The effect of postural control and balance on femoral anteversion in children with spastic cerebral palsy

Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review

(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.

Measuring muscle activation using electromyography during neurodevelopmental treatment in individuals with severe cerebral palsy

BACKGROUND

In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide.

OBJECTIVE

To verify muscle activation in NDT handling in individuals with severe CP using electromyography.

METHODS

This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV-V) and 20 typically-developing individuals (control group). These groups were homogeneous with respect to age and gender.

RESULTS

There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, "sitting on horseback", sitting on the roll, and proprioceptive stimulation sitting on the ball.

CONCLUSION

The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP.

Evaluation of postural control in children with increased femoral anteversion

BACKGROUND

Femoral anteversion is defined as the angular difference between the axis of the femoral neck and the transcondylar axis of the knee and the most common cause of an in-toe gait in children.

RESEARCH QUESTION

Does increased femoral anteversion (IFA) adversely affect postural stability and balance in healthy children?

METHODS

Sixteen children with IFA aged 10-15 years and an age-matched control group of 16 children who were growing typically were included. Postural stability (PS), limits of stability (LoS), and the modified clinical test of sensory integration of balance (mCTSIB) were used to evaluate postural control by "Biodex Balance System® (BBS)" and Balance Error Scoring System (BESS), which is a visual observation of instability in 3 stance positions under 6 different conditions, were performed for all cases. SPSS v.20 program was used for data analysis. Independent Samples T-test or Mann Whitney U test were used for between-group comparisons depending on the distribution properties of the data. The significance level was set at p < 0.05.

RESULTS

A significant difference was found between the groups for overall and anterior/posterior stability index in PS (p < 0.05), all parameters of LoS (p < 0.05) and mCTSIB (p < 0.05). Also there was a significant difference between the BESS firm surface (p = 0.007), BESS foam surface (p < 0.001), and total surface scores (p < 0.001).

SIGNIFICANCE

The results indicate that the children with IFA were significantly more unstable in all parameters of BBS and BESS when compared to their healthy peers. This shows that postural stability and balance are impaired in healthy children with IFA. To the extent of our knowledge, this study is the first to examine the postural control problems associated with IFA in healthy children.

Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial

BACKGROUND:

Spasticity is common in cerebral palsy and can result in pain and diminished health-related quality of life.

OBJECTIVE:

To evaluate the safety and efficacy of onabotulinumtoxinA for lower limb spasticity treatment in children with cerebral palsy.

METHODS:

In this registrational phase 3, multinational, randomized, double-blind, placebo-controlled trial (NCT01603628), children (2–< 17 years) with cerebral palsy and ankle spasticity (Modified Ashworth Scale-Bohannon [MAS] score≥2) were randomized 1 : 1 : 1 to standardized physical therapy and onabotulinumtoxinA (4 or 8 U/kg), or placebo. Primary endpoint was average change from baseline at weeks 4 and 6 in MAS ankle score. Secondary endpoints included the Modified Tardieu Scale (MTS) and Global Attainment Scale (GAS).

RESULTS:

381 participants were randomized. MAS scores averaged at weeks 4 and 6 were significantly reduced with both onabotulinumtoxinA doses (8 U/kg: –1.06, p = 0.010; 4 U/kg: –1.01, p = 0.033) versus placebo (–0.8). Significant improvements in average dynamic component of spasticity, measured by MTS, and in function, measured by GAS, were observed at several time points with both onabotulinumtoxinA doses versus placebo. Most adverse events were mild or moderate.

CONCLUSIONS:

OnabotulinumtoxinA was well tolerated and effective in reducing lower limb spasticity and improving functional outcomes versus placebo in children.

Correlation between the Korean Version of the Trunk Control Measurement Scale and the Selective Control Assessment of the Lower Extremity Scores in Children with Cerebral Palsy

Background and Objectives: The purpose of this study was to investigate the correlation between the Korean version of the trunk control measurement scale (K-TCMS) and the selective control assessment of the lower extremity (SCALE). Through this, we tried to find out the effect of proximal stabilization on distal motor development. Materials and Methods: Fifty-one children with gross motor function classification system level I–III, diagnosed with cerebral palsy (CP), were studied. The K-TCMS was used to evaluate the body control ability of the children. SCALE was used to quantify selective voluntary motor control (SVMC). Results: Analysis of SCALE and K-TCMS showed a significant positive correlation in all items. Multiple regression analysis showed that the SCALE score decreased as age increased, and that it increased as the static sitting balance ability score and the dynamic sitting balance ability score of the K-TCMS increased significantly (p < 0.05). Conclusions: In children with cerebral palsy, there was a close correlation between trunk control and selective voluntary motor control of the lower extremities. Therefore, when trying to improve the lower extremity function of a child with cerebral palsy, a trunk control intervention should be considered.

Trunk and pelvic alignment in relation to postural control in children with cerebral palsy

BACKGROUND

Trunk-pelvic mal-alignment and postural control deficit are common problems facing children with cerebral palsy (CP).

OBJECTIVE

The aim of this study was to investigate the relation of trunk and pelvic alignment with postural control in children with diplegic CP.

METHODS

Seventy seven children with spastic diplegic CP, aged from 6 to 8 years with level II on Gross Motor Function Classification System, participated in this study. Trunk imbalance, lateral deviation of the spine and pelvic tilt were evaluated by using Formetric instrumentation system while postural control was assessed by using Pediatric Balance Scale.

RESULTS

The results showed that there was a moderate negative correlation of trunk imbalance, lateral deviation of the spine and pelvic tilt with postural control (-0.44, -0.59 and -0.57, respectively).

CONCLUSIONS

Increased trunk imbalance, lateral deviation of the spine and pelvic tilt may be associated with decreased postural control ability in children with diplegic CP.

[Effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy]

OBJECTIVE

To study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.

METHODS

A total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.

RESULTS

Over the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).

CONCLUSIONS

Suspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.

[Effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy]

OBJECTIVE

To study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.

METHODS

A total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.

RESULTS

Over the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).

CONCLUSIONS

Suspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.