Cerebral palsy in children: a clinical overview

The effectiveness of non-invasive brain stimulation in enhancing lower extremity function in children with spastic cerebral palsy: Protocol for a systematic review and meta-analysis

Non-invasive brain stimulation (NIBS) techniques have emerged as a promising non-pharmacological adjunct to neurorehabilitation. Children with Cerebral Palsy (CP) exhibit altered cortical excitability, and while CP remains incurable, physiotherapy combined with other interventions is essential for managing motor dysfunction. Although some studies have examined NIBS using various stimulation parameters, there is limited evidence regarding its effects on the lower extremities and optimal administration protocols. This review aims to evaluate the effectiveness of NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for the treatment of motor function in spastic cerebral palsy, specifically in the lower extremity. A systematic search will be conducted in databases including MEDLINE, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. The search strategy will follow the PICO framework (Participants, Intervention, Comparison, Outcomes), focusing on randomized controlled trials (RCTs). Two independent reviewers will manage screening, selection, data extraction, risk of bias assessment, and grading of evidence. This review will provide key insights into the effectiveness of NIBS for lower-extremity function in children with spastic CP, guiding future research and clinical applications.

Effects of mind-body exercise in children with cerebral palsy-A systematic review and meta-analysis

BACKGROUND AND PURPOSE

An increasing number of studies have investigated the efficacy of mind-body exercise in the treatment of children with cerebral palsy (CP). However, the findings of these researches have produced inconsistent results. The objective of this study was to evaluate the effects of mind-body exercise on children with CP in order to provide more conclusive results.

MATERIALS AND METHODS

A comprehensive search was conducted in PubMed, Cochrane, Embase, Web of Science, and Ovid databases from inception to May 2024. One researcher extracted the data, including first author, study type, country, year of publication, population, age, sample size, intervention details and outcomes, accuracy was verified by a second researcher. The included studies were analyzed using Review Manager 5.4 (RevMan 5.4) and StataNow/MP 18.5 software, with publication bias examined using funnel plots, and result stability assessed through sensitivity analysis.

RESULTS

A total of six eligible studies, comprising 173 patients, were included in the meta-analysis. The results of the meta-analysis indicated that mind-body exercise can improve balance function in children with CP (SMD = 0.48, P = 0.006). There was no significant difference in the effect of mind-body exercise on walking function in children with CP (SMD = -0.23, P = 0.58).

CONCLUSION

Compared with routine care and rehabilitation, mind-body exercise may provide a safe and convenient approach to improving balance functions in children with CP, but showed no statistically significant beneficial effects on walking in children with CP.

PROSPERO REGISTRATION NUMBER

CRD42024534257.

Split tendon transfer of the posterior tibialis for spastic equinovarus foot deformity: Does tendon routing impact post-operative ankle kinematics?

BACKGROUND

Split tendon transfer of the posterior tibialis (SPOTT) is a surgical procedure in which the split posterior tibialis tendon is transferred posterior to the fibula (PO) with insertion on the peroneus brevis tendon to rebalance the forces across the hindfoot. Routing of the split tendon through the interosseous membrane (IO) is a variation with the potential benefit of augmenting ankle dorsiflexion in swing.

RESEARCH QUESTION

Does IO routing improve ankle dorsiflexion in swing and/or varus in stance compared to PO routing?

METHODS

A retrospective chart review was completed to identify forty-two patients who underwent a SPOTT procedure for equinovarus foot deformity. 14 patients received IO routing and 28 received PO routing. Two main outcomes: maximum ankle dorsiflexion in swing and average ankle coronal angle in stance were analyzed using a mixed effects model.

RESULTS

Both the IO and PO routing significantly improved maximum dorsiflexion in swing (p = 0.018 and p = 0.001, respectively.) There was no significant difference in the maximum dorsiflexion during swing, post-operatively, between the two groups (p = 0.431). Pre-operatively, patients in the IO group exhibited significantly more average ankle varus during stance, with a median of 6.7 degrees of varus compared to a median of 1.8 degrees of varus in the PO group (p = 0.024). The IO group yielded a statistically significant reduction in average ankle varus during stance (p < 0.001) whereas there was no significant change in the PO group (p = 0.138). There was no difference between groups in proportion of patients that achieved an average ankle coronal angle during stance within one SD of normative data (between -8.7 and 0.7 degrees, p = 0.381).

SIGNIFICANCE

The SPOTT procedure utilized for correction of spastic equinovarus foot deformity, can improve ankle kinematics with routing of the tendon through the IO membrane or posterior to the fibula if performed concurrently with the appropriate tendon lengthening to address equinus contracture. More clinical studies are needed to better understand potential confounding factors.

Multimodal fuzzy logic-based gait evaluation system for assessing children with cerebral palsy

Gait analysis is crucial for identifying functional deviations from the normal gait cycle and is essential for the individualized treatment of motor disorders such as cerebral palsy (CP). The primary contribution of this study is the introduction of a multimodal fuzzy logic system-based gait index (FLS-GIS), designed to provide numerical scores for gait patterns in both healthy children and those with CP, before and after surgery. This study examines and evaluates the surgical outcomes in children with CP who have undergone Achilles tendon lengthening. The FLS-GIS utilizes hierarchical feature fusion and fuzzy logic models to systematically evaluate and score gait patterns, focusing on spatial and temporal features across the hip, knee, and ankle joints. The two FLS types-1 (FLS-GIS-T1) and type-2 (FLS-GIS-T2) indices, respectively, were implemented to comprehensively study gait profiles. Starting with the gait parameters of all subjects, the changes in gait parameters in post-surgery children reflect significant improvements in gait dynamics, bringing walking patterns in CP children closer to those of their typically healthy peers. Both FLS-GIS-T1 and FLS-GIS-T2 demonstrated significant improvements in post-surgery evaluations compared to pre-surgery assessments, with p values < 0.05 and < 0.001, respectively, when compared to traditional indices. The proposed FLS-based index offers clinicians a robust and standardized gait evaluation tool, characterized by a fixed range of values, enabling consistent assessment across various gait conditions.

Understanding Parental Satisfaction in Caring for Children with Cerebral Palsy

INTRODUCTION

The life satisfaction of parents of children with cerebral palsy should be assessed. Parenting a child with a disability may bring more challenges and efforts, impacting overall quality of life.

AIM OF THE STUDY

the study aimed to evaluate the satisfaction with life of parents of children with cerebral palsy.

MATERIAL AND METHODS

The study was designed to assess the satisfaction with life of parents of children with cerebral palsy. To measure this outcome, we developed an original survey consisting of 29 questions inspired by the Satisfaction With Life Scale (SWLS). The study involved 43 parents or legal guardians of children diagnosed with cerebral palsy.

RESULTS

A correlation was identified between parental life satisfaction and the amount of leisure time reported by parents (p = 0.004, R = 0.46). The research indicates that parental life satisfaction does not depend on the parent's satisfaction with the level of therapy (p > 0.05) and the degree of improvement in the child's functioning (p > 0.05).

CONCLUSIONS

The level of parental life satisfaction does not depend on the level and outcome of therapy. The more leisure time the parents have, the greater their life satisfaction is. Parents of children with cerebral palsy should take care of their free time.

An automated framework for pediatric hip surveillance and severity assessment using radiographs

PURPOSE

Hip dysplasia is the second most common orthopedic condition in children with cerebral palsy (CP) and may result in disability and pain. The migration percentage (MP) is a widely used metric in hip surveillance, calculated based on an anterior-posterior pelvis radiograph. However, manual quantification of MP values using hip X-ray scans in current standard practice has challenges including being time-intensive, requiring expert knowledge, and not considering human bias. The purpose of this study is to develop a machine learning algorithm to automatically quantify MP values using a hip X-ray scan, and hence provide an assessment for severity, which then can be used for surveillance, treatment planning, and management.

METHODS

X-ray scans from 210 patients were curated, pre-processed, and manually annotated at our clinical center. Several machine learning models were trained using pre-trained weights from Inception ResNet-V2, VGG-16, and VGG-19, with different strategies (pre-processing, with and without region of interest (ROI) detection, with and without data augmentation) to find an optimal model for automatic hip landmarking. The predicted landmarks were then used by our geometric algorithm to quantify the MP value for the input hip X-ray scan.

RESULTS

The pre-trained VGG-19 model, fine-tuned with additional custom layers, outputted the lowest mean squared error values for both train and test data, when ROI cropped images were used along with data augmentation for model training. The MP value calculated by the algorithm was compared to manual ground truth labels from our orthopedic fellows using the hip screen application for benchmarking.

CONCLUSION

The results showed the feasibility of the machine learning model in automatic hip landmark detection for reliably quantifying MP value from hip X-ray scans. The algorithm could be used as an accurate and reliable tool in orthopedic care for diagnosing, severity assessment, and hence treatment and surgical planning for hip displacement.

The relationship between pneumonia and dental visits in patients with cerebral palsy: A nationwide registry-based cohort study in Taiwan

Background/purpose

In general, improving oral health can reduce the risk of pneumonia. The purpose of this retrospective cohort study was to investigate the risk of pneumonia between cerebral palsy (CP) cohort and non-CP cohort as well as the association of pneumonia with the number of dental visits in CP patients in Taiwan.

Materials and methods

We identified 10,544 patients who were diagnosed with CP between 2010 and 2019 from the Taiwan National Health Insurance Research Database. 63,264 individuals who had never been diagnosed with CP were captured and matched in a 6:1 ratio. Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between CP cohort and non-CP cohort.

Results

Our findings demonstrated that CP cohort had 2.619-fold risk for pneumonia as compared with non-CP cohort after adjustment (95 % CI = 2.574-2.813, P < 0.0001). Cox regression analysis indicated that the CP group had significantly higher incidence risk of pneumonia (log rank P < 0.0001). Higher risks of pneumonia in CP patients were associated with younger age, and lower urbanization level. Some comorbidities as well as history of pneumonia had the higher aHR for pneumonia within 180 days prior to index date. In addition, there was a positive association with the more than two dental visits for the decrease 0.887-fold incidence of pneumonia in CP-cohort as compared with no dental visit (95 % CI: 0.799-0.984).

Conclusion

Taken together, CP patients had a higher risk of pneumonia. Dental visits are beneficial for preventing the risk of pneumonia in CP patients. The patients with CP should receive regular dental checkup.

Development of a Virtual Robot Rehabilitation Training System for Children with Cerebral Palsy: An Observational Study

This paper presents the development of a robotic system for the rehabilitation and quality of life improvement of children with cerebral palsy (CP). The system consists of four modules and is based on a virtual humanoid robot that is meant to motivate and encourage children in their rehabilitation programs. The efficiency of the developed system was tested on two children with CP. The effect of using the robot is an increase in the number of exercise repetitions, as well as the time spent on therapy, developing and strengthening the child's musculature. Additionally, the children are able to produce socially acceptable gestures in the context of non-verbal communication for socialization. The main advantages of this system are its flexibility and ease of use. Besides the proposed use in CP rehabilitation, this system can be used in the rehabilitation of people recovering from surgery or injuries. Use of the proposed system significantly decreases the work load of the therapist who would be conducting the repetitive motion, allowing the therapist to see an increased number of patients. In the future, the number of different movements the robot is able to perform will be increased by way of domain-specific modelling and language.

Selective dorsal rhizotomy outcomes in mixed spasticity and dystonia cases

INTRODUCTION

This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.

METHOD

A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.

RESULTS

Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.

CONCLUSION

SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.

Association between hand grip strength and quality of life in children with cerebral palsy: a cross-sectional study

Background

Cerebral palsy (CP) covers a wide range of causes and symptoms. It is characterized by persistent motor and postural dysfunction caused by a non-progressing pathological lesion of the immature brain. Development of fine motor skills, such as the ability to manipulate objects with smaller muscles, is crucial for a child's development. It is evident that there is a lack of hand grip strength (HGS) and quality of life (QoL) data in children with CP compared to typically developed (TD) children. Understanding the relationship between these factors might help facilitate healthcare provision and provide insight into rehabilitation programs. The aim of this study is to investigate the relationship between HGS and health-related quality of life (HRQoL) in children with CP compared to TD children.

Methods

An experimental cross-sectional study was conducted and 60 children (30 CP and 30 TD) were chosen; age, gender, height, weight, body mass index, preferred hand, number of siblings, school attendance, and housing type data were collected. HGS was measured using a standard hand dynamometer, and HRQoL was measured using the KIDSCREEN-10 item questionnaire.

Results

There was a statistically significant main effect of gender on the average HGS, F (1, 56) = 24.09, p < 0.001, and the KIDSCREEN-10 sum score, F (1, 56) = 8.66, p < 0.001, and the main effect of group on the KIDSCREEN-10 sum score, F (1, 56) = 17.64, p < 0.001. A significant correlation between HGS and the KIDSCREEN-10 sum score in the CP group (r = 0.35, p = 0.03), and the TD group (r = 0.56, p = 0.001).

Conclusion

HGS was lower in children with CP, and girls had significantly lower HGS compared to boys in both groups, CP and TD children. HRQoL was significantly lower in children with CP, with boys reporting higher HRQoL on the KIDSCREEN-10 questionnaire compared to girls. Our data showed that the higher the KIDSCREEN-10 sum score is, the stronger the HGS of children in both groups. The results of this study indicate that hand grip strength may significantly impact the QoL of children with CP. A correlation between HGS and HRQoL points to the importance of improving strength in children with CP through interventions and directed rehabilitation programs.

A Combined Comprehensive Palliative and Rehabilitative Care Plan for a Child With Cerebral Palsy

Cerebral palsy (CP) is a group of neurological disorders that affect movement, muscle tone, and motor skills. Here, we present a case of an 11-year-old female patient who presented with tightness in both lower limbs, since birth, and delayed walking, accompanied by difficulty walking due to spasticity. She was diagnosed with spastic diplegic cerebral palsy. This case highlights the combined use of palliative and rehabilitative care. Developmental milestones were delayed, and she was diagnosed with CP at an early age. A comprehensive treatment plan was implemented, including physical therapy, speech therapy, and pharmacological treatment with baclofen to reduce spasticity. Non-pharmacological treatments such as neurodevelopmental therapy, biofeedback, and orthotic support were also employed. The child's rehabilitation progress included improved mobility, speech fluency, and reduced spasticity, with notable benefits in gait. Palliative care played a critical role in addressing the emotional, psychological, and social aspects of the child's condition and providing the family support, counseling, and guidance on managing the care burden. This integrated approach emphasizes the importance of early palliative care alongside rehabilitation to optimize a child's quality of life. This case highlights how a multidisciplinary approach addressing both physical and emotional needs can lead to better overall outcomes for children with cerebral palsy, improving not just mobility but also their well-being and family support system.

Risperidone-Induced Hypothermia in a Cerebral Palsy Patient: A Case Report and Literature Review

Cerebral palsy (CP) is a debilitating disorder that can lead to life-long disability, with a high incidence in Saudi Arabia. Secondary epilepsy and cardiac complications are common in CP patients. We present a rare case of a 17-year-old female with CP, attention-deficit hyperactivity disorder (ADHD), secondary epilepsy, and a history of post-cardiac arrest, with home medications carbamazepine, risperidone, and sodium valproate. The patient presented with behavioral changes, bradycardia, hypothermia, and hypotension. The patient experienced a generalized tonic-clonic seizure, which was treated. Despite initial interventions, bradycardia and hypothermia persisted. Cardiology evaluation revealed normal cardiac function. Risperidone was temporarily replaced with clonazepam and hydrocortisone, resulting in the patient's arousal and stable vital signs. During the course of hospitalization, the patient also developed watery diarrhea, which was resolved after stopping antibiotics on the sixth day. The patient was discharged after 13 days with stable vital signs and follow-up instructions. This case highlights the complexity of managing CP patients with multiple comorbidities and the importance of a multidisciplinary approach to their care. It also underscores the urgent need for further research to improve the understanding of CP and its associated complications and develop more effective management strategies.

Artificial intelligence and machine learning approaches in cerebral palsy diagnosis, prognosis, and management: a comprehensive review

Cerebral palsy (CP) is a group of disorders that alters patients' muscle coordination, posture, and movement, resulting in a wide range of deformities. Cerebral palsy can be caused by various factors, both prenatal and postnatal, such as infections or injuries that damage different parts of the brain. As brain plasticity is more prevalent during childhood, early detection can help take the necessary course of management and treatments that would significantly benefit patients by improving their quality of life. Currently, cerebral palsy patients receive regular physiotherapies, occupational therapies, speech therapies, and medications to deal with secondary abnormalities arising due to CP. Advancements in artificial intelligence (AI) and machine learning (ML) over the years have demonstrated the potential to improve the diagnosis, prognosis, and management of CP. This review article synthesizes existing research on AI and ML techniques applied to CP. It provides a comprehensive overview of the role of AI-ML in cerebral palsy, focusing on its applications, benefits, challenges, and future prospects. Through an extensive examination of existing literature, we explore various AI-ML approaches, including but not limited to assessment, diagnosis, treatment planning, and outcome prediction for cerebral palsy. Additionally, we address the ethical considerations, technical limitations, and barriers to the widespread adoption of AI-ML for CP patient care. By synthesizing current knowledge and identifying gaps in research, this review aims to guide future endeavors in harnessing AI-ML for optimizing outcomes and transforming care delivery in cerebral palsy rehabilitation.

Transcutaneous Spinal Stimulation Combined with Locomotor Training Improves Functional Outcomes in a Child with Cerebral Palsy: A Case Study

BACKGROUND AND PURPOSE

activities-based locomotor training (AB-LT) is a restorative therapeutic approach to the treatment of movement deficits in people with non-progressive neurological conditions, including cerebral palsy (CP). Transcutaneous spinal stimulation (TSS) is an emerging tool in the rehabilitation of individuals with sensorimotor deficits caused by neurological dysfunction. This non-invasive technique delivers electrical stimulation over the spinal cord, leading to the modulation of spinal sensorimotor networks. TSS has been used in combination with AB-LT and has been shown to improve muscle activation patterns and enhance motor recovery. However, there are no published studies comparing AB-LT + TSS to AB-LT alone in children with CP. The purpose of this case study was to compare the impact of AB-LT alone versus AB-LT combined with TSS on functional movement and quality of life in a child with CP.

METHODS

A 13-year-old male with quadriplegic CP participated in this pilot study. He was classified in the Gross Motor Function Classification System (GMFCS) at Level III. He completed 20 sessions of AB-LT (5x/week), then a 2-week washout period, followed by 20 sessions of body-AB-LT + TSS. Treatment sessions consisted of 1 h of locomotor training with body weight support and manual facilitation and 30 min of overground play-based activities. TSS was applied using the RTI Xcite®, with stimulation at the T11 and L1 vertebral levels. Assessments including the Gross Motor Function Measure (GMFM), 10-m walk test (10 MWT), and Pediatric Balance Scale (PBS) were performed, while spatiotemporal gait parameters were assessed using the Zeno Walkway®. All assessments were performed at three time points: before and after AB-LT, as well as after AB-LT + TSS.

OUTCOMES

After 19/20 sessions of AB-LT alone, the participant showed modest improvements in the GMFM scores (from 86.32 to 88), 10 MWT speed (from 1.05 m/s to 1.1 m/s), and PBS scores (from 40 to 42). Following the AB-LT combined with TSS, scores improved to an even greater extent compared with AB-LT alone, with the GMFM increasing to 93.7, 10 MWT speed to 1.43 m/s, and PBS to 44. The most significant gains were observed in the GMFM and 10 MWT. Additionally, improvements were noted across all spatiotemporal gait parameters, particularly at faster walking speeds. Perhaps most notably, the child transitioned from the GMFCS level III to level II by the end of the study.

DISCUSSION

Higher frequency and intensity interventions aimed at promoting neuroplasticity to improve movement quality in children with CP are emerging as a promising alternative to traditional physical therapy approaches. This case study highlights the potential of TSS to augment neuroplasticity-driven treatment approaches, leading to improvements in neuromotor function in children with CP. These findings suggest that TSS could be a valuable addition to rehabilitation strategies, warranting further research to explore its efficacy in larger populations.

The circular RNA circNFIX regulates MEF2C expression in muscle satellite cells in spastic cerebral palsy

Cerebral palsy (CP) is a pediatric onset disorder with poorly understood molecular causes and progression, making early diagnosis difficult. Circular RNAs are regulatory RNAs that show promise as biomarkers in various diseases but the role of circular RNAs in CP is beginning to be understood. This study identified the role of circNFIX in regulating the expression of myocyte-specific enhancer factor 2C (MEF2C), an important transcription factor for sarcomere development. We found that circNFIX is downregulated in the muscle cells of individuals with CP, and its localization shifts toward the nucleus as visualized using single-molecule resolution imaging. The decreased expression of circNFIX, MEF2C, and MEF2C targets persisted throughout myoblasts to myotubes differentiation, and in the skeletal muscle tissue. Bioinformatic and experimental validation confirmed that circNFIX acts as a sponge for miR373-3p, a microRNA that represses MEF2C translation. In normal muscle, circNFIX derepresses MEF2C translation by sponging miR373-3p, allowing for normal sarcomere generation. In CP, reduced circNFIX expression results in loss of miRNA sponging, leading to lower MEF2C expression and downregulation of sarcomere genes, potentially causing shortened and dysfunctional muscle fibers. Knockdown (KD) of circNFIX reduced myogenic capacity of myoblasts to fuse and form myotubes similar to CP cells evident from the lower fusion index in CP and KD as compared to control myotubes. This is the first study reporting reduction of MEF2C in CP and single-molecule resolution imaging of circNFIX's subcellular distribution and its role in CP, suggesting circNFIX as a potential therapeutic target and biomarker for early CP diagnosis.

Epilepsy in Cerebral Palsy: Unraveling Prevalence, Risk Factors, and Subtype Associations in a Large-Scale Population Study

Background and Objective: Cerebral palsy (CP) constitutes a group of enduring movement disorders arising from non-progressive brain damage, often accompanied by epilepsy. This study aims to explore the prevalence of epilepsy in CP patients, dissecting demographic characteristics, healthcare parameters, and nuanced risk factors. Materials and Methods: The study employed the National Inpatient Sample (NIS) database (2016-2019, four years). CP patients were identified through ICD-10 codes, excluding non-CP patients and those with missing values. Baseline characteristics of CP patients, such as age, subtype distribution, and types of epilepsy, were tabulated, and disparities were assessed using the chi-squared test. Univariate and multivariate logistic regression analyses were conducted to examine predictors of epilepsy according to CP subtypes and infant-related conditions. Data were presented as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results: In this comprehensive analysis of 88,138 CP patients, 44,901 with epilepsy and 43,237 without epilepsy, disparities between those with and without epilepsy were uncovered, revealing distinct demographic patterns and healthcare characteristics. Spastic diplegic CP showed the strongest association with epilepsy (adjusted OR = 1.88, 95% CI [1.73-2.04], p < 0.0001), underscoring the significance of subtype-specific considerations. Perinatal infection emerged as a noteworthy risk factor for epilepsy development (adjusted OR = 1.61, 95% CI [1.17-2.23], p = 0.004). Conclusions: The study provides nuanced insights into the prevalence and associations of epilepsy in CP patients. Specific CP subtypes and perinatal factors play pivotal roles in epilepsy risk. These findings offer a foundation for tailored clinical management and support services, addressing the complex needs of individuals with CP and epilepsy.

Comparison of participation in out-of-school activities, activity preferences and quality of life of children with cerebral palsy and typical development

The aim of this correlational study was to compare the participation in out of school activities, activity preferences, and quality of life (QoL) of children between 8 and 12 years of age with cerebral palsy (CP) (n = 30) and typical development (n = 60) in Turkey. Outcome measures included the Children's Assessment of Participation and Enjoyment, Preferences for Activity of Children, and the Health-Related Quality of Life Questionnaire. Results suggest children with CP were at a disadvantage compared to their typically developing peers in participating in out-of-school activities, however they tended to report greater preference for these activities than their typically developing peers. Based on these findings, we recommended health professionals aim to increase the quality of life for clients with CP by including social participation as one component of rehabilitation.

Parental acceptance of dental treatment with SDF in children with CP

INTRODUCTION

This study aims to evaluate parental acceptance of dental treatment with silver diamine fluoride (SDF) in children with cerebral palsy (CP).

METHODS

The present study is a case-control study with 80 children in the age range of 6-11 years. Group I consisted of children diagnosed with CP and Group II consisted of children without any Special Health Care Needs and systemic conditions. Preoperative and postoperative behavior assessment was done using Frankl's behavior Rating Scale. 38 % SDF application was done in any one primary molar with occlusal dentinal caries. A well-designed validated structured questionnaire with 10 questions was developed to assess the parental acceptance of dental treatment with SDF. The questionnaire comprised 10 close-ended questions with subdivisions on socio-demographic details, the reason for the previous and current dental visit, and acceptance of dental treatment with SDF. The data were analyzed using SPSS (version 26, IBM, Chicago, USA). Continuous variables were expressed as mean ± standard deviation (M ± SD). Categorical variables were expressed as frequency (n) and percentage (%). The chi-square test was used for qualitative analysis. The level of significance was set at 5%.

RESULTS

The number of children showing positive behavior on Frankl's behavior Rating Scale increased from 55% to 70% after dental treatment with SDF and this difference was statistically significant in Group I (p-value < 0.001). 87.5% of parents in Group I had accepted the discoloration caused after dental treatment with SDF compared to 80% in Group II. In Group I, 95% of parents agreed strongly, while in Group II, 82.5% agreed strongly that SDF can be done on un-cooperative and special health care needs children. This difference in agreement seen between parents of Group I and Group II was found to be statistically significant (p-value = 0.02). Also, the acceptance of SDF was found to be higher in parents who were educationally more qualified in Group I. This difference in the acceptance level of SDF seen based on the educational status of parents was statistically significant (p-value < 0.001).

CONCLUSION

Parental acceptance of SDF for dental treatment was higher in Group I (children with CP) as a greater number of parents accepted dental treatment despite discoloration with the modality being noninvasive and less time-consuming. Improved behavior rating was observed among children in both groups after dental treatment with SDF.

Infant sleep spindle measures from EEG improve prediction of cerebral palsy

OBJECTIVE

Early identification of infants at risk of cerebral palsy (CP) enables interventions to optimize outcomes. Central sleep spindles reflect thalamocortical sensorimotor circuit function. We hypothesized that abnormal infant central spindle activity would predict later contralateral CP.

METHODS

We trained and validated an automated detector to measure spindle rate, duration, and percentage from central electroencephalogram (EEG) channels in high-risk infants (n = 35) and age-matched controls (n = 42). Neonatal magnetic resonance imaging (MRI) findings, infant motor exam, and CP outcomes were obtained from chart review. Using univariable and multivariable logistic regression models, we examined whether spindle activity, MRI abnormalities, and/or motor exam predicted future contralateral CP.

RESULTS

The detector had excellent performance (F1 = 0.50). Spindle rate (p = 0.005, p = 0.0004), duration (p < 0.001, p < 0.001), and percentage (p < 0.001, p < 0.001) were decreased in hemispheres corresponding to future CP compared to those without. In this cohort, PLIC abnormality (p = 0.004) and any MRI abnormality (p = 0.004) also predicted subsequent CP. After controlling for MRI findings, spindle features remained significant predictors and improved model fit (p < 0.001, all tests). Using both spindle duration and MRI findings had highest accuracy to classify hemispheres corresponding to future CP (F1 = 0.98, AUC 0.999).

CONCLUSION

Decreased central spindle activity improves the prediction of future CP in high-risk infants beyond early MRI or clinical exam alone.

SIGNIFICANCE

Decreased central spindle activity provides an early biomarker for CP.

Effects of motor and cognitive dual tasks on walking and balance in children with diparetic cerebral palsy

This study investigates the effects of motor and cognitive dual tasks on walking and balance in Children with diparetic cerebral palsy. The subjects of this study were 12 children (experimental group n = 6, control group n = 6) who were medical diagnosed with diparetic cerebral palsy. They aged 8-12 years. Experimental group was administered treatment for 30 min, 2 times a week for 8 weeks, with the experimental group performing motor and cognitive dual task, while the control group did not have such a training. Wilcoxon signed-rank test was performed to analyze changes in balance, gross motor function in the group, and the Mann-Whitney test was conducted to compare the differences between the two groups before and after intervention. In This study, the mean time for completing the Timed Up and Go Test in single and dual tasks and mean cognitive responses, there was a significant difference between the two groups (P < 0.05). Conclusion: Considering that many activities in daily life are dual tasks, these difficulties they experience in performing dual tasks show that children's daily lives are also affected. Therefore, dual task evaluations are very important for individuals to be independent in daily life.

Enhanced Infant Movement Analysis Using Transformer-Based Fusion of Diverse Video Features for Neurodevelopmental Monitoring

Neurodevelopment is a highly intricate process, and early detection of abnormalities is critical for optimizing outcomes through timely intervention. Accurate and cost-effective diagnostic methods for neurological disorders, particularly in infants, remain a significant challenge due to the heterogeneity of data and the variability in neurodevelopmental conditions. This study recruited twelve parent-infant pairs, with infants aged 3 to 12 months. Approximately 25 min of 2D video footage was captured, documenting natural play interactions between the infants and toys. We developed a novel, open-source method to classify and analyse infant movement patterns using deep learning techniques, specifically employing a transformer-based fusion model that integrates multiple video features within a unified deep neural network. This approach significantly outperforms traditional methods reliant on individual video features, achieving an accuracy of over 90%. Furthermore, a sensitivity analysis revealed that the pose estimation contributed far less to the model's output than the pre-trained transformer and convolutional neural network (CNN) components, providing key insights into the relative importance of different feature sets. By providing a more robust, accurate and low-cost analysis of movement patterns, our work aims to enhance the early detection and potential prediction of neurodevelopmental delays, whilst providing insight into the functioning of the transformer-based fusion models of diverse video features.

Arachnoid Cyst as a Late Complication of Selective Dorsal Rhizotomy: A Case Report

Background and importance  Selective dorsal rhizotomy (SDR) is a surgical technique to treat spasticity, mainly in children with spastic cerebral palsy (CP). In this report, a unique case of a late arachnoid cyst, causing radiating pain in the left leg, is presented. This is relevant to clinicians managing the long-term follow-up of patients who underwent selective dorsal rhizotomy (SDR). Clinical presentation  A 25-year-old male with bilateral spastic CP, who underwent SDR at the age of 7, presented with symptoms of progressive radiating pain in the left leg. Magnetic resonance imaging (MRI) revealed the presence of a large arachnoid cyst and a remarkable dorsal position of the cauda equina. After dissection of the cyst, the previously experienced radiating pain immediately subsided; however, the patient developed urinary retention and constipation. Cauda compression was ruled out by MRI. The constipation subsided quickly, and the patient performed self-catheterization until 1 month postoperatively for the urinary retention after which there were no signs of ongoing bladder dysfunction. Conclusion  Arachnoid cyst formation can be a late complication of SDR and can cause lumbosacral radicular syndrome in the late postoperative course in select cases.

Femoral neck-shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy

Introduction

The neck-shaft angle and head-shaft angle in children with varying levels of neurological disability were evaluated to define change over different ages.

Methods

Children aged 1-12 years with spastic cerebral palsy, spinal muscular atrophy types 1 and 2, or typical development were reviewed to evaluate the neck-shaft angle and head-shaft angle. Patients were divided into five groups: Gross Motor Function Classification System levels I and II, Gross Motor Function Classification System level III, Gross Motor Function Classification System levels IV and V, spinal muscular atrophy types 1 and 2, and typical development. A linear mixed model was utilized to evaluate neck-shaft angle and head-shaft angle.

Results

Data from 196 children (mean age 4.8 ± 4.5 years) were included. Gross Motor Function Classification System levels I and II: 22 children, 130 hip radiographs measured, neck-shaft angle 143.7 ± 7.4, and head-shaft angle 160.0 ± 7.1. Gross Motor Function Classification System level III: 8 children, 33 hips evaluated, neck-shaft angle 153.1 ± 4.3, and head-shaft angle 163.4 ± 4.2. Gross Motor Function Classification System levels IV and V: 30 children, 137 hip radiographs measured, neck-shaft angle 156.4 ± 5.6, and head-shaft angle 167.9 ± 6.8. Spinal muscular atrophy types 1 and 2: 32 children, 83 hip radiographs measured, neck-shaft angle 161.9 ± 9.7, and head-shaft angle 173.4 ± 7.4. Typical development: 104 children, 222 hip radiographs measured, neck-shaft angle 138.6 ± 7.0, and head-shaft angle 156.4 ± 5.9. There were significant statistical differences when comparing neck-shaft angle and head-shaft angle.

Conclusion

As children grow, neck-shaft angle and head-shaft angle tend to decrease in typical development and Gross Motor Function Classification System levels I and II groups. However, in low-tone (spinal muscular atrophy types 1 and 2) and high-tone groups (Gross Motor Function Classification System levels IV and V), neck-shaft angle and head-shaft angle tend to increase with age. In both low-tone and high-tone groups, coxa valga is observed. When evaluating the effect of proximal femur-guided growth, these defined normal growth patterns should be considered.

Level of Evidence

Level III Retrospective comparative study.

The Effect of Transcranial Direct Current Stimulation on M1 with and without Mirror Visual Feedback on Range of Motion and Hand Grip Strength of the Affected Upper Limb in Children with Spastic Hemiplegic Cerebral Palsy

Objectives

This study investigated the effects of transcranial direct current stimulation (tDCS) before and during the mirror visual feedback (MVF) on hand grip strength (HGS) and range of motion of the affected hand in children with spastic hemiplegia cerebral palsy (SHCP).

Materials & Methods

Twelve children with SHCP participated in this randomized, crossover, and double-blind study. They were randomly exposed to one of four intervention conditions, including 1) a-tDCS-offline, 2) s-tDCS-offline, 3) a-tDCS-online, and 4) s-tDCS-online, with a one-week interval. Participants in the online condition received either anodal or sham tDCS during MVF, while those in the offline condition received tDCS before performing MVF. The tDCS was applied over the M1 area of the affected hemisphere for 20 minutes at 1 mA intensity. The HGS and range of motion of the wrist and elbow (ROM-W and ROM-E) of the affected limb were measured before (pre) and immediately after (post) interventions in each session.

Results

The results showed that the HGS was significantly higher under a-tDCS-offline (p=0.001), s-tDCS-offline (p=0.004), and s-tDCS-online (p=0.005) compared to the a-tDCS-online. Moreover, the ROM-W was significantly higher under a-tDCS-offline (p=0.034), s-tDCS-offline (0.011), and s-tDCS-online (p=0.027) compared to the a-tDCS-online. Eventually, the ROM-E was significantly higher under a-tDCS-offline, s-tDCS-offline, and s-tDCS-online compared to the a-tDCS-online (p ˂0.001; p ˂0.001; p=0.01, respectively).

Conclusion

The results might have practical implications regarding the timing of the application of tDCS in conjunction with MVF in children with SHCP.

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Physical activity and sedentary behavior among ambulatory children with cerebral palsy using accelerometer: a cross-sectional study

Background and objective

Physical activity (PA) is paramount for childhood development and growth. However, children diagnosed with Cerebral Palsy (CP) were often considered sedentary, and their physical inactivity was associated with adverse health conditions and complications. Therefore, this study aimed to objectively describe and compare the PA levels and SB levels of children with and without CP of the same age group. It also studied the factors correlating with PA, SB, and step count per day in children with CP.

Subjects and methods

A cross-sectional study using a wrist-worn accelerometer was conducted. PA and SB were measured over seven consecutive days.

Results

Eighty-five children aged 6-12 years, consisting of 41 children with CP and 44 TD children, participated in this study with a mean age of 9.18 ± 1.95 and 8.45 ± 1.78 years, respectively. According to the gross functional measures, 53.6% of children with CP were classified as first classification. A significant amount of time was spent in SB and Light PA (LPA) by children with CP compared to TD children, and no significant differences were observed in moderate PA (MPA) or step count. Gender mainly affected MPA as girls spent more time in MPA than boys. The age, height, and weight of children with CP correlate significantly with SB. As children's age, height, and weight increase, SB increases. Additionally, children with higher weights have lower step counts per day.

Conclusion

This study showed that children with CP spend more time in LPA and SB than typically developed children. Therefore, concerted efforts are needed to encourage physical activity and reduce the sedentary lifestyle, to take into account the gender and anthropometric measures of children to enhance the quality of life among children with CP, and to consider gender and anthropometric measures of the children.

Correlation between Bronchopulmonary Dysplasia and Cerebral Palsy in Children: A Comprehensive Analysis Using the National Inpatient Sample Dataset

Background: The existing literature lacks conclusive evidence regarding the relationship between bronchopulmonary dysplasia (BPD) and cerebral palsy (CP). This large epidemiological study aimed to explore the co-occurrence of BPD and CP among children. Methods: This retrospective cohort analysis utilized the National Inpatient Sample (NIS) dataset from 2016 to 2019, investigating pediatric patients with BPD and CP diagnoses. Descriptive and inferential statistics, including univariate and multivariate regression analyses, were conducted to explore the association between BPD and CP. Results: Overall, 3,951,039 patients were analyzed. Among them, 28,880 patients had CP (n = 796 with BPD and n = 28,084 without BPD). The rates of intraventricular hemorrhage grade 3 and 4, central nervous system anomalies, chromosomal disorders, retinopathy of prematurity (≥grade 3), periventricular leukomalacia, prematurity, and low birth weight were significantly higher in the CP-with-BPD arm contrasted to the CP-without-BPD arm. Univariate regression demonstrated a significant BPD-CP association (odds ratio [OR] = 7.78, 95% confidence interval [CI]: 7.24-8.37, p < 0.0001). Multivariate analysis, adjusting for various confounders, reinforced this association (OR = 5.70, 95% CI: 5.17-6.28, p < 0.0001). We observed a significant association between increasing prematurity in neonates with BPD and an elevated risk of CP. Conclusions: This nationwide study identified a strong correlation between the co-occurrence of BPD and CP, though it does not establish causality. Rigorous adjustments revealed that patients with BPD appear to have a six-fold increased likelihood of being diagnosed with CP later on, compared to those without BPD. While aligned with the existing literature, this study represents the largest sample size with recommendations for targeted preventive strategies to mitigate the burden of CP.

Comparison of the Effect of Two Therapeutic Interventions for the Treatment of Chronic Constipation in Children With Cerebral Palsy: A Randomized Clinical Trial

Objectives. Constipation is one of the most common gastrointestinal symptoms in children with neurological disorders. This study was performed to compare the therapeutic effect of polyethylene glycol (PEG) plus domperidone with PEG plus placebo in the treatment of chronic constipation in children with cerebral palsy. Methods. In this a double-blind clinical trial study was done on the children with cerebral palsy who had chronic constipation and was referred to Mohammad Kermanshahi hospital of Kermanshah city in the west of Iran. The participants were randomly divided into 2 groups with 2 therapies of PEG combined with domperidone (case group, n = 21) and PEG with placebo (control group, n = 21). The information was extracted from patients based on the checklist before and after treatment and the response to treatment in the 2 groups were determined and compared. The data were analyzed by T-test or Mann-Whitney U test to compare quantitative variables and Chi-square and Fisher's exact tests for comparing qualitative variables. Results. In both case and control groups, all Rome IV criteria for a diagnosis of chronic constipation except incontinence were significantly reduced after treatment. However, the successful response rate in the case group (PEG + domperidone) was 90.5%, while this rate was 61.9% in the control group. Conclusion. Based on the results of the present study, it seems that PEG plus domperidone had a positive effect on the treatment of children with cerebral palsy and chronic constipation.

The use of shear-wave elastography for the assessment of muscle spasticity in patients with cerebral palsy, a systematic review

We explore the use of shear wave elastography (SWE) for assessing muscle stiffness and treatment response in cerebral palsy (CP) children by way of a systematic review. SWE offers real-time muscle stiffness measurements, showing significant differences between CP patients and controls. Studies suggest that SWE can be used to follow muscle stiffness post-botulinum toxin treatment, correlating with clinical improvement. However, methodological variations and small sample sizes prevent comparison between different studies. Standardized protocols could enhance SWE's clinical utility. In conclusion, SWE holds promise for CP management, though standardized methodologies and larger studies are needed to validate its efficacy and integration into clinical practice.

Mesenchymal Stem Cell-Induced Neuroprotection in Pediatric Neurological Diseases: Recent Update of Underlying Mechanisms and Clinical Utility

Pediatric neurological diseases refer to a group of disorders that affect the nervous system in children. These conditions can have a significant impact on a child's development, cognitive function, motor skills, and overall quality of life. Stem cell therapy is a new and innovative approach to treat various neurological conditions by repairing damaged neurons and replacing those that have been lost. Mesenchymal stem cells (MSCs) have gained significant recognition in this regard due to their ability to differentiate into different cell types. MSCs are multipotent self-replicating stem cells known to render promising results in the treatment of stroke and spinal cord injury in adults. When delivered to the foci of damage in the central nervous system, stem cells begin to differentiate into neural cells under the stimulation of paracrine factors and secrete various neurotrophic factors (NTFs) like nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) that expedite the repair process in injured neurons. In the present review, we will focus on the therapeutic benefits of the MSC-based therapies in salient pediatric neurological disorders including cerebral palsy, stroke, and autism.

Tendon transfer in spastic cerebral palsy upper limb

Cerebral palsy (CP) in upper limb produces functional, aesthetic and hygienic issues, and is not always amenable to surgical procedures. We are reporting a single-center, long follow-up experience with tendon transfer in wrist and forearm CP. The CP cases who had undergone tendon transfer in hand, wrist and forearm in a 14-year period were evaluated for change in motion, function and cosmetic appearance and also assessed by Manual Ability Classification System (MACS), and Dash (Disability of Arm, Shoulder, Hand) scores. Forty-two spastic CP patients with a mean age of 19.81 (10-34 years, SD: 5.36) years with a mean follow-up of 5.5 (2-14) years, entered the study. 24 cases were GMFCS I or II and 18 were III or IV. Supination beyond neutral was seen in 48.5%, and improvement in MACS scores in all the cases. Improved 'grasp' and 'release' and keyboard use was seen in 50%, 71% and 87% respectively. The satisfaction from appearance and improved function of 83-96% correlated positively with GMFSC, MACS and DASH scores. Noticeable improvement in personal hygienic care was seen in only 52% of cases. Tendon transfer in well-selected spastic upper extremity CP cases results in long-time improved function, and limb appearance - correlating with initial GMFCS and MACS scores.

Uncovering early predictors of cerebral palsy through the application of machine learning: a case-control study

OBJECTIVE

Cerebral palsy (CP) is a group of neurological disorders with profound implications for children's development. The identification of perinatal risk factors for CP may lead to improved preventive and therapeutic strategies. This study aimed to identify the early predictors of CP using machine learning (ML).

DESIGN

This is a retrospective case-control study, using data from the two population-based databases, the Slovenian National Perinatal Information System and the Slovenian Registry of Cerebral Palsy. Multiple ML algorithms were evaluated to identify the best model for predicting CP.

SETTING

This is a population-based study of CP and control subjects born into one of Slovenia's 14 maternity wards.

PARTICIPANTS

A total of 382 CP cases, born between 2002 and 2017, were identified. Controls were selected at a control-to-case ratio of 3:1, with matched gestational age and birth multiplicity. CP cases with congenital anomalies (n=44) were excluded from the analysis. A total of 338 CP cases and 1014 controls were included in the study.

EXPOSURE

135 variables relating to perinatal and maternal factors.

MAIN OUTCOME MEASURES

Receiver operating characteristic (ROC), sensitivity and specificity.

RESULTS

The stochastic gradient boosting ML model (271 cases and 812 controls) demonstrated the highest mean ROC value of 0.81 (mean sensitivity=0.46 and mean specificity=0.95). Using this model with the validation dataset (67 cases and 202 controls) resulted in an area under the ROC curve of 0.77 (mean sensitivity=0.27 and mean specificity=0.94).

CONCLUSIONS

Our final ML model using early perinatal factors could not reliably predict CP in our cohort. Future studies should evaluate models with additional factors, such as genetic and neuroimaging data.

Exploring the Relationship between Cerebral Palsy and Hip Dysplasia: Insights from the National Inpatient Sample

Background and Objective: Cerebral palsy (CP) significantly impacts quality of life globally. Hip dysplasia (HD) is a common musculoskeletal issue in CP patients. This study investigates the prevalence, risk factors, and impact of HD on CP patients using a large national database. Materials and Methods: Data from the National Inpatient Sample (NIS) database (2016-2019) were used, identifying CP and HD diagnoses through ICD-10 codes. Baseline characteristics were tabulated. Univariate and multivariate logistic regression analyses examined predictors of HD development in CP patients, presenting data as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Among 3,951,040 pediatric patients, 28,880 had CP (27,466 without HD, and 1414 with HD), and 3,922,160 did not have CP. CP significantly increased the likelihood of developing HD in univariate (OR = 35.03, 95% CI [33.01, 37.17], p < 0.0001) and multivariate (OR = 26.61, 95% CI [24.94, 28.40], p < 0.0001) analyses. Among patients with CP, race was significantly associated with HD, with ORs below 1 for all racial categories compared to Whites. Females had nearly twice the odds of HD compared to males (OR = 1.96, 95% CI [1.86, 2.05], p < 0.0001). Age was significantly associated with HD, with each additional year increasing the odds (OR = 1.03, 95% CI [1.026, 1.034], p < 0.0001). Individuals in the high 51st-75th income quartile had a 17% increase in the odds of HD (OR = 1.17, 95% CI [1.09, 1.25], p < 0.0001) compared to the low 1st-25th income quartile. Conclusions: This study reinforces the strong association between CP and HD, highlighting the need for further research and prospective studies to validate these findings.

Rectus femoris electromyography signal clustering: Data-driven management of crouch gait in patients with cerebral palsy

This study aimed to investigate how electromyography (EMG) cluster analysis of the rectus femoris (RF) could help to better interpret gait analysis in patients with cerebral palsy (CP). The retrospective gait data of CP patients were categorized into two groups: initial examination (E1, 881 patients) and subsequent examination (E2, 377 patients). Envelope-formatted EMG data of RF were collected. Using PCA and a combined PSO-K-means algorithm, main clusters were identified. Patients were further classified into crouch, jump, recurvatum, stiff and mild gait for detailed analysis. The clusters (labels) were characterized by a significant peak EMG activity during mid-swing (L1), prolonged EMG activity during stance (L2), and a peak EMG activity during loading response (L3). Notably, L2 contained 76% and 92% of all crouch patients at E1 and E2, respectively. Comparing patients with a crouch gait pattern in L2-E1 and L2-E2, two subgroups emerged: patients with persistent crouch (G1) and patients showing improvement at E2 (G2). The minimum activity of RF during 20-45% of the gait was significantly higher (p = 0.025) in G1 than in G2. A greater chance of improvement from crouch gait might be associated with lower RF activity during the stance phase. Using our findings, we could potentially establish an approach to improve clinical decision-making regarding treatment of patients with CP.

Rare Earth Element Content in Hair Samples of Children Living in the Vicinity of the Kola Peninsula Mining Site and Nervous System Diseases

The aim of this study is to assess the rare earth element (REE) content in hair samples of children living in Lovozero village, near an REE mining site, and the possible effects of REEs on the prevalence of nervous system diseases in Lovozersky District (Murmansk region, Kola Peninsula). Fifty-three school-age children were recruited for the analysis of REE content in hair samples. REE (Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb, and Lu) content was estimated by means of inductively coupled plasma mass spectrometry (ICP-MS). The analysis of REE content in the hair of children living in Russia, Kazakhstan, and China indicated REE intake from the environment. The possible contribution of REEs to nervous system disorders is supported by the link between the REE content in hair samples of children living near REE mining areas (China) and the manifestation of cognitive disorders in these children. It is also found that the prevalence of nervous system diseases in children aged 15-17 years is higher in Lovozersky District compared to the other districts of the Murmansk region. In this paper, the possible contribution of REEs to the prevalence of episodic paroxysmal disorders (G40-G47), cerebral palsy (G80-G83), and epilepsy and status epilepticus (G40-G41) is discussed.

Ultrasonic neuromodulation as a new therapy for spasticity in an animal model of spastic cerebral palsy

PURPOSE

This study aimed to evaluate a new therapeutic option for the spasticity using ultrasound neuromodulation in an animal model of spastic cerebral palsy.

METHODS

Thirty-two adult male Wistar rats were randomly distributed in: negative control (NC); positive control (PC); untreated model (UTM); and treated model (TM). Rats in the control groups received sham surgery, and rats in the model groups received the spastic cerebral palsy model surgery. The rats' motor functions were evaluated by the Rotarod and CatWalk tests before and after surgery. PC and TM groups underwent ultrasonic neuromodulation by a physiotherapeutic ultrasound (intensity 0.1 W/cm2, at 1 MHz) continuous mode for 5 seconds, for seven days.

RESULTS

Twelve rats showed a spastic pattern (UTM = 6 and TM = 6), motor limitations (UTM = 6 and TM = 6), and ten had difficulty feeding (UTM = 5 and TM = 5). One UTM group rat could not recover its preoperative latency time, while the other rats in the model groups did. The speed at which the limbs swung reduced after surgery and increased in subsequent assessments, demonstrating greater instability and a deficit in locomotion balance.

CONCLUSIONS

Results were not yet sufficient to assert ultrasound neuromodulation as a possible therapy for spasticity in spastic cerebral palsy in the parameters used, and more studies are necessary.

To what extent are guidelines used in spasticity clinics? A qualitative study of facilitators and barriers to spasticity guideline implementation

OBJECTIVE

To determine the common understanding of focal muscle spasticity guidelines amongst clinicians working in spasticity clinics. To examine the facilitators and barriers to their implementation as well as their influence on clinic processes.

DESIGN

A qualitative study based on a phenomenological approach.

SETTING

Online videoconferencing platform.

PARTICIPANTS

Sixteen experienced multi-disciplinary clinicians providing specialised care across 12 spasticity clinics in Victoria, Australia.

INTERVENTION

Observational.

MAIN MEASURES

Two independent reviewers performed line by line coding of transcripts. Reflexive thematic analysis was undertaken with themes/subthemes inductively derived.

RESULTS

Seven key themes emerged. First, knowledge of specific guideline recommendations was low amongst some clinicians. Second, there is a lack of health service resources to support guideline implementation. Third, a limited evidence base for guidelines affected clinicians' willingness to implement the recommendations. Fourth, peer support was highly valued but opportunities to collaborate were limited. Fifth, a large amount of intrinsic motivation and personal time was required from clinicians to successfully implement guideline recommendations. Sixth, the standardisation of clinic processes was one way in which clinicians felt they could better align their clinical practice to guidelines. Lastly, guidelines overall had a moderate influence on spasticity clinic processes.

CONCLUSIONS

Knowledge of recommendations varied but, overall, guidelines had an influence on clinic processes and staff perceptions across the state-wide services. Health service resources, limited evidence for guideline recommendations and time constraints were considered barriers to spasticity guideline implementation. Multi-disciplinary expertise and teamwork, the individual's motivation to change and inter-clinic collaboration were considered to be the facilitators.

Advances in Cerebral Palsy Treatment

Background:

Cerebral palsy is a complex neurodevelopmental disorder with various etiological factors and treatment options. This narrative review aimed to summarize the causes of cerebral palsy, identify areas needing additional research in treatment approaches, and highlight areas requiring further investigation. In order to provide a thorough overview of management techniques to lessen the effects of the illness and its consequences, this review has drawn data from a number of studies.

Introduction:

Prematurity increases the risk of brain damage during the developing stage and accounts for a sizable fraction of cerebral palsy cases. In a sizable portion of cases, maternal diabetes and hypertension are listed as the main causes. Damage to the brain tissue results from hypoxic-ischemic injuries sustained during pregnancy that upset the equilibrium of oxidants and antioxidants. To alter the oxidative stress pathway and ease related issues, pharmacological treatments, such as therapeutic hypothermia, free radical inhibition therapy, and mitochondrial therapy, have been proposed. Therapeutic strategies, such as physiotherapy, occupational therapy, speech therapy, and surgical interventions, have added quality to the lives of the children. Some of the most recent developments in this area include the development of biomarkers for muscle activity detection, machine learning to predict the types of cerebral palsy and abnormal movements, disease prediction with eye images, wireless inertia measuring unit for spasticity detection, computerbased video analysis of typical and atypical infants, identification of intellectual disabilities with algorithms, and deep learning methods for predicting cerebral palsy.

Methods:

This narrative review is based on a careful analysis of numerous researches conducted on cerebral palsy, which have served as the basis for statistical distribution. It reviews the causes of cerebral palsy, available treatments, and ongoing research with the goal of providing physicians and researchers in the field with useful information. The objectives, study questions, inclusion criteria, and search approach have all been outlined in a thorough protocol. To find pertinent research published up to September 2021, a literature search was carried out using electronic databases, including Google Scholar, PubMed, Cochrane Library, Scopus, and Web of Science. A combination of pertinent keywords, such as "cerebral palsy," "management," "technology," "wearable technology," "prematurity," and "artificial intelligence," has been used in the search approach.

Results:

Recent advances in the field include the discovery of biomarkers for the detection of muscle activity, machine learning algorithms to predict the types of cerebral palsy and abnormal movements, disease prediction using eye images, wireless inertia measuring units for the detection of spasticity, computer-based video analysis for the detection of atypical infants, and algorithms to identify intellectual disabilities. Additionally, employing technologies, like virtual reality systems, electrical stimulators, activity trackers, machine learning, and deep learning approaches, has shown promise in evaluating, diagnosing, and predicting treatment outcomes linked to gait, upper limb, and lower limb function.

Conclusion:

Future research should examine the clinical application of nanomedicine, stem cell therapy, and cutting-edge therapeutic strategies to prevent hypoxic-ischemic damage in the developing brain. Additionally, research is required to effectively assist children with severe speech difficulties using alternate communication modalities and cutting-edge computational tools. The outcomes for people with cerebral palsy can be improved by combining interdisciplinary efforts with cutting-edge technological interventions.

A case report of spastic diplegic cerebral palsy in a late preterm child with hypoplastic left heart syndrome

Background

Congenital heart disease (CHD) is the most common birth defect, affecting 1% of children who are born in the United States each year. Children with hypoplastic left heart syndrome, a type of critical CHD, are at high risk for neurodevelopmental disabilities, which are conditions that can affect motor, language, and cognitive development. In children with critical CHD, the severity and prevalence of their motor delays is most pronounced in infancy.

Case Description

We present a case of a former late preterm male with hypoplastic left heart syndrome and history of hypoxic ischemic encephalopathy, who was diagnosed with spastic diplegic cerebral palsy in the setting of periventricular leukomalacia. Like many children with critical CHD, this child had gross motor delays and tone abnormalities in infancy. However, unlike many children with CHD, he continued to have neurologic differences that prompted additional evaluation through a Cardiac Neurodevelopmental Program. He was diagnosed with spastic diplegic cerebral palsy based upon clinical history and physical examination. Ancillary testing showed periventricular leukomalacia on brain magnetic resonance imaging (MRI); this finding was consistent with his clinical diagnosis.

Conclusions

This is an interesting case report of spastic diplegic cerebral palsy in a late preterm infant with critical CHD. When making a diagnosis of cerebral palsy, it is important to consider the etiology of the motor impairment. Selective vulnerability may have played a factor in this child's condition. The most vulnerable part of the neonatal brain is the periventricular white matter; cerebral hypoxia can lead to periventricular leukomalacia. Children with CHD have brain dysmaturity beginning in-utero. Thus, it is possible that this child's brain dysmaturity may have increased his susceptibility to periventricular leukomalacia. Because most children with CHD have gross motor delays in infancy, it may be challenging to make a definitive diagnosis of cerebral palsy in an infant with critical CHD. Children with cerebral palsy have early motor delays that persist throughout life. It is the identification of persistent motor impairments through repeat evaluations that enabled this child's cerebral palsy diagnosis. This illustrates the importance of developmental surveillance in children with critical CHD.

HEP® (Homeostasis-Enrichment-Plasticity) Approach Changes Sensory-Motor Development Trajectory and Improves Parental Goals: A Single Subject Study of an Infant with Hemiparetic Cerebral Palsy and Twin Anemia Polycythemia Sequence (TAPS)

BACKGROUND

Early intervention (EI) for infants identified as being at high risk for cerebral palsy (CP), or who have been diagnosed with it, is critical for promotion of postnatal brain organization. The aim of this study was to explore the effectiveness of the Homeostasis-Enrichment-Plasticity (HEP) Approach, which is a contemporary EI model that applies the key principles of enriched environment paradigms and neuronal plasticity from experimental animal studies to ecological theories of human development on the motor development, sensory functions, and parental goals of an infant with twin anemia polycythemia sequence (TAPS) and CP.

METHODS

An AB phase with follow-up single case study design which consisted of multiple baseline assessments with the Peabody Developmental Motor Scales-2 (PDMS-2) and the Test of Sensory Functions in Infants (TSFI) was used. Non-overlapping confidence intervals analysis was used for pre-post PDMS-2 scores. The measurement of progress toward goals and objectives was conducted using the Goal Attainment Scale (GAS). The HEP Approach intervention consisted of 12 one-hour sessions implemented over a period of 3 months, where a physical therapist provided weekly clinic-based parental coaching.

RESULTS

Results found a stable baseline during Phase A and improvement in response to the HEP Approach intervention during Phase B in both the PDMS-2 and TSFI according to 2SD Band analysis. The confidence intervals for the PDMS-2 scores also indicated a significant improvement after HEP intervention. The scores for both the PDMS-2 and the TSFI were consistent or showed improvement throughout the Follow-Up phase. A GAS t-score of 77.14 indicated that the infant exceeded intervention goal expectations.

CONCLUSIONS

Although our findings suggest that the HEP Approach intervention has promise in enhancing sensory functions, motor skill outcomes, and parental goals in an infant with TAPS and CP, further research is required to validate and apply these results more broadly.

Understanding Clinical Effectiveness and Safety Implications of Botulinum Toxin in Children: A Narrative Review of the Literature

Since its first approval by the Food and Drug Administration in 1989 for strabismus, botulinum toxin indications of use have been widely expanded. Due to its anticholinergic properties, this toxin is currently approved in adult patients for the treatment of a wide range of neuromuscular, otolaryngologic, orthopedic, gastrointestinal, and urologic disorders. Approved pediatric indications of use include the treatment of blepharospasm associated with dystonia, strabismus, lower-limb spasticity, focal spasticity in patients with cerebral palsy, and neurogenic detrusor overactivity. Alongside these approved indications, botulinum toxin is extensively used off-label. Although several clinical studies have shown that botulinum toxin is effective and well-tolerated in children, uncertainties persist regarding its long-term effects on growth and appropriate dosing in this population. As such, further research is needed to better define the botulinum toxin risk-benefit profile and expand approved uses in pediatrics. This narrative review aimed to provide a broad overview of the evidence concerning the clinical effectiveness and safety of BoNT with respect to its principal authorized and non-authorized pediatric therapeutic indications, as well as to describe perspectives on its future use in children.

Care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy

AIM

This study's aim is to determine the relationship between care burden, perceived social support, coping attitudes and life satisfaction of mothers with children with cerebral palsy (CP).

METHODS

This descriptive study was conducted in Turkey between March and June 2022 to determine the relationship between caregiving burden, perceived social support, coping attitudes and life satisfaction of 122 mothers with CP children. Path analysis was used to evaluate the data.

RESULTS

Correlation analysis showed a positive relationship between mothers' social support perceptions and life satisfaction and coping attitudes, a positive relationship between their life satisfaction and coping attitudes (p < .001). The path analysis showed that the social support perceived by the mothers significantly affected their coping attitudes (β = .257; p < .001) and life satisfaction (β = .081; p < .001). Mothers' care burden (β = .169; p < .001) and coping attitudes (β = .071; p < .05) also had a significant effect on their life satisfaction.

CONCLUSIONS

It is an important finding of this study that mothers' perceptions of social support and coping attitudes have a positive effect on their life satisfaction. Long-term care can cause physical and psychological problems for mothers. Mothers' strong coping strategies and high levels of social support may reduce the occurrence of these problems. Drawing attention to this issue in mothers and revealing the effects of these variables is important in terms of indirectly supporting child outcomes.

Enhanced EEG power density during painful stretching in individuals with cerebral palsy

BACKGROUND

Pain perception mechanisms in cerebral palsy remain largely unclear.

AIMS

This study investigates brain activity in adults with cerebral palsy during painful and non-painful stretching to elucidate their pain processing characteristics.

METHODS AND PROCEDURES

Twenty adults with cerebral palsy and 20 controls underwent EEG in three conditions: rest, non-painful stretching, and painful stretching. Time-frequency power density of theta, alpha, and beta waves in somatosensory and frontal cortices was analyzed, alongside baseline pressure pain thresholds.

OUTCOMES AND RESULTS

Cerebral palsy individuals exhibited higher theta, alpha, and beta power density in both cortices during painful stretching compared to rest, and lower during non-painful stretching. Controls showed higher power density during non-painful stretching but lower during painful stretching. Cerebral palsy individuals had higher pain sensitivity, with those more sensitive experiencing greater alpha power density.

CONCLUSIONS AND IMPLICATIONS

These findings confirm alterations in the cerebral processing of pain in individuals with cerebral palsy. This knowledge could enhance future approaches to the diagnosis and treatment of pain in this vulnerable population.

Current approach to cerebral palsy

This teaching review aims to provide an overview of the current approach to children with cerebral palsy (CP), retrieving the best available evidence and summarizing existing knowledge in the field of CP in children. We also highlight areas where more research is needed and novel strategies for diagnosing and treating cerebral palsy. CP includes a group of permanent disorders of movement and posture that cause activity limitation. Multiple risk factors, occurring preconceptionally, prenatally, perinatally, or postneonatally, are involved in the pathogenesis of CP, with the prenatal ones accounting for 80-90 % of cases. Due to its heterogeneity, CP has various classifications, but usually is classified based on clinical findings and motor impairment. Standardized function classification systems have been developed to address inconsistencies in previous classifications. The combination of clinical assessment and validated predictive tools is recommended for an early diagnosis, which is important for early intervention and prevention of secondary impairments. The therapeutic regimen in CP involves prevention and management of the motor and associated problems. It includes the enhancement of motor performance, the enrichment of cognition and communication skills, the prevention of secondary impairments, and the support of parents and caregivers. The care of CP children demands a multidisciplinary approach focused on improving motor skills, reducing comorbidities, enhancing the quality of life, and prolonging survival.

How do parents frame their engagement experience in early intervention? A grounded theory study

PURPOSE

Parent and therapist engagement and partnership are critical in early intervention physiotherapy and occupational therapy for infants with cerebral palsy to improve outcomes. The main aim of this study was to understand how parents perceive their engagement experience in early intervention over time.

METHODS

Grounded theory methodology was used. Twenty parents of diverse backgrounds participated in 22 interviews (including some repeated longitudinally) to reflect on their engagement experience within the context of early intervention community services provided in the UK NHS.

RESULTS

The findings highlight how parents' perspectives of their engagement in EI change according to critical circumstances, including their preceding neonatal trauma, the at-risk CP label, firmer diagnosis of CP and their child's response to intervention. We theorise that this disrupted transition experience to parenthood becomes part of parental framing (or sense-making) of their engagement in EI. Overlapping frames of uncertainty, pursuit and transformation capture and explain nuances in parents' engagement patterns within EI over time.

CONCLUSION

This theorising has implications for early intervention therapists in how they engage in the lives of families and partner with parents to support healthier parental transition, wellbeing and subsequent improved infant outcomes.

Synergistic effect of functional strength training and cognitive intervention on gross motor function in children with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is a posture and movement disorder, however; it often includes disturbance of different aspects of cognitive function. This study aimed to investigate if combined functional strength training (FST) and cognitive intervention are more effective than either of them alone on gross motor function in children with spastic diplegic CP.

METHODS

Sixty-four children with spastic diplegic CP, with ages ranging from 8 to 12 years, were assigned randomly into four treatment groups; Group I; FST, group II; cognitive training, group III; combined FST and cognitive training, group IV; conventional physical therapy. The Gross Motor Function Measure (GMFM-88) was used to assess gross motor function at baseline, post-treatment, and 6 months follow-up.

RESULTS

Group III achieved a significant improvement in GMFM-88 when compared to other groups post-treatment and at follow-up.

CONCLUSION

This study suggests that combined lower limb FST and cognitive intervention had the potential to produce significantly more favorable effects than the single use of either of them on gross motor function in children with spastic diplegia.

Efficacy of neuromuscular electrical stimulation and interrupted serial casting in children with spastic diplegia

Objectives

This research was aimed at comparing the effects of neuromuscular electrical stimulation (NMES) combined with interrupted serial casting (SC) versus SC alone on various aspects of lower limb function in children with diplegic cerebral palsy. SC is a clinical technique used to increase passive range of motion (ROM), decrease hypertonicity, and improve walking in children with cerebral palsy (CP).

Methods

This randomized comparative trial involved 33 children with diplegic CP, who were randomly assigned to group A or group B at recruitment. Group A received SC along with a customized physical therapy program, whereas group B received the same interventions as group A along with NMES applied through cast windows during casting. Evaluations were based on ROM, the Modified Tardieu Scale, handheld dynamometer measurements, and the Observational Gait Scale. Assessments were conducted before and after 8 weeks of intervention.

Results

Both groups exhibited significant improvements in dorsiflexion ROM, popliteal angle, gastrocnemius dynamic spasticity, and hamstring dynamic spasticity after the intervention (P = 0.0001 for all). However, significant differences (P < 0.05) in dorsiflexor strength, knee extensor strength, and observational gait scale score were observed between groups after the intervention, favoring group B.

Conclusions

The use of NMES during SC may help overcome the substantial decrease in strength resulting from casting, thus achieving less reduction of tone, improving ROM without significantly decreasing strength, and attaining greater improvements in gait function.

Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy

OBJECTIVE

This study aimed to compare the effect of core stabilization exercises and rebound therapy on balance in children with hemiplegic cerebral palsy (CP).

METHODS

Fifty- two children of spastic hemiplegic CP aged 5 up to 8 years from both genders were assigned randomly into two groups: core stability and rebound therapy groups. Both groups received 3 sessions/week, 1.5-h training per session, for 12 successive weeks. The measurement was performed at baseline and post-treatment. Balance as a primary outcome for this study was measured by a Biodex Balance System (BBS), and knee extensor strength and functional capacity as secondary outcomes were assessed using a hand-held dynamometer, and a six-minute walk test (6MWT), respectively.

RESULTS

All variables showed a significant improvement after intervention in each group (p < 0.0001), with significant improvement in all stability indices (overall, anteroposterior, and mediolateral) in core stability group when compared to rebound therapy group.

CONCLUSION

Core stability exercises and rebound therapy are recommended in the rehabilitation of children with hemiplegic CP. Core stability exercises were more effective than rebound therapy for balance improvement.

TRIAL REGISTRATION NUMBER

NCT05739396.

Saudi Cerebral Palsy Register (SCPR): Protocol on the Methods and Technical Details

This protocol presents a comprehensive proposal for the establishment of the Saudi Cerebral Palsy Register (SCPR), a crucial project for investigating and addressing the prevalence, etiology, and management of cerebral palsy (CP) in Saudi Arabia. The SCPR will not only provide a robust database for ongoing research and analysis but will also serve as a platform for investigating the causes of CP, implementing preventative strategies, and improving the quality of care and outcomes for people with CP and their families in Saudi Arabia. Detailed case definitions, inclusion/exclusion criteria, and data collection protocols are discussed to ensure the integrity and comparability of the data. The plan also outlines strategic funding, institutional and government endorsement, sustainability considerations, potential challenges and proposed solutions, and expected outcomes and impact. These include creating research and educational opportunities, fostering regional and international collaborations, and significantly contributing to CP prevention strategies. Overcoming anticipated obstacles, such as stigma, institutional policies, and collaborations, and securing both necessary funding and endorsements are highlighted as critical for the success of the SCPR. The project is not only aligned with promote prevention of health risks, a target of Vision 2030 in Saudi Arabia, but is also expected to have a substantial impact on the health and quality of life of people with CP and their families in Saudi Arabia, serving as inspiration for similar efforts worldwide.

Cerebral Palsy: A Current Perspective

Cerebral palsy (CP) is the most common cause of motor disability in children. Insults to the brain at different times lead to diverse injuries. As a result, CP is an extremely heterogeneous clinical diagnosis, presenting differently in each individual and at various ages. With improving survival rates of preterm newborns, increasing active resuscitation of extremely preterm newborns, and widespread availability of extensive genetic testing soon after birth, it is imperative to focus on earlier diagnosis and long-term outcomes of CP. CP is primarily classified into 4 categories based on type of motor impairment, functional ability, distribution, and etiology. As the understanding of CP has evolved significantly in the last 2 decades, the methods of early detection of CP have consequently advanced. Appropriate diagnosis is essential for proper education and counseling of affected families, and introduction of therapeutic interventions as early as possible. In this review, we focus on early brain development and provide an overview of the etiology, classification, diagnosis, early therapeutic options, and prognosis of CP.