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Lyster AE, Hansen SL, Andersen CT, Nielsen JB, Westerterp K, Wouters L, Kiens B, Ritterband-Rosenbaum A. Oral Motor Impairments Contribute to Weight Status of Adults with Severe Cerebral Palsy. Nutrients 2023; 15:5042. [PMID: 38140301 PMCID: PMC10745858 DOI: 10.3390/nu15245042] [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: 11/01/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Adults with severe cerebral palsy (CP) are susceptible to malnutrition and metabolic disorders due to limited daily physical activity and challenges related to eating. We hypothesized that the condition of being underweight arises from inadequate energy intake due to difficulties in eating, rather than heightened total energy expenditure or an elevated resting metabolic rate. The present study encompassed 17 adults with severe CP (classified as GMFSC III-V). Energy intake, utilization, and expenditure were gauged via thorough dietary recordings and double-labeled water (DLW) analyses. Resting metabolic rates were assessed through indirect calorimetry, and metabolic health was investigated via blood samples. Oral motor function, eating assessment during meals, and weight fluctuations throughout the experimental period were also evaluated. We found significant correlations between weight, oral impairments (p < 0.01), and eating difficulties (p < 0.05). While total energy expenditure and daily consumption were similar between underweight (UW) and overweight (OW) individuals, significant variability in both expenditure and intake was evident within the UW group. Particularly, those with lower BMIs experienced heightened mealtime impairments and complications. Our present findings indicate that eating difficulties are the central concern for UW status in this population.
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Affiliation(s)
- Aslak Emil Lyster
- The August Krogh Section for Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen, Denmark; (A.E.L.); (B.K.)
| | - Solvejg Lis Hansen
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
| | | | - Jens Bo Nielsen
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Klaas Westerterp
- Department of Nutrition and Movement Sciences, The Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (K.W.); (L.W.)
| | - Loek Wouters
- Department of Nutrition and Movement Sciences, The Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (K.W.); (L.W.)
| | - Bente Kiens
- The August Krogh Section for Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen, Denmark; (A.E.L.); (B.K.)
| | - Anina Ritterband-Rosenbaum
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
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Is Standing Function Improved After Orthopaedic Surgery in Children With Cerebral Palsy at GMFCS Levels III/IV? J Pediatr Orthop 2023; 43:e48-e53. [PMID: 36240672 DOI: 10.1097/bpo.0000000000002276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels III/IV are at risk for losses in standing function during adolescence and transition to adulthood. Multilevel surgery (MLS) is an effective treatment to improve gait, but its effects on standing function are not well documented. The objectives of our study were to describe standing function in children with CP classified as GMFCS levels III/IV and evaluate change after MLS. METHODS This retrospective study included children with CP (GMFCS III/IV) ages 6 to 20 years who underwent instrumented gait analysis. A subset who underwent MLS were evaluated for change. Primary outcome measures were Gross Motor Function Measure dimension D, gait velocity, functional mobility scale, and the Pediatric Outcomes Data Collection Instrument (PODCI). Additional impairment level measures included foot pressure, knee extension during stance phase of gait, and knee extension passive range of motion. RESULTS Four hundred thirty-seven instrumented gait analysis sessions from 321 children with CP (ages 13.7±4.8 y; GMFCS III-81%/IV-19%) were included. The GMFCS III group had higher Gross Motor Function Measure dimension D, gait velocity, PODCI scores, and better knee extension compared with the GMFCS IV group ( P <0.05); 94 MLS were evaluated for postoperative change 15.3±4.2 months after MLS. Children at GMFCS level III had improved PODCI scores ( P <0.05), better knee extension passive range of motion ( P <0.01), and improved coronal plane foot pressure ( P <0.05) post MLS. Maximum knee extension during stance and heel impulse improved significantly in both groups ( P <0.01). CONCLUSIONS Standing function of children with CP at GMFCS IV was significantly more limited than at GMFCS III. After MLS, both groups (III/IV) showed improvement in impairment level outcomes (knee extension and foot position), whereas only those functioning at GMFCS III had improvement in activity/participation outcomes according to the PODCI. For children with CP at GMFCS levels IV, MLS may improve standing function, but appropriate goals related to assisted standing and measurement protocols sensitive to limited functional mobility should be adopted. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Won JH, Jung SH. Bone Mineral Density in Adults With Cerebral Palsy. Front Neurol 2021; 12:733322. [PMID: 34566876 PMCID: PMC8460852 DOI: 10.3389/fneur.2021.733322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Low bone mineral density (BMD) is an emerging health issue in adults with cerebral palsy (CP). This cross-sectional study aimed to describe the characteristics of BMD in adults with CP, and to elucidate the risk factors for low BMD in this population. People aged ≥20 years and diagnosed with CP were recruited from February 2014 to November 2014. We assessed BMD using dual-energy X-ray absorptiometry (DXA) for the lumbar spine, femoral neck, and total femur. Moreover, the body composition was assessed using DXA. We included a total of 87 adults with CP (mean age 42.01 years; 52 men). The prevalence of low BMD was 25.3%. Male sex and age were associated with lower BMD. BMD was significantly lower in the non-ambulatory group than that in the ambulatory group for both lumbar spine and femoral neck. The total fat mass demonstrated a positive correlation with the Z-score and BMD for the femur neck and total femur. Body mass index (BMI) and total fat mass were positively correlated with BMD in the lumbar spine, femoral neck, and total femur. However, the Gross Motor Function Classification Scale levels were negatively correlated with BMD at the aforementioned three sites. In conclusion, adults with CP revealed decreased BMD, which was associated with male sex, age, decreased gross motor function, loss of ambulatory function, low BMI, decreased total fat mass, and decreased total fat-free mass.
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Affiliation(s)
- Jun Hee Won
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Shin YK, Heo JH, Lee JY, Park YJ, Cho SR. Collagen-binding peptide reverses bone loss in a mouse model of cerebral palsy based on clinical databases. Ann Phys Rehabil Med 2020; 64:101445. [PMID: 33130040 DOI: 10.1016/j.rehab.2020.09.009] [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: 02/17/2020] [Revised: 08/06/2020] [Accepted: 09/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Individuals with cerebral palsy (CP) experience bone loss due to impaired weight bearing. Despite serious complications, there is no standard medication. OBJECTIVE To develop a new pharmacological agent, we performed a series of studies. The primary aim was to develop an animal model of CP to use our target medication based on transcriptome analysis of individuals with CP. The secondary aim was to show the therapeutic capability of collagen-binding peptide (CBP) in reversing bone loss in the CP mouse model. METHODS A total of 119 people with CP and 13 healthy adults participated in the study and 140 mice were used for the behavioral analysis and discovery of therapeutic effects in the preclinical study. The mouse model of CP was induced by hypoxic-ischemic brain injury. Inclusion and exclusion criteria were established for CBP medication in the CP mouse model with bone loss. RESULTS On the basis of clinical outcomes showing insufficient mechanical loading from non-ambulatory function and that underweight mainly affects bone loss in adults with CP, we developed a mouse model of CP with bone loss. Injury severity and body weight mainly affected bone loss in the CP mouse model. Transcriptome analysis showed SPP1 expression downregulated in adults with CP who showed lower bone density than healthy controls. Therefore, a synthesized CBP was administered to the mouse model. Trabecular thickness, total collagen and bone turnover activity increased with CBP treatment as compared with the saline control. Immunohistochemistry showed increased immunoreactivity of runt-related transcription factor 2 and osteocalcin, so the CBP participated in osteoblast differentiation. CONCLUSIONS This study can provide a scientific basis for a promising translational approach for developing new anabolic CBP medication to treat bone loss in individuals with CP.
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Affiliation(s)
- Yoon-Kyum Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Jeong Hyun Heo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea; Graduate Program of NanoScience and Technology, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
| | - Jue Yeon Lee
- Central Research Institute, Nano Intelligent Biomedical Engineering Corporation (NIBEC), 03080 Seoul, Republic of Korea
| | - Yoon-Jeong Park
- Central Research Institute, Nano Intelligent Biomedical Engineering Corporation (NIBEC), 03080 Seoul, Republic of Korea; Department of Dental Regenerative Biotechnology, School of Dentistry, Seoul National University, 03080 Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea; Graduate Program of NanoScience and Technology, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea.
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Trinh A, Wong P, Fahey MC, Brown J, Strauss BJ, Ebeling PR, Fuller PJ, Milat F. Longitudinal changes in bone density in adolescents and young adults with cerebral palsy: A case for early intervention. Clin Endocrinol (Oxf) 2019; 91:517-524. [PMID: 31246317 DOI: 10.1111/cen.14052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/30/2022]
Abstract
CONTEXT Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal or infant brain. The subsequent lack of ambulation, nutritional deficiencies, anticonvulsant use and hormonal deficiencies have been implicated in the low bone mass associated with this condition. OBJECTIVE To assess changes in areal bone mineral density (aBMD) during adolescence and young adulthood in individuals with CP. The effect of ambulation, nutrition, hypogonadism on longitudinal changes in aBMD is also examined. DESIGN Retrospective longitudinal study. SETTING AND PARTICIPANTS Forty-five subjects with CP who had longitudinal dual-energy X-ray absorptiometry (DXA) scans at a single tertiary hospital between 2006 and 2018. RESULTS Mean age at first DXA was 19.4 years (range: 10-36 years), 57.8% were male and 80% were nonambulatory. The mean Z-scores at baseline were <-2.0 at all sites - lumbar spine (LS), femoral neck (FN), total hip (TH) and total body (TB). The median change in aBMD was +1.2%-1.9% per year in all subjects but in those <20 years of age, the median change was 4%-8% per year. Z-scores across all sites remained stable over time. Reduced functional state as measured by the gross motor functional classification scale (GMFCS) had a small negative effect on aBMD over time. CONCLUSION In adolescents with CP, low bone mass was evident from the baseline DXA. However, significant bone accrual occurred during the second decade, followed by bone maintenance in young adulthood. Future studies should focus on optimizing bone health from early childhood.
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Affiliation(s)
- Anne Trinh
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillip Wong
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Michael C Fahey
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash Health, Melbourne, Victoria, Australia
| | - Justin Brown
- Department of Paediatrics, Monash Health, Melbourne, Victoria, Australia
- Department of Paediatric Endocrinology and Diabetes, Monash Health, Melbourne, Victoria, Australia
| | - Boyd J Strauss
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Mcphee PG, Claridge EA, Noorduyn SG, Gorter JW. Cardiovascular disease and related risk factors in adults with cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:915-923. [PMID: 30221763 DOI: 10.1111/dmcn.14028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 01/23/2023]
Abstract
AIM To summarize the literature on the prevalence of cardiovascular disease (CVD), risk factors of CVD, and CVD-related mortality in adults with cerebral palsy (CP). METHOD A systematic review was conducted by searching the PubMed, Embase, MEDLINE (Ovid), Cochrane, and CINAHL databases. Selection criteria included adults with CP aged 18 years or over. Methodological quality was assessed using the Newcastle-Ottawa scale for observational studies. Data were reported descriptively. RESULTS Nineteen studies met the inclusion criteria. Only one study reported directly on the presence of CVD in adults with CP, which found adults with CP reported greater CVD conditions than adults without CP (15.1 vs 9.1%, p<0.001). The most commonly reported risk factor of CVD in adults with CP was overweight/obesity. Five studies included data on CVD-related mortality in persons with CP, where CVD-related and circulatory system-related deaths were elevated and more common at a younger age in adults with CP than in the general population. INTERPRETATION The prevalence of CVD and the risk of death because of CVD in this population seems increased, though the knowledge base is fragmented by studies that are small in size and geographically isolated. Further research is required to understand prevalence of risk factors among adults with CP, in particular overweight/obesity. WHAT THIS PAPER ADDS Overweight and obesity are risk factors of cardiovascular disease (CVD) that are commonly reported in adults with cerebral palsy (CP). CVD-related and circulatory system-related deaths are elevated in individuals with CP compared to the general population.
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Affiliation(s)
- Patrick G Mcphee
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Everett A Claridge
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephen G Noorduyn
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Mus-Peters CTR, Huisstede BMA, Noten S, Hitters MWMGC, van der Slot WMA, van den Berg-Emons RJG. Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review. Disabil Rehabil 2018; 41:2392-2402. [PMID: 29783868 DOI: 10.1080/09638288.2018.1470261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied. Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ -2.0. In addition, we focused on Z-score ≤ -1.0 because this may indicate a tendency towards low bone mineral density. Results: We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ -2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ -1.0) for several body parts. Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy. Implications for Rehabilitation Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.
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Affiliation(s)
| | - Bionka M A Huisstede
- b Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neurosciences , University Medical Centre Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Suzie Noten
- c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | | | - Wilma M A van der Slot
- c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands.,d Rijndam Rehabilitation , Rotterdam , The Netherlands
| | - Rita J G van den Berg-Emons
- a Libra Rehabilitation & Audiology , Eindhoven/Tilburg , The Netherlands.,c Department of Rehabilitation Medicine , Erasmus University Medical Centre , Rotterdam , The Netherlands
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Shin YK, Yoon YK, Chung KB, Rhee Y, Cho SR. Patients with non-ambulatory cerebral palsy have higher sclerostin levels and lower bone mineral density than patients with ambulatory cerebral palsy. Bone 2017; 103:302-307. [PMID: 28720522 DOI: 10.1016/j.bone.2017.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/29/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
Bone loss is a serious clinical issue in patients with cerebral palsy (CP). Sclerostin has garnered interest as a key mechanosensor in osteocytes, leading to considerations of the therapeutic utilization of anti-sclerostin medications. This study was undertaken to determine associations among mechanical unloading, sclerostin levels, and bone imbalance in patients with CP. A total of 28 patients with CP participated in this cross-sectional study. The following measurements were taken: anthropometrics, clinical diagnosis of CP subtype and ambulatory status, bone mineral density (BMD) z-scores at the lumbar spine and hip, and blood biochemical markers, including sclerostin, parathyroid hormone (PTH), osteocalcin, C-terminal telopeptide, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, creatinine, calcium, and phosphorus. In analysis according to CP subtype, patients with spastic CP showed significantly lower BMD z-scores at the lumbar spine and femur neck regions than patients with dyskinetic CP. In analysis according to ambulatory status, patients with non-ambulatory CP showed significantly lower BMD z-scores at all lumbar spine and femoral sites, lower PTH and creatinine levels, and higher plasma sclerostin levels than patients with ambulatory CP. In regression analysis, ambulatory status was a significant determinant of plasma sclerostin levels. This study is the first to report on sclerostin levels and BMD in patients with CP, based on the hypothesis that patients who lack sufficient weight-bearing activities would show increased sclerostin levels and decreased BMD scores, compared with patients who sustain relatively sufficient physical activity. Therefore, this report may provide clinical insights for clinicians considering ambulatory status, sclerostin levels, and bone loss in patients with CP.
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Affiliation(s)
- Yoon-Kyum Shin
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young Kwon Yoon
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Kyung Bae Chung
- Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Avison Biomedical Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Avison Biomedical Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
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Sá-Caputo DC, Costa-Cavalcanti R, Carvalho-Lima RP, Arnóbio A, Bernardo RM, Ronikeile-Costa P, Kutter C, Giehl PM, Asad NR, Paiva DN, Pereira HVFS, Unger M, Marin PJ, Bernardo-Filho M. Systematic review of whole body vibration exercises in the treatment of cerebral palsy: Brief report. Dev Neurorehabil 2016; 19:327-33. [PMID: 25826535 DOI: 10.3109/17518423.2014.994713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Whole body vibration (WBV) is increasingly being used to improve balance and motor function and reduce the secondary complications associated with cerebral palsy (CP). The purpose of this study was to systematically appraise published research regarding the effects of static and/or dynamic exercise performed on a vibrating platform on gait, strength, spasticity and bone mineral density (BMD) within this population. METHODS Systematic searches of six electronic databases identified five studies that met our inclusion criteria (2 at Level II and 3 at Level III-2). Studies were analysed to determine: (a) participant characteristics; (b) optimal exercise and WBV treatment protocol; (c) effect on gait, strength, spasticity and BMD; and (d) the outcome measures used to evaluate effect. As data was not homogenous a meta-analysis was not possible. RESULTS Several design limitations were identified and intervention protocols are poorly described. The effects on strength, gait, spasticity and BMD in persons with CP remain inconclusive with weak evidence that WBV may improve selected muscle strength and gait parameters and that prolonged exposure may improve BMD; there is currently no evidence that WBV can reduce spasticity. CONCLUSIONS The evidence for exercise performed on a vibrating platform on mobility, strength, spasticity and BMD in CP remains scant and further larger scale investigations with controlled parameters to better understand the effects of WBV exercises in this population is recommended.
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Affiliation(s)
- Danúbia C Sá-Caputo
- a Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Rebeca Costa-Cavalcanti
- a Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Rafaelle P Carvalho-Lima
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Adriano Arnóbio
- c Programa de Pós-graduação em Ciências Médicas , Rio de Janeiro , RJ , Brasil
| | - Raquel M Bernardo
- d Curso de Medicina, Universidade do Grande Rio , Duque de Caxias , RJ , Brasil
| | - Pedro Ronikeile-Costa
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Cristiane Kutter
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Paula M Giehl
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Nasser R Asad
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Dulciane N Paiva
- e Programa de Pós-Graduação em Promoção da Saúde da Universidade Santa Cruz do Sul , Santa Cruz do Sul , RS , Brasil
| | - Heloisa V F S Pereira
- f Departamento de Pediatria , Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
| | - Marianne Unger
- g Division of Physiotherapy, Faculty of Medicine and Health Sciences , Stellenbosch University , South Africa , and
| | - Pedro J Marin
- h Universidad Europea Miguel de Cervantes, Laboratorio de Fisiologia , Valladolid , Spain
| | - Mario Bernardo-Filho
- b Departamento de Biofísica e Biometria , Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro , Rio de Janeiro , RJ , Brasil
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10
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Marciniak C, Gabet J, Lee J, Ma M, Brander K, Wysocki N. Osteoporosis in adults with cerebral palsy: feasibility of DXA screening and risk factors for low bone density. Osteoporos Int 2016; 27:1477-1484. [PMID: 26576540 DOI: 10.1007/s00198-015-3393-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/28/2015] [Indexed: 01/26/2023]
Abstract
UNLABELLED This study aims to describe osteoporosis screening in adults with cerebral palsy (CP) and identify any associated factors. Bone mineral density (BMD) was often lower than expected-for-age in these adults, and present even in young adulthood, particularly at the spine. Low BMD is frequent in adults with CP. INTRODUCTION This study aims to describe the feasibility of dual-energy X-Ray absorptiometry (DXA) screening in adults with cerebral palsy (CP) and identify factors associated with low bone mineral density (BMD), including longitudinal changes. METHODS A retrospective chart review study of these adults seen at an urban academic rehabilitation clinic and who underwent DXA scan(s). BMD and Z-scores for the lumbar spine, hips, and femoral (neck and total) were recorded. The change in BMD and Z-scores from baseline to follow-up DEXA, Gross Motor Functional Classification System (GMFCS), CP pattern (hemiplegic, diplegic, or quadriplegic), body mass index (BMI), and transfer and ambulation status were assessed. RESULTS Forty-two patients (83 % less than age 50 years) had at least one DXA. Seventeen had at least two studies, 15 without pharmacologic interventions between studies. Thirteen fractures in eight subjects were noted, most often lower limb. Fifty percent of spine studies in individuals under 50 had a Z-score of less than -2, while 25 and 30.8 % of these individuals had such scores at the right and left total hip sites, respectively. Need for transfer assistance was associated with lower BMD and Z-scores at all hip sites, but not the lumbar spine. Progressive abnormalities were seen at follow-up DXAs at some sites, however these were not statistically significant. CONCLUSIONS Lower than expected-for-age BMD was very frequent in adults with CP with mobility limitations, present at both spine and hip sites. Low BMI and need for transfer assistance had a negative impact on BMD. Although not statistically significant, progression of abnormalities was seen at follow-up for DXAs Z-scores at some sites, which suggests longitudinal studies in this population are needed.
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Affiliation(s)
- C Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Department of Neurology, Northwestern University, Chicago, IL, USA.
- Rehabilitation Institute of Chicago, Room 1154, 345 E. Superior, Chicago, IL, 60611, USA.
| | - J Gabet
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Lee
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA
| | - M Ma
- Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA
| | - K Brander
- College of Osteopathic Medicine, Midwestern University, Arizona Campus, Glendale, AZ, USA
| | - N Wysocki
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Room 1154, 345 E. Superior, Chicago, IL, 60611, USA
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Bone density in premenopausal women and men under 50 years of age with cerebral palsy. Arch Phys Med Rehabil 2015; 96:1304-9. [PMID: 25838020 DOI: 10.1016/j.apmr.2015.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine bone mineral density (BMD) z scores in adults with cerebral palsy (CP), an understudied population. DESIGN Cross-sectional. SETTING Medical facility. PARTICIPANTS Adults (N=48; mean age, 34.3±5.8y; range, 25-46y) with CP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BMD z scores at the lumbar spine and hip using dual-energy x-ray absorptiometry, Gross Motor Function Classification System (GMFCS), body mass index (BMI), and ambulatory status. RESULTS Mean BMD z scores were -1.40 for the lumbar spine, -1.36 for the total hip, and -1.02 for the femoral neck. The z scores were significantly lower for the nonambulatory group at all 3 sites (P<.05). Significant differences were found among GMFCS levels for the lumbar spine and total hip z scores (P<.05). For the lumbar spine, the mean z scores for level V (the lowest mobility level) were significantly lower than the mean for levels I/II (P=.001), III (P=.002), and IV (P=.013). For the total hip, the mean z scores for level V were significantly lower than the mean for levels I/II (P=.045). A significant positive relationship between the z scores and age was found for the lumbar spine (Spearman ρ=.40, P=.005). Significant positive relationships between BMI and z scores were found for all sites (P<.05). CONCLUSIONS This study contributes to the sparse literature about bone health in adults with CP. In contrast with pediatric data, z scores did not decrease as a function of age in this adult cohort. This information is important for clinicians considering treatment options for this population.
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Kim W, Lee SJ, Yoon YK, Shin YK, Cho SR, Rhee Y. Adults with spastic cerebral palsy have lower bone mass than those with dyskinetic cerebral palsy. Bone 2015; 71:89-93. [PMID: 25316282 DOI: 10.1016/j.bone.2014.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/05/2014] [Accepted: 10/05/2014] [Indexed: 11/16/2022]
Abstract
Adults with cerebral palsy (CP) are known to have low bone mass with an increased risk of fragility fracture. CP is classified into two major types: spastic (pyramidal) and dyskinetic (extrapyramidal). Spastic CP is the most common and is characterized by muscle hypertonicity and impaired neuromuscular control. By contrast, dyskinetic CP is characterized by mixed muscle tone with involuntary movements. The aim of this study was to elucidate the relationship between bone metabolism and subtype of CP. Fifty-eight adults with CP (aged 18 to 49years, mean age 33.2years; 32 men, 26 women) were included in this cross-sectional analysis. Lumbar spine and femoral bone mineral density (BMD) Z-scores were measured. Bone markers, including C-telopeptide of type I collagen (CTx) and osteocalcin (OCN), were also analyzed. Among these participants, 30 had spastic CP and 28 had dyskinetic CP. The Z-scores of lumbar spine BMD did not differ between the two types. However, the Z-scores of femur trochanteric BMD were significantly lower in participants with spastic CP than in those with dyskinetic CP (-1.6±1.2 vs. -0.9±1.1, p<0.05). Seventy-four percent of participants with either type of CP had abnormally elevated CTx, while about 90% of participants showed normal OCN levels. When participants were subclassified into nonambulatory and ambulatory groups, the nonambulatory group had significantly lower BMD in the femur, including the trochanteric and total regions, whether they were spastic or dyskinetic (p<0.05). Because the type of CP affects bone mass, nonambulatory spastic CP participants showed the lowest total hip region BMD among the four groups. These results reveal that reduced weight bearing and immobility related to CP cause a negative bone balance because of increased bone resorption, which leads to a lower bone mass. In addition, hypertonicity of the affected limbs in participants with spastic CP resulted in lower bone mass than in those with dyskinetic CP. Type of CP and degree of ambulatory function in adults with CP should be regarded as important factors affecting bone metabolism.
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Affiliation(s)
- Wonjin Kim
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Su Jin Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Young-Kwon Yoon
- Graduate School of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yoon-Kyum Shin
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Avison Biomedical Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Avison Biomedical Research Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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