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Wang X, Teh SH, Wang XH. Knowledge mapping of spastic cerebral palsy. A bibliometric analysis of global research (2000-2022). Ital J Pediatr 2024; 50:9. [PMID: 38238820 PMCID: PMC10797869 DOI: 10.1186/s13052-024-01577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is characterized by abnormal pronunciation, posture, and movement. Spastic CP accounts for more than 70% of all CP. To date, there has been no bibliometric analysis to summarize study on spastic CP. Here, we aim to conduct a bibliometric analysis of spastic CP to summarize this field's knowledge structure, research hotspots, and frontiers. METHOD Publications about spastic CP were searched utilizing the Web of Science Core Collection (WoSCC) database from 1 January 2000 to 30 November 2022, the WoSCC literature analysis wire, VOSviewer 1.6.18, CiteSpace 6.1.R4 and Online analysis platform for bibliometrics were used to conduct the analysis. RESULTS A total of 3988 publications, consisting of 3699 articles and 289 reviews, were included in our study. The United States emerged as the most productive country, while Kathleen Univ Leuven was the most productive institution. The leading author was Desloovere K. A total of 238 journals contributed to this field, with Developmental medicine and child neurology being the leading journal. Important keywords and keyword clusters included Spastic cerebral palsy, Reliability, and Gross motor function. Keywords identified through burst detection indicated that hotspots in this field were management, randomized controlled trials, and definition. CONCLUSION Based on the analysis of bibliometric on spastic CP over the past 20 years, the trends and the knowledge graph of the countries, institutions, authors, references, and the keywords have been identified, providing accurate and expedited insights into critical information and potentially new directions in the study of spastic CP.
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Affiliation(s)
- Xing Wang
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Famous TCM Expert Heritage Studio, Xi'an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
| | - Siew Hoon Teh
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
| | - Xing-Hua Wang
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia.
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2
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Bell BG, Shah S, Coulson N, McLaughlin J, Logan P, Luke R, Avery AJ. The impact of ageing on adults with cerebral palsy: the results of a national online survey. BJGP Open 2023; 7:BJGPO.2023.0028. [PMID: 37591553 PMCID: PMC11176684 DOI: 10.3399/bjgpo.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is one of the most common neurological disorders in children and results in lifelong physical impairments. Adults with CP have approximately the same life expectancy as their non-disabled peers, so helping them to stay healthy throughout the life course will have long-term cost benefits via reductions in hospital admissions, long-term care, and unemployment rates. AIM To explore how adults with CP experience ageing. DESIGN & SETTING National online survey given to adults with CP in the UK. METHOD The participants were adults with CP. Items for the online survey were taken from existing self-report measures, with additional items developed for the survey. Several domains of functioning were assessed including mobility, dexterity, fatigue, pain, speech, mental health, swallowing and health maintenance/self-care as well as healthcare usage. Data were analysed using χ2 to examine the relationships between the demographic variables and the survey responses. RESULTS The survey was completed by 395 participants, of whom 74.2% were female and approximately 59.3% aged <45 years. Responders reported having problems with mobility, pain, and fatigue with older participants reporting higher levels of pain and more mobility problems, although the correlations were fairly small. Healthcare usage was surprisingly low. CONCLUSION The study found that age was associated with a decline in mobility and a higher level of pain, although the relationships were weak. It is possible that the low healthcare usage among the responders is owing to services not being available to respond to their needs.
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Affiliation(s)
- Brian G Bell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sonali Shah
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Coulson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Janice McLaughlin
- School of Geography, Politics, and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Anthony J Avery
- School of Medicine, University of Nottingham, Nottingham, UK
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3
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Expósito D, Morales-Suarez MM, Soriano JM, Soler C. Tools for Nutrition Assessment of Adults with Cerebral Palsy: Development of a Gold Standard. Curr Nutr Rep 2023; 12:545-553. [PMID: 37486592 DOI: 10.1007/s13668-023-00485-w] [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] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Cerebral palsy (CP) is a group of disorders caused by non-stabilized cerebral lesions. Individuals with this disorder are at a higher risk of suffering from malnutrition and other related detrimental effects to their quality of life. For this reason, accurate methods of nutritional assessment are vital for people suffering from this condition. While assessment of nutritional status in children with CP has been extensively studied, very few studies have been carried out on adults. These limitations are due to the great anatomical-functional variability characteristic of this syndrome. Difficulties that derive from this variability in adult patients with CP mean that there remains an urgent need for certain standards of nutritional assessment for this population. The objective of this review is to compile the latest trends in nutritional assessment in adults with CP to guide the development of a conceptual framework for future research. RECENT FINDINGS With this aim, relevant studies have been identified. The most commonly used technique to evaluate nutritional status is the BMI because of its ease-of-use. However, its well-known limitations fail to adequately estimate the nutritional status in this population, with measurements of patients with CP yielding results that are much less accurate than those that already exist in the general population. Although more studies are needed, kinanthropometry is considered one of the most reliable techniques; nevertheless, the anatomical limitation characteristic of CP plays a limiting factor.
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Affiliation(s)
- D Expósito
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain.
- Department of Basic Medical Sciences, Universidad Católica de Valencia, 46001, Valencia, Spain.
- Department of Nutrition, Universidad Católica de Valencia, 46001, Valencia, Spain.
| | - M M Morales-Suarez
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100, Burjassot, Valencia, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - J M Soriano
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
| | - C Soler
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
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4
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Pereira KU, Silva MZ, Pfeifer LI. The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021283. [PMID: 36921161 PMCID: PMC10014025 DOI: 10.1590/1984-0462/2023/41/2021283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/30/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To identify in national and international literature the use of virtual reality to develop manual skills of children with cerebral palsy. METHODS This is a systematic review carried out in the PubMed database, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and the Online System for Search and Analysis of Medical Literature (Ovid Medline) using the keywords "cerebral palsy", "virtual reality", "occupational therapy", "child", "daily activities/activities of daily living", in English and in Portuguese. The selected articles had their methodological quality evaluated through the Physiotherapy Evidence Database (PEDro scale). RESULTS 228 studies were selected, as they included children with cerebral palsy undergoing treatment with exposure to virtual reality to improve manual function in daily activities. Studies on other themes, incomplete, and duplicated reviews were excluded. Three evaluators conducted the study selection process and included 14 articles in the analysis. CONCLUSIONS The findings suggest that virtual reality therapy has contributed to an improvement in the manual function of children with cerebral palsy, constituting a useful resource for a supporting intervention to enhance traditional therapies.
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Affiliation(s)
| | | | - Luzia Iara Pfeifer
- Universidade de São Paulo, Ribeirão Preto, SP, Brazil.,Universidade Federal de São Carlos, São Carlos, SP, Brazil
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5
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Shi Z, Luo K, Jani S, February M, Fernandes N, Venkatesh N, Sharif N, Tan S. Mimicking partial to total placental insufficiency in a rabbit model of cerebral palsy. J Neurosci Res 2022; 100:2138-2153. [PMID: 34173261 PMCID: PMC8709884 DOI: 10.1002/jnr.24901] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
All placental abruptions begin as partial abruptions, which sometimes manifest as fetal bradycardia. The progression from partial to total abruption was mimicked by a new rabbit model of placental insufficiency, and we compared it, with sufficient statistical power, with the previous model mimicking total placental abruption. The previous model uses total uterine ischemia at E22 or E25 (70% or 79% term, respectively), in pregnant New Zealand white rabbits for 40 min (Full H-I). The new model, Partial+Full H-I, added a 30-min partial ischemia before the 40-min total ischemia. Fetuses were delivered either at E31.5 (full term) vaginally for neurobehavior testing, or by C-section at E25 for ex vivo brain cell viability evaluation. The onset of fetal bradycardia was within the first 2 min of either H-I protocol. There was no difference between Full H-I (n = 442 for E22, 312 for E25) and Partial+Full H-I (n = 154 and 80) groups in death or severely affected kits at E22 (76% vs. 79%) or at E25 (66% vs. 64%), or normal kits at E22 or E25, or any of the individual newborn neurobehavioral tests at any age. No sex differences were found. Partial+Full H-I (n = 6) showed less cell viability than Full H-I (n = 8) at 72-hr ex vivo in the brain regions studied. Partial+Full H-I insult produced similar cerebral palsy phenotype as our previous Full H-I model in a sufficiently powered study and may be more suitable for testing of potential neuroprotectants.
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Affiliation(s)
- Zhongjie Shi
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Kehuan Luo
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Sanket Jani
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Melissa February
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | - Nithi Fernandes
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
| | | | | | - Sidhartha Tan
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI
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6
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Hastings S, Zhong H, Feinstein R, Zelczer G, Mitrovich C, Gad P, Edgerton VR. A pilot study combining noninvasive spinal neuromodulation and activity-based neurorehabilitation therapy in children with cerebral palsy. Nat Commun 2022; 13:5660. [PMID: 36198701 PMCID: PMC9535012 DOI: 10.1038/s41467-022-33208-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Cerebral Palsy (CP) is the most common pediatric motor disability with multiple symptoms and etiologies. CP is exhibited through sensorimotor delays, impaired posture resulting in limited activities and participation. Our recently concluded, single arm, unblinded, pilot study (NCT04882592) explored whether an intervention combining non-invasive spinal neuromodulation during an activity-based neurorehabilitation therapy (ABNT) can improve voluntary sensory-motor function captured via the Gross Motor Function Measure (GMFM-88) scores (primary outcome). Sixteen children diagnosed with CP with Gross Motor Function Classification Scale levels I-V were recruited and received the same intervention (2x/week for 8 weeks) to correct the dysfunctional connectivity between supraspinal and spinal networks using the normally developed proprioception. We demonstrate that the intervention was associated with clinically and statistically significant improvement in GMFM-88 scores in all children, thus meeting the prespecified primary endpoint. However, the improvement with ABNT alone needs further exploration. No serious adverse events were observed (safety endpoint). Here the authors report a single arm pilot trial to investigate combined spinal neuromodulation and activity-based neurorehabilitation therapy on voluntary sensory-motor function in children with cerebral palsy.
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Affiliation(s)
- Susan Hastings
- Susan Hastings Pediatric Physical Therapy, San Jose, CA, 95128, USA
| | - Hui Zhong
- Rancho Research Institute, Downey, CA, 90242, USA
| | | | | | | | - Parag Gad
- Rancho Research Institute, Downey, CA, 90242, USA. .,SpineX Inc., Los Angeles, CA, 90064, USA.
| | - V Reggie Edgerton
- Rancho Research Institute, Downey, CA, 90242, USA.,SpineX Inc., Los Angeles, CA, 90064, USA.,USC Neurorestoration Center, University of Southern California, Los Angeles, CA, 90033, USA.,Institut Guttmann. Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, 08916, Badalona, Spain
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7
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The Profile of Epilepsy and its characteristics in Children with Cerebral Palsy. Seizure 2022; 101:190-196. [DOI: 10.1016/j.seizure.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
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8
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Alenazi KA. Vitamin D deficiency in children with cerebral palsy: A narrative review of epidemiology, contributing factors, clinical consequences and interventions. Saudi J Biol Sci 2022; 29:2007-2013. [PMID: 35531196 PMCID: PMC9072905 DOI: 10.1016/j.sjbs.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/16/2021] [Accepted: 12/12/2021] [Indexed: 11/02/2022] Open
Abstract
Sufficient vitamin D levels are necessary, not only for mineralization, normal growth and development of bones, but also for the prevention of fatal chronic diseases like diabetes mellitus, metabolic syndrome and cancer. This is of particular importance in children with neuro- and musculoskeletal disorders, especially cerebral palsy (CP). CP is a heterogeneous group of childhood developmental disability disorders described by uncharacteristic posture, balance, and movement. Patients with CP are at an increased risk of vitamin D deficiency and as a result reduced bone mineral density, bone fragility, osteopenia, and rickets. The present review aims to combine and summarize available evidence, regarding the epidemiology, underlying contributing factors, clinical consequences, and treatment interventions of vitamin D deficiency in children with CP.
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9
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Malatt C, Tagliati M. Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia. Pediatr Neurosurg 2022; 57:225-237. [PMID: 35439762 DOI: 10.1159/000524577] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been utilized for over two decades to treat medication-refractory dystonia in children. Short-term benefit has been demonstrated for inherited, isolated, and idiopathic cases, with less efficacy in heredodegenerative and acquired dystonia. The ongoing publication of long-term outcomes warrants a critical assessment of available information as pediatric patients are expected to live most of their lives with these implants. SUMMARY We performed a review of the literature for data describing motor and neuropsychiatric outcomes, in addition to complications, 5 or more years after DBS placement in patients undergoing DBS surgery for dystonia at an age younger than 21. We identified 20 articles including individual data on long-term motor outcomes after DBS for a total of 78 patients. In addition, we found five articles reporting long-term outcomes after DBS in 9 patients with status dystonicus. Most patients were implanted within the globus pallidus internus, with only a few cases targeting the subthalamic nucleus and ventrolateral posterior nucleus of the thalamus. The average follow-up was 8.5 years, with a range of up to 22 years. Long-term outcomes showed a sustained motor benefit, with median Burke-Fahn-Marsden dystonia rating score improvement ranging from 2.5% to 93.2% in different dystonia subtypes. Patients with inherited, isolated, and idiopathic dystonias had greater improvement than those with heredodegenerative and acquired dystonias. Sustained improvements in quality of life were also reported, without the development of significant cognitive or psychiatric comorbidities. Late adverse events tended to be hardware-related, with minimal stimulation-induced effects. KEY MESSAGES While data regarding long-term outcomes is somewhat limited, particularly with regards to neuropsychiatric outcomes and adverse events, improvement in motor outcomes appears to be preserved more than 5 years after DBS placement.
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Affiliation(s)
- Camille Malatt
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA,
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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10
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Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study. Neurol Res Int 2021; 2021:9993912. [PMID: 34966561 PMCID: PMC8712143 DOI: 10.1155/2021/9993912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/07/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country. Objective To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019. Methods An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27. Results Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31-68.88), central nervous system infections (AOR: 0.02, 95% CI: 0-0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03-0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15-161.73). Conclusion Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.
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11
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Sarajchi M, Al-Hares MK, Sirlantzis K. Wearable Lower-Limb Exoskeleton for Children With Cerebral Palsy: A Systematic Review of Mechanical Design, Actuation Type, Control Strategy, and Clinical Evaluation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2695-2720. [PMID: 34910636 DOI: 10.1109/tnsre.2021.3136088] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children with a neurological disorder such as cerebral palsy (CP) severely suffer from a reduced quality of life because of decreasing independence and mobility. Although there is no cure yet, a lower-limb exoskeleton (LLE) has considerable potential to help these children experience better mobility during overground walking. The research in wearable exoskeletons for children with CP is still at an early stage. This paper shows that the number of published papers on LLEs assisting children with CP has significantly increased in recent years; however, no research has been carried out to review these studies systematically. To fill up this research gap, a systematic review from a technical and clinical perspective has been conducted, based on the PRISMA guidelines, under three extended topics associated with "lower limb", "exoskeleton", and "cerebral palsy" in the databases Scopus and Web of Science. After applying several exclusion criteria, seventeen articles focused on fifteen LLEs were included for careful consideration. These studies address some consistent positive evidence on the efficacy of LLEs in improving gait patterns in children with CP. Statistical findings show that knee exoskeletons, brushless DC motors, the hierarchy control architecture, and CP children with spastic diplegia are, respectively, the most common mechanical design, actuator type, control strategy, and clinical characteristics for these LLEs. Clinical studies suggest ankle-foot orthosis as the primary medical solution for most CP gait patterns; nevertheless, only one motorized ankle exoskeleton has been developed. This paper shows that more research and contribution are needed to deal with open challenges in these LLEs.
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12
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Gad P, Hastings S, Zhong H, Seth G, Kandhari S, Edgerton VR. Transcutaneous Spinal Neuromodulation Reorganizes Neural Networks in Patients with Cerebral Palsy. Neurotherapeutics 2021; 18:1953-1962. [PMID: 34244928 PMCID: PMC8608961 DOI: 10.1007/s13311-021-01087-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 02/04/2023] Open
Abstract
Spinal neuromodulation and activity-based rehabilitation triggers neural network reorganization and enhances sensory-motor performances involving the lower limbs, the trunk, and the upper limbs. This study reports the acute effects of Transcutaneous Electrical Spinal Cord Neuromodulation (SCONE™, SpineX Inc.) on 12 individuals (ages 2 to 50) diagnosed with cerebral palsy (CP) with Gross Motor Function Classification Scale (GMFCS) levels ranging from I to V. Acute spinal neuromodulation improved the postural and locomotor abilities in 11 out of the 12 patients including the ability to generate bilateral weight bearing stepping in a 2-year-old (GMFCS level IV) who was unable to step. In addition, we observed independent head-control and weight bearing standing with stimulation in a 10-year-old and a 4-year old (GMFCS level V) who were unable to hold their head up or stand without support in the absence of stimulation. All patients significantly improved in coordination of flexor and extensor motor pools and inter and intralimb joint angles while stepping on a treadmill. While it is assumed that the etiologies of the disruptive functions of CP are associated with an injury to the supraspinal networks, these data are consistent with the hypothesis that spinal neuromodulation and functionally focused activity-based therapies can form a functionally improved chronic state of reorganization of the spinal-supraspinal connectivity. We further suggest that the level of reorganization of spinal-supraspinal connectivity with neuromodulation contributed to improved locomotion by improving the coordination patterns of flexor and extensor muscles by modulating the amplitude and firing patterns of EMG burst during stepping.
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Affiliation(s)
- Parag Gad
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.
- Rancho Research Institute, Downey, CA, 90242, USA.
- SpineX Inc, Los Angeles, CA, 91324, USA.
| | - Susan Hastings
- Susan Hastings Pediatric Physical Therapy, San Jose, CA, 95125, USA
| | - Hui Zhong
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA
| | - Gaurav Seth
- Indian Institute of Technology, Banaras Hindu University, Uttar Pradesh, Varanasi, 221005, India
| | | | - V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, 90095, USA
- Brain Research Institute, University of California, Los Angeles, CA, 90095, USA
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a La Universitat Autònoma de Barcelona, 08916 Badalona, Barcelona, Spain
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13
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Barger MK. Current Resources for Evidence-Based Practice, May/June 2021. J Midwifery Womens Health 2021; 66:413-421. [PMID: 34166576 DOI: 10.1111/jmwh.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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14
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Obeid R, Jacobs M, Chang T, Massaro AN, Bluth E, Murnick JG, Bulas D, Bandarkar A, Oluigbo C, Penn AA. The utility of the fronto-temporal horn ratio on cranial ultrasound in premature newborns: a ventriculomegaly marker. Pediatr Res 2021; 89:1715-1723. [PMID: 33504959 DOI: 10.1038/s41390-020-01337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aims of this study were to find the normal value of fronto-temporal horn ratio (FTHR) as a marker of ventriculomegaly on cranial ultrasound (CUS) in premature newborns and the relation to white matter injury (WMI) and cerebral palsy (CP). METHODS This is a retrospective study of newborns admitted between 2011 and 2014. Inclusion criteria were: (1) gestation <29 weeks, (2) birth weight ≤1500 g, (3) referred within 7 days of life, (4) at least two CUS preformed, (5) brain magnetic resonance imaging (MRI) at term age-equivalent. Intraventricular hemorrhage (IVH) grade was identified and FTHR was measured on all CUS. WMI on MRI was evaluated through (1) injury score (Kidokoro 2013) and (2) fractional anisotropy (FA) on the MRI diffusion tensor imaging. CP was estimated using the gross motor function classification system (GMFCS). RESULTS One hundred neonates met the inclusion criteria: 37 with no IVH, 36 with IVH grade 1-2, and 27 with IVH grade 3-4. The FTHR cut-point of 0.51 had the highest sensitivity and specificity for moderate-to-severe WMI. In the IVH grade 3-4 group, the elevated FTHR correlated with lower FA and higher GMFCS. CONCLUSIONS FTHR is a useful quantitative biomarker of ventriculomegaly in preterm newborns. It may help standardize ventricular measurement and direct intervention. IMPACT The fronto-temporal horn ratio has the potential to become a standardized tool that can provide an actionable measure to direct intervention for post-hemorrhagic ventricular dilation. This current study will provide the basis of a future clinical trial to optimize intervention timing to decrease the risk of white matter injury in this vulnerable population.
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Affiliation(s)
- Rawad Obeid
- Neurology, Beaumont Children Hospital/Oakland University School of Medicine, Royal Oak, MI, USA.
| | - Marni Jacobs
- Children's Research Institute, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Taeun Chang
- Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - An N Massaro
- Neonatology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.,Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA.,Fetal and Translational Medicine, Children's National Hospital, Washington, DC, USA
| | - Eresha Bluth
- Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA
| | - Jonathan G Murnick
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Dorothy Bulas
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Anjum Bandarkar
- Radiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Chima Oluigbo
- Pediatric Neurosurgery, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Anna A Penn
- Neonatology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.,Center for Neuroscience Research, Children's Research Institute, Washington, DC, USA.,Fetal and Translational Medicine, Children's National Hospital, Washington, DC, USA.,Chief, Division of Neonatology, Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, 10032, USA
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15
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Abstract
Abstract
One of the most significant biological factors predisposing to cerebral palsy (CP) are infections. The paper aims to analyze neonatal infections’ influence in the risk of CP development with consideration of all significant risk factors including single, twin, full-term and pre-term pregnancies.
278 children with CP attending the chosen school-educational centers in Poland were included in the questionnaire. The control group included data obtained from the medical documentation of 435 children born in Limanowa County Hospital, Poland. Socio-economic factors, factors connected with pregnancy, and the coexisting disorders and diseases in children were taken into consideration. Constructed models of logistic regression were applied in the statistical analysis.
Neonatal infections increase the risk of CP development in all children (odds ratio (OR) 5.1, 95% confidence interval (CI) 2.6–9.8), children from single pregnancies (OR 5.8, 95% CI: 3.0–11.29), full-term (OR 6.2, 95% CI: 3.2–12.3), and single full-term pregnancies (OR 6.0, 95% CI: 3.0–12.0). The influence of neonatal infections in the risk of CP development in children from pre-term and single premature pregnancies was not indicated.
Neonatal infections are an independent risk factor for CP development in newborns from full-term pregnancy (>37 weeks of pregnancy). The patho-mechanism of CP is different in children from full-term and premature pregnancy and results from interrelating factors are discussed in this paper.
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16
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Ying K, Rostenberghe HV, Kuan G, Mohd Yusoff MHA, Ali SH, Yaacob NS. Health-Related Quality of Life and Family Functioning of Primary Caregivers of Children with Cerebral Palsy in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052351. [PMID: 33670850 PMCID: PMC7957778 DOI: 10.3390/ijerph18052351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022]
Abstract
Caregiving for children with cerebral palsy (CP) has proved to negatively impact on the physical and psychological well-being of their primary caregivers. The aim of the current study was to examine the overall impact of caregiving for children with CP on the primary caregivers' health-related quality of life (HRQOL) and family functioning, and to identify potential factors associated with primary caregivers' HRQOL and family functioning. The cross-sectional study involved a total of 159 primary caregivers of children with CP with a mean age of 42.8 ± 8.4 years. Demographic data and information on the physical and leisure activities of the primary caregivers were collected, and their quality of life (QOL) was measured based on the self-reported Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Primary caregivers in the current study have shown good HRQOL and family functioning, with scores of 82.4 and 85.3 out of 100, respectively. Through multiple linear regression analyses, the mother's level of education, family monthly income, sleeping problems in children with CP, and the existence of children with other types of disability have been identified as factors contributing to HRQOL and family functioning. The findings help set out the course for stakeholders to establish action to enhance the QOL of primary caregivers.
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Affiliation(s)
- Kelvin Ying
- Interdisciplinary Health Sciences Unit, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
| | - Hans Van Rostenberghe
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Garry Kuan
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Exercise and Sports Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohammad Haris Amirul Mohd Yusoff
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Siti Hawa Ali
- Interdisciplinary Health Sciences Unit, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Correspondence: (S.H.A.); (N.S.Y.)
| | - Nik Soriani Yaacob
- Cerebral Palsy Research Cluster, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (H.V.R.); (G.K.); (M.H.A.M.Y.)
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (S.H.A.); (N.S.Y.)
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17
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Valadão P, Piitulainen H, Haapala EA, Parviainen T, Avela J, Finni T. Exercise intervention protocol in children and young adults with cerebral palsy: the effects of strength, flexibility and gait training on physical performance, neuromuscular mechanisms and cardiometabolic risk factors (EXECP). BMC Sports Sci Med Rehabil 2021; 13:17. [PMID: 33637124 PMCID: PMC7908003 DOI: 10.1186/s13102-021-00242-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Background Individuals with cerebral palsy (CP) have problems in everyday tasks such as walking and climbing stairs due to a combination of neuromuscular impairments such as spasticity, muscle weakness, reduced joint flexibility and poor coordination. Development of evidence-based interventions are in pivotal role in the development of better targeted rehabilitation of CP, and thus in maintaining their motor function and wellbeing. Our aim is to investigate the efficacy of an individually tailored, multifaceted exercise intervention (EXECP) in children and young adults with CP. EXECP is composed of strength, flexibility and gait training. Furthermore, this study aims to verify the short-term retention of the adaptations three months after the end of the EXECP intervention. Methods Twenty-four children and young adults with spastic CP will be recruited to participate in a 9-month research project with a 3-month training intervention, consisting of two to three 90-min sessions per week. In each session, strength training for the lower limbs and trunk muscles, flexibility training for the lower limbs and inclined treadmill gait training will be performed. We will evaluate muscle strength, joint flexibility, neuromuscular and cardiometabolic parameters. A nonconcurrent multiple baseline design with two pre-tests and two post-tests all interspaced by three months is used. In addition to the CP participants, 24 typically developing age and sex-matched participants will perform the two pre-tests (i.e. no intervention) to provide normative data. Discussion This study has a comprehensive approach examining longitudinal effects of wide variety of variables ranging from physical activity and gross motor function to sensorimotor functions of the brain and neuromuscular and cardiometabolic parameters, providing novel information about the adaptation mechanisms in cerebral palsy. To the best of our knowledge, this is the first intervention study providing supervised combined strength, flexibility and gait training for young individuals with CP. Trial registration number ISRCTN69044459, prospectively registered (21/04/2017).
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Affiliation(s)
- Pedro Valadão
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Harri Piitulainen
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Eero A Haapala
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tiina Parviainen
- Centre for Interdisciplinary Brain Research, University of Jyväskylä, Jyväskylä, Finland
| | - Janne Avela
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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18
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Carmona-Pérez C, Pérez-Ruiz A, Garrido-Castro JL, Vidal FT, Alcaraz-Clariana S, García-Luque L, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Design, Validity, and Reliability of a New Test, Based on an Inertial Measurement Unit System, for Measuring Cervical Posture and Motor Control in Children with Cerebral Palsy. Diagnostics (Basel) 2020; 10:E661. [PMID: 32882885 PMCID: PMC7555956 DOI: 10.3390/diagnostics10090661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to design and propose a new test based on inertial measurement unit (IMU) technology, for measuring cervical posture and motor control in children with cerebral palsy (CP) and to evaluate its validity and reliability. METHODS Twenty-four individuals with CP (4-14 years) and 24 gender- and age-matched controls were evaluated with a new test based on IMU technology to identify and measure any movement in the three spatial planes while the individual is seated watching a two-minute video. An ellipse was obtained encompassing 95% of the flexion/extension and rotation movements in the sagittal and transversal planes. The protocol was repeated on two occasions separated by 3 to 5 days. Construct and concurrent validity were assessed by determining the discriminant capacity of the new test and by identifying associations between functional measures and the new test outcomes. Relative reliability was determined using the intraclass correlation coefficient (ICC) for test-retest data. Absolute reliability was obtained by the standard error of measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90). RESULTS The discriminant capacity of the area and both dimensions of the new test was high (Area Under the Curve ≈ 0.8), and consistent multiple regression models were identified to explain functional measures with new test results and sociodemographic data. A consistent trend of ICCs higher than 0.8 was identified for CP individuals. Finally, the SEM can be considered low in both groups, although the high variability among individuals determined some high MDC90 values, mainly in the CP group. CONCLUSIONS The new test, based on IMU data, is valid and reliable for evaluating posture and motor control in children with CP.
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Affiliation(s)
- Cristina Carmona-Pérez
- Centro de Recuperación Neurológica de Córdoba (CEDANE), 14005 Córdoba, Spain;
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Alberto Pérez-Ruiz
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Juan L. Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071 Córdoba, Spain; (J.L.G.-C.); (F.T.V.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Francisco Torres Vidal
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071 Córdoba, Spain; (J.L.G.-C.); (F.T.V.)
| | - Sandra Alcaraz-Clariana
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Lourdes García-Luque
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (A.P.-R.); (F.A.-S.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
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19
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Abstract
OBJECTIVE The objective is to provide guidelines for the use of antenatal magnesium sulphate for fetal neuroprotection of the preterm infant. OPTIONS Antenatal magnesium sulphate administration should be considered for fetal neuroprotection when women present at ≤33 + 6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications. There are no other known fetal neuroprotective agents. OUTCOMES The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death. EVIDENCE Published literature was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library in December 2017, using appropriate controlled vocabulary and key words (magnesium sulphate, cerebral palsy, preterm birth). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2017. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (relative risk [RR] 0.85; 95% confidence interval [CI] 0.74-0.98; 4 trials, 4446 infants), "death or moderate-severe CP" (RR 0.85; 95% CI 0.73-0.99; 3 trials, 4250 infants), "any CP" (RR 0.71; 95% CI 0.55-0.91; 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0.60; 95% CI 0.43-0.84; 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0.60; 95% CI 0.43-0.83; 3 trials, 4287 women) at 2 years of age. Results were consistent between trials and across the meta-analyses. There is no anticipated significant increase in health care-related costs because women eligible to receive antenatal magnesium sulphate will be judged to have imminent preterm birth. VALIDATION Australian National Clinical Practice Guidelines were published in March 2010 by the Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel. Antenatal magnesium sulphate was recommended for fetal neuroprotection in the same dosage as recommended in these guidelines. However, magnesium sulphate was recommended only at <30 weeks gestation, based on 2 considerations. First, no single gestational age subgroup was considered to show a clear benefit. Second, in the face of uncertainty, the committee felt it was prudent to limit the impact of their clinical practice guidelines on resource allocation. In March 2010, the American College of Obstetricians and Gynecologists issued a Committee Opinion on magnesium sulphate for fetal neuroprotection. It stated that "the available evidence suggests that magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants." No official opinion was given on a gestational age cut-off, but it was recommended that physicians develop specific guidelines around the issues of inclusion criteria, dosage, concurrent tocolysis, and monitoring in accordance with 1 of the larger trials. Similarly, the World Health Organization also strongly recommends use of magnesium sulphate for fetal neuroprotection in its 2015 recommendations on interventions to improve preterm birth outcomes but cites further researching on dosing regimen and re-treatment. SPONSORS Canadian Institutes of Health Research (CIHR). SUMMARY STATEMENT RECOMMENDATIONS.
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20
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The effect of antenatal magnesium sulfate on intraventricular hemorrhage in premature infants: a systematic review and meta-analysis. Obstet Gynecol Sci 2020; 63:395-406. [PMID: 32689768 PMCID: PMC7393747 DOI: 10.5468/ogs.19210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/08/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. METHODS Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. RESULTS In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. CONCLUSION RESULTS of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610.
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21
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DiFazio RL, Glader LJ, Tombeno R, Lawler K, Friel K, Brustowicz RM, Shore BJ. Team Approach: The Perioperative Management of Reconstructive Hip Surgery for the Non-Ambulatory Child with Cerebral Palsy and Spastic Hip Disease. JBJS Rev 2020; 8:e1900185. [PMID: 32678539 DOI: 10.2106/jbjs.rvw.19.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cerebral palsy (CP) is the leading cause of physical disability in children. Although physical disability is the hallmark of CP, children with CP also often have complex medical comorbidities. Spastic hip subluxation is the second most common orthopaedic deformity in children with CP, and the incidence increases with the severity of CP. Hip surveillance should be implemented in children with CP to monitor hip stability over time. A reconstructive surgical procedure is recommended when the migration percentage is >40%. Perioperative care of children undergoing a hip reconstructive surgical procedure is a multidisciplinary endeavor requiring the expertise of professionals with different backgrounds. The core team should comprise orthopaedic surgeons, nurses, nurse practitioners, pediatricians, nurse case managers, anesthesiologists, and physical therapists. Additional team members include nutritionists, clinical pharmacists, social workers, child life therapists, and consulting specialty services. This review describes the team approach to the perioperative care of non-ambulatory children with spastic hip subluxation undergoing a reconstructive hip surgical procedure, utilizing a case scenario of a 7-year old girl with CP and complex associated medical comorbidities.
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Affiliation(s)
- Rachel L DiFazio
- 1Boston Children's Hospital, Boston, Massachusetts 2Harvard Medical School, Boston, Massachusetts
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22
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Bolbocean C, Shevell M. The impact of high intensity care around birth on long-term neurodevelopmental outcomes. HEALTH ECONOMICS REVIEW 2020; 10:22. [PMID: 32642972 PMCID: PMC7346442 DOI: 10.1186/s13561-020-00279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND An equitable and affordable healthcare system requires a constant search for the optimal way to deliver increasingly expensive neonatal care. Therefore, evaluating the impact of hospital intensity around birth on long-term health outcomes is necessary if we are to assess the value of high intensity neonatal care against its costs. METHODS This study exploits uneven geographical distribution of high intensity birth hospitals across Canada to generate comparisons across similar Cerebral Palsy (CP) related births treated at hospitals with different intensities. We employ a rich dataset from the Canadian Multi-Regional CP Registry (CCPR) and instrumental variables related to the mother's location of residence around birth. RESULTS We find that differences in hospitals' intensities are not associated with differences in clinically relevant, long-term CP health outcomes. CONCLUSIONS Our results suggest that existing matching mechanism of births to hospitals within large metropolitan areas could be improved by early detection of high risk births and subsequent referral of these births to high intensity birthing centers. Substantial hospitalization costs might be averted to Canadian healthcare system ($16 million with a 95% CI of $6,131,184 - $24,103,478) if CP related births were assigned to low intensity hospitals and subsequently transferred if necessary to high intensity hospitals.
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Affiliation(s)
- Corneliu Bolbocean
- Department of Preventive Medicine, University of Tennessee Health Science Centre, 66 N. Pauline Street, Memphis, TN, 38163, USA.
- The Centre for Addiction and Mental Health, Toronto, Ontario, 33 Russell St, Toronto, ON, M5S 2S1, Canada.
| | - Michael Shevell
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, QC, H3G 2M1, Canada
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23
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Fathi M, Hussein AS, M Elghazaly S, Al-Kinawy AM, Abdeltawab AK, Mansour YM, Elbehbeh NA, Sherif A, Afifi AM. Effect of Botulinum Toxin on Equinus Foot Deformity in Cerebral Palsy Patients: A Systematic Review and Network Meta-analysis. Curr Pharm Des 2020; 26:4796-4807. [PMID: 32418518 DOI: 10.2174/1381612826666200518105633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a brain disorder that affects the development, movement and posture leading to limitation of Range of Movement (ROM) in the growing children. CP leads to deformities such as equinus foot deformity. We aim to investigate the efficacy of different botulinum toxin (BTX) products with or without serial casting in reducing the muscle spasticity in equinus foot deformity in patients with CP. METHODS A systematic review of the literature was performed by searching different electronic databases. Pub- Med, Scopus, Web of Science (WOS), and GHL databases were used. We analyzed the extracted data by network meta-analysis method using the R software package (version 3.5.0). RESULTS Regarding Modified Ashworth score (MAS), BTX-A was superior compared to placebo and BTX-A plus immediate casting (MD = -0.39, 95% CI [-0.60; -0.18]) and (MD = -0.50, 95% CI [-0.98; -0.02]), respectively. Concerning growth motor function movement Classification System (GMFM), Neuronox ranked above at 3 months (MD = -1.60, 95% CI [-2.87; -0.33]) and at six months (MD = -1.90, 95% CI [-3.48; -0.32]) compared to BTX-A. Regarding the Modified Tardieu scale (MTS) with knee flexion, BTX-A was superior to BTX-A plus immediate casting (MD = 8.60, 95% CI [1.76; 15.44]). Concerning passive range of movement (PROM) with Knee flexion or extension at 3 months, BTX-A showed a significant improvement compared to BTX-A plus immediate casting. CONCLUSION BTX-A ranked best on a physician rating scale (PRS), MAS, MTS with knee flexion and PROM (Knee flexion and extension) compared to Neuronox and Botulax. BTX-A alone was also better than BTX-A plus immediate casting.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed Sherif
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Afifi
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Burak M, Kavlak E. Investigation of the relationship between quality of life, activity participation and environmental factors in adolescents with cerebral palsy. NeuroRehabilitation 2020; 45:555-565. [PMID: 31561397 DOI: 10.3233/nre-191288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy. METHODS Seventy-five (75) adolescents (M:45, F:30) aged between 14-18 years (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manual Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments. RESULTS It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions, a moderate and high level of correlation between quality of life and activity participation and body functions with gross motor function levels, and a moderate and low level correlation between environmental factors and gross motor function levels (p < 0.05). CONCLUSIONS The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.
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Affiliation(s)
- Mustafa Burak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
| | - Erdoğan Kavlak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
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25
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Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy. Diagnostics (Basel) 2020; 10:diagnostics10020080. [PMID: 32024117 PMCID: PMC7168926 DOI: 10.3390/diagnostics10020080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/29/2023] Open
Abstract
Objective: This study aimed to determine the validity and reliability of Inertial Measurement Units (IMUs) for the assessment of craniocervical range of motion (ROM) in patients with cerebral palsy (CP). Methods: twenty-three subjects with CP and 23 controls, aged between 4 and 14 years, were evaluated on two occasions, separated by 3 to 5 days. An IMU and a Cervical Range of Motion device (CROM) were used to assess craniocervical ROM in the three spatial planes. Validity was assessed by comparing IMU and CROM data using the Pearson correlation coefficient, the paired t-test and Bland–Altman plots. Intra-day and inter-day relative reliability were determined using the Intraclass Correlation Coefficient (ICC). The Standard Error of Measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90) were obtained for absolute reliability. Results: High correlations were detected between methods in both groups on the sagittal and frontal planes (r > 0.9), although this was reduced in the case of the transverse plane. Bland–Altman plots indicated bias below 5º, although for the range of cervical rotation in the CP group, this was 8.2º. The distance between the limits of agreement was over 23.5º in both groups, except for the range of flexion-extension in the control group. ICCs were higher than 0.8 for both comparisons and groups, except for inter-day comparisons of rotational range in the CP group. Absolute reliability showed high variability, with most SEM below 8.5º, although with worse inter-day results, mainly in CP subjects, with the MDC90 of rotational range achieving more than 20º. Conclusions: IMU application is highly correlated with CROM for the assessment of craniocervical movement in CP and healthy subjects; however, both methods are not interchangeable. The IMU error of measurement can be considered clinically acceptable; however, caution should be taken when this is used as a reference measure for interventions.
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Jaseja H. Management of Spasticity in Cerebral Palsy: An Electroencephalogram-Oriented Novel Approach. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1701191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractCerebral palsy (CP) is commonly associated with spasticity though the exact pathophysiology is still unknown. Management of spasticity is an important aspect of care because it can adversely affect quality of life. Patients with CP also commonly exhibit interictal epileptiform discharges (IEDs) on their electroencephalograms (EEGs) even without clinical epilepsy. This brief article studies the relationship between spasticity and IEDs. Based on the intrinsic relationship between the two and available pathophysiological evidence of spasticity, the author suggests a mandatory EEG in all patients with CP and spasticity and consideration for initiation of IEDs when detected.
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Evora A, Sloan E, Castellino S, Hawkes EW, Susko T. Pilot Study of Cadence, a Novel Shoe for Patients with Foot Drop. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5291-5296. [PMID: 31947051 DOI: 10.1109/embc.2019.8857096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Foot Drop is a mobility disorder that limits ankle dorsiflexion, complicating the swing phase of gait and balance. It is a common result of a neurological injury or disease such as stroke, cerebral palsy or multiple sclerosis. Here we present Cadence, a low-cost assistive shoe designed to passively improve the biomechanics and rhythmicity of gait for people with foot drop. The shoe reduces the magnitude of scuffing forces when dragging the foot forward across the ground by using regions of low-friction material that can retract into the shoe to restore friction during stance phase. We report the results from a pilot study of Cadence, which show the biomechanical and performance effects of the device for five adults with foot drop due to neurological disorder. In 3 of the 5 subjects, we found that the shoe immediately improved gait mechanics, speed over ground, and qualitative gait comfort.
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Chauhan A, Singh M, Jaiswal N, Agarwal A, Sahu JK, Singh M. Prevalence of Cerebral Palsy in Indian Children: A Systematic Review and Meta-Analysis. Indian J Pediatr 2019; 86:1124-1130. [PMID: 31300955 DOI: 10.1007/s12098-019-03024-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the pooled-prevalence of cerebral palsy in Indian children. METHODS The authors searched the published literature from different databases (PubMed, Ovid SP and EMBASE) and also tried to acquire information from the unpublished literature about the prevalence of cerebral palsy. They screened prospective/retrospective, cross-sectional, and cohort studies of children with cerebral palsy in the Indian population. Data were extracted from the included studies, and quality assessment was performed. Data were analysed using STATA MP12 (Texas, College Station). RESULTS Of the 862 publications searched, eight studies were qualified and included for quantitative analysis. The overall pooled prevalence of cerebral palsy per 1000 children surveyed was 2.95 (95% CI 2.03-3.88). Sub-group analysis for rural, urban and mixed rural-urban study population demonstrated the pooled prevalence as 1.83 (95% CI 0.41-3.25), 2.29 (95% CI 1.43-3.16) and 4.37 (95% CI 2.24-6.51) respectively. CONCLUSIONS This systematic review observed a paucity of high-quality, prevalence studies of cerebral palsy in India, which is a limitation to estimate the inferences for a national estimate. The observed prevalence of cerebral palsy in India is near similar to global estimates. There is a need to re-allocate resources and revisit the implementation of the existing policies for the prevention and management of cerebral palsy, taking into account the current disease burden.
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Affiliation(s)
- Anil Chauhan
- Evidence Based Health Informatics Unit, Regional Resource Centre, Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manvi Singh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nishant Jaiswal
- Evidence Based Health Informatics Unit, Regional Resource Centre, Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Agarwal
- Evidence Based Health Informatics Unit, Regional Resource Centre, Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Meenu Singh
- Evidence Based Health Informatics Unit, Regional Resource Centre, Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
BACKGROUND Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitations, leading the most common movement disorder to children. Scalp acupuncture (SA) is one of several specialized acupuncture techniques, and it has been used widely in China to alleviate several CP symptoms, despite the deficiency of high-quality evidence related to this practice. Therefore, we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of scalp acupuncture for treating CP in children. METHODS The following electronic databases will be searched from inception to May 1, 2019 MEDLINE, PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang Database, and Chinese Biomedical Literature Database (CBM). All published English and Chinese articles randomized controlled trials (RTCs) will be included. All types of CP of children in the trials will be included in this study and these individuals will be involved as core searchers to evaluate the efficacy of scalp acupuncture. Rev Man V.5.3 software will be implemented for the assessment of bias risk, data synthesis, subgroup analysis, and meta-analyses if inclusion conditions are met. Continuous outcomes will be presented as mean difference (MD) or standard mean difference (SMD), while dichotomous data will be expressed as a relative risk. RESULTS The systematic review will synthesize the available knowledge surrounding scalp acupuncture for children with CP. The findings will be synthesized to determine the efficacy and safety of scalp acupuncture for children with CP. CONCLUSION This protocol will present the evidence of whether scalp acupuncture is an effective intervention for children with CP.
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Affiliation(s)
- Go-Eun Lee
- School of Acupuncture – Tuina and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Pei-Ting Lee
- School of Acupuncture – Tuina and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Ni Ran
- Southwest Medical University, Luzhou
| | - Jianwei Zhou
- Sichuan Academy of Chinese Medicine Sciences, No. 51, Fourth Section of Ren-min South Road, Chengdu 610075, Sichuan Province, PR China
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Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, Blumberg SJ, Kogan MD, Boyle CA. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017. Pediatrics 2019; 144:peds.2019-0811. [PMID: 31558576 PMCID: PMC7076808 DOI: 10.1542/peds.2019-0811] [Citation(s) in RCA: 560] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder; autism spectrum disorder; blindness; cerebral palsy; moderate to profound hearing loss; learning disability; intellectual disability; seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated and stratified by demographic and socioeconomic characteristics. RESULTS From 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%-17.8%, P < .001), attention-deficit/hyperactivity disorder (8.5%-9.5%, P < .01), autism spectrum disorder (1.1%-2.5%, P < .001), and intellectual disability (0.9%-1.2%, P < .05), but a significant decrease for any other developmental delay (4.7%-4.1%, P < .05). The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight ≥2500 g, and children living in urban areas and with less-educated mothers. CONCLUSIONS The prevalence of developmental disability among US children aged 3 to 17 years increased between 2009 and 2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care.
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Affiliation(s)
- Benjamin Zablotsky
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland;
| | - Lindsey I Black
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Matthew J Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Michael D Kogan
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Coleen A Boyle
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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Cavarsan CF, Gorassini MA, Quinlan KA. Animal models of developmental motor disorders: parallels to human motor dysfunction in cerebral palsy. J Neurophysiol 2019; 122:1238-1253. [PMID: 31411933 PMCID: PMC6766736 DOI: 10.1152/jn.00233.2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disability in children. Much of the previous research on CP has focused on reducing the severity of brain injuries, whereas very few researchers have investigated the cause and amelioration of motor symptoms. This research focus has had an impact on the choice of animal models. Many of the commonly used animal models do not display a prominent CP-like motor phenotype. In general, rodent models show anatomically severe injuries in the central nervous system (CNS) in response to insults associated with CP, including hypoxia, ischemia, and neuroinflammation. Unfortunately, most rodent models do not display a prominent motor phenotype that includes the hallmarks of spasticity (muscle stiffness and hyperreflexia) and weakness. To study motor dysfunction related to developmental injuries, a larger animal model is needed, such as rabbit, pig, or nonhuman primate. In this work, we describe and compare various animal models of CP and their potential for translation to the human condition.
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Affiliation(s)
- Clarissa F Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Monica A Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Katharina A Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
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Duke R, Eyong K, Burton K, MacLeod D, Dutton GN, Gilbert C, Bowman R. The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: study protocol for a randomized controlled trial. Trials 2019; 20:417. [PMID: 31291989 PMCID: PMC6617659 DOI: 10.1186/s13063-019-3527-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/15/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child's environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial. METHODS/DESIGN This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4-9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1-3 and 4-5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision. DISCUSSION This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting. TRIAL REGISTRATION Pan African Clinical Trials Registration, PACTR201612001886396 . Registered on 3 December 2016.
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Affiliation(s)
- Roseline Duke
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
- Calabar Childrens’ Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | - Komomo Eyong
- Paediatric Neurology Unit, Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | | | - David MacLeod
- Calabar Childrens’ Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State Nigeria
| | | | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, WC1E 7HT UK
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Burak M, Kavlak E. Investigation of the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy. NeuroRehabilitation 2019:NRE192688. [PMID: 31282433 DOI: 10.3233/nre-192688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy. METHODS Seventy-five adolescents (M:45, F:30) ages between 14-18 yrs (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manuel Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments. RESULTS It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions; moderate and high level of correlation between quality of life and activity participation and body functions with the gross motor function levels; moderate and low level correlation between environmental factors and gross motor function levels (p < 0,05). CONCLUSIONS The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.
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Affiliation(s)
- Mustafa Burak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
| | - Erdogan Kavlak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
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Pariser JJ, Welk B, Kennelly M, Elliott SP. Reliability and Validity of the Neurogenic Bladder Symptom Score in Adults with Cerebral Palsy. Urology 2019; 128:107-111. [DOI: 10.1016/j.urology.2019.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Abstract
Cerebral palsy occurs more often in preterm than in term deliveries and is one of the major neurologic injuries seen in preterm infants. Magnesium sulfate has been found to reduce the risk of cerebral palsy in patients at risk of delivery before 32 weeks' gestational age. Multiple large clinical trials have shown this effect. The authors recommend magnesium sulfate bolus followed by continuous dosing of magnesium sulfate in those at risk of delivery before 32 weeks' gestation until delivery occurs or is no longer imminent. This article also discusses novel and emerging therapies for the prevention of cerebral palsy.
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Affiliation(s)
- Rebecca A Jameson
- Department of Obstetrics and Gynecology, The State University of New York Upstate Medical University, 750 East Adams Street, 2204 Weiskotten Hall, Syracuse, NY 13210, USA
| | - Helene B Bernstein
- Department of Obstetrics and Gynecology, The State University of New York Upstate Medical University, 750 East Adams Street, 2204 Weiskotten Hall, Syracuse, NY 13210, USA; Department of Microbiology and Immunology, The State University of New York Upstate Medical University, 750 East Adams Street, 2204 Weiskotten Hall, Syracuse, NY 13210, USA.
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LI QING, KINSMAN STEPHENL, JENKINS DOROTHEAD, HOVELL MELBOURNEF, RYAN RITAM. Decreasing prevalence of cerebral palsy in birth cohorts in South Carolina using Medicaid, disability service, and hospital discharge data, 1996 to 2009. Dev Med Child Neurol 2019; 61:593-600. [PMID: 30417338 PMCID: PMC6450726 DOI: 10.1111/dmcn.14085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/27/2022]
Abstract
AIM Since cross-sectional trends of 8-year-old cerebral palsy (CP) birth prevalence based on record review were stable from 1985 to 2002 in Metropolitan Atlanta, we examined birth cohort trends using administrative data sets promptly. METHOD Among 755 433 live births from 1996 to 2009 in South Carolina, 2080 received CP diagnosis by age 4 years from linked Medicaid claims with International Classification of Diseases, Ninth Revision codes 343.X (contributing 1061 [51%] unique cases), hospital discharge data (57 [3%] unique cases), and Department of Disabilities and Special Needs program (64 [3%] unique cases). Trends were assessed using negative binominal regression. RESULTS Including 3.7 percent of cases who died before age 4 years, CP prevalence per 1000 live births decreased significantly from 3.6 in 1996 to 2.1 in 2006 (-3.0% average annual change; 95% confidence interval -4.4 to -1.6). The overall prevalence was 2.8 per 1000 live births, 46.0 per 1000 very-low-birthweight (VLBW) live births, and 53.0 per 1000 VLBW 1-year survivors. Disparities and downward trends persisted across subgroups with higher rates among non-Hispanic black infants than non-Hispanic white and among males compared to females. INTERPRETATION Downward CP prevalence rates and persistent disparities remain in South Carolina. Further research should validate this methodology, including early deaths, and develop broad surveillance systems to inform clinical practices and etiology. WHAT THIS PAPER ADDS Birth cohort cerebral palsy (CP) prevalence decreased in South Carolina from 1996 to 2009. CP prevalence was higher in very-low-birthweight infants, non-Hispanic blacks, and males. Three administrative data sets captured 2080 patients with CP in South Carolina. Medicaid claims contributed 51% of unique cases of CP to the cohort. CP diagnoses included 76 patients who died before age 4 years.
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Affiliation(s)
- QING LI
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - STEPHEN L. KINSMAN
- Department of Pediatrics, Division of Pediatric Neurology, Medical University of South Carolina, Charleston, SC
| | - DOROTHEA D JENKINS
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, USA
| | - MELBOURNE F HOVELL
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - RITA M RYAN
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, USA
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Pinto F, Fernandes E, Virella D, Abrantes A, Neto M. Born Preterm: A Public Health Issue. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2019. [DOI: 10.1159/000497249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Kang J, Ghonasgi K, Walsh CJ, Agrawal SK. Simulating Hemiparetic Gait in Healthy Subjects Using TPAD With a Closed-Loop Controller. IEEE Trans Neural Syst Rehabil Eng 2019; 27:974-983. [PMID: 30932841 DOI: 10.1109/tnsre.2019.2907683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hemiparetic gait is abnormal asymmetric walking, often observed among patients with cerebral palsy or stroke. One of the major features of asymmetric gait is excessive reliance on the healthy leg, which results in improper load shift, slow walking speed, higher metabolic cost, and weakness of the unused leg. Hence, clinically it is desirable to promote gait symmetry to improve walking. While there are no clear methods to achieve this goal, we are exploring new methods where we guide the pelvis to change the gait symmetry. This controller is designed to mimic the hands of a physical therapist holding the pelvis and guiding it to promote the usage of both legs during walking. In this paper, we show that the essence of this method can be demonstrated by promoting asymmetry in the gait of healthy subjects when walking with the device. The results showed that their kinematics and kinetics changed asymmetrically during the intervention. Subjects demonstrated asymmetric lateral ground reaction force to compensate for the lateral forces applied on the pelvis. Muscle activities increased on the targeted leg show the forced use of the leg which can be used for rehabilitation of patients with an asymmetric gait.
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Magee LA, De Silva DA, Sawchuck D, Synnes A, von Dadelszen P. No 376 - Recours au sulfate de magnésium aux fins de neuroprotection fœtale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:523-542. [DOI: 10.1016/j.jogc.2018.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McPhee PG, Benner JL, Balemans ACJ, Verschuren O, van den Berg-Emons RJG, Hurvitz EA, Peterson MD, van der Slot WMA, Roebroeck ME, Gorter JW. Multimorbidity risk assessment in adolescents and adults with cerebral palsy: a protocol for establishing a core outcome set for clinical research and practice. Trials 2019; 20:176. [PMID: 30890152 PMCID: PMC6425572 DOI: 10.1186/s13063-019-3265-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Estimates of multimorbidity, defined as the presence of at least two chronic conditions, some of which attributable to modifiable behaviours, are high in adults with cerebral palsy (CP). An assessment protocol evaluating multimorbidity risk is needed in order to develop and evaluate effective interventions to optimize lifelong health in individuals with CP. The aim of this protocol paper is to describe the development of a core outcome set (COS) for assessing multimorbidity risk in adolescents and adults with CP, to be used in clinic and research. METHODS The expert consortium will first define the target population and outcomes to be measured. Through a process of literature review and an international Delphi survey with expert clinicians and researchers, we will then determine which outcome measurement instruments (OMIs) can best measure those outcomes. The resulting OMIs will be used in a feasibility study with adolescents and adults with CP from an international clinical research network. Finally, a face-to-face stakeholder meeting with adolescents and adults with CP, their families/caregivers and researchers and clinicians who are experts in CP, will be organized to reach final agreement on the COS. DISCUSSION This COS will guide clinicians and researchers in assessing multimorbidity risk in adolescents and adults with CP. The inclusion of experts and individuals with CP from international locations for establishing the COS lends strong support to its generalizability. Evidence of its feasibility and approval from all stakeholders will enable implementation in clinical practice, and guide future research using the COS in individuals with CP.
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Affiliation(s)
- Patrick G McPhee
- School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Astrid C J Balemans
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Public Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - Wilma M A van der Slot
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
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Prolonged length of stay for acute hospital admissions as the increasing of age: A nationwide population study for Taiwan's patients with cerebral palsy. Pediatr Neonatol 2019; 60:74-82. [PMID: 29739652 DOI: 10.1016/j.pedneo.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/21/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Studies investigating reasons for the admission and the associated lengths of stay (LOSs) among cerebral palsy (CP) patients are limited. This study determined common reasons for acute hospitalizations and the LOSs among children, adolescents, and young adults with CP. METHODS We performed a secondary analysis of data. CP patients aged 4-32.9 years were identified by CP registry in the catastrophic illness patient registry of the 2010 Taiwan National Health Insurance Research Database. Data of admission claims from 2010 to 2011 were analyzed. Reasons for admissions were identified according to International Classification of Diseases codes. Common reasons, frequencies of admissions for each reason, and LOSs were reported. RESULTS Pneumonia, other respiratory problems, and epilepsy were the top three reasons for admissions in all groups. Other common reasons in all groups were sepsis, other respiratory infections, and gastrointestinal problems. The reasons specific to children included orthopedic issues; ear, nose, and throat problems; and urinary tract infections (UTIs). In youths, scoliosis, and contractures, were unique reasons. In young adults, UTIs, blood problems, and mental illness, were special reasons. Most admission reasons appeared to prolong LOS, and the LOS exhibited an increasing trend as age increased. CONCLUSION The results implied that patients with CP are more susceptible to most disease invasions. Our results also suggest that the current care system in Taiwan is unsuitable for patients with CP. These results can be used as guidance for planning effective multidisciplinary assessments in the future.
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Chiang KL, Kuo FC, Cheng CY, Chang KP. Prevalence and demographic characteristics of comorbid epilepsy in children and adolescents with cerebral palsy: a nationwide population-based study. Childs Nerv Syst 2019; 35:149-156. [PMID: 30074083 DOI: 10.1007/s00381-018-3920-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The nationwide prevalence of cerebral palsy (CP) is unknown due to the lack of a population-based registration system for CP in Taiwan. This study was the largest nationwide, population-based, cross-sectional study to estimate the prevalence of CP, prevalence rates of comorbid epilepsy in patients with CP, and association with socioeconomic status (SES) in Taiwan. The crude prevalence rate and age- and gender-specific prevalence rates were estimated. METHODS A total of 8419 patients with CP were enrolled, and the estimated prevalence of CP was 1.76‰ in the pediatric population and 1.51‰ and 1.98‰ in girls and boys, respectively. The prevalence rate of epilepsy in patients with CP was 29.8%. RESULTS The result revealed a higher prevalence of CP and epileptic CP in members of families with lower insurance premiums than those with higher insurance premiums and those from East Taiwan compared with those from other areas of Taiwan. Moreover, a higher prevalence of CP is shown in rural area than urban area. DISCUSSION SES and geographic variables were significantly associated with the risk of epilepsy in children with CP. Patients with epileptic CP had a higher odds ratio of several neuropsychiatric diseases, including mental retardation, ophthalmologic problems, hearing impairment, and hydrocephalus.
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Affiliation(s)
- Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Road, Shalu District, Taichung, 433, Taiwan, Republic of China.,Program of Health Administration, Tunghai University, No.1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung, 40704, Taiwan.,Department of Nutrition, Hungkuang University, No. 1018, Section 6, Taiwan Boulevard, Shalu District, Taichung, 43302, Taiwan
| | - Fang-Chuan Kuo
- Department of Physical Therapy, Hungkuang University, No. 1018, Section 6, Taiwan Boulevard, Shalu District, Taichung, 43302, Taiwan
| | - Chen-Yang Cheng
- Program of Health Administration, Tunghai University, No.1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung, 40704, Taiwan. .,Department of Industrial Engineering and Management, National Taipei University of Technology, Section 3, Zhongxiao East Road, Taipei, 10608, Taiwan, Republic of China.
| | - Kai-Ping Chang
- Department of Pediatrics, Taipei Veterans General Hospital, No.201, Section 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan
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Smith DD, Sagaram D, Miller R, Gyamfi-Bannerman C. Risk of cerebral palsy by gestational age among pregnancies at-risk for preterm birth. J Matern Fetal Neonatal Med 2018; 33:2059-2063. [PMID: 30318944 DOI: 10.1080/14767058.2018.1536745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Our objective was to describe cerebral palsy (CP) incidence stratified by gestational age (GA) groups within a group at risk for spontaneous preterm birth (sPTB).Study design: This is a secondary analysis of a large study of magnesium for neuroprotection. Nonanomalous, singleton gestations complicated by preterm premature rupture of membranes (PPROM) or preterm labor (PTL) were included. Infants that developed CP were compared to controls that did not. The incidence of CP was stratified by GA groups. A logistic regression model was fit to adjust for confounders.Results: Of 1747 included pregnancies, 75 (4.3%) were affected by CP. Increasing GA at delivery was associated with lower rates of CP (RR 0.96, 95% CI 0.95-0.97; p<.0001). The most significant risk factor for CP was neonatal sepsis while the most significant protective factors were magnesium and antibiotic exposure. In the adjusted analysis, magnesium exposure (aRR 0.52, 95% CI 0.33-0.84; p = .007) and antibiotic exposure (aRR 0.52, 95% CI 0.28-0.95; p = .034) remained protective.Conclusion: The risk of CP among populations at high risk for sPTB decreases with advancing GA. While the majority of cases of CP occurred in children born <34 weeks, residual risk persisted thereafter. The effect of magnesium exposure is most pronounced before 28 weeks.
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Affiliation(s)
- Devin D Smith
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Deepika Sagaram
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Russell Miller
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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Ahmadi M, O’Neil M, Fragala-Pinkham M, Lennon N, Trost S. Machine learning algorithms for activity recognition in ambulant children and adolescents with cerebral palsy. J Neuroeng Rehabil 2018; 15:105. [PMID: 30442154 PMCID: PMC6238270 DOI: 10.1186/s12984-018-0456-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/06/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common physical disability among children (2.5 to 3.6 cases per 1000 live births). Inadequate physical activity (PA) is a major problem effecting the health and well-being of children with CP. Practical, yet accurate measures of PA are needed to evaluate the effectiveness of surgical and therapy-based interventions to increase PA. Accelerometer-based motion sensors have become the standard for objectively measuring PA in children and adolescents; however, current methods for estimating physical activity intensity in children with CP are associated with significant error and may dramatically underestimate HPA in children with more severe mobility limitations. Machine learning (ML) models that first classify the PA type and then predict PA intensity or energy expenditure using activity specific regression equations may be more accurate than standalone regression models. However, the feasibility and validity of ML methods has not been explored in youth with CP. Therefore, the purpose of this study was to develop and test ML models for the automatic identification of PA type in ambulant children with CP. METHODS Twenty two children and adolescents (mean age: 12.8 ± 2.9 y) with CP classified at GMFCS Levels I to III completed 7 activity trials while wearing an ActiGraph GT3X+ accelerometer on the hip and wrist. Trials were categorised as sedentary (SED), standing utilitarian movements (SUM), comfortable walking (CW), and brisk walking (BW). Random forest (RF), support vector machine (SVM), and binary decision tree (BDT) classifiers were trained with features extracted from the vector magnitude (VM) of the raw acceleration signal using 10 s non-overlapping windows. Performance was evaluated using leave-one-subject out cross validation. RESULTS SVM (82.0-89.0%) and RF (82.6-88.8%) provided significantly better classification accuracy than BDT (76.1-86.2%). Hip (82.7-85.5%) and wrist (76.1-82.6%) classifiers exhibited comparable prediction accuracy, while the combined hip and wrist (86.2-89.0%) classifiers achieved the best overall performance. For all classifiers, recognition accuracy was excellent for SED (94.1-97.9%), good to excellent for SUM (74.0-96.6%) and brisk walking (71.5-86.0%), and modest for comfortable walking (47.6-70.4%). When comfortable and brisk walking were combined into a single walking class, recognition accuracy ranged from 90.3 to 96.5%. CONCLUSIONS ML methods provided acceptable classification accuracy for detection of a range of activities commonly performed by ambulatory children with CP. The resultant models can help clinicians more effectively monitor bouts of brisk walking in the community. The results indicate that 2-step models that first classify PA type and then predict energy expenditure using activity specific regression equations are worthy of exploration in this patient group.
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Affiliation(s)
- Matthew Ahmadi
- Institute of Health and Biomedical Innovation at QLD Centre for Children’s Health Research, School of Exercise and Nutrition Sciences, Queensland University of Technology, 62 Graham St, South Brisbane, QLD 4101 Australia
| | - Margaret O’Neil
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry St., Philadelphia, PA USA
| | | | - Nancy Lennon
- Gait Analysis Laboratory, AI DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE USA
| | - Stewart Trost
- Institute of Health and Biomedical Innovation at QLD Centre for Children’s Health Research, School of Exercise and Nutrition Sciences, Queensland University of Technology, 62 Graham St, South Brisbane, QLD 4101 Australia
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Abstract
Spasticity is a movement disorder characterized by a velocity-dependent increase in muscle tone and a hyperexcitable stretch reflex. Common causes of spasticity include cerebral palsy, spinal cord injury, and stroke. Surgical treatment plans for spasticity must be highly individualized and based on the characteristics of patients and the spasticity in order to maximize functional gains. Candidates for surgery must be carefully selected. In this article, the authors review the pathophysiology of spasticity and discuss general considerations for surgical management with an emphasis on patient factors and spasticity characteristics. Specific considerations for the common causes of spasticity are presented.
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Affiliation(s)
- Michael S Gart
- Plastic & Reconstructive Surgery, Hand and Upper Extremity Surgery, OrthoCarolina Hand Center, 1915 Randolph Road, Charlotte, NC 28207, USA
| | - Joshua M Adkinson
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 232, Indianapolis, IN 46202, USA.
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Abstract
Spasticity is a motor disorder that manifests as a component of the upper motor neuron syndrome. It is associated with paralysis and can cause significant disability. The most common causes leading to spasticity include stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and cerebral palsy. This article discusses the pathophysiology and clinical findings associated with each of the most common etiologies of upper extremity spasticity.
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Cherni Y, Pouliot Laforte A, Parent A, Marois P, Begon M, Ballaz L. Lower limb extension is improved in fast walking condition in children who walk in crouch gait. Disabil Rehabil 2018; 41:3210-3215. [PMID: 30266072 DOI: 10.1080/09638288.2018.1493158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background and purpose: The strategies for walking fast have never been reported in children with cerebral palsy who walk in crouch gait. This study aimed to assess to what extent children who walk in crouch gait are able to increase their gait speed and to report the corresponding three-dimensional kinematic adaptations.Methods: Eleven children and adolescents (aged between 7 and 17 years) with bilateral cerebral palsy, who walk in crouch gait, were asked to walk at their self-selected comfortable speed and then as fast as possible without running. The spatio-temporal and kinematic parameters, as well as the center of mass displacements were compared between walking conditions.Results: Children were able to walk 30% faster than their comfortable speed (+0.30 m/s, p = 0.000) by increasing both cadence (+21 step/min, p = 0.000) and step length (+0.05 m, p = 0.001). During the stance phase, pelvis anteversion (+3 Deg, p = 0.010), hip flexion-extension range of motion (+4 Deg, p = 0.002), and knee extension (+5 Deg, p = 0.000) were increased in fast walking. During fast walking, the center of mass showed larger range of vertical displacements (p < 0.05).Conclusions: Children with cerebral palsy who walk in crouch gait increased their walking speed by adopting a less crouched posture. Compared to comfortable walking speed condition, fast walking could be beneficial in rehabilitation to solicit higher lower limbs range of motion.Implications for rehabilitation:Children who walk in crouch gait can walk 30% fasterFast walking required higher hip and knee extensions during stance phaseFast walking could be an interesting training modality to improve the lower limb range of motion of children who walk in crouch gait.
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Affiliation(s)
- Yosra Cherni
- School of Kinesiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Annie Pouliot Laforte
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
| | - Audrey Parent
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
| | - Pierre Marois
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Mickael Begon
- School of Kinesiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Laurent Ballaz
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Department of Physical Activity Sciences, Université de Québec à Montréal, Montréal, Québec, Canada
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Tabrizi PR, Obeid R, Mansoor A, Ensel S, Cerrolaza JJ, Penn A, Linguraru MG. Cranial ultrasound-based prediction of post hemorrhagic hydrocephalus outcome in premature neonates with intraventricular hemorrhage. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:169-172. [PMID: 29059837 DOI: 10.1109/embc.2017.8036789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Premature neonates with intraventricular hemorrhage (IVH) followed by post hemorrhagic hydrocephalus (PHH) are at high risk for brain injury. Cranial ultrasound (CUS) is used for monitoring of premature neonates during the first weeks after birth to identify IVH and follow the progression to PHH. However, the lack of a standardized method for CUS evaluation has led to significant variability in decision making regarding treatment. We propose a quantitative imaging tool for the evaluation of PHH on CUS for premature neonates based on morphological features of the cerebral ventricles. We retrospectively studied 64 extremely premature neonates born less than 29 weeks gestational age, less than 1,500 grams weight at birth, admitted to our center within two weeks of life, and diagnosed with different grades of IVH. We extracted morphological features of the lateral ventricles from CUS imaging using image analysis techniques to compare neonates who needed a temporizing intervention to treat PHH to the ones who did not. From the original set of features, an optimal ranking was obtained based on linear support vector machine. A subset of features was subsequently selected that maximizes the overall accuracy level. Regarding whether or not there was a need for temporizing intervention, we predicted the outcome of PHH with an improved accuracy level of 84%, compared to the 76% rate obtained by linear manual measurement. The proposed imaging tool allowed us to establish a quantitative method for PHH evaluation on CUS in extremely premature neonates with IVH. Further studies will help standardize the evaluation of CUS in those neonates to institute treatments earlier and improve outcomes.
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The use of clinical examination and cranial ultrasound in the diagnosis and management of post-hemorrhagic ventricular dilation in extremely premature infants. J Perinatol 2018; 38:374-380. [PMID: 29255191 DOI: 10.1038/s41372-017-0017-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study is to describe clinical and ultrasound changes in a cohort of premature newborns with post-hemorrhagic ventricular dilation (PHVD), and to correlate these changes with outcome. STUDY DESIGN Premature newborns <29 weeks gestational age (GA) and ≤ 1,500 g birth weight with intraventricular hemorrhage were retrospectively reviewed. Clinical signs and cranial ultrasound (CUS) findings between time after birth and time before first cerebrospinal fluid temporizing intervention were compared with GA-equivalent newborns without interventions. White matter injury was assessed on brain magnetic resonance imaging. RESULTS Between 2011 and 2014, 64 newborns met inclusion criteria; 23% had PHVD. The growth rates of the ventricles on CUS and the head circumference (HC) were higher in newborns with PHVD (p < 0.01 and p = 0.04, respectively) and correlated inversely with white matter injury (p = 0.006 and p < 0.001, respectively). CONCLUSION Progression of PHVD in premature newborns as demonstrated by CUS and the HC correlated with outcome. Consistent measurement of these simple parameters will allow for much needed treatment comparisons, to define optimal protocols that decrease the risk of cerebral palsy in extremely preterm populations.
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Nutritional and dental issues in patients with intellectual and developmental disabilities. J Am Dent Assoc 2018; 149:317-321. [DOI: 10.1016/j.adaj.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/06/2017] [Accepted: 11/11/2017] [Indexed: 11/23/2022]
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