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Herard GAM, Hung YC, Brandao MB, Gordon AM. Bimanual Coordination in Children with Bilateral Cerebral Palsy: A Cross-Sectional Study. Phys Occup Ther Pediatr 2024:1-16. [PMID: 39007684 DOI: 10.1080/01942638.2024.2376062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
AIM To compare bimanual coordination in children with bilateral cerebral palsy (BCP) with that of children with typical development (TD) and correlate bimanual coordination with clinical measures of hand function. METHODS 3-D kinematic data were collected from 14 children with BCP (mean age 13 years 1 month; range 7.3-17.2 years, 5 females) and 14 age-matched children with TD (mean age 13 years 1 month, range 7.0-16.0 years, 7 females) as they opened a drawer with one hand and activated a switch inside it with the other hand at self-paced and as-fast-as-possible speeds. Hand roles varied in each condition. Participants' hand function levels were classified using the Manual Ability Classification System. Unimanual dexterity and bimanual performance were evaluated using the Box and Blocks Test and Both Hands Assessment respectively. RESULTS Participants with BCP performed the bimanual task more slowly (p < 0.001) and sequentially, as evidenced by greater time differences between the two hands achieving the end goal (p = 0.01). Faster speeds, particularly when the less affected hand opened the drawer, facilitated time-related measures of bimanual coordination (p < 0.05). Bimanual coordination correlated with all clinical measures of hand function (p < 0.05). CONCLUSION For children with BCP, speed and hand used for each subcomponent of the task influence bimanual coordination. Better bimanual coordination is associated with less impairment of both hands.
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Affiliation(s)
- Grace-Anne M Herard
- Doctorate of Physical Therapy Program, University of St. Augustine for Health Sciences, Coral Gables, FL, USA
- Department of Biobehavioral Sciences, Columbia University, New York, NY, USA
| | - Ya-Ching Hung
- Department of Family, Nutrition and Exercise Science, Queens College, Flushing, NY, USA
| | - Marina B Brandao
- Department of Occupational Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Columbia University, New York, NY, USA
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2
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Panda S, Singh A, Kato H, Kokhanov A. Cerebral Palsy: A Current Perspective. Neoreviews 2024; 25:e350-e360. [PMID: 38821909 DOI: 10.1542/neo.25-6-e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024]
Abstract
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.
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Affiliation(s)
- Sanjeet Panda
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Ajay Singh
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX
| | - Hugo Kato
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Artemiy Kokhanov
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
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3
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Jang YH, Ham J, Kasani PH, Kim H, Lee JY, Lee GY, Han TH, Kim BN, Lee HJ. Predicting 2-year neurodevelopmental outcomes in preterm infants using multimodal structural brain magnetic resonance imaging with local connectivity. Sci Rep 2024; 14:9331. [PMID: 38653988 DOI: 10.1038/s41598-024-58682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
The neurodevelopmental outcomes of preterm infants can be stratified based on the level of prematurity. We explored brain structural networks in extremely preterm (EP; < 28 weeks of gestation) and very-to-late (V-LP; ≥ 28 and < 37 weeks of gestation) preterm infants at term-equivalent age to predict 2-year neurodevelopmental outcomes. Using MRI and diffusion MRI on 62 EP and 131 V-LP infants, we built a multimodal feature set for volumetric and structural network analysis. We employed linear and nonlinear machine learning models to predict the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) scores, assessing predictive accuracy and feature importance. Our findings revealed that models incorporating local connectivity features demonstrated high predictive performance for BSID-III subsets in preterm infants. Specifically, for cognitive scores in preterm (variance explained, 17%) and V-LP infants (variance explained, 17%), and for motor scores in EP infants (variance explained, 15%), models with local connectivity features outperformed others. Additionally, a model using only local connectivity features effectively predicted language scores in preterm infants (variance explained, 15%). This study underscores the value of multimodal feature sets, particularly local connectivity, in predicting neurodevelopmental outcomes, highlighting the utility of machine learning in understanding microstructural changes and their implications for early intervention.
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Affiliation(s)
- Yong Hun Jang
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea
| | - Jusung Ham
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, 52242, USA
| | - Payam Hosseinzadeh Kasani
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyuna Kim
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea
| | - Joo Young Lee
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea
| | - Gang Yi Lee
- Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea
| | - Tae Hwan Han
- Division of Neurology, Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Division of Children and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea.
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4
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Grajales López V, Hernández Suárez OI, Pinzón Bernal MY, Salamanca Duque LM. [Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5years of age: Systematic review]. Rehabilitacion (Madr) 2024; 58:100832. [PMID: 38141422 DOI: 10.1016/j.rh.2023.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/25/2023]
Abstract
Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary.
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5
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Zhussupova Z, Ayaganov D, Tekebayeva L, Jaxybayeva A, Mamedbayli A, Tamadon A, Zharmakhanova G. General movements assessment: A bibliometric analysis. Early Hum Dev 2024; 188:105924. [PMID: 38142466 DOI: 10.1016/j.earlhumdev.2023.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
This bibliometric analysis provides an in-depth exploration of the scholarly landscape in the field of Prechtl General Movement Assessment (GMA) research, spanning the period from 1961 to 2023. It offers valuable insights into the evolutionary trajectory and global impact of GMA. The study employs a longitudinal approach, meticulously tracking trends in scholarly output, international collaborations, and authorship patterns. Notably, our findings reveal a significant increase in GMA-related publications, highlighting the growing prominence of this field. The dominance of Australia and Austria in scholarly contributions underscores their pivotal roles. International collaborations are prominent, with active participation from European nations and the Americas. However, it is essential to acknowledge certain limitations, including potential data source biases and a reliance on English-language publications. This analysis serves as a valuable resource for stakeholders in the field, emphasizing the need for ongoing evaluation and collaborative efforts to enhance GMA applications and further our understanding of its clinical implications.
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Affiliation(s)
- Zhanna Zhussupova
- Department of Neurology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
| | - Dinmukhamed Ayaganov
- Department of Neurology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
| | - Latina Tekebayeva
- Department of Neurology, Kazakhstan's Medical University "KSPH", Almaty, Kazakhstan.
| | | | - Ayten Mamedbayli
- Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
| | - Amin Tamadon
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
| | - Gulmira Zharmakhanova
- Department of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
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Gao Q, Yao S, Tian Y, Zhang C, Zhao T, Wu D, Yu G, Lu H. Automating General Movements Assessment with quantitative deep learning to facilitate early screening of cerebral palsy. Nat Commun 2023; 14:8294. [PMID: 38097602 PMCID: PMC10721621 DOI: 10.1038/s41467-023-44141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
The Prechtl General Movements Assessment (GMA) is increasingly recognized for its role in evaluating the integrity of the developing nervous system and predicting motor dysfunctions, particularly in conditions such as cerebral palsy (CP). However, the necessity for highly trained professionals has hindered the adoption of GMA as an early screening tool in some countries. In this study, we propose a deep learning-based motor assessment model (MAM) that combines infant videos and basic characteristics, with the aim of automating GMA at the fidgety movements (FMs) stage. MAM demonstrates strong performance, achieving an Area Under the Curve (AUC) of 0.967 during external validation. Importantly, it adheres closely to the principles of GMA and exhibits robust interpretability, as it can accurately identify FMs within videos, showing substantial agreement with expert assessments. Leveraging the predicted FMs frequency, a quantitative GMA method is introduced, which achieves an AUC of 0.956 and enhances the diagnostic accuracy of GMA beginners by 11.0%. The development of MAM holds the potential to significantly streamline early CP screening and revolutionize the field of video-based quantitative medical diagnostics.
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Affiliation(s)
- Qiang Gao
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Siqiong Yao
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- SJTU-Yale Joint Center of Biostatistics and Data Science, National Center for Translational Medicine, MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Tian
- Department of Health Management, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuncao Zhang
- Department of Health Management, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tingting Zhao
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Wu
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai Jiao Tong University, Shanghai, China.
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
| | - Hui Lu
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China.
- SJTU-Yale Joint Center of Biostatistics and Data Science, National Center for Translational Medicine, MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai Jiao Tong University, Shanghai, China.
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8
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Pettinger KJ, Copper C, Boyle E, Blower S, Hewitt C, Fraser L. Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis. Pediatrics 2023; 152:e2023061878. [PMID: 37946609 PMCID: PMC10657778 DOI: 10.1542/peds.2023-061878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.
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Affiliation(s)
| | | | - Elaine Boyle
- University of Leicester, Leicester, United Kingdom
| | | | | | - Lorna Fraser
- University of York, York, United Kingdom
- King’s College London, London, United Kingdom
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Babik I, Cunha AB, Srinivasan S. Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy. Infant Behav Dev 2023; 73:101881. [PMID: 37643499 DOI: 10.1016/j.infbeh.2023.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, USA.
| | - Andrea B Cunha
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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O'Regan E, Stadskleiv K, Czuba T, Alriksson-Schmidt AI. Cognitive assessments among children with cerebral palsy in Sweden and the use of augmentative and alternative communication and interpreters: a cross-sectional registry study. Disabil Rehabil 2023; 45:3656-3667. [PMID: 36308310 DOI: 10.1080/09638288.2022.2138571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Children with cerebral palsy (CP) have an increased risk of cognitive difficulties and should be offered cognitive assessments. In Sweden, the CPCog protocol recommends children with CP undergo cognitive assessments at the start of primary and secondary school. To assess children with CP can be challenging, in particular when children are non-vocal or do not speak the local language. In such instances, augmentative and alternative communication (AAC) and qualified medical interpreters should be considered. The purpose of this study was to monitor the implementation and equitable delivery of the CPCog protocol in Sweden between the years 2017-2020. MATERIALS AND METHODS In this cross-sectional study, registry data were extracted from the combined follow-up program and national registry for individuals with CP (CPUP), and a convenience sample of psychologists responded to an online survey. RESULTS AND CONCLUSIONS Each year, less than 5% of eligible children had registered cognitive assessments in CPUP. There was underuse of AAC during assessments and a discrepancy between the registered versus reported use of interpreters. Psychologists perceived AAC as more reliable for cognitive assessments than interpreters. Greater availability of and capacity to offer cognitive assessments in other formats and languages could help increase test accessibility for all children with CP.Implications for RehabilitationThe cognitive assessment of children with cerebral palsy (CP) is a complex but important issue within disability and re/habilitation.Individualized cognitive assessments should be offered and carried out by psychologists.Rehabilitation centers should strive to be inclusive through reliable test adaptations for functional abilities, means of communication, and language.Greater availability of- and capacity to offer cognitive assessments in more formats and languages could help increase test accessibility for children with disabilities.
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Affiliation(s)
- Elisabeth O'Regan
- Department of Clinical Sciences, Lund Orthopedics, Lund University, Lund, Sweden
| | - Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Tomasz Czuba
- Department of Clinical Sciences, Lund University, Lund, Sweden
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11
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Kather C, Shofer FS, Park JI, Bogen D, Pierce SR, Kording K, Nilan KA, Zhang H, Prosser LA, Johnson MJ. Quantifying interaction with robotic toys in pre-term and full-term infants. Front Pediatr 2023; 11:1153841. [PMID: 37928351 PMCID: PMC10622661 DOI: 10.3389/fped.2023.1153841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
Infants born pre-term are at an increased risk for developmental, behavioral, and motor delay and subsequent disability. When these problems are detected early, clinical intervention can be effective at improving functional outcomes. Current methods of early clinical assessment are resource intensive, require extensive training, and do not always capture infants' behavior in natural play environments. We developed the Play and Neuro Development Assessment (PANDA) Gym, an affordable, mechatronic, sensor-based play environment that can be used outside clinical settings to capture infant visual and motor behavior. Using a set of classification codes developed from the literature, we analyzed videos from 24 pre-term and full-term infants as they played with each of three robotic toys designed to elicit different types of interactions-a lion, an orangutan, and an elephant. We manually coded for frequency and duration of toy interactions such as kicking, grasping, touching, and gazing. Pre-term infants gazed at the toys with similar frequency as full-term infants, but infants born full-term physically engaged more frequently and for longer durations with the robotic toys than infants born pre-term. While we showed we could detect differences between full-term and pre-term infants, further work is needed to determine whether differences seen were primarily due to age, developmental delays, or a combination.
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Affiliation(s)
- Collin Kather
- Rehabilitation Robotics Lab, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, United States
| | - Frances S. Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeong Inn Park
- Rehabilitation Robotics Lab, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Bogen
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Samuel R. Pierce
- Department of Physical Therapy, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Konrad Kording
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Kathleen A. Nilan
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Huayan Zhang
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neonatology, Guangzhou Women’s and Children’s Medical Center, Guangzhou, China
| | - Laura A. Prosser
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, United States
- Division of Rehabilitation Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Michelle J. Johnson
- Rehabilitation Robotics Lab, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
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12
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Long HL, Hustad KC. Marginal and Canonical Babbling in 10 Infants at Risk for Cerebral Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1835-1849. [PMID: 36758205 PMCID: PMC10561958 DOI: 10.1044/2022_ajslp-22-00165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE This study is a preliminary quantification and characterization of the development of marginal and canonical syllable patterns in 10 infants at risk for cerebral palsy (CP). METHOD We calculated marginal and canonical babbling ratios from parent-infant laboratory recordings of 10 infants at two time points, approximately 13 and 16 months of age. The frequency and diversity of labial, coronal, and velar types of marginal and canonical syllables were also examined. Differences across three outcome groups were compared: infants later diagnosed with CP (n = 3, CP group), risk of CP due to ongoing gross motor delays (n = 4, risk group), and current typically developing status with resolved gross motor delays (n = 3, TDx group). Performance on the Mullen Scales was included for perspective on cognitive development. RESULTS Higher marginal syllable ratios were observed in the CP and risk groups than the TDx group. An increasing canonical syllable ratio across the two ages was consistently observed in the TDx group. The TDx group produced a greater frequency and diversity of canonical syllable types than the risk and CP groups, and of marginal syllable types than the CP group. CONCLUSIONS This study offers preliminary support for the possibility that speech motor impairment in infants with CP have the potential to be observed and quantified early in vocal development prior to the expected onset of first words. Prolonged rates of marginal syllable forms may be suggestive of speech motor impairment; however, additional longitudinal outcome data over a longer time course and a larger sample of infants are needed to provide further support for this possibility.
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Affiliation(s)
| | - Katherine C Hustad
- Waisman Center, University of Wisconsin-Madison
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
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Cabezas-López M. How Is Cerebral Palsy Different from Other Childhood Neurological Disorders? JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2023. [DOI: 10.1007/s40817-023-00140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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14
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Rouabhi A, Husein N, Dewey D, Letourneau N, Daboval T, Oskoui M, Kirton A, Shevell M, Dunbar MJ. Development of a Bedside Tool to Predict the Diagnosis of Cerebral Palsy in Term-Born Neonates. JAMA Pediatr 2023; 177:177-186. [PMID: 36648921 PMCID: PMC9857831 DOI: 10.1001/jamapediatrics.2022.5177] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/24/2022] [Indexed: 01/18/2023]
Abstract
Importance Cerebral palsy (CP) is the most common abnormality of motor development and causes lifelong impairment. Early diagnosis and therapy can improve outcomes, but early identification of infants at risk remains challenging. Objective To develop a CP prognostic tool that can be applied to all term neonates to identify those at increased risk of developing CP. Design, Setting, and Participants This case-control study used data from the Canadian Cerebral Palsy Registry (data collected from January 2003 to December 2019) for children with CP and the Alberta Pregnancy Outcomes and Nutrition study (mothers enrolled from May 2009 to September 2012; data extracted in 2020) for controls. There were 2771 children with CP and 2131 controls evaluated; 941 and 144, respectively, were removed for gestational age less than 37 weeks at birth, 565 with CP removed for incomplete data, and 2 controls removed for a diagnosis of CP. Data were analyzed from April to August 2022. Exposures Potential risk factors were selected a priori based on the literature, including maternal, intrapartum, and infant characteristics. Main Outcomes and Measures Diagnosis of CP, defined as a disorder of motor function due to a nonprogressive brain abnormality before age 1 year and classified by Gross Motor Function Classification System levels I to V. Results Of 3250 included individuals, 1752 (53.9%) were male, and the median (IQR) gestational age at birth was 39 (38-40) weeks. Encephalopathy was present in 335 of 1184 infants with CP (28%) and 0 controls. The final prediction model included 12 variables and correctly classified 75% of infants, with a sensitivity of 56% (95% CI, 52-60) and specificity of 82% (95% CI, 81-84). The C statistic was 0.74 (95% CI, 71-76). Risk factors were found to be additive. A proposed threshold for screening is probability greater than 0.3, with a sensitivity of 65% (95% CI, 61-68) and specificity of 71% (95% CI, 69-73). The prognostic tool identified 2.4-fold more children with CP than would have presented with encephalopathy (odds ratio, 13.8; 95% CI, 8.87-22.65; P < .001). Conclusions and Relevance In this case-control study, a prognostic model using 12 clinical variables improved the prediction of CP compared with clinical presentation with encephalopathy. This tool can be applied to all term newborns to help select infants for closer surveillance or further diagnostic tests, which could improve outcomes through early intervention.
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Affiliation(s)
- Amira Rouabhi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Nafisa Husein
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Thierry Daboval
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Maryam Oskoui
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Adam Kirton
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mary J. Dunbar
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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15
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Ahmad S, Wu Y, Wu Z, Thung KH, Liu S, Lin W, Li G, Wang L, Yap PT. Multifaceted atlases of the human brain in its infancy. Nat Methods 2023; 20:55-64. [PMID: 36585454 PMCID: PMC9834057 DOI: 10.1038/s41592-022-01703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022]
Abstract
Brain atlases are spatial references for integrating, processing, and analyzing brain features gathered from different individuals, sources, and scales. Here we introduce a collection of joint surface-volume atlases that chart postnatal development of the human brain in a spatiotemporally dense manner from two weeks to two years of age. Our month-specific atlases chart normative patterns and capture key traits of early brain development and are therefore conducive to identifying aberrations from normal developmental trajectories. These atlases will enhance our understanding of early structural and functional development by facilitating the mapping of diverse features of the infant brain to a common reference frame for precise multifaceted quantification of cortical and subcortical changes.
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Affiliation(s)
- Sahar Ahmad
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ye Wu
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Zhengwang Wu
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kim-Han Thung
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Siyuan Liu
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Weili Lin
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Gang Li
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Li Wang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Pew-Thian Yap
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA.
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16
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Longo E, Monteiro R, Hidalgo-Robles Á, Paleg G, Shrader C, De Campos AC. Assigning F-words as ingredients of interventions for children with cerebral palsy functioning at GMFCS IV and V: A scoping review protocol. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1110552. [PMID: 36873816 PMCID: PMC9978822 DOI: 10.3389/fresc.2023.1110552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023]
Abstract
Introduction Children with Cerebral Palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels IV and V require "on time" identification and intervention. Interventions offered continue to be a challenge, in high-, but even more so in middle-, and low-income countries. Aim To describe the methods developed to explore the ingredients of published studies on early interventions in young children with cerebral palsy (CP) at highest risk of being non-ambulant based on the "F-words for child development framework" and the design of a scoping review exploring these ingredients. Method An operational procedure was developed through expert panels to identify ingredients of published interventions and related F-words. After sufficient agreement among researchers was reached, a scoping review was designed. The review is registered in the Open Science Framework database. The "Population, Concept and Context" framework was used. Population: young children (0-5 years with CP and at highest risk for being non-ambulant (GMFCS levels IV or V); Concept: non-surgical and non-pharmacological early intervention services measuring outcomes from any ICF domain; Context: studies published from 2001 to 2021. After duplicated screening and selection, data will be extracted and quality will be assessed with the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) and Mixed Methods Appraisal (MMAT) tools. Results We present the protocol to identify the explicit (directly measured outcomes and respective ICF domains) and implicit (intervention features not explicitly intended or measured) ingredients. Conclusion Findings will support the implementation of the F-words in interventions for young children with non-ambulant CP.
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Affiliation(s)
- E Longo
- Department of Physical Therapy, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - R Monteiro
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Á Hidalgo-Robles
- Facultad de Educación, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| | - G Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
| | - C Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - A C De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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17
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Fry-Hilderbrand K, Chen YP, Howard A. Automated assessment of infant motor development to predict infant age: The determination of objective metrics of spontaneous kicking. WEARABLE TECHNOLOGIES 2022; 3:e29. [PMID: 38486904 PMCID: PMC10936260 DOI: 10.1017/wtc.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/12/2022] [Accepted: 10/01/2022] [Indexed: 03/17/2024]
Abstract
Though early intervention can improve outcomes for children with motor disabilities, delays in diagnosis can impact the success of intervention programs. Prior work indicates that spontaneous kicking patterns can be used to model typical infant motor development to assist in the early detection of motor delays. However, abnormalities in spontaneous movements are not well defined or readily observable through traditional functional assessments. In this research, a method is introduced for the early detection of delays through the assessment of spontaneous kicking data gathered using a wearable sensing suit. We present formulations of kinematic features identified in the clinical space, identify which features are significant predictors of infant age, and establish normative values. Finally, we offer an analysis of preterm (PT) infant data compared to normative values derived from term infants. Term and PT infants ranging in age from 1 to 10 months were studied. We found that frequency, duration, acceleration, inter-joint coordination, and maximum joint excursion metrics had a significant correlation with age. From these features, models of typical kicking development were created using data from term, typically developing infants. When compared to normative trends, PT infants display differing developmental trends.
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Affiliation(s)
- Katelyn Fry-Hilderbrand
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, 85 5th St. NW, Atlanta, GA30308, USA
| | - Yu-Ping Chen
- Department of Physical Therapy, Georgia State University, 140 Decatur St., Atlanta, GA30303, USA
| | - Ayanna Howard
- College of Engineering, The Ohio State University, 2070 Neil Ave., Columbus, OH43210, USA
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Palomo-Carrión R, Pinero-Pinto E, Romay-Barrero H, Escobio-Prieto I, Lillo-Navarro C, Romero-Galisteo RP. Shall we start? Ready, set, go! Toward early intervention in infants with unilateral cerebral palsy. A randomized clinical trial protocol. Ther Adv Chronic Dis 2022; 13:20406223221136059. [PMID: 36420043 PMCID: PMC9676300 DOI: 10.1177/20406223221136059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/14/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND It is crucial to start an early intervention in unilateral cerebral palsy. Intensive therapies are focused on training based on activities. OBJECTIVE The objective of the study was to study the changes in the bimanual functional performance (BFP) after early intensive therapies at home compared with standard care in children with unilateral cerebral palsy from 9 to 18 months of age. DESIGN A single-blind comparative effectiveness study will be conducted. METHODS AND ANALYSIS Children will be randomized into four groups: infant-mCIMT, infant-BIT, infant-hybrid, and infant standard therapy (control group, CG). Each early intensive protocol will last 50 h and will be applied throughout a 10-week period with the family involvement at home. The main outcomes are BFP measure with mini-Assisting Hand Assessment (mini-AHA) scale, functional goals measure with Goal Attainment Scale (GAS), and satisfaction and expectations on intensive therapy from parents measure through specific questionnaire. Baseline characteristics between groups will be compared using independent t test and Fisher's exact test. Pre- and post-treatment outcomes of standard assessments will be compared using analysis of variance (ANOVA) for parametric and Kruskal-Wallis test for non-parametric variables. The Bonferroni correction is applied for multiple comparisons. An alpha level of p ⩽ 0.05 is considered significant. DISCUSSION In relation to other studies that have analyzed intensive therapies, although with fewer intervention groups, it seems that the application of any of the intensive interventions is effective with the applied dose to obtain changes in BFP and increase the spontaneous use of the affected upper limb. REGISTRATION ClinicalTrials.gov Identifier: NCT04642872.
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Affiliation(s)
- Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla- La Mancha (UCLM), Toledo, Spain
- GIFTO Group, Group of researching in Physiotherapy, Toledo, Spain
| | - Elena Pinero-Pinto
- Faculty of Nursery, Physiotherapy and Podiatry, Department of Physiotherapy, University of Seville, Avicena Street, S/N, 41009 Seville, Spain
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla- La Mancha (UCLM), Toledo, Spain
- GIFTO Group, Group of researching in Physiotherapy, Toledo, Spain
| | - Isabel Escobio-Prieto
- Faculty of Nursery, Physiotherapy and Podiatry, Department of Physiotherapy, University of Seville, Seville, Instituto de Biomedicina de Sevilla (IBIS), Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT), University Miguel Hernández, Alicante, Spain
| | - Rita-Pilar Romero-Galisteo
- Faculty of Health Sciences. Department of Physiotherapy, University of Málaga, Institute of Biomedicine of Málaga (IBIMA), Málaga, Spain
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de Mendonça KT, Lanza FC, de Sousa Morais RL, Camargos ACR. Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit. Early Hum Dev 2022; 174:105682. [PMID: 36206619 DOI: 10.1016/j.earlhumdev.2022.105682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). OBJECTIVE To describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. METHODS Fifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. RESULTS Preterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). CONCLUSION PIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.
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Affiliation(s)
- Karoline Tury de Mendonça
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Córdoba Lanza
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosane Luzia de Sousa Morais
- Graduate Program in Health, Society and Environment and Department of Physiotherapy, Universidade Federal do Vale do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ana Cristina Resende Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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20
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Araneda R, Ebner-Karestinos D, Dricot L, Herman E, Hatem SM, Friel KM, Gordon AM, Bleyenheuft Y. Impact of early brain lesions on the optic radiations in children with cerebral palsy. Front Neurosci 2022; 16:924938. [PMID: 36278011 PMCID: PMC9583910 DOI: 10.3389/fnins.2022.924938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Due to their early brain lesion, children with unilateral spastic cerebral palsy (USCP) present important changes in brain gray and white matter, often manifested by perturbed sensorimotor functions. We predicted that type and side of the lesion could influence the microstructure of white matter tracts. Using diffusion tensor imaging in 40 children with USCP, we investigated optic radiation (OR) characteristics: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). First, we compared the OR of the lesional and non-lesional hemisphere. Then we evaluated the impact of the brain lesion type (periventricular or cortico-subcortical) and side in the differences observed in the lesional and non-lesional OR. Additionally, we examined the relationship between OR characteristics and performance of a visuospatial attention task. We observed alterations in the OR of children with USCP on the lesional hemisphere compared with the non-lesional hemisphere in the FA, MD and RD. These differences were influenced by the type of lesion and by the side of the lesion. A correlation was also observed between FA, MD and RD and the visuospatial assessment mainly in children with periventricular and right lesions. Our results indicate an important role of the timing and side of the lesion in the resulting features of these children’s OR and probably in the compensation resulting from neuroplastic changes.
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Affiliation(s)
- Rodrigo Araneda
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Laurance Dricot
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Enimie Herman
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Samar M. Hatem
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- Physical and Rehabilitation Medicine, Brugmann University Hospital, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kathleen M. Friel
- Burke-Cornell Medical Research Institute, White Plains, NY, United States
| | - Andrew M. Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
- *Correspondence: Yannick Bleyenheuft,
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Fioroni Ribeiro da Silva C, Menici V, Tudella E, Beani E, Barzacchi V, Battini R, Orsini A, Cioni G, Sgandurra G. Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10833. [PMID: 36078549 PMCID: PMC9517859 DOI: 10.3390/ijerph191710833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Parental practices and environmental factors can impact a child's development and, consequently, functionality. The objective is to assess the parental practices and environmental differences in healthy and at-risk infants at 3-6 months of age living in upper-middle (Brazil) and high-income (Italy) countries. A total group of 115 infants was identified and classified into four groups: healthy Italian infants (H_IT); Italian infants exposed to biological risk factors (R_IT); healthy Brazilian infants (H_BR); and Brazilian infants exposed to environmental risk factors (L_BR). The dependent variables were parental practices and environmental factors, which were assessed through a semi-structured interview and the "variety of stimulation dimension" from the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire. Descriptive analyses, a multivariate analysis of variance (MANOVA), and correlation tests were applied. Regarding the environment and parental practices, the mother's age, maternal and paternal education, civil status, and variety of stimulation showed significant differences among the infants living in Brazil or in Italy. There were strong dissimilarities in parental practices and environmental factors among infants living in low/upper-middle and high-income countries. Since the home environment is the main stimulus for infant growth and development, our results are meaningful for providing knowledge about these two different cultures.
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Affiliation(s)
- Carolina Fioroni Ribeiro da Silva
- Postgraduate Program in Physiotherapy (PPG-Ft), Department of Physiotherapy, Nucleus of Studies in Neuropediatrics and Motricity (NENEM), Federal University of São Carlos (UFSCar), São Carlos 13565-905, Brazil
| | - Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
- Ph.D. Programme in Clinical and Translational Sciences, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Eloisa Tudella
- Postgraduate Program in Physiotherapy (PPG-Ft), Department of Physiotherapy, Nucleus of Studies in Neuropediatrics and Motricity (NENEM), Federal University of São Carlos (UFSCar), São Carlos 13565-905, Brazil
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Veronica Barzacchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, 50121 Florence, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric Department, Santa Chiara University Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
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22
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van Boven MR, Henke CE, Leemhuis AG, Hoogendoorn M, van Kaam AH, Königs M, Oosterlaan J. Machine Learning Prediction Models for Neurodevelopmental Outcome After Preterm Birth: A Scoping Review and New Machine Learning Evaluation Framework. Pediatrics 2022; 150:188249. [PMID: 35670123 DOI: 10.1542/peds.2021-056052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Outcome prediction of preterm birth is important for neonatal care, yet prediction performance using conventional statistical models remains insufficient. Machine learning has a high potential for complex outcome prediction. In this scoping review, we provide an overview of the current applications of machine learning models in the prediction of neurodevelopmental outcomes in preterm infants, assess the quality of the developed models, and provide guidance for future application of machine learning models to predict neurodevelopmental outcomes of preterm infants. METHODS A systematic search was performed using PubMed. Studies were included if they reported on neurodevelopmental outcome prediction in preterm infants using predictors from the neonatal period and applying machine learning techniques. Data extraction and quality assessment were independently performed by 2 reviewers. RESULTS Fourteen studies were included, focusing mainly on very or extreme preterm infants, predicting neurodevelopmental outcome before age 3 years, and mostly assessing outcomes using the Bayley Scales of Infant Development. Predictors were most often based on MRI. The most prevalent machine learning techniques included linear regression and neural networks. None of the studies met all newly developed quality assessment criteria. Studies least prone to inflated performance showed promising results, with areas under the curve up to 0.86 for classification and R2 values up to 91% in continuous prediction. A limitation was that only 1 data source was used for the literature search. CONCLUSIONS Studies least prone to inflated prediction results are the most promising. The provided evaluation framework may contribute to improved quality of future machine learning models.
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Affiliation(s)
- Menne R van Boven
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Celina E Henke
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development.,Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aleid G Leemhuis
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Mark Hoogendoorn
- Faculty of Science, Quantitative Data Analytics Group, Department Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Marsh Königs
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Jaap Oosterlaan
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
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23
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Adiguzel H, Sarikabadayi YU, Elbasan B. Investigation of the effectiveness of family collaborative physiotherapy programs applied to high-risk infants. Physiother Theory Pract 2022:1-17. [PMID: 35387569 DOI: 10.1080/09593985.2022.2062504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The inclusion of families in intervention programs for infants may be more effective in ensuring adherence and positive outcomes. Approaches that include natural and enriched environments that provide communication and family interaction are important in the rehabilitation of high-risk infants. OBJECTIVE To compare the effectiveness of Family Collaborative Approach (FCA) and Neurodevelopmental Therapy (NDT)-based family training. METHODS High-risk infants (n = 63) with a mean age of 32.60 ± 4.53 months received early intervention for 12 weeks. Prechtl's General movements (GMs) assessment, Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE), BAYLEY-III Scales of Infant and Toddler Development, and Third Addition (BSID-III) were performed. RESULTS Significant differences between groups were found in HINE scores at the 3rd, 6th, and 12th months (p ≤ .028), and in BSID-III scores at the 6th month (cognitive, language, and motor) (p < .001) and the 12th month (language) (p = .031). There was significant difference between NDT and control group in 3rd month HINE scores and Reflex&Reactions scores (p ≤ .021). FCA group and NDT group was significantly different from control group in 6th month HINE (p = .032) and 12th month HINE scores (p = .007). FCA group significantly different from NDT group (p ≤ .002) and control group (p < .001) in 6th month BSID-III cognitive, language, and motor scores. There was significant difference between FCA and control group in 12 month BSID-III language scores (p = .024). CONCLUSIONS Early physiotherapy interventions were effective in high-risk infants and FCA program was superior to NDT.
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Affiliation(s)
- Hatice Adiguzel
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutcu Imam University, Dulkadiroglu, Turkey
| | | | - Bulent Elbasan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Cankaya, Turkey
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Saiote C, Sutter E, Xenopoulos-Oddsson A, Rao R, Georgieff M, Rudser K, Peyton C, Dean D, McAdams RM, Gillick B. Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury. Pediatr Phys Ther 2022; 34:268-276. [PMID: 35385465 PMCID: PMC9200232 DOI: 10.1097/pep.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in lifelong motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. METHODS Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to noninvasively measure CST functional and structural integrity across multiple time points in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. DISCUSSION This protocol will identify bioindicators of motor outcome and neuroplasticity and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds, and related diagnoses.
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Affiliation(s)
- Catarina Saiote
- Waisman Center (Drs Saiote, Sutter, Dean, and Gillick), Department of Pediatrics (Drs Dean, McAdams, and Gillick), and Department of Medical Physics (Dr Dean), University of Wisconsin-Madison, Madison, Wisconsin; Department of Rehabilitation Medicine (Dr Sutter and Ms Xenopoulos-Oddsson), Department of Pediatrics (Drs Rao and Georgieff), and Division of Biostatistics (Dr Rudser), University of Minnesota, Minneapolis, Minnesota; Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics (Dr Peyton), Northwestern University, Chicago, Illinois
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25
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From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.
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26
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Cuzzilla R, Olsen JE, Eeles AL, Rogerson SR, Anderson PJ, Cowan FM, Doyle LW, Cheong JLY, Spittle AJ. Relationships between early postnatal cranial ultrasonography linear measures and neurobehaviour at term-equivalent age in infants born <30 weeks' gestational age. Early Hum Dev 2022; 164:105520. [PMID: 34896733 DOI: 10.1016/j.earlhumdev.2021.105520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between early postnatal brain development and neurobehaviour at term-equivalent age (TEA) remains uncertain. AIM We aimed to explore relationships between early postnatal cranial ultrasonography (cUS) linear measures of brain size and brain growth with neurobehaviour at TEA in infants born <30 weeks' gestational age (GA). STUDY DESIGN Prospective observational cohort study. SUBJECTS 137 infants born <30 weeks' GA without major brain injury on neonatal cUS. OUTCOME MEASURES Neurobehaviour at TEA assessed using the General Movements Assessment (GMA) and Hammersmith Neonatal Neurological Examination (HNNE). RESULTS The GMA was administered in 115/137 (84%) infants; 80 (70%) presented with abnormal general movements (GMs) (79 poor repertoire, 1 cramped synchronised). The HNNE was assessed in 106/137 (77%) infants; 52 (49%) had a suboptimal total score. With respect to brain size, larger measures of the corpus callosum length (CCL) and right anterior horn width (AHW) at 1-month were related to lower risk of abnormal GMs, and larger measures of the biparietal diameter at 1-week and 2-months were related to lower risk of a suboptimal HNNE. As for brain growth, increases of the CCL and transcerebellar diameter between birth and 1-month, and left and right AHWs between 1- and 2-months, were related to lower risk of abnormal GMs. CONCLUSION Early postnatal brain size and brain growth were related to neurobehaviour at TEA in infants born <30 weeks' GA. This study provides preliminary evidence for the prognostic utility of early postnatal cUS linear measures as potential markers of neurodevelopment in later childhood.
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Affiliation(s)
- Rocco Cuzzilla
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
| | - Joy E Olsen
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
| | - Abbey L Eeles
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | | | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Frances M Cowan
- Department of Paediatrics, Imperial College, London, United Kingdom
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
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Kline JE, Yuan W, Harpster K, Altaye M, Parikh NA. Association between brain structural network efficiency at term-equivalent age and early development of cerebral palsy in very preterm infants. Neuroimage 2021; 245:118688. [PMID: 34758381 PMCID: PMC9264481 DOI: 10.1016/j.neuroimage.2021.118688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Very preterm infants (born at less than 32 weeks gestational age) are at high risk for serious motor impairments, including cerebral palsy (CP). The brain network changes that antecede the early development of CP in infants are not well characterized, and a better understanding may suggest new strategies for risk-stratification at term, which could lead to earlier access to therapies. Graph theoretical methods applied to diffusion MRI-derived brain connectomes may help quantify the organization and information transfer capacity of the preterm brain with greater nuance than overt structural or regional microstructural changes. Our aim was to shed light on the pathophysiology of early CP development, before the occurrence of early intervention therapies and other environmental confounders, to help identify the best early biomarkers of CP risk in VPT infants. In a cohort of 395 very preterm infants, we extracted cortical morphometrics and brain volumes from structural MRI and also applied graph theoretical methods to diffusion MRI connectomes, both acquired at term-equivalent age. Metrics from graph network analysis, especially global efficiency, strength values of the major sensorimotor tracts, and local efficiency of the motor nodes and novel non-motor regions were strongly inversely related to early CP diagnosis. These measures remained significantly associated with CP after correction for common risk factors of motor development, suggesting that metrics of brain network efficiency at term may be sensitive biomarkers for early CP detection. We demonstrate for the first time that in VPT infants, early CP diagnosis is anteceded by decreased brain network segregation in numerous nodes, including motor regions commonly-associated with CP and also novel regions that may partially explain the high rate of cognitive impairments concomitant with CP diagnosis. These advanced MRI biomarkers may help identify the highest risk infants by term-equivalent age, facilitating earlier interventions that are informed by early pathophysiological changes.
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Affiliation(s)
- Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, United States
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Radiology, Division of Occupational Therapy and Physical Therapy, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Karen Harpster
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, United States; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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28
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Sharova O, Smiyan O, Borén T. Immunological effects of cerebral palsy and rehabilitation exercises in children. Brain Behav Immun Health 2021; 18:100365. [PMID: 34704080 PMCID: PMC8522480 DOI: 10.1016/j.bbih.2021.100365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is a group of motor disorders caused by non-progressive lesions of the premature brain with lifelong pathophysiological consequences that include dysregulation of innate immunity. Persistent inflammation with increased levels of circulating pro-inflammatory tumor necrosis factor alpha (TNF-a) is negatively associated with rehabilitation outcome in children with CP. Because of the crosstalk between innate and adaptive immunity, we investigated the effect of CP and rehabilitation exercises on the adaptive immune system in children with CP by measuring the levels of CD3+, CD4+, CD8+ Т-cells, and CD22+ B-cells and the levels of immunoglobulins. Children with CP had higher levels of CD3+, CD4+, CD8+ Т-cells, and CD22+ B-cells compared to healthy children, and the rehabilitation exercise programs produced better outcomes in terms of increased gains in motor function at an earlier age. Rehabilitation exercises performed over a month resulted in significantly decreased levels of IgA in serum and reduced numbers of B-lymphocytes and reduced IgM levels. Our study suggests that rehabilitation programs with a focus on neuroplasticity and physical exercises in children with CP can reduce both cellular and humoral immune responses. Children with CP demonstrate increased levels of T and B cells. Rehabilitation exercises helped balance immune responses.
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Affiliation(s)
- Oleksandra Sharova
- Department of Pediatrics, Sumy State University, 40031, Sumy, Ukraine
- Corresponding author.
| | - Oleksandr Smiyan
- Department of Pediatrics, Sumy State University, 40031, Sumy, Ukraine
| | - Thomas Borén
- Department of Medical Biochemistry and Biophysics, Umeå University, SE-90187, Umeå, Sweden
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29
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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30
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Røhder K, Willerslev-Olsen M, Nielsen JB, Greisen G, Harder S. Parent-Infant Interactions Among Infants With High Risk of Cerebral Palsy: A Protocol for an Observational Study of Infant and Parental Factors for Dyadic Reciprocity. Front Psychiatry 2021; 12:736676. [PMID: 34658969 PMCID: PMC8511395 DOI: 10.3389/fpsyt.2021.736676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: An early diagnosis of chronic disability, such as risk of Cerebral Palsy (CP), is likely to affect the quality of parent-infant interactions by affecting both infant and parental factors. Due to adverse perinatal events, infants at high risk of CP may exhibit less engagement in interactions, while parents may experience increased mental health problems and disrupted parental representations that can have a negative effect on parental sensitivity. Recent clinical guidelines on early intervention among families with infants at risk of CP recommends supporting parental sensitivity and mutual enjoyable interactions more research is needed to inform such interventions. This includes understanding how infant and parental risk as well as resilience factors impact parent-infant interactions and how existing parenting programs developed among typical developing infants should be adapted to families with infants at risk of CP. In addition, as majority of research on infant neurohabilitation focus on improving motor and cognitive outcomes research on infant emotional development is needed. The study aim is to assess the quality of early parent-infant interactions in families with high-risk infants, compared to families with low-risk infants, and to explore how interaction quality is affected by infant and parental factors. Three potential mediating factors explaining the association between CP risk and less optimal parent-infant interactions will be explored: infant interactional capacities, parental mental health and well-being, and parents' representations of their child. Methods: The prospective, longitudinal design will follow infants at high risk for CP and their parents and a control group at three time points from 15 weeks to 15 months corrected infant age (CA). Measures comprise infant developmental assessments, questionnaires and interviews with both parents, and global ratings of video-recorded parent-infant interactions. Discussion: Study results will enhance our understanding of how parent-infant interactions may be affected by perinatal neurological risk and identify potential important mechanisms for observed associations. This knowledge could assist in planning future early screening and intervention programs and identifying families who should be offered targeted psychological interventions in addition to neurohabilitation programs.
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Affiliation(s)
- Katrine Røhder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Maria Willerslev-Olsen
- Elsass Foundation, Charlottenlund, Denmark
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Elsass Foundation, Charlottenlund, Denmark
- Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Neonatal Department, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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31
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Hoyt CR, Sherman SK, Brown SK, Newbold DJ, Miller RL, Van AN, Shimony JS, Ortega M, Nguyen AL, Schlaggar BL, Dosenbach NUF. Toward a More Comprehensive Assessment of School Age Children with Hemiplegic Cerebral Palsy. Rehabil Process Outcome 2021; 10:11795727211010500. [PMID: 34497455 PMCID: PMC8282143 DOI: 10.1177/11795727211010500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Cerebral palsy (CP) is the leading cause of disability in children. While motor deficits define CP, many patients experience behavioral and cognitive deficits which limit participation. The purpose of this study was to contribute to our understanding of developmental delay and how to measure these deficits among children with CP. Methods: Children 5 to 15 years with hemiplegic CP were recruited. Cognition and motor ability were assessed. The brain injury associated with observed motor deficits was identified. Accelerometers measured real-world bilateral upper extremity movement and caregivers completed behavioral assessments. Results: Eleven children participated, 6 with presumed perinatal stroke. Four children scored below average intelligence quotient while other measures of cognition were within normal limits (except processing speed). Motor scores confirmed asymmetrical deficits. Approximately one third of scores indicated deficits in attention, behavior, or depression. Conclusions: Our findings corroborate that children with CP experience challenges that are broader than motor impairment alone. Despite the variation in brain injury, all participants completed study procedures. Implications: Our findings suggest that measuring behavior in children with CP may require a more comprehensive approach and that caregivers are amenable to using online collection tools which may assist in addressing the therapeutic needs of children with CP.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Catherine R Hoyt, Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-94-01, St. Louis, MO 63110, USA.
| | - Sarah K Sherman
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Shelby K Brown
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryland L Miller
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nico UF Dosenbach
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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32
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Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study. Brain Sci 2021; 11:brainsci11091189. [PMID: 34573210 PMCID: PMC8469407 DOI: 10.3390/brainsci11091189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the “Shishu Shorgo” (Bengali title, which translates to ‘Children’s Heaven’) Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.
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33
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Walker C, Shierk A, Roberts H. Constraint Induced Movement Therapy in Infants and Toddlers with Hemiplegic Cerebral Palsy: A Scoping Review. Occup Ther Health Care 2021; 36:29-45. [PMID: 34339315 DOI: 10.1080/07380577.2021.1953206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cerebral Palsy (CP) is the leading cause of motor disability in childhood. Recent studies have investigated the effectiveness of constraint induced movement therapy (CIMT) as an early intervention for infants and toddlers with hemiplegic CP. This scoping review aims to identify current evidence for CIMT protocols for children 3 months to 5 years 11 months as well as clinical applications for practice and gaps in research. Selected databases and additional studies were searched and reviewed with 10 studies were selected for review. Results show CIMT for infants and toddlers is a feasible and effective treatment consisting of caregiver coaching, treatment in the child's typical environment, and just right activities. Future research is needed to determine the effects of different dosages in early CIMT, and the long term developmental effects throughout childhood.
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Affiliation(s)
- Casey Walker
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
| | - Angela Shierk
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
| | - Heather Roberts
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
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34
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Chandwani R, Kline JE, Harpster K, Tkach J, Parikh NA. Early micro- and macrostructure of sensorimotor tracts and development of cerebral palsy in high risk infants. Hum Brain Mapp 2021; 42:4708-4721. [PMID: 34322949 PMCID: PMC8410533 DOI: 10.1002/hbm.25579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Infants born very preterm (VPT) are at high risk of motor impairments such as cerebral palsy (CP), and diagnosis can take 2 years. Identifying in vivo determinants of CP could facilitate presymptomatic detection and targeted intervention. Our objectives were to derive micro‐ and macrostructural measures of sensorimotor white matter tract integrity from diffusion MRI at term‐equivalent age, and determine their association with early diagnosis of CP. We enrolled 263 VPT infants (≤32 weeks gestational age) as part of a large prospective cohort study. Diffusion and structural MRI were acquired at term. Following consensus guidelines, we defined early diagnosis of CP based on abnormal structural MRI at term and abnormal neuromotor exam at 3–4 months corrected age. Using Constrained Spherical Deconvolution, we derived a white matter fiber orientation distribution (fOD) for subjects, performed probabilistic whole‐brain tractography, and segmented nine sensorimotor tracts of interest. We used the recently developed fixel‐based (FB) analysis to compute fiber density (FD), fiber‐bundle cross‐section (FC), and combined fiber density and cross‐section (FDC) for each tract. Of 223 VPT infants with high‐quality diffusion MRI data, 14 (6.3%) received an early diagnosis of CP. The cohort's mean (SD) gestational age was 29.4 (2.4) weeks and postmenstrual age at MRI scan was 42.8 (1.3) weeks. FD, FC, and FDC for each sensorimotor tract were significantly associated with early CP diagnosis, with and without adjustment for confounders. Measures of sensorimotor tract integrity enhance our understanding of white matter changes that antecede and potentially contribute to the development of CP in VPT infants.
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Affiliation(s)
- Rahul Chandwani
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julia E Kline
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Jean Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Raghuram K, Orlandi S, Church P, Chau T, Uleryk E, Pechlivanoglou P, Shah V. Automated movement recognition to predict motor impairment in high-risk infants: a systematic review of diagnostic test accuracy and meta-analysis. Dev Med Child Neurol 2021; 63:637-648. [PMID: 33421120 DOI: 10.1111/dmcn.14800] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/21/2022]
Abstract
AIM To assess the sensitivity and specificity of automated movement recognition in predicting motor impairment in high-risk infants. METHOD We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus databases and identified additional studies from the references of relevant studies. We included studies that evaluated automated movement recognition in high-risk infants to predict motor impairment, including cerebral palsy (CP) and non-CP motor impairments. Two authors independently assessed studies for inclusion, extracted data, and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies-2. Meta-analyses were performed using hierarchical summary receiver operating characteristic models. RESULTS Of 6536 articles, 13 articles assessing 59 movement variables in 1248 infants under 5 months corrected age were included. Of these, 143 infants had CP. The overall sensitivity and specificity for motor impairment were 0.73 (95% confidence interval [CI] 0.68-0.77) and 0.70 (95% CI 0.65-0.75) respectively. Comparatively, clinical General Movements Assessment (GMA) was found to have sensitivity and specificity of 98% (95% CI 74-100) and 91% (95% CI 83-93) respectively. Sensor-based technologies had higher specificity (0.88, 95% CI 0.80-0.93). INTERPRETATION Automated movement recognition technology remains inferior to clinical GMA. The strength of this study is its meta-analysis to summarize performance, although generalizability of these results is limited by study heterogeneity.
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Affiliation(s)
- Kamini Raghuram
- Department of Neonatal-Perinatal Medicine, University of Toronto, Toronto, ON, Canada
| | - Silvia Orlandi
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Paige Church
- Department of Newborn and Developmental Paediatrics, Women and Babies' Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Elizabeth Uleryk
- The Hospital for Sick Children, University of Toronto Libraries, Toronto, ON, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
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Dolinskaya IY, Solopova IA, Zhvansky DS, Keshishian ES, Ivanenko Y. Increasing muscle activity correlations during spontaneous movements in the first six months of life. Neurosci Lett 2021; 756:135957. [PMID: 33989731 DOI: 10.1016/j.neulet.2021.135957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/07/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Spontaneous muscle activity in the first months of life is an important prerequisite to developing voluntary motor skills and to adapting sensorimotor circuits and muscle tone to body and environmental changes. Even though high variability is a characteristic of early development, several studies have reported significant correlations of limb movements. These assessments were typically made based on kinematics, while the analysis of lower and upper limb muscle activity may provide additional information about maturation of the neuromuscular control. To this end, we examined the electromyographic activity of 12 muscles of the upper and lower limbs in full-term healthy infants (n = 40) aged from 1 week to six months. An increase of ipsilateral and contralateral limb muscle activity correlations with age was found in both flexors and extensors and may reflect a progressive emergence of elements of coordinative neuromuscular behaviour. Correlations between arm and leg muscle responses also increased during passive leg movements. Overall, the findings are consistent with maturation of physiologically relevant neuromuscular network connections during the course of transition from spontaneous-like to voluntary goal-directed movements during early development.
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Affiliation(s)
- I Y Dolinskaya
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia.
| | - I A Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - D S Zhvansky
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - E S Keshishian
- Moscow Research Institute of Clinical Pediatrics of Russian Federation, Moscow, Russia
| | - Y Ivanenko
- Laboratory of Neuromotor Physiology, Fondazione Santa Lucia, Rome, Italy
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Glass HC, Li Y, Gardner M, Barkovich AJ, Novak I, McCulloch CE, Rogers EE. Early Identification of Cerebral Palsy Using Neonatal MRI and General Movements Assessment in a Cohort of High-Risk Term Neonates. Pediatr Neurol 2021; 118:20-25. [PMID: 33714922 DOI: 10.1016/j.pediatrneurol.2021.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common motor disability of childhood. Its early identification is an important priority for parents and is critical for access to early intervention resources, which may optimize function. METHODS A prospective cohort of term neonates at high risk for CP was assessed by neonatal magnetic resonance imaging (MRI) to determine myelination of the posterior limb of the internal capsule, General Movements Assessment to assess typical fidgety movements at age three months, and followed to at least age two years to determine diagnosis of CP based on neurological examination. RESULTS Seven of 58 children developed CP (12%), two with moderate/severe CP. Sensitivity and specificity for abnormal myelination of the posterior limb of the internal capsule were (PLIC) was 29% and 94%, and for absent fidgety movements, 29% and 98%, respectively. Negative predictive value of both absent myelination of the PLIC and absent fidgety movements was 90% (79% to 96%) for any CP and 98% (90% to 100%) for moderate/severe CP cerebral palsy. None of the children with both normal PLIC and normal fidgety movements had moderate/severe CP. CONCLUSION Normal neonatal MRI and General Movements Assessment at age three months are reassuring that a high-risk term-born child is at low risk for moderate/severe CP. These results are important for counseling parents and individualizing therapy resources in the community.
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Affiliation(s)
- Hannah C Glass
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
| | - Yi Li
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Marisa Gardner
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Benioff Children's Hospital, Oakland, California
| | - A James Barkovich
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Huisenga D, la Bastide-Van Gemert S, Van Bergen A, Sweeney J, Hadders-Algra M. Children with complex congenital heart disease and new meta-analyses. Dev Med Child Neurol 2021; 63:117-118. [PMID: 33094481 DOI: 10.1111/dmcn.14711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Darlene Huisenga
- Advocate Children's Hospital - Pediatric Rehabilitation and Development, Oak Lawn, IL, USA.,University of Groningen, University Medical Center Groningen - Developmental Neurology, Groningen, the Netherlands
| | | | - Andrew Van Bergen
- Advocate Children's Hospital - Heart Institute Division of Pediatric Cardiac Critical Care, Oak Lawn, IL, USA
| | - Jane Sweeney
- Rocky Mountain University of Health Professionals - Pediatric Science Doctoral Program, Provo, UT, USA
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen - Developmental Neurology, Groningen, the Netherlands
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Battistin T, Mercuriali E, Zanardo V, Gregori D, Lorenzoni G, Nasato L, Reffo ME. Distance support and online intervention to blind and visually impaired children during the pandemic COVID-19. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103816. [PMID: 33271446 PMCID: PMC7682482 DOI: 10.1016/j.ridd.2020.103816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 05/12/2023]
Abstract
The COVID-19 pandemic imposed dramatic changes to everyone's daily routines, but especially to children with developmental disabilities. The Robert Hollman Foundation decided not to interrupt its service to all the visually impaired children and initiated a Distance Support Project. It was an online process covering all aspects of support for the children and involving audio-video calls, videos and tailored-made multisensory material created specifically for each child. A questionnaire, carried out after the 5-month project duration, was created to collect feedback from parents and professionals to understand the impact this project had on everyone involved. Overall both parents and professionals indicated high levels of satisfaction, but in a significant number of questions parents reported consistently higher levels of satisfaction (p-value <0.001). It was shown that parents felt reassured at this otherwise very difficult time because their children were able to continue their treatment, even if in a very different way. This fact encourages us to consider enriching our existing programmes of support and care, integrating this online approach when necessary. At the same time, it seems clear that the responses of the professionals indicate their belief that the benefits of the traditional ways of working remain of unquestionable importance for children with sight deprivation.
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Affiliation(s)
- Tiziana Battistin
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy.
| | - Elena Mercuriali
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
| | - Vincenzo Zanardo
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Laura Nasato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Maria Eleonora Reffo
- Robert Hollman Foundation "Consultation and Support for the Development of Visually Impaired Children", Via Siena 1, Padova, Italy
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Abstract
Cerebral palsy is a group of neuromuscular diseases that is primarily common in the pediatric population and is the most common cause of neurological and motor disability in children. Cerebral palsy is comprised of various subtypes with the most common type being spastic cerebral palsy. It is highly associated with prematurity and affects nerve function, motor function, and intellectual capacity. It is also associated with nutritional deficiencies and gastrointestinal dysfunction. Cerebral palsy is diagnosed via clinical evaluation and does not have specific laboratory or image findings, but certain imaging findings are positively correlated with it. There are numerous interventions and treatment modalities that are aimed at ensuring the highest quality of life for the patient and their families. This article was compiled with peer-reviewed publications from the PubMed database in which various keywords were utilized in the search engine. These peer-reviewed articles were selected without geographical restrictions and selected based on the use of the English language. These articles were also selected on the restriction of publication within the last 10 years. This review article on cerebral palsy will serve as a medium of education for the physician, healthcare team, and family involved in the management of children or adults with cerebral palsy. It is important because it discusses the possible etiologies, diagnostic and assessment techniques, prevention methods, and possible rehabilitation interventions. This article aims to broaden the reader's understanding of cerebral palsy and answer any questions that may arise during the management of this disease. The management of cerebral palsy is often plagued with frustration, depression, and anxiety. The main goal of treatment is to attain the highest quality of life for the family and the child.
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Cappellini G, Sylos-Labini F, Dewolf AH, Solopova IA, Morelli D, Lacquaniti F, Ivanenko Y. Maturation of the Locomotor Circuitry in Children With Cerebral Palsy. Front Bioeng Biotechnol 2020; 8:998. [PMID: 32974319 PMCID: PMC7462003 DOI: 10.3389/fbioe.2020.00998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
The first years of life represent an important phase of maturation of the central nervous system, processing of sensory information, posture control and acquisition of the locomotor function. Cerebral palsy (CP) is the most common group of motor disorders in childhood attributed to disturbances in the fetal or infant brain, frequently resulting in impaired gait. Here we will consider various findings about functional maturation of the locomotor output in early infancy, and how much the dysfunction of gait in children with CP can be related to spinal neuronal networks vs. supraspinal dysfunction. A better knowledge about pattern generation circuitries in infancy may improve our understanding of developmental motor disorders, highlighting the necessity for regulating the functional properties of abnormally developed neuronal locomotor networks as a target for early sensorimotor rehabilitation. Various clinical approaches and advances in biotechnology are also considered that might promote acquisition of the locomotor function in infants at risk for locomotor delays.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Arthur H Dewolf
- Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Irina A Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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Parisi C, Hesse N, Tacke U, Pujades Rocamora S, Blaschek A, Hadders-Algra M, Black MJ, Heinen F, Müller-Felber W, Schroeder AS. Analyse der Spontanmotorik im 1. Lebensjahr: Markerlose 3-D-Bewegungserfassung zur Früherkennung von Entwicklungsstörungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:881-890. [DOI: 10.1007/s00103-020-03163-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungKinder mit motorischer Entwicklungsstörung profitieren von einer frühen Entwicklungsförderung. Eine frühe Diagnosestellung in der kinderärztlichen Vorsorge (U2–U5) kann durch ein automatisiertes Screening verbessert werden. Bisherige Ansätze einer automatisierten Bewegungsanalyse sind jedoch teuer und aufwendig und nicht in der Breite anwendbar. In diesem Beitrag soll ein neues System zur Videoanalyse, das Kinematic Motion Analysis Tool (KineMAT) vorgestellt werden. Es kann bei Säuglingen angewendet werden und kommt ohne Körpermarker aus. Die Methode wird anhand von 7 Patienten mit unterschiedlichen Diagnosen demonstriert.Mit einer kommerziell erhältlichen Tiefenbildkamera (RGB-D[Red-Green-Blue-Depth]-Kamera) werden 3‑minütige Videosequenzen von sich spontan bewegenden Säuglingen aufgenommen und mit einem virtuellen Säuglingskörpermodell (SMIL[Skinned Multi-infant Linear]-Modell) in Übereinstimmung gebracht. Das so erzeugte virtuelle Abbild erlaubt es, beliebige Messungen in 3‑D mit hoher Präzision durchzuführen. Eine Auswahl möglicher Bewegungsparameter wird mit diagnosespezifischen Bewegungsauffälligkeiten zusammengeführt.Der KineMAT und das SMIL-Modell erlauben eine zuverlässige, dreidimensionale Messung der Spontanaktivität bei Säuglingen mit einer sehr niedrigen Fehlerrate. Basierend auf maschinellen Lernalgorithmen kann der KineMAT trainiert werden, pathologische Spontanmotorik automatisiert zu erkennen. Er ist kostengünstig und einfach anzuwenden und soll als Screeninginstrument für die kinderärztliche Vorsorge weiterentwickelt werden.
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Filisetti M, Cattarelli D, Bonomi S. Positional plagiocephaly from structure to function: Clinical experience of the service of pediatric osteopathy in Italy. Early Hum Dev 2020; 146:105028. [PMID: 32450443 DOI: 10.1016/j.earlhumdev.2020.105028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Aim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic integrated approach. METHODS We review clinical experience of the "Program for Neurodevelopmental Follow-up and Pediatric Osteopathy", a service dedicated to newborns at risk for developmental disorders. RESULTS We present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that could be related to plagiocephaly. CONCLUSIONS The experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies (81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives.
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Affiliation(s)
| | | | - Stefano Bonomi
- Desenzano del Garda Hospital (ASST del Garda, Bs), Italy; Osteopathic Center for Children Italy (Lonato del Garda, Bs), Italy
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Redd CB, Barber LA, Boyd RN, Varnfield M, Karunanithi MK. Development of a Wearable Sensor Network for Quantification of Infant General Movements for the Diagnosis of Cerebral Palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:7134-7139. [PMID: 31947480 DOI: 10.1109/embc.2019.8857377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Qualitative assessments of infant spontaneous movements can be performed to measure neurodevelopmental status and provide early insight into the presence of any abnormalities. Clinical assessments of infant movements at 12 weeks post term age are up to 98% predictive of the eventual development of Cerebral Palsy, but their reach is often limited to infants already identified as high-risk within the traditional healthcare system. We present the development of a network of wearable sensors designed to noninvasively measure spontaneous movements in infants from 12-20 weeks post-term- age both within the clinic and for future home use. Pilot data on a single healthy term infant is presented to demonstrate clinical functionality towards future validation studies in infants at high-risk of Cerebral Palsy. Using this system for tele- delivered assessments in the home could enhance screening of neurodevelopmental disorders for infants and families in rural and remote areas, a population with reduced health services.
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Ferre CL, Babik I, Michel GF. A perspective on the development of hemispheric specialization, infant handedness, and cerebral palsy. Cortex 2020; 127:208-220. [PMID: 32224319 DOI: 10.1016/j.cortex.2020.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
Cerebral Palsy (CP), a common form of neurological pediatric disability, results from pre- or perinatal brain injury. Although there is growing evidence of the efficacy of motor learning-based therapies, several factors interact to produce variability in impairment and limit the effectiveness of these therapies. The variability of hand function present in children with CP indicates that a range of developmental pathways must contribute to the manifestation of individually unique characteristics of impairment. Despite two decades of progress using therapies derived from understanding the mechanisms controlling hand function, very little is known about the sensorimotor experiences occurring during development that likely shape later functional problems for children with CP. In this "perspective" paper, we propose that the study of the development of motor skills in typically developing infants may reveal experiential factors potentially important for creating remedial therapies for children with CP. Specifically, we use the development of infant handedness, a model of hemispheric specialization of function, as an example of how self-generated experiences and sensorimotor feedback can shape the development of limb control and hemispheric specialization. We illustrate how early sensorimotor asymmetries concatenate into pronounced differences in skill between the two hands. We suggest that this model of infant handedness provides a framework for studying the individual differences manifested in children with CP. These differences likely arise from aberrant sensorimotor experiences created by sensorimotor circuits disrupted by the early brain injury. We conclude that knowledge of the developmental events, including subtle motor behaviors, that shape sensorimotor pathways, can improve treatment options for children with CP.
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Affiliation(s)
- Claudio L Ferre
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
| | - Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, USA
| | - George F Michel
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
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Abstract
OBJECTIVE The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy. METHODS Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis. RESULTS The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources. CONCLUSION Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.
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47
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Steele PR, Cavarsan CF, Dowaliby L, Westefeld M, Katenka N, Drobyshevsky A, Gorassini MA, Quinlan KA. Altered Motoneuron Properties Contribute to Motor Deficits in a Rabbit Hypoxia-Ischemia Model of Cerebral Palsy. Front Cell Neurosci 2020; 14:69. [PMID: 32269513 PMCID: PMC7109297 DOI: 10.3389/fncel.2020.00069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022] Open
Abstract
Cerebral palsy (CP) is caused by a variety of factors attributed to early brain damage, resulting in permanently impaired motor control, marked by weakness and muscle stiffness. To find out if altered physiology of spinal motoneurons (MNs) could contribute to movement deficits, we performed whole-cell patch-clamp in neonatal rabbit spinal cord slices after developmental injury at 79% gestation. After preterm hypoxia-ischemia (HI), rabbits are born with motor deficits consistent with a spastic phenotype including hypertonia and hyperreflexia. There is a range in severity, thus kits are classified as severely affected, mildly affected, or unaffected based on modified Ashworth scores and other behavioral tests. At postnatal day (P)0-5, we recorded electrophysiological parameters of 40 MNs in transverse spinal cord slices using whole-cell patch-clamp. We found significant differences between groups (severe, mild, unaffected and sham control MNs). Severe HI MNs showed more sustained firing patterns, depolarized resting membrane potential, and fired action potentials at a higher frequency. These properties could contribute to muscle stiffness, a hallmark of spastic CP. Interestingly altered persistent inward currents (PICs) and morphology in severe HI MNs would dampen excitability (depolarized PIC onset and increased dendritic length). In summary, changes we observed in spinal MN physiology likely contribute to the severity of the phenotype, and therapeutic strategies for CP could target the excitability of spinal MNs.
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Affiliation(s)
- Preston R. Steele
- Interdepartmental Neuroscience Program, University of Rhode Island, Kingston, RI, United States
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
| | - Clarissa Fantin Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Lisa Dowaliby
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Megan Westefeld
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - N. Katenka
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, United States
| | | | - Monica A. Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Katharina A. Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Jiang H, Liu H, He H, Yang J, Liu Z, Huang T, Lyu J, Li X. Specific White Matter Lesions Related to Motor Dysfunction in Spastic Cerebral Palsy: A Meta-analysis of Diffusion Tensor Imaging Studies. J Child Neurol 2020; 35:146-154. [PMID: 31646936 DOI: 10.1177/0883073819879844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Assessing motor impairment in spastic cerebral palsy is a key factor in the treatment and rehabilitation of patients. We intend to investigate the correlation between diffusion tensor imaging properties of sensorimotor pathways and motor function in spastic cerebral palsy using meta-analysis, and to determine specific white matter lesions that are closely related to motor dysfunction in spastic cerebral palsy. METHODS We conducted a literature search of PubMed, Embase, Scopus, and Web of Science databases to identify trials published from January 1999 to January 2019 that had evaluated the correlation between fractional anisotropy and motor function scores in spastic cerebral palsy. Correlation coefficient (r) values were extracted for each study, and the extent of r was quantitatively explored. The r values between fractional anisotropy within different sensorimotor pathways and motor function scores were pooled respectively. RESULTS Nineteen studies involving 504 children with spastic cerebral palsy, were included. Fractional anisotropy in both sensory and motor pathways significantly correlated with motor function scores. However, compared with the corticospinal tract and thalamic radiation, fractional anisotropy in the posterior limb of the internal capsule correlated more strongly with gross motor function classification system and upper limb motor function (r = -0.71, 95% confidence interval [CI] -0.80 to -0.60; r = 0.73, 95% CI 0.60-0.82, respectively; P < .05). CONCLUSIONS Fractional anisotropy within the posterior limb of the internal capsule is more closely related to motor dysfunction and can potentially be a biomarker for evaluating the degree of motor impairment in spastic cerebral palsy.
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Affiliation(s)
- Haoxiang Jiang
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Radiology, Xi'an Children Hospital, Xi'an, China
| | - Heng Liu
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Hairong He
- Department of Clinical Research Center, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- The Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhe Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Tingting Huang
- Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research Center, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xianjun Li
- Department of Diagnostic Radiology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Lotfian M, Dadashi F, Rafieenazari Z, Shahroki A, Rasteh M, Molavi M, Mirbagheri A, Mirbagheri MM. The Effects of Anti-gravity Treadmill Training on Gait Characteristics in Children with Cerebral Palsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5256-5259. [PMID: 31947043 DOI: 10.1109/embc.2019.8856660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral palsy is a disorder that affects muscle tone, movement and motor skills. Most of the children with cerebral palsy (CP) are not able to walk or can walk in incorrect pattern and are dependent on assistive devices. Recently an antigravity treadmill has been found to be beneficial as a new therapeutic approach. Thus, we aimed to investigate the effects of antigravity treadmill training (AlterG) on gait characteristic in children with cerebral palsy. We provided a 45-minute training program, 3 times a week for 8 weeks for six CP children as our experimental group. Our control group was a group consisted of four CP children who took typical occupational therapy, accordingly. All subjects in both AlterG and control groups were evaluated at the gait lab before and after 8 weeks training. Gait patterns were characterized using spatiotemporal parameters and dynamic balance features. We also evaluated the popular clinical gait measures including walking speed and endurance, and mobility and balance.Our results demonstrated that spatiotemporal, dynamic balance and clinical features all improved more after 8 weeks AlterG training rather than control group ones. These findings suggest that AlterG training can be considered as an effective approach for improving walking ability and gait characteristics in children with cerebral palsy.
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Garfinkle J, Li P, Boychuck Z, Bussières A, Majnemer A. Early Clinical Features of Cerebral Palsy in Children Without Perinatal Risk Factors: A Scoping Review. Pediatr Neurol 2020; 102:56-61. [PMID: 31416726 DOI: 10.1016/j.pediatrneurol.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The early identification of cerebral palsy (CP) in the primary care context is often problematic and referral for diagnosis often delayed. This study aimed to identify clinical features associated with the early detection of CP that can be used by the primary care provider. METHODS We performed a scoping review by searching six electronic databases. We included English language articles that addressed the diagnosis of CP and/or its differential diagnosis in children and ways of detecting CP before the diagnosis is established (i.e., early clinical signs of CP) via (1) questions on the patient's clinical history, (2) developmental screening and/or health questionnaires, or (3) physical or neurological examination. RESULTS Included studies (n = 41; 27 overview studies and 14 original studies) were grouped into the three themes. Most of the overview articles relied on expert opinion, and all original studies included patients at high risk of developing CP. The most commonly identified features from each theme were early hand preference on clinical history, delayed or absent achievement of motor developmental milestones on developmental screening, and persistent primitive reflexes on neurological examination. CONCLUSIONS Overall, the literature on the early observable clinical signs that should prompt referral for investigation of possible CP in the specific context of well-baby care surveillance was sparse and inconsistent. Further research should focus on evaluating the contribution of readily identifiable clinical features.
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Affiliation(s)
- Jarred Garfinkle
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Zachary Boychuck
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - André Bussières
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Annette Majnemer
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada; School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada.
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