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Ali MS. Does spasticity affect the postural stability and quality of life of children with cerebral palsy? J Taibah Univ Med Sci 2021; 16:761-766. [PMID: 34690659 PMCID: PMC8498706 DOI: 10.1016/j.jtumed.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Cerebral palsy is a unique physical disability that primarily affects children's gross motor functions and postural control. Cerebral palsy has a direct impact on children's daily activities and quality of life. This study aims to determine the relationship between spasticity, motor function, postural stability, and the quality life of children with cerebral palsy. METHODS Forty-five children (age range 4-6 years) diagnosed with spasticity from cerebral palsy participated in this study. Spasticity was evaluated by the modified Ashwarth scale; the children's functions were evaluated by gross motor functional measures, postural stability was evaluated by biodex balance system, and quality of life was measured with the pediatric quality of life inventory. RESULTS There was a strong positive correlation between the degree of spasticity and quality of life. Additionally, there was a significantly strong association between spasticity and gross motor function. In contrast, there was no correlation between spasticity and postural stability indices. Moreover, there was a strong positive correlation between quality of life and gross motor function. Lastly, there was no association between quality of life and the postural stability index. CONCLUSION The findings highlight the impact of spasticity on motor function and the quality of life of a cohort of children with cerebral palsy. These findings may determine therapeutic interventions and priorities to plan physical therapy programs. Such measures may overcome the main cause of disorders that delay and undermine the daily routines of the affected children.
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Affiliation(s)
- Mostafa S. Ali
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
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Ayala L, Winter S, Byrne R, Fehlings D, Gehred A, Letzkus L, Noritz G, Paton MCB, Pietruszewski L, Rosenberg N, Tanner K, Vargus-Adams J, Novak I, Maitre NL. Assessments and Interventions for Spasticity in Infants With or at High Risk for Cerebral Palsy: A Systematic Review. Pediatr Neurol 2021; 118:72-90. [PMID: 33563492 DOI: 10.1016/j.pediatrneurol.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The majority of children with cerebral palsy develop spasticity, which interferes with motor development, function, and participation. This systematic review appraised current evidence regarding assessments and interventions for spasticity in children aged less than two years with or at high risk for cerebral palsy and integrated findings with parent preferences. METHODS Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using PRISMA guidelines. Quality of the evidence was reviewed by two independent reviewers using Quality Assessment of Diagnostic Accuracy Studies, second edition (QUADAS-2), the RTI Item Bank on Risk of Bias and Precision of Observational Studies (RTI), or The Cochrane Collaboration's tool for assessing risk of bias in randomized trials (RoB). An online survey was conducted regarding parent preferences through social media channels. RESULTS Twelve articles met inclusion criteria. No high-quality assessment tool emerged for this population. Six interventions (botulinum toxin-A, orthotic use, radial extracorporeal shock wave therapy, erythropoietic stimulating agents, medical cannabis, and homeopathy) were identified. There was low-quality evidence for the use of botulinum toxin-A and radial extracorporeal shock wave therapy to improve short-term outcomes. Survey respondents indicated that spasticity assessments and interventions are highly valued, with nonpharmacologic interventions ranked most preferably. CONCLUSIONS Further research is needed to validate assessments for spasticity in children younger than two years. Conditional recommendations can be made for botulinum toxin-A and radial extracorporeal shock wave therapy based on low level of evidence to reduce spasticity in children aged less than two years.
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Affiliation(s)
- Lauren Ayala
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Sarah Winter
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alison Gehred
- Nationwide Children's Hospital, Grant Morrow III Library, Columbus, Ohio
| | - Lisa Letzkus
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, Virginia
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Madison C B Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Nathan Rosenberg
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly Tanner
- Department of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio
| | - Jilda Vargus-Adams
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Nathalie L Maitre
- Center for Perinatal Research, Nationwide Children's Hospital, Columbus, Ohio
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Yang AS. Investors’ trust and financial participation: Latent difficulty measurement. ASIA PACIFIC MANAGEMENT REVIEW 2020. [DOI: 10.1016/j.apmrv.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flanigan M, Gaebler-Spira D, Kocherginsky M, Garrett A, Marciniak C. Spasticity and pain in adults with cerebral palsy. Dev Med Child Neurol 2020; 62:379-385. [PMID: 31602643 DOI: 10.1111/dmcn.14368] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate whether spasticity measures are related to pain in adults with cerebral palsy (CP). METHOD This cross-sectional study recruited individuals aged 16 to 89 years with a diagnosis of CP. Participants completed the Penn Spasm Frequency Scale (PSFS), Brief Pain Inventory (BPI), and PROMIS Pain Interference measures. The Modified Ashworth Scale (MAS) and Tardieu spasticity angles of six joints were rated and summed to composite MAS and Tardieu scores for each participant. Associations between spasticity and pain measures were evaluated. RESULTS Forty-seven participants (27 females, 20 males) with a mean age of 35 years 7 months (range 18-77y) spanning all Gross Motor Function Classification System (GMFCS) levels were included. Twenty-six participants reported their average pain level on BPI as greater than 0 over the past week (median pain level 4.0). Median PSFS was 1.0 (range 0.0-1.0) and this correlated with average BPI and Pain Interference T scores (median 40.7; ρ=0.33 and ρ=0.31 respectively [both p=0.01]). When adjusted for pain medication use and age, MAS correlated with BPI (ρ=0.30; p=0.04). Other pain and spasticity measures, or GMFCS level, were not significantly related with pain interference or BPI rating. Age was weakly associated with BPI (slope=0.10; p<0.01). INTERPRETATION PROMIS Pain Interference was lower than population-based norms. Patient-rated spasm frequency demonstrated better association with pain levels and interference than physician-rated MAS and Tardieu. WHAT THIS PAPER ADDS Pain was not associated with Gross Motor Function Classification System level. Pain increased with age, as anticipated. Self-reported spasm scores were associated with increased pain in contrast to clinical examination scales. Adjusted, summed spasticity on the Modified Ashworth Scale was associated with pain scores on the Brief Pain Inventory. Although pain is experienced by adults with cerebral palsy, pain did not interfere with activities.
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Affiliation(s)
- Megan Flanigan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatric Rehabilitation, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Masha Kocherginsky
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
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Synergistic Improvement in Children with Cerebral Palsy Who Underwent Double-Course Human Wharton's Jelly Stem Cell Transplantation. Stem Cells Int 2019; 2019:7481069. [PMID: 31636676 PMCID: PMC6766101 DOI: 10.1155/2019/7481069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/30/2019] [Indexed: 01/02/2023] Open
Abstract
Background Our previous studies confirmed that human Wharton's Jelly stem cell (hWJSC) transplantation improved motor function in children with spastic cerebral palsy (CP). This study investigated the dose-effect relationship between the transplanted cell dosage and efficacy in CP children. Methods CP children who received one- or two-course (four or eight times lumbar puncture, 4 or 8 × 107 hWJSCs) cell therapy were recruited into this study. Assessments of motor function were performed according to scales for gross motor function measurement (GMFM) and fine motor function measurement (FMFM). The measurement data obtained in the two different groups were analyzed by t-test. Univariate repeated measures analysis of variance was used to compare the data obtained at baseline and 6 or 12 months posttransplantation and met the conditions for Mauchly's sphericity test. Results The results for fifty-seven pediatric CP patients (including 35 male and 22 female patients) who completed follow-up showed that gross and fine motor functions improved after cell therapy. Interestingly, the GMFM and FMFM scores in patients who received one course of transplantation were significantly increased at 6 months after treatment. Moreover, another course of transplantation further improved gross and fine motor function in children. The scores for GMFM and FMFM were significantly higher at 6 months posttransplantation than at baseline and showed a linear upward trend. There was no gender difference in GMFM. Interestingly, there was a significant difference between male and female patients in the B and C dimensions of FMFM. These results reveal a gender-related susceptibility to stem cell therapy, especially for movement capability of the upper extremity joint and grasping ability. Similarly, in the group aged ≤3 years old, the improvement observed in dimension A (lying and rolling) of GMFM was nearly exponential and showed a quadratic trend. The results for FMFM were similar to those for GMFM. Moreover, the improvement in motor function was not age dependent. Conclusions In this study, our data collectively reveal that CP children display sex- or age-dependent responses to hWJSC therapy; these results shed light on the clinical utility of this approach in specific populations.
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Smits DW, van Gorp M, van Wely L, Verheijden J, Voorman J, Wintels S, van der Cruijsen J, Ketelaar M. Participation in Social Roles of Adolescents With Cerebral Palsy: Exploring Accomplishment and Satisfaction. Arch Rehabil Res Clin Transl 2019; 1:100021. [PMID: 33543052 PMCID: PMC7853369 DOI: 10.1016/j.arrct.2019.100021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To explore participation in social roles of adolescents (aged 12-18y) with cerebral palsy (CP), in terms of satisfaction compared with accomplishment. Design Cohort study as part of a prospective longitudinal research program. Setting Clinic. Participants Participants were adolescents (N=45; 58% male, mean age 15y 6mo) with CP at levels I-II (88%) and III-IV-V (12%) of the Gross Motor Function Classification System. Interventions Not applicable. Main Outcome Measures Accomplishment (0-9 scale; with score <8 “having difficulties”) and satisfaction (1-5 scale; with score 3 “neutral”) were assessed using the Life-Habits questionnaire, on 6 domains (Responsibilities, Interpersonal relationships, Community life, Education, Employment, Recreation). Per domain, we analyzed scatterplots of accomplishment vs satisfaction. Additionally, we compared determinant-models (including factors of CP, activity, person, and environment) using regression analysis. Results For accomplishment, mean scores were <8.00 except for Interpersonal relationships. For satisfaction, mean scores varied between 3.85 and 4.34. Overall, individuals with similar levels of accomplishment showed large ranges in their levels of satisfaction, which was expressed by low explained variances, especially on Education (6%). Furthermore, different sets of determinants were found for accomplishment (predominantly CP factors) compared with satisfaction (predominantly environment factors). Conclusions This study revealed a dissociation between participation accomplishment and satisfaction with participation among adolescents with CP. For practice and research, we recommend not only to focus on accomplishment but also, if not mainly, on satisfaction.
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Key Words
- Adolescent
- CP, cerebral palsy
- Cerebral palsy
- GMFCS, Gross Motor Function Classification System
- GMFM, Gross Motor Function Measure
- ICF, International Classification of Functioning, Disability, and Health
- Life-H, Life Habits questionnaire
- MACS, Manual Ability Classification System
- PEDI, Pediatric Evaluation of Disability Inventory
- PERRIN, Pediatric Rehabilitation Research in the Netherlands
- Personal satisfaction
- PiP, Participation in Perspective
- Rehabilitation
- Social participation
- UCL, Utrecht Coping List
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Affiliation(s)
- Dirk-Wouter Smits
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marloes van Gorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leontien van Wely
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Johannes Verheijden
- BOSK, Association of Persons with a Physical Disability, Utrecht, The Netherlands
| | - Jeanine Voorman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sophie Wintels
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Joyce van der Cruijsen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Corresponding author Marjolijn Ketelaar, PhD, Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM Utrecht, The Netherlands.
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Pogwizd P, Pasterczyk-Szczurek A, Bigosińska M. Effect of vibrational therapy on muscle tissue. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0012.6898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an adult human, on average, muscles constitute about 40% of their body mass. They are the basic structural and functional elements of the musculoskeletal system based mainly on shrinkage of their fibres. This state, among others, ensures and induces motor reactions defined in a given situation, affects balance and muscle balance, the efficiency of neuromuscular connections, and also decides the efficiency of the motor system. The aim of the work was to review literature regarding the impact of treatments using vibrational stimulus on human muscle tissue. Particular attention was paid to the observed improvement of its motor properties after the completion of t vibrational therapy application. An attempt was also made to present the widest possible use of vibrational procedures in various disease states related to the functionality of muscle tissue, which is why in the present overview, the included research was differentiated in terms of target groups and investigated muscles. The analysis included domestic and foreign literature, in which the positive effect of vibrational treatments on the motor properties of adults was discussed. Studies were selected, the authors of which described the most important parameters of the vibrational stimulus used, such as: frequency, amplitude and duration of exposure. Research work from the last 15 years has been analysed (not including the historical part). However, as many as 70% of the studies referred to have been published in the last 5 years. Data from the following databases was analysed: Medline, Embase, Cochrane CENTRAL trials register, ScienceDirect, PubMed, IEEE Xplore, Wiley Online Library. Key words used: muscles, force, vibration, WBV. Numerous reports indicate the positive effect of vibrational therapy on human muscle tissue. These treatments, among others, prevent muscle atrophy, and in this way, improve or reproduce the lost motor skills of the investigated people. Treatments with the use of vibrations can be performed by the patients themselves without special supervision, the devices that trigger them are easy to use and do not require significant physical effort, which is an undoubted advantage for the elderly and ill patients as well as athletes during the restitution period. It seems wise that any future research regarding the possibility of use of using vibrations in various disease states, including covering the broadly understood pathology of the musculoskeletal system, should focus on the development of optimal parameters and conditions for the use of vibration treatments, associating them with selected disease entities, developing indications and contraindications for their use, as well as determine hypotheses of the effectiveness of undertaken activities and their scientific verification. This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. null
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Affiliation(s)
- Paweł Pogwizd
- Dział Badawczo Rozwojowy Firmy Vitberg, Nowy Sącz / Research and Development Department of Vitberg, Nowy Sącz, Poland
| | - Alicja Pasterczyk-Szczurek
- Dział Badawczo Rozwojowy Firmy Vitberg, Nowy Sącz / Research and Development Department of Vitberg, Nowy Sącz, Poland
| | - Monika Bigosińska
- Zakład Wychowania Fizycznego, Instytut Kultury Fizycznej, Państwowa Wyższa Szkoła Zawodowa, Nowy Sącz / Department of Physical Education, Institute of Physical Education, State University of Applied Science, Nowy Sącz, Poland
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Wintels SC, Smits DW, van Wesel F, Verheijden J, Ketelaar M. How do adolescents with cerebral palsy participate? Learning from their personal experiences. Health Expect 2018; 21:1024-1034. [PMID: 29858544 PMCID: PMC6250857 DOI: 10.1111/hex.12796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/30/2022] Open
Abstract
Background Participation in society can be difficult for adolescents with cerebral palsy (CP). Information is often based on quantitative studies, and little is known about their personal participation experiences. Objective The aim of this study was to examine the participation experiences of adolescents (aged 12‐17 years) with CP. Methods A qualitative participatory research method was used. Twenty‐three semi‐structured open interviews were conducted with 13 male and 10 female adolescents (mean age 15 years) with CP. An interview checklist was developed jointly with adolescents with CP. This checklist ensured that the adolescents reflected on various participation areas, that is school, sports, health care and work. The analysis was based on principles of grounded theory. Findings From the adolescents’ experiences, 4 key categories were identified. One concerned participation, as such, expressed as “My participation experiences,” including experiences, thoughts and feelings while participating in daily life. Three other categories concerned factors that influence participation experiences, expressed as “My disability,” “Me as a person” and “My environment.” These 4 categories together formed a model showing the interactions and dynamics of participation according to adolescents with CP. Conclusion Adolescents with CP expressed their participation experiences, including various important influencing factors. This study conceptualized these experiences into a dynamic model. This experience‐based participation model may provide new, personalized perspectives for practice, for instance in rehabilitation, but also for schools and sports (or sports clubs) attended by adolescents. Focusing on personal and environmental factors might be the key to successful participation.
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Affiliation(s)
- Sophie Catharina Wintels
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Dirk-Wouter Smits
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Floryt van Wesel
- Department of Methodology & Statistics, Utrecht University, Utrecht, The Netherlands
| | | | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Tusor N, Benders MJ, Counsell SJ, Nongena P, Ederies MA, Falconer S, Chew A, Gonzalez-Cinca N, Hajnal JV, Gangadharan S, Chatzi V, Kersbergen KJ, Kennea N, Azzopardi DV, Edwards AD. Punctate White Matter Lesions Associated With Altered Brain Development And Adverse Motor Outcome In Preterm Infants. Sci Rep 2017; 7:13250. [PMID: 29038505 PMCID: PMC5643493 DOI: 10.1038/s41598-017-13753-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
Preterm infants who develop neurodevelopmental impairment do not always have recognized abnormalities on cerebral ultrasound, a modality routinely used to assess prognosis. In a high proportion of infants, MRI detects punctate white matter lesions that are not seen on ultrasonography. To determine the relation of punctate lesions to brain development and early neurodevelopmental outcome we used multimodal brain MRI to study a large cohort of preterm infants. Punctate lesions without other focal cerebral or cerebellar lesions were detected at term equivalent age in 123 (24.3%) (59 male) of the 506 infants, predominantly in the centrum semiovale and corona radiata. Infants with lesions had higher gestational age, birth weight, and less chronic lung disease. Punctate lesions showed a dose dependent relation to abnormalities in white matter microstructure, assessed with tract-based spatial statistics, and reduced thalamic volume (p < 0.0001), and predicted unfavourable motor outcome at a median (range) corrected age of 20.2 (18.4–26.3) months with sensitivity (95% confidence intervals) 71 (43–88) and specificity 72 (69–77). Punctate white matter lesions without associated cerebral lesions are common in preterm infants currently not regarded as at highest risk for cerebral injury, and are associated with widespread neuroanatomical abnormalities and adverse early neurodevelopmental outcome.
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Affiliation(s)
- Nora Tusor
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom.
| | - Manon J Benders
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Phumza Nongena
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Moegamad A Ederies
- Division of Clinical Sciences, Imperial College London, Hammersmith Hospital, London, W12 0HS, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Nuria Gonzalez-Cinca
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Sunay Gangadharan
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Vasiliki Chatzi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Karina J Kersbergen
- Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Nigel Kennea
- St. George's, University of London, London, SW17 0QT, United Kingdom
| | - Denis V Azzopardi
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, Perinatal Imaging and Health, Division of Imaging Sciences and Bioengineering, King's College London, St Thomas' Hospital, London, SE1 7EH, United Kingdom
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Park EY, Kim WH. Effect of neurodevelopmental treatment-based physical therapy on the change of muscle strength, spasticity, and gross motor function in children with spastic cerebral palsy. J Phys Ther Sci 2017. [PMID: 28626301 PMCID: PMC5468216 DOI: 10.1589/jpts.29.966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the effectiveness of neurodevelopmental treatment-based physical therapy on muscle tone, strength, and gross motor function in children with spastic cerebral palsy. [Subjects and Methods] One-hundred-seventy-five children with spastic cerebral palsy (88 diplegia; 78 quadriplegia) received neurodevelopmental treatment-based physical therapy for 35 minutes per day, 2–3 times per week for 1 year. Spasticity, muscle strength, and gross motor function were measured before and after treatment with the Modified Ashworth Scale, Manual Muscle Testing, and Gross Motor Function Measure, respectively. [Results] Spasticity was significantly reduced after 1 year of treatment. The Gross Motor Functional Classification System levels I–II group showed a significant increase in muscle strength compared with the Gross Motor Functional Classification System levels III–V, and the latter showed a significant decrease in spasticity compared with the former. [Conclusion] Neurodevelopmental treatment-based physical therapy in children with cerebral palsy seems to be effective in reducing spasticity, but does not improve gross motor function. Therefore, other interventional approaches are needed to improve gross motor function in children with cerebral palsy.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, Republic of Korea
| | - Won-Ho Kim
- Department of Physical Therapy, Ulsan College, Republic of Korea
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Qiu A, Yang Z, Li Z. Recent perspectives of cerebral palsy in children. Minerva Pediatr 2017; 71:297-303. [PMID: 28353322 DOI: 10.23736/s0026-4946.17.04880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The movement and posture disorder of cerebral palsy (CP) is presumed to mainly be a consequence of the motor disorder, but accompanying disturbances with sensations and perception have also been suggested to influence motor function. The heterogeneous condition of CP is caused by an injury to the immature brain affecting movement and posture development. The attainment of standing and walking can be difficult and an assistive device to accomplish the tasks may be required for some children with CP. In this review, we enlightened the role of possible sensory and perceptual disturbances for standing difficulties in children with CP.
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Affiliation(s)
- Aizhen Qiu
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
| | - Zhongxiu Yang
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China -
| | - Zhilin Li
- Department of Rehabilitation, Xuzhou Children's Hospital, Xuzhou, China
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Eken MM, Harlaar J, Dallmeijer AJ, de Waard E, van Bennekom CAM, Houdijk H. Squat test performance and execution in children with and without cerebral palsy. Clin Biomech (Bristol, Avon) 2017; 41:98-105. [PMID: 28040656 DOI: 10.1016/j.clinbiomech.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knowledge on lower extremity strength is imperative to informed decision making for children with cerebral palsy (CP) with mobility problems. However, a functional and clinically feasible test is not available. We aimed to determine whether the squat test is suitable for this purpose by investigating test performance and execution in children with cerebral palsy and typically developing (TD) peers. METHODS Squat test performance, defined by the number of two-legged squats until fatigue (max 20), was assessed in twenty children with bilateral CP (6-19years; gross motor function classification system I-III) and sixteen TD children (7-16years). Muscle fatigue was assessed from changes in electromyography (EMG). Joint range-of-motion and net torque were calculated for each single squat, to investigate differences between groups and between the 2nd and last squat. FINDINGS Fifteen children with CP performed <20 squats (median=13, IQR=7-19), while all TD children performed the maximum of 20 squats. Median EMG frequency decreased and amplitude increased in mm. quadriceps of both groups. Ankle and knee range-of-motion were reduced in children with CP during a single squat by 10 to 15°. No differences between 2nd and last squat were observed, except for knee range-of-motion which increased in TD children and decreased in children with CP. INTERPRETATION Squat test performance was reduced in children with CP, especially in those with more severe CP. Muscle fatigue was present in both children with CP and TD peers, confirming that endurance of the lower extremity was tested. Minor execution differences between groups suggest that standardized execution is important to avoid compensation strategies. It is concluded that the squat test is feasible to test lower extremity strength in children with CP in a clinically meaningful way. Further clinimetric evaluation is needed before clinical implementation.
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Affiliation(s)
- M M Eken
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands.
| | - J Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A J Dallmeijer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - E de Waard
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - C A M van Bennekom
- Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands; Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Houdijk
- Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands; Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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Vos RC, Becher JG, Voorman JM, Gorter JW, van Eck M, van Meeteren J, Smits DW, Twisk JW, Dallmeijer AJ. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy. Arch Phys Med Rehabil 2016; 97:1329-37. [PMID: 27085848 DOI: 10.1016/j.apmr.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/22/2016] [Accepted: 03/20/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). DESIGN A prospective cohort study. SETTING Rehabilitation departments of university medical centers and rehabilitations centers. PARTICIPANTS A sample (N=327) consisting of 148 children (aged 5-9y) and 179 youth (aged 11-20y) with CP, Gross Motor Function Classification System level I (n=180), level II (n=44), level III (n=36), level IV (n=34), and level V (n=33). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gross motor capacity was assessed with the Gross Motor Function Measure-66 over a period of 2 to 4 years in different age cohorts. Neuromusculoskeletal function included selective motor control (SMC), muscle strength, spasticity, and range of motion (ROM) of the lower extremities. RESULTS Multilevel analyses showed that SMC was significantly associated with gross motor capacity in children and youth with CP, showing higher values and a more favorable course of gross motor capacity in those with better SMC. Strength was only associated with gross motor capacity in youth. Reduced ROM of hip (children) and knee extension (youth) and spasticity of the hip adductors (youth) were additionally-but more weakly-associated with lower values and a less favorable course of gross motor capacity. CONCLUSIONS Results indicate that children and youth with more severely impaired SMC and youth with reduced muscle strength have a less favorable course of gross motor capacity, while spasticity and reduced ROM are less determinative.
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Affiliation(s)
- Rimke C Vos
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jan Willem Gorter
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, Canada; Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jetty van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Wouter Smits
- Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Jos W Twisk
- Department of Biostatistics and Methodology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Ward R, Reynolds JE, Bear N, Elliott C, Valentine J. What is the evidence for managing tone in young children with, or at risk of developing, cerebral palsy: a systematic review. Disabil Rehabil 2016; 39:619-630. [DOI: 10.3109/09638288.2016.1153162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Roslyn Ward
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jess E. Reynolds
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Sport, Science, Exercise and Health, the University of Western Australia, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Physiotherapy, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Department of Clinical Research, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Catherine Elliott
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Occupational Therapy and Social Work, Curtin University, Western Australia, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
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15
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Love S, Gibson N, Smith N, Bear N, Blair E. Interobserver reliability of the Australian Spasticity Assessment Scale (ASAS). Dev Med Child Neurol 2016; 58 Suppl 2:18-24. [PMID: 26762706 DOI: 10.1111/dmcn.13000] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of this paper is to present the Australian Spasticity Assessment Scale (ASAS) and to report studies of its interrater reliability. The ASAS identifies the presence of spasticity by confirming a velocity-dependent increased response to rapid passive movement and quantifies it using an ordinal scale. METHOD The rationale and procedure for the ASAS is described. Twenty-two participants with spastic CP (16 males; age range 1y 11mo-15y 3mo) who had not had botulinum neurotoxin-A within 4 months, or bony or soft tissue surgery within 12 months, were recruited from the spasticity management clinic of a tertiary paediatric teaching hospital. Fourteen muscles in each child were assessed by each of three experienced independent raters. ASAS was recorded for all muscles. Interrater reliability was calculated using the weighted kappa statistic (quadratic weighting; κqw) for individual muscles, for upper limbs, for lower limbs, and between raters. RESULTS The weighted kappa ranged between 0.75 and 0.92 for individual muscle groups and was 0.87 between raters. INTERPRETATION The ASAS complies with the definition of spasticity and is clinically feasible in paediatric settings. Our estimates of interrater reliability for the ASAS exceed that of the most commonly used spasticity scoring systems.
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Affiliation(s)
- Sarah Love
- Physiotherapy Department, Princess Margaret Hospital, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Noula Gibson
- Physiotherapy Department, Princess Margaret Hospital, Perth, WA, Australia
| | - Nadine Smith
- Physiotherapy Department, Princess Margaret Hospital, Perth, WA, Australia
| | - Natasha Bear
- Physiotherapy Department, Princess Margaret Hospital, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Kruijsen-Terpstra AJA, Ketelaar M, Verschuren O, Smits DW, Jongmans MJ, Gorter JW. Determinants of Developmental Gain in Daily Activities in Young Children with Cerebral Palsy. Phys Occup Ther Pediatr 2014; 35:265-279. [PMID: 25232647 DOI: 10.3109/01942638.2014.957429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT The aim of this study was to examine which child and family characteristics at the child's age of 2 years are determinants of development of self-care and mobility activities over a period of 2 years in young children with cerebral palsy (CP). Longitudinal data of 92 children, representing all levels of the Gross Motor Function Classification System (GMFCS), were analyzed. Children's self-care and mobility activities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory. Development of self-care and mobility activities was related to several child determinants but no family determinants. GMFCS, type of CP, intellectual capacity, and epilepsy were related to the development of self-care and mobility activities, while manual ability and spasticity were related to development of mobility activities. Multivariate analysis indicated that GMFCS and intellectual capacity were the strongest determinants of development of self-care activities, and GMFCS was the strongest determinant of development of mobility activities. The change in self-care and mobility activities was less favorable in severely affected children with severe disability. Knowledge of GMFCS level and intellectual capacity is important in anticipating change over time and goal setting in young children with CP.
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Affiliation(s)
- Anne J A Kruijsen-Terpstra
- 1Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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How do changes in motor capacity, motor capability, and motor performance relate in children and adolescents with cerebral palsy? Arch Phys Med Rehabil 2014; 95:1577-84. [PMID: 24792140 DOI: 10.1016/j.apmr.2014.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/21/2014] [Accepted: 04/01/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the relations between changes in motor capacity (can do, in standardized environment), motor capability (can do, in daily environment), and motor performance (does do, in daily environment) among children with cerebral palsy (CP). DESIGN Prospective longitudinal study. After baseline measurements (at the age of 18 mo, 30 mo, 5 y, 7 y, 9 y, 11 y, or 13 y), 2-year follow-up measurements were performed. Change scores were calculated, and Pearson correlations were used for change score relations. SETTING Outpatient clinic. PARTICIPANTS Toddlers, school-age children, and adolescents with CP (N=321; 200 boys, 121 girls). Levels of severity according to the Gross Motor Function Classification System included level I (42%), level II (15%), level III (17%), level IV (13%), and level V (13%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Change in motor capacity was assessed with the Gross Motor Function Measure-66. Changes in motor capability and motor performance were assessed with the Pediatric Evaluation of Disability Inventory using the Functional Skills Scale and Caregiver Assistance Scale, respectively. RESULTS Within the total group, change score correlations were moderate (.52-.67) and significant (P<.001). For age groups, correlations were significantly higher in toddlers than school-age children and adolescents. For severity levels, correlations were significantly higher in children at level III than level I, IV, and V. CONCLUSIONS Results imply that change in motor capacity does not automatically translate to change in motor capability and change in motor capability does not automatically translate to change in motor performance. Results also show different relations for clinically relevant subgroups. These are important insights for clinical practice because they can guide evidence-based interventions with a focus on activities.
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Yi TI, Jin JR, Kim SH, Han KH. Contributing factors analysis for the changes of the gross motor function in children with spastic cerebral palsy after physical therapy. Ann Rehabil Med 2013; 37:649-57. [PMID: 24236252 PMCID: PMC3825941 DOI: 10.5535/arm.2013.37.5.649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/30/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the factors which contribute to the improvements of the gross motor function in children with spastic cerebral palsy after physical therapy. METHODS The subjects were 45 children with spastic cerebral palsy with no previous botulinum toxin injection or operation history within 6 months. They consisted of 24 males (53.3%) and 21 females (46.7%), and the age of the subjects ranged from 2 to 6 years, with the mean age being 41±18 months. The gross motor function was evaluated by Gross Motor Function Measure (GMFM)-88 at the time of admission and discharge, and then, the subtractions were correlated with associated factors. RESULTS The GMFM-88 was increased by 7.17±3.10 through 52±16 days of physical therapy. The more days of admission, the more improvements of GMFM-88 were attained. The children with initial GMFM-88 values in the middle range showed more improvements in GMFM-88 (p<0.05). The children without dysphagia and children with less spasticity of lower extremities also showed more improvements in GMFM-88 (p<0.05). CONCLUSION We can predict the improvements of the gross motor function after physical therapy according to the days of admission, initial GMFM-88, dysphagia, and spasticity of lower extremities. Further controlled studies including larger group are necessary.
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Affiliation(s)
- Tae Im Yi
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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19
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Smits DW, Gorter JW, Hanna SE, Dallmeijer AJ, van Eck M, Roebroeck ME, Vos RC, Ketelaar M. Longitudinal development of gross motor function among Dutch children and young adults with cerebral palsy: an investigation of motor growth curves. Dev Med Child Neurol 2013; 55:378-84. [PMID: 23356539 DOI: 10.1111/dmcn.12083] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP). METHOD This longitudinal study included 423 individuals (260 males, 163 females) with CP. The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1- or 2-year intervals between 2002 and 2009. Data were analysed using non-linear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development. RESULTS The SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development. INTERPRETATION The results validate the existence of five distinct patterns for gross motor development by level of severity of CP.
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Affiliation(s)
- Dirk-Wouter Smits
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.
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20
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Malheiros SRP, Monteiro CBDM, da Silva TD, Torriani-Pasin C, de Andrade MSR, Valenti VE, Raimundo RD, Roosch A, Rodrigues LMR, Manhabusque KV, Camargo RCT, Drezzet J, Quadrado VH, de Abreu LC. Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy. Int Arch Med 2013; 6:1. [PMID: 23302576 PMCID: PMC3599980 DOI: 10.1186/1755-7682-6-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/15/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children's habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities. METHODS Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used. RESULTS We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1. CONCLUSION We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.
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Affiliation(s)
- Silvia RP Malheiros
- Faculdade Metropolitanas Unidas (FMU), Av. Santo Amaro 1239. 04506-000, São Paulo, SP, Brazil
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Carlos B de Mello Monteiro
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
- Departamento de Saúde Materno-infantil, Faculdade de Saúde Pública, USP, Av. Dr. arnaldo, 715. 01246-904, São Paulo, SP, Brazil
| | - Talita Dias da Silva
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Camila Torriani-Pasin
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
| | - Michele SR de Andrade
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
| | - Vitor E Valenti
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, UNESP, Av. Hygino Muzzi Filho, 737, 17525-900, Marília, SP, Brazil
| | - Rodrigo Daminello Raimundo
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Anelise Roosch
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
- Departamento de Saúde Materno-infantil, Faculdade de Saúde Pública, USP, Av. Dr. arnaldo, 715. 01246-904, São Paulo, SP, Brazil
| | - Luciano MR Rodrigues
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Katia Valeria Manhabusque
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
- Departamento de Saúde Materno-infantil, Faculdade de Saúde Pública, USP, Av. Dr. arnaldo, 715. 01246-904, São Paulo, SP, Brazil
| | - Regina Céliac Trindade Camargo
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Jefferson Drezzet
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
| | - Virginia Helena Quadrado
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000. 03828-000, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Escrita Científica, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821. 09060-650, Santo André, SP, Brazil
- Departamento de Saúde Materno-infantil, Faculdade de Saúde Pública, USP, Av. Dr. arnaldo, 715. 01246-904, São Paulo, SP, Brazil
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Shilt JS, Seibert PS, Kadyan V. Optimal management for people with severe spasticity. Degener Neurol Neuromuscul Dis 2012; 2:133-140. [PMID: 30890884 DOI: 10.2147/dnnd.s16630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spasticity is characterized by velocity-dependent increase in tonic stretch reflexes and tendon jerks. Many people affected by spasticity receive late treatment, or no treatment, which greatly reduces the potential to regain full motor control and restore function. There is much to consider before determining treatment for people with spasticity. Treatment of pediatric patients increases the complexity, because of the substantial difference between adult and pediatric spasticity. Proper patient evaluation, utilization of scales and measures, and obtaining patient and caregiver history is vital in determining optimal spasticity treatment. Further, taking into consideration the limitations and desires of individuals serve as a guide to best management. We have grouped contributing factors into the IDAHO Criteria to elucidate a multidisciplinary approach, which considers a person's complete field of experience. This model is applied to goal setting, and recognizes the importance of a spasticity management team, comprising the treatment subject, his/her family, the environment, and a supportive, well-informed medical staff. The criteria take into account the complexity associated with diagnosing and treating spasticity, with the ultimate goal of improved function.
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Affiliation(s)
- Jeffrey S Shilt
- Idaho Spasticity Program, Saint Alphonsus Health Systems, Boise, ID
| | - Pennie S Seibert
- Department of Psychology, Boise State University, Boise, ID, USA,
| | - Vivek Kadyan
- Idaho Spasticity Program, Saint Alphonsus Health Systems, Boise, ID
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22
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Affiliation(s)
- Eva Brogren Carlberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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23
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Gaebler-Spira D. Overview of Sensorimotor Dysfunction in Cerebral Palsy. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1701-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Smits DW, Ketelaar M, Gorter JW, van Schie P, Dallmeijer A, Jongmans M, Lindeman E. Development of daily activities in school-age children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:222-234. [PMID: 21041062 DOI: 10.1016/j.ridd.2010.09.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 09/28/2010] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to describe the course of capabilities in self-care, mobility, and social function in school-age children with cerebral palsy (CP) and to investigate associations with CP-, child-, and family-characteristics. A clinic-based sample of children with CP (n = 116; 76 males, 40 females; mean age 6 y 3 mo, SD 12 mo) was followed longitudinally in three yearly measurements. Children's capabilities were assessed with the Pediatric Evaluation of Disability Inventory Functional Skills Scale (PEDI-FSS). Averaged for the total group, significant increases over time were shown in PEDI-FSS scores in all three domains. For self-care, the course was best predicted by a model including level of gross motor function (measured by the Gross Motor Function Classification System) and intellectual capacity (measured by Raven's Coloured Progressive Matrices). For mobility, the course was best predicted by a model containing only level of gross motor function. For social function, the course was best predicted by a model comprising level of bimanual function (measured by the Manual Ability Classification System) and paternal educational level. Generally, the increase in capabilities was greater if level of functioning was higher, except for level of paternal education. The findings indicate that there are different sets of determinants for the course of different domains of daily activities. Such different sets of determinants may help to set realistic expectations and to create appropriate treatment plans for different domains of daily activities in school-age children with CP.
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Affiliation(s)
- Dirk-Wouter Smits
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
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Tilton A, Vargus-Adams J, Delgado MR. Pharmacologic treatment of spasticity in children. Semin Pediatr Neurol 2010; 17:261-7. [PMID: 21183133 DOI: 10.1016/j.spen.2010.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many clinicians frequently face the dilemma of whether and how to medically treat spasticity. When pharmacologic intervention is deemed appropriate, treatment decisions must first be based on accurate assessment using valid and reliable clinical instruments, and, importantly, specific, measurable, achievable, and realistic treatment goals should be delineated. For the treatment of localized or segmental spasticity, botulinum toxin (BoNT-A) is recommended as an effective and generally safe treatment. For more generalized spasticity, a number of useful oral agents and intrathecal baclofen are available, each with their positive and negative attributes. Fundamental knowledge of pharmacologic properties and toxicities of these medications is required for safe and appropriate use. To achieve optimum results, spasticity treatment should be part of an integrated therapeutic approach in which patients, caregivers, therapists, physicians, and surgeons have an open and clear communication about the overall rehabilitation process of the patient. This review summarizes the current pharmacologic approaches to spasticity treatment in children, critically evaluating published studies in the context of established evidence-based criteria.
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Affiliation(s)
- Ann Tilton
- Louisiana State University, New Orleans, LA, USA
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Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:421-8. [PMID: 20298834 DOI: 10.1016/j.apmr.2009.11.017] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/29/2009] [Accepted: 11/01/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training. DESIGN Single-center, intrarater and interrater reliability study. SETTING Institutional ambulatory care. PARTICIPANTS Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15). INTERVENTIONS The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally. MAIN OUTCOME MEASURES Intrarater and interrater reliability of the Tardieu Scale. RESULTS After training, nonexperienced raters had mean +/- SD intrarater and interrater agreement rates across all joints and parameters of 80%+/-14% and 74%+/-16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%+/-13% and 66%+/-15%, respectively, versus 90%+/-8% and 81%+/-13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements. CONCLUSIONS Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability.
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Affiliation(s)
- Jean-Michel Gracies
- Department of Physical Medicine and Rehabilitation, CHU Henri Mondor, Créteil, France
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