with each child and their parents.IMPLICATIONS FOR REHABILITATIONChildren with cerebral palsy had varied experiences of pain, and health professionals need to tailor their pain management approaches to the individual child.Health services should offer pain education to expand children's repertoire of pain management strategies.When a child's pain influences their daily activities, health services must ensure that the school is informed of the child's situation, and able to make necessary adjustments.Health professionals should strive to include children's own descriptions whenever possible to make sure children feel heard and believed.Even children with communicative and cognitive impairments were able to self-report when necessary adjustments in the communication situation were made.
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Affiliation(s)
- Elisabeth Rønning Rinde
- Division of Habilitation, Telemark Hospital Trust, Skien, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Agneta Anderzén-Carlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Reidun Birgitta Jahnsen
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Randi Dovland Andersen
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research, Telemark Hospital Trust, Skien, Norway
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Bonden H, Jahnsen RB, Klevberg GL. Self-care and hand function in preschool children with unilateral or bilateral cerebral palsy: A cross-sectional study. Child Care Health Dev 2024; 50:e13208. [PMID: 38083836 DOI: 10.1111/cch.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/24/2023] [Accepted: 11/19/2023] [Indexed: 01/25/2024]
Abstract
AIMS To describe self-care capabilities among children with cerebral palsy (CP) and explore associations between self-care and hand function for children with unilateral cerebral palsy (UCP) and children with bilateral cerebral palsy (BCP) separately. METHOD Cross-sectional data on self-care capabilities (Pediatric Evaluation of Disability Inventory, PEDI), manual abilities (Manual Ability Classification System, MACS) and hand use during bimanual performance (Assisting Hand Assessment, AHA; Both Hands Assessment, BoHA) were retrieved from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Eighty-seven children with CP (UCP, n = 61, mean age 4 years 1 month, SD 1 year 3 months, range 56) or BCP (n = 26, mean age 4 years 4 months, SD 1 year, range 41), classified at MACS level I (n = 26), II (n = 40) or III (n = 21), were included. RESULTS No significant differences in self-care capabilities were found between children with UCP and children with BCP. Analysis of variance showed significant differences in self-care between MACS levels for the whole group. No significant differences in self-care between MACS levels were observed for children with UCP (p = 0.36), but significant differences were found for those with BCP (p < 0.001). Whereas a small correlation (r = 0.3) between PEDI and AHA scores was found for children with UCP, a large correlation (r = 0.6) was found for those with BCP. Children with BCP with symmetric hand use during bimanual performance (BoHA) had higher PEDI scores than children with asymmetric hand use. CONCLUSION Though children with UCP and children with BCP who were classified at MACS I-III exhibited similar self-care capabilities, the limited hand use seems to contribute differently between the two groups. The two different measures of hand use exhibit different associations with self-care capabilities for young children with UCP and BCP, respectively, and illustrate the need to treat UCP and BCP as two distinct groups, each requiring tailored interventions according to their specific needs.
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Affiliation(s)
- Hilde Bonden
- Children's and Youth Rehabilitation Section, Sarpsborg Clinic, Østfold Hospital Trust, Grålum, Norway
| | - Reidun Birgitta Jahnsen
- Department of Neurosciences in Children, Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunvor Lilleholt Klevberg
- Department of Neurosciences in Children, Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, Oslo, Norway
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Malesevic N, Svensson I, Hägglund G, Antfolk C. An Integrated Approach for Real-Time Monitoring of Knee Dynamics with IMUs and Multichannel EMG. SENSORS (BASEL, SWITZERLAND) 2023; 23:8955. [PMID: 37960654 PMCID: PMC10649777 DOI: 10.3390/s23218955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
Measuring human joint dynamics is crucial for understanding how our bodies move and function, providing valuable insights into biomechanics and motor control. Cerebral palsy (CP) is a neurological disorder affecting motor control and posture, leading to diverse gait abnormalities, including altered knee angles. The accurate measurement and analysis of knee angles in individuals with CP are crucial for understanding their gait patterns, assessing treatment outcomes, and guiding interventions. This paper presents a novel multimodal approach that combines inertial measurement unit (IMU) sensors and electromyography (EMG) to measure knee angles in individuals with CP during gait and other daily activities. We discuss the performance of this integrated approach, highlighting the accuracy of IMU sensors in capturing knee joint movements when compared with an optical motion-tracking system and the complementary insights offered by EMG in assessing muscle activation patterns. Moreover, we delve into the technical aspects of the developed device. The presented results show that the angle measurement error falls within the reported values of the state-of-the-art IMU-based knee joint angle measurement devices while enabling a high-quality EMG recording over prolonged periods of time. While the device was designed and developed primarily for measuring knee activity in individuals with CP, its usability extends beyond this specific use-case scenario, making it suitable for applications that involve human joint evaluation.
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Affiliation(s)
- Nebojsa Malesevic
- Department of Biomedical Engineering, Faculty of Engineering, 223 63 Lund, Sweden; (I.S.); (C.A.)
| | - Ingrid Svensson
- Department of Biomedical Engineering, Faculty of Engineering, 223 63 Lund, Sweden; (I.S.); (C.A.)
| | - Gunnar Hägglund
- Orthopedics, Department of Clinical Sciences, Lund University, 223 65 Lund, Sweden;
- Department of Orthopedics, Skane University Hospital, 223 65 Lund, Sweden
| | - Christian Antfolk
- Department of Biomedical Engineering, Faculty of Engineering, 223 63 Lund, Sweden; (I.S.); (C.A.)
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Dhondt E, Dan B, Plasschaert F, Degelaen M, Dielman C, Dispa D, Ebetiuc I, Hasaerts D, Kenis S, Lombardo C, Pelc K, Wermenbol V, Ortibus E. Prevalence of cerebral palsy and factors associated with cerebral palsy subtype: A population-based study in Belgium. Eur J Paediatr Neurol 2023; 46:8-23. [PMID: 37364404 DOI: 10.1016/j.ejpn.2023.06.003] [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: 03/06/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
AIM To report on the prevalence, neuroimaging patterns, and function of children with cerebral palsy (CP) in Belgium for birth years 2007-2012, and identify distinctive risk indicators and differences in outcome between CP subtypes. METHODS Antenatal and perinatal/neonatal factors, motor and speech function, associated impairments, and neuroimaging patterns were extracted from the Belgian Cerebral Palsy Register. Prevalence was estimated per 1000 (overall, ante/perinatal, spastic, dyskinetic CP) or 10,000 (post-neonatal, ataxic CP) live births. Multinomial logistic regression analyses were performed to ascertain the effects of antenatal/perinatal/neonatal factors and neuroimaging patterns on the likelihood of dyskinetic or ataxic CP relative to spastic CP, and test the likelihood of the occurrence of impaired motor and speech function and associated impairments in dyskinetic or ataxic CP relative to spastic CP. RESULTS In total, 1127 children with CP were identified in Belgium. The birth prevalence of overall CP was 1.48 per 1000 live births. The likelihood of dyskinetic CP increases if the child was born to a mother aged ≥35 years, mechanically ventilated, and had predominant grey matter injury, while an increased likelihood of ataxic CP is associated with ≥2 previous deliveries. Children with dyskinetic and ataxic CP are more likely to function with impairments in motor, speech, and intellectual abilities. CONCLUSION Distinctive risk indicators and differences in outcome between CP subtypes were identified. These factors can be incorporated into clinical practice to facilitate early, accurate, and reliable classification of CP subtype, and may lead to individually tailored neonatal care and other (early) intervention options.
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Affiliation(s)
- Evy Dhondt
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Bernard Dan
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium; Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Plasschaert
- Cerebral Palsy Reference Centre, University Hospital Ghent, Ghent, Belgium; Human Structure and Repair, Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marc Degelaen
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium; Department of Rehabilitation Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Charlotte Dielman
- Cerebral Palsy Reference Centre Antwerp (CePRA), Ziekenhuis Netwerk Antwerpen Queen Paola Children's Hospital, Wilrijk, Belgium
| | - Delphine Dispa
- Reference Centre for Cerebral Palsy (IMOC), Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Iulia Ebetiuc
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Hospital De La Citadelle, Liege, Belgium
| | - Danielle Hasaerts
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), University Hospital Brussels, Brussels, Belgium
| | - Sandra Kenis
- Cerebral Palsy Reference Centre Antwerp (CePRA), Antwerp University Hospital, Belgium
| | - Costanza Lombardo
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Queen Fabiola Children's University Hospital (QFCUH), Brussels, Belgium
| | - Karine Pelc
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Vanessa Wermenbol
- Inter-University Reference Centre for Cerebral Palsy (CIRICU), Erasmus Hospital, Brussels, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Cerebral Palsy Reference Centre, University Hospital Leuven, Leuven, Belgium
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TELLÉUS A, KIAPEKOS N, VON HEIDEKEN J, WAGNER P, BROSTRÖM E, HÄGGLUND G, ÅSTRAND P. Orthopedic surgical procedures in 3,305 children and young adults with cerebral palsy: a register-based cohort study. Acta Orthop 2022; 93:472-477. [PMID: 35611478 PMCID: PMC9131193 DOI: 10.2340/17453674.2022.2583] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Few reports have described the panorama of orthopedic surgeries that children with cerebral palsy (CP) undergo. We analyzed the risk of a first surgery, and describe the frequency of orthopedic surgeries in terms of age, sex, anatomical location, and Gross Motor Function Classification System (GMFCS) level in children and young adults with CP. PATIENTS AND METHODS This was a register-based cohort study of 3,305 individuals followed until 2-25 years of age. We used data from 2 national Swedish registers: the CPUP CP surveillance program and the Swedish National Patient Register. Kaplan-Meier survival curves were calculated to describe the risk of undergoing a first orthopedic surgery, related to age. RESULTS We included data for 3,311 orthopedic operations in 1,717 surgical sessions. The percentage of children operated on before age 15 years increased from 22% (95% CI 19-26) for GMFCS level I to 70% (CI 64-75) for level V. Ankle and foot surgery was predominant as first surgery for GMFCS I-II, and hip and femur surgery for GMFCS IV-V. Spinal surgery occurred almost exclusively for GMFCS IV-V. Descriptive data showed repeated surgical sessions to be frequent for higher GMFCS levels. INTERPRETATION The risk of having a first orthopedic surgical treatment increased with increasing GMFCS level and was initiated at younger age in children with higher GMFCS level.
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Affiliation(s)
- Anna TELLÉUS
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Nikolaos KIAPEKOS
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm,Department of Pediatric Orthopedics, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, Stockholm
| | - Johan VON HEIDEKEN
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm,Department of Pediatric Orthopedics, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, Stockholm
| | - Philippe WAGNER
- Centre for Clinical Research Västerås, Uppsala University—Region Västmanland, Västerås
| | - Eva BROSTRÖM
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm,Department of Pediatric Orthopedics, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, Stockholm
| | - Gunnar HÄGGLUND
- Department of Clinical Sciences, Lund, Orthopedics, Lund University, Sweden
| | - Per ÅSTRAND
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm,Department of Pediatric Orthopedics, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, Stockholm
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Jeglinsky I, Alriksson-Schmidt AI, Hägglund G, Ahonen M. Prevalence and treatment of hip displacement in children with cerebral palsy in Finland. J Child Orthop 2022; 16:128-135. [PMID: 35620122 PMCID: PMC9127885 DOI: 10.1177/18632521221089439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim was to study the prevalence of hip displacements, dislocations, and the hip surgeries performed in a Finnish cohort of children with cerebral palsy not followed up in a hip surveillance program and to compare these with previous studies performed in Northern European countries before and after the implementation of hip surveillance programs. METHODS A cross-sectional study. A cohort including 480 children with cerebral palsy, born during the period 2000-2018, not enrolled in a hip surveillance program. Migration percentages were recorded from hip radiographs, age at first hip surgery and type of surgery was extracted from medical records. In a separate analysis, the inclusion criteria were adapted to fit two studies analyzing hip dislocation and hip surgery in Sweden, Norway, and Scotland before and after the implementation of a hip surveillance program. Chi-square tests were used to assess differences in proportions between the groups. RESULTS In total, 286 children (60%) have had at least one hip radiograph. Of these, 10 (3.5%) developed hip dislocation, which is more than in children of countries with hip surveillance programs (Sweden 0.7%, Scotland 1.3%, p < 0.001). Initial surgery to prevent hip dislocation was performed at an older age (p < 0.001). CONCLUSION Children with cerebral palsy in Finland not participating in a surveillance hip program were more likely to undergo hip surgery at an older age and to develop hip displacements and dislocations. The results support the effectiveness of surveillance programs to prevent hip dislocation in children with cerebral palsy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ira Jeglinsky
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland,Ira Jeglinsky, Department of Health and Welfare, Arcada University of Applied Sciences, Jan-Magnus Janssonin aukio 1, 00560 Helsinki, Finland.
| | - Ann I Alriksson-Schmidt
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gunnar Hägglund
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Matti Ahonen
- Department of Pediatric Surgery, Helsinki Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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An Emerging Role for Epigenetics in Cerebral Palsy. J Pers Med 2021; 11:jpm11111187. [PMID: 34834539 PMCID: PMC8625874 DOI: 10.3390/jpm11111187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Cerebral palsy is a set of common, severe, motor disabilities categorized by a static, nondegenerative encephalopathy arising in the developing brain and associated with deficits in movement, posture, and activity. Spastic CP, which is the most common type, involves high muscle tone and is associated with altered muscle function including poor muscle growth and contracture, increased extracellular matrix deposition, microanatomic disruption, musculoskeletal deformities, weakness, and difficult movement control. These muscle-related manifestations of CP are major causes of progressive debilitation and frequently require intensive surgical and therapeutic intervention to control. Current clinical approaches involve sophisticated consideration of biomechanics, radiologic assessments, and movement analyses, but outcomes remain difficult to predict. There is a need for more precise and personalized approaches involving omics technologies, data science, and advanced analytics. An improved understanding of muscle involvement in spastic CP is needed. Unfortunately, the fundamental mechanisms and molecular pathways contributing to altered muscle function in spastic CP are only partially understood. In this review, we outline evidence supporting the emerging hypothesis that epigenetic phenomena play significant roles in musculoskeletal manifestations of CP.
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Treatment of spasticity in children and adolescents with cerebral palsy in Northern Europe: a CP-North registry study. BMC Neurol 2021; 21:276. [PMID: 34253183 PMCID: PMC8274039 DOI: 10.1186/s12883-021-02289-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries. Methods This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland. Results A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017–2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries. Conclusion There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.
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Platt MJ. How do you measure cerebral palsy prevalence and motor function? Dev Med Child Neurol 2021; 63:634. [PMID: 33336799 DOI: 10.1111/dmcn.14770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mary Jane Platt
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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