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Lynch ME, Daniels DJ, Brandenburg JE. Gabapentin as part of a multimodal pain protocol for selective dorsal rhizotomy does not impact percentage of rootlets transected. Childs Nerv Syst 2024; 40:487-494. [PMID: 37676296 DOI: 10.1007/s00381-023-06124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE We aim to determine whether preoperatively initiated gabapentin for pain control impacts the percentage of rootlets cut during monitored, limited laminectomy selective dorsal rhizotomy (SDR) procedure. METHODS This retrospective cohort study includes participants with cerebral palsy who had SDR for treatment of spasticity between 2010 and 2019 at a single-institution tertiary care center. One-level laminectomy SDR aimed to evaluate the cauda equina roots from levels L2-S1 with EMG monitoring. Gabapentin titration began 3 weeks prior to SDR. Data was analyzed using simple linear regression. Thirty-one individuals met inclusion criteria. Mean age was 7 years, 4 months. Eighteen participants (58%) identified as male, 12 (39%) female, and one (3%) non-binary. Thirty (97%) had bilateral CP. Sixteen (52%) were GMFCS II, four (13%) GMFCS III, five (16%) GMFCS IV, and six (19%) GMFCS V. RESULTS Mean percentage of rootlets transected was 50.75% (SD 6.00, range 36.36-60.87). There was no relationship between the dose of gabapentin at time of SDR and percentage of rootlets cut with a linear regression slope of - 0.090 and an R2 of 0.012 (P = 0.56). CONCLUSION Results indicate that preoperative initiation of gabapentin did not impact the percentage of rootlets transected. Thus, gabapentin can be initiated prior to SDR at moderate dosages without impacting SDR surgical outcomes.
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Affiliation(s)
- Mary E Lynch
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Chu C, Huang S, Wang X, Zhao G, Hao W, Zhong Y, Ma Z, Huang C, Peng Y, Wei F. Randomized controlled trial comparing the impacts of Saccharomyces boulardii and Lactobacillus rhamnosus OF44 on intestinal flora in cerebral palsy rats: insights into inflammation biomarkers and depression-like behaviors. Transl Pediatr 2024; 13:72-90. [PMID: 38323178 PMCID: PMC10839280 DOI: 10.21037/tp-23-566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Background Cerebral palsy (CP) is a unique neurological disorder which adversely affects motion. Cytokines and gut microbial composition contribute to CP and other diseases, such as reproductive tract inflammation and bone loss. Importantly, Saccharomyces boulardii (S. boulardii) reduces the degree of inflammation and improves overall health status. As our previous study showed that Lactobacillus rhamnosus (L. rhamnosus) OF44, a selected strain of gut bacteria originally used to treat reproductive tract inflammation and bone loss, has effects similar to that of S. boulardii, we decided to use L. rhamnosus OF44 on CP rats. Validation of the effects of L. rhamnosus OF44 on CP adds to its confirmed effects in treating osteoporosis and reproductive tract microbiota disorders, increasing its potential as a probiotic. The purpose of this was to ascertain whether L. rhamnosus OF44 can alleviate the symptoms of CP. Methods CP rat models were created through left carotid artery ligation. Following this, 100-day old CP rats were exposed to L. rhamnosus OF44, S. boulardii, or normal saline gastric gavage daily for 28 days. Grouping of the rats is determined randomly. Before and after the gavage, behavioral experiments were conducted and the inflammation levels assessed via measurements of interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor alpha (TNF-α) inflammatory markers. The efficacy of the outcome is measured by performing statistical analysis like the t-test on the data to see its significance. Additionally, variations inside gut microbiome were evaluated via 16S ribosomal RNA sequencing. Results Before intervention, CP rats failed to exhibit depression-like behavior (P=0.6). L. rhamnosus OF44 treatment significantly reduced the level of IL-6 (P=4.8e-05), S. boulardii treatment significantly reduced the level of TNF-α (P=0.04). In addition, both treatments altered the composition and complexity of the gut microbiome. Conclusions Our results indicated that L. rhamnosus OF44 has potential in alleviating inflammation and altering the gut microbial composition in CP, and that it has the potential to clinically treat CP. There are some limitations of this study. For example, dietary differences and their effects on gastrointestinal dysfunction are not considered in this study, and only two behavioral experiments were used.
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Affiliation(s)
- Chunuo Chu
- International Department, Shenzhen Middle School, Shenzhen, China
| | - Shang Huang
- Department of Centre Lab, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
- Shenzhen Children’s Hospital of China Medical University, Shenzhen, China
| | - Xin Wang
- Department of Centre Lab, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
- School of Clinical Medicine, Jiamusi University, Jiamusi, China
| | - Guoqiang Zhao
- Department of Clinical Laboratory, Binzhou People’s Hospital, Binzhou, China
| | - Wenqi Hao
- Department of ENT, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Yiyi Zhong
- Department of Nutrition, BGI Nutrition Precision Co., Ltd., Shenzhen, China
| | - Zhihui Ma
- Department of Nutrition, BGI Nutrition Precision Co., Ltd., Shenzhen, China
| | - Congfu Huang
- Department of Pediatrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Yuanping Peng
- The Outpatient Department, Longgang District Social Welfare Center, Shenzhen, China
| | - Fengxiang Wei
- Department of Centre Lab, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
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Thomas SP, Novak I, Ritterband-Rosenbaum A, Lind K, Webb A, Gross P, McNamara M. The critical need to accelerate cerebral palsy research with consumer engagement, global networks, and adaptive designs. J Pediatr Rehabil Med 2024; 17:9-17. [PMID: 38552123 PMCID: PMC10977364 DOI: 10.3233/prm-240014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
The prevalence of cerebral palsy (CP) varies globally, with higher rates and burden of disease in low- and middle-income countries. CP is a lifelong condition with no cure, presenting diverse challenges such as motor impairment, epilepsy, and mental health disorders. Research progress has been made but more is needed, especially given consumer demands for faster advancements and improvements in the scientific evidence base for interventions. This paper explores three strategies to accelerate CP research: consumer engagement, global clinical trial networks, and adaptive designs. Consumer engagement involving individuals with lived experience enhances research outcomes. Global clinical trial networks provide efficiency through larger and more diverse participant pools. Adaptive designs, unlike traditional randomized controlled trials, allow real-time modifications based on interim analyses, potentially answering complex questions more efficiently. The establishment of a CP Global Clinical Trials Network, integrating consumer engagement, global collaboration, and adaptive designs, marks a paradigm shift. The Network aims to address consumer-set research priorities. While challenges like ethical considerations and capacity building exist, the potential benefits for consumers, clinicians, researchers, and funding bodies are substantial. This paper underscores the urgency of transforming CP research methodologies for quicker translation of novel treatments into clinical practice to improve quality of life for those with CP.
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Affiliation(s)
- Sruthi P. Thomas
- H. Ben Taub Department of Physical Medicine and Rehabilitation and Departments of Neurosurgery and Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Karin Lind
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Annabel Webb
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Paul Gross
- Cerebral Palsy Research Network, Greensville, SC, USA
| | - Maria McNamara
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - the CP Global Clinical Trials Network
- H. Ben Taub Department of Physical Medicine and Rehabilitation and Departments of Neurosurgery and Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Elsass Foundation, Charlottenlund, Denmark
- Cerebral Palsy Research Network, Greensville, SC, USA
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Christopher P, Sutter EN, Gavioli M, Lench DH, Nytes G, Mak V, Simpson EA, Ikonomidou C, Villegas MA, Saiote C, Gillick BT. Safety, tolerability and feasibility of remotely-instructed home-based transcranial direct current stimulation in children with cerebral palsy. Brain Stimul 2023; 16:1325-1327. [PMID: 37652136 PMCID: PMC10986357 DOI: 10.1016/j.brs.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Preston Christopher
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Ellen N Sutter
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA; Department of Rehabilitation Medicine, University of Minnesota, MMC 388, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Marissa Gavioli
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Daniel H Lench
- Department of Neurology, Medical University of South Carolina, 208B Rutledge Ave, Charleston, SC, 29403, USA
| | - Gwendolyn Nytes
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Veronika Mak
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Emma A Simpson
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA; Des Moines University-College of Osteopathic Medicine, Munroe, 3200 Grand Ave, Des Moines, IA, 50312, USA
| | - Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
| | - Melissa A Villegas
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA; Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Ave, Mail Code 4108, Madison, WI, 53792, USA
| | - Catarina Saiote
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Bernadette T Gillick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA; Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Ave, Mail Code 4108, Madison, WI, 53792, USA.
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Damianos A, Sammour I. Barriers in translating stem cell therapies for neonatal diseases. Semin Perinatol 2023; 47:151731. [PMID: 36990922 DOI: 10.1016/j.semperi.2023.151731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Over the last 20 years, stem cells of varying origin and their associated secretome have been investigated as a therapeutic option for a myriad of neonatal models of disease, with very promising results. Despite the devastating nature of some of these disorders, translation of the preclinical evidence to the bedside has been slow. In this review, we explore the existing clinical evidence for stem cell therapies in neonates, highlight the barriers faced by researchers and suggest potential solutions to move the field forward.
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Affiliation(s)
- Andreas Damianos
- Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Ibrahim Sammour
- Riley Hospital for Children, Indiana University, Indianapolis, USA.
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Zhang JJ, Yang YL, Hu J, Zhao CF, He XH, Yang QY, Qi XS, Lu H, He C, Liu H. Development and validation of a novel model based on hand knob score and white matter injury on MRI to predict hand function in children with cerebral palsy. Ann Transl Med 2022; 10:1102. [PMID: 36388818 PMCID: PMC9652546 DOI: 10.21037/atm-22-4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Childhood hand function is considered to be one of the strongest predictors of the ability to participate in daily activities as children with cerebral palsy (CP) reach adulthood. The manual ability classification system (MACS) is currently the most widely used for grading hand function in children with CP. However, the MACS method is subjective and may be affected by the raters' experience. Hand knob is an important control center for hand movement. Therefor this study aimed to develop and validate an objective model for hand function estimation in children with CP and visualize it as a nomogram. METHODS A total of 70 Children (2-12 years old) with CP underwent magnetic resonance imaging (MRI) scanning, MACS assessment. According to MACS, children with CP were divided into mild impairment group (grade I-III) and severe impairment group (grade IV-V). Hand function prediction models based on (I) hand knob score, (II) clinical features, and (III) the combination of clinical features and hand knob score were developed and validated separately. The models were subjected to stepwise regression according to the maximum likelihood method, and the Akaike information criterion was used to select the best model. Model discrimination was assessed using receiver operating characteristic (ROC) and calibration curves. The nomogram was finally built according to the best model. RESULTS The area under the curve (AUC) of the hand knob score model in the training set was 0.752, the clinical features model was 0.819, and the hand knob score and clinical features combined model was 0.880. The AUC of the hand knob score model in the validation set was 0.765, the clinical features model was 0.782, and the combined model was 0.894. The best model was the hand knob score-clinical features combined model, and the nomogram finally incorporated two assessment items: the hand knob score and white matter injury. The estimated probability of hand function injury degree of the combined model displayed good agreement with the actual occurrence probability. CONCLUSIONS The hand knob score-clinical features combined model can be used to preliminarily assess the degree of hand impairment in children with CP, with good calibration.
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Affiliation(s)
- Jing-Jing Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Radiology, Mianyang Hospital of T.C.M, Mianyang, China
| | - Yan-Li Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Hu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chun-Feng Zhao
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xing-Hong He
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian-Yu Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiao-Shan Qi
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Lu
- Department of Radiology, The Seventh People’s Hospital of Chongqing, The Central Hospital Affiliated to Chongqing University of Technology, Chongqing, China
| | - Cheng He
- Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Chaudhary S, Bhatta NK, Poudel P, Agrawal J, Kalawar RPS, Jayswal JP. Profile of children with cerebral palsy at a tertiary hospital in eastern Nepal. BMC Pediatr 2022; 22:415. [PMID: 35831826 PMCID: PMC9277817 DOI: 10.1186/s12887-022-03477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background The clinical spectrum of Cerebral palsy (CP) can differ in various places depending upon knowledge of the people and resources for prevention, diagnosis and management. Although studied extensively in high-resource countries, adequate data related to CP from resource-constraint settings are lacking. This study aims to describe the profile of children with CP at a tertiary care center in eastern Nepal. Methods This was a hospital-based cross-sectional descriptive study done from 2017 to 2018. Children 6 months to 15 years who presented with CP were enrolled and their clinical details recorded and described. Results Amongst 110 children with CP, 74.54% were male. Majority (76.36%) were 5 years or below with the median age being 3(2.00–4.75) years. Children with spastic quadriplegia (44.44%) and Gross Motor Function Classification System level III (41.81%) were most common. Etiologically, perinatal factors (64.54%) like perinatal asphyxia (35.45%) and prematurity (20.90%) and postnatal infections (25.45%) were common. The common comorbidities were intellectual disability (71.81%) and epilepsy (66.36%). The main treatment modalities were: antiepileptics (59.09%) and centre-based physiotherapy sessions (35.45%). School education was provided in 23.07% with special education in 11.53%. Conclusions This study describes the profile of CP at our centre in eastern Nepal. Predominance of perinatal complications and postnatal infections points towards the urgent need to further improve the perinatal and neonatal health care delivery system and practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03477-x.
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Affiliation(s)
| | | | | | - Jyoti Agrawal
- B P Koirala Institute of Health Sciences, Dharan, Nepal
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Halfpenny R, Stewart A, Kelly P, Conway E, Smith C. Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol. Syst Rev 2021; 10:312. [PMID: 34903269 PMCID: PMC8667523 DOI: 10.1186/s13643-021-01861-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics. METHODS This study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed. DISCUSSION This review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia. SYSTEMATIC REVIEW REGISTRATION Open science framework osf.io/ja4dr.
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Affiliation(s)
- Rhiannon Halfpenny
- Great Ormond Street Hospital, Great Ormond Street, London, UK.
- University College London, London, UK.
| | - Alexandra Stewart
- Great Ormond Street Hospital, Great Ormond Street, London, UK
- University College London, London, UK
| | - Paula Kelly
- Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Eleanor Conway
- Great Ormond Street Hospital, Great Ormond Street, London, UK
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Yin H, Wang X, Yang H, Zhu X, Wang J, Li Z. A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke. Early Hum Dev 2021; 163:105484. [PMID: 34655917 DOI: 10.1016/j.earlhumdev.2021.105484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/12/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. METHOD Twenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. RESULTS Eight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. INTERPRETATION The GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.
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Affiliation(s)
- Huanhuan Yin
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xinrui Wang
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China
| | - Jun Wang
- Department of Rehabilitation, Children's Hospital Fudan University, Shanghai, China.
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Key Laboratory of Neonatal Disease, National Health Commission, Shanghai 201102, China.
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Abstract
The need for long-term noninvasive positive pressure ventilation (NiPPV) in children with chronic respiratory failure is rapidly growing. This article reviews pediatric-specific considerations of NiPPV therapy. Indications for NiPPV therapy can be categorized by the cause of the respiratory failure: (1) upper airway obstruction, (2) musculoskeletal and/or neuromuscular disease, (3) lower respiratory tract diseases, and (4) control of breathing abnormalities. The role of NiPPV therapy in select rare conditions (spinal muscular atrophy, congenital central hypoventilation syndrome, cerebral palsy, scoliosis, and Chiari malformations) is also reviewed.
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Affiliation(s)
- Jenny Shi
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Nawal Al-Shamli
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada
| | - Reshma Amin
- The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada.
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Xu N, Matsumoto H, Hyman J, Roye B, Kim H, Roye DP. Evaluation of assessment of caregiver experience with neuromuscular disease: reliability and responsiveness of a new caregiver-reported outcome measure in patients with cerebral palsy. Transl Pediatr 2020; 9:507-512. [PMID: 32953548 PMCID: PMC7475311 DOI: 10.21037/tp-19-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of chronic childhood disability. Caregivers often provide prolonged care over patients' life span, thus measuring the impact of the disease and its treatments on caregivers has become a recent focus in research. The current study aims to present an evaluation of the reliability and responsiveness of assessment of caregiver experience with neuromuscular disease (ACEND) following botulinum toxin injection to relieve spasticity in children with CP. METHODS Patients with baseline ACEND scores and at least one assessment following botulinum toxin injection were enrolled. Data on their gender, age, diagnoses, and functional levels (according to The Gross Motor Function Classification System, GMFCS), and ACEND scores were analyzed. Statistical analyses performed included paired t-test and linear regression. RESULTS Baseline ACEND scores (117.7±47.7) were strongly correlated with follow-up scores (120.4±49.5) with a coefficient of 0.929 (P<0.001), suggesting the high reliability of the questionnaire. Paired-sample t-test revealed an insignificant average improvement in ACEND of 2.7 (P=0.352). The ICD-10 code and the GMFCS level were found to be significant predictors for baseline (P=0.043, P<0.001) and follow-up ACEND scores (P=0.025, P<0.001). Male gender was a significant predictor for improvement in ACEND scores. CONCLUSIONS We demonstrated the reliability of ACEND through strong correlations of scores before and after botulinum toxin injection. In terms of responsiveness, while the burden of care is largely determined by ICD-10 diagnosis and the GMFCS level, changes in care burden are only related to the gender of the patient and the follow-up time interval.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joshua Hyman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Benjamin Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Heakyung Kim
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.,JuniperMD, New York, NY, USA
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12
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Wiedemann A, Pastore-Wapp M, Slavova N, Steiner L, Weisstanner C, Regényi M, Steinlin M, Grunt S, Bigi S, Datta A, Fluss J, Hackenberg A, Keller E, MacKay MT, Maier O, Mercati D, Marcoz JP, Poloni C, Ramelli GP, Regényi M, Schmid R, Schmitt-Mechelke T. Impact of stroke volume on motor outcome in neonatal arterial ischemic stroke. Eur J Paediatr Neurol 2020; 25:97-105. [PMID: 31740218 DOI: 10.1016/j.ejpn.2019.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/22/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal arterial ischemic stroke (NAIS) can lead to long-term neurological consequences such as cerebral palsy (CP). The aim of this study was to evaluate the predictive value of acute diffusion-weighted imaging (DWI) for CP by analyzing stroke volume next to brain structure involvement. METHODS We included 37 term-born infants with NAIS prospectively registered in a nationwide pediatric stroke registry. DWI was performed between 0 and 8 days (mean 3 days) after stroke manifestation. Participants were neurologically assessed at the age of 2 years. We calculated the stroke volume (in mm3) and the ratio of the stroke volume to the volume of the entire brain (relative stroke volume). The predictive value of the relative stroke volume was analyzed and an optimal threshold for classification of children with high- and low-rates of CP was calculated. Predictive value of brain structure involvements and the prevalence of CP in combinations of different brain structures was also assessed. RESULTS Sixteen children (43.2%) developed CP. Relative stroke volume significantly predicted CP (p < .001). Its optimal threshold for division into high- and low-rate of CP was 3.3%. The basal ganglia (OR 8.3, 95% CI 1.2-60.0) and basis pontis (OR 18.5, 95% CI 1.8-194.8) were independently associated with CP. CONCLUSION In addition to determining the involvement of affected brain areas, the volumetric quantification of stroke volume allows accurate prediction of cerebral palsy in newborns with NAIS.
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Affiliation(s)
- Andreas Wiedemann
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland; Support Center of Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nedelina Slavova
- Support Center of Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Leonie Steiner
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Christian Weisstanner
- Support Center of Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Mária Regényi
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Inselspital, Bern, Switzerland.
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13
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Abstract
Cerebral palsy (CP) is a disorder characterized by abnormal tone, posture and movement and clinically classified based on the predominant motor syndrome-spastic hemiplegia, spastic diplegia, spastic quadriplegia, and extrapyramidal or dyskinetic. The incidence of CP is 2-3 per 1,000 live births. Prematurity and low birthweight are important risk factors for CP; however, multiple other factors have been associated with an increased risk for CP, including maternal infections, and multiple gestation. In most cases of CP the initial injury to the brain occurs during early fetal brain development; intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop CP. The diagnosis of CP is primarily based on clinical findings. Early diagnosis is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging (MRI); however, in most clinical settings CP is more reliably recognized by 2 years of age. MRI scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic tests and tests for inborn errors of metabolism are indicated based on clinical findings to identify specific disorders. Because CP is associated with multiple associated and secondary medical conditions, its management requires a multidisciplinary team approach. Most children with CP grow up to be productive adults.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kamalazoo, MI, USA
| | - Mekala Neelakantan
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kamalazoo, MI, USA
| | - Karan Pandher
- Chicago Medical School at Rosalind Franklin University, Chicago, IL, USA
| | - Joav Merrick
- Hadassah Hebrew University Medical Center, Jarusalem, Israel.,University of Kentucky, Lexington, KY, USA.,School of Public Health, Georgia State University, Atlanta, GA, USA
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14
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Liu H, Jiang H, Wang X, Zheng J, Zhao H, Cheng Y, Tao X, Wang M, Liu C, Huang T, Wu L, Jin C, Li X, Wang H, Yang J. Treatment response prediction of rehabilitation program in children with cerebral palsy using radiomics strategy: protocol for a multicenter prospective cohort study in west China. Quant Imaging Med Surg 2019; 9:1402-1412. [PMID: 31559169 DOI: 10.21037/qims.2019.04.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Cerebral palsy (CP) is a major cause of chronic childhood disability worldwide, causing activity limitation as well as impairments in sensation, cognition, and communication. Leveraging biomarkers to establish individualized predictions of future treatment responses will be of great value. We aim to develop and validate a model that can be used to predict the individualized treatment response in Children with CP. Methods A multicenter prospective cohort study will be conducted in 4 hospitals in west China. One hundred and thirty children with CP will be recruited and undergo clinical assessment using the Peabody Developmental Motor Scales, Manual Ability Classification System (MACS), Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), and Gross Motor Function Classification System (GMFCS). The data collected will include MRI image, clinical status, and socioeconomic status. The clinical information and MRI features extracted using radiomics strategy will be combined for exploratory analysis. The accuracy, sensitivity, and specificity of the model will be assessed using multiple modeling methodologies. Internal and external validation will be used to evaluate the performance of the radiomics model. Discussion We hypothesized that the findings from this study could provide a critical step towards the prediction of treatment response in children with CP, which could also complement other biomarkers in the development of precision medicine approaches for this severe disorder. Trial registration The study was registered with clinicaltrials.gov (NCT02979743).
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Affiliation(s)
- Heng Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China.,Medical Imaging Center of Guizhou Province, Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Haoxiang Jiang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Xiaoyu Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Huifang Zhao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yannan Cheng
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xingxing Tao
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Miaomiao Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Congcong Liu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ting Huang
- Department of Radiology, the First Affiliated Hospital of Henan University of TCM, Zhengzhou 450046, China
| | - Liang Wu
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
| | - Chao Jin
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Xianjun Li
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hui Wang
- Department of Brain Disease, Xi'an Brain Disease Hospital of Traditional Chinese Medicine, Xi'an 710032, China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710054, China
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15
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Nevalainen P, Metsäranta M, Toiviainen-Salo S, Lönnqvist T, Vanhatalo S, Lauronen L. Bedside neurophysiological tests can identify neonates with stroke leading to cerebral palsy. Clin Neurophysiol 2019; 130:759-766. [PMID: 30904770 DOI: 10.1016/j.clinph.2019.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The unspecific symptoms of neonatal stroke still challenge its bedside diagnosis. We studied the accuracy of routine electroencephalography (EEG) and simultaneously recorded somatosensory evoked potentials (EEG-SEP) for diagnosis and outcome prediction of neonatal stroke. METHODS We evaluated EEG and EEG-SEPs from a hospital cohort of 174 near-term neonates with suspected seizures or encephalopathy, 32 of whom were diagnosed with acute ischemic or hemorrhagic stroke in MRI. EEG was scored for background activity and seizures. SEPs were classified as present or absent. Developmental outcome of stroke survivors was evaluated from medical records at 8- to 18-months age. RESULTS The combination of continuous EEG and uni- or bilaterally absent SEP (n = 10) was exclusively seen in neonates with a middle cerebral artery (MCA) stroke (specificity 100%). Moreover, 80% of the neonates with this finding developed with cerebral palsy. Bilaterally present SEPs did not exclude stroke, but predicted favorable neuromotor outcome in stroke survivors (positive predictive value 95%). CONCLUSIONS Absent SEP combined with continuous EEG background in near-term neonates indicates an MCA stroke and a high risk for cerebral palsy. SIGNIFICANCE EEG-SEP offers a bedside method for diagnostic screening and a reliable prediction of neuromotor outcome in neonates suspected of having a stroke.
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Affiliation(s)
- Päivi Nevalainen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland.
| | - Marjo Metsäranta
- Department of Pediatrics, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sanna Toiviainen-Salo
- Department of Pediatric Radiology, Children's Hospital, HUS Medical Imaging Center, Radiology, University of Helsinki and HUH, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
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16
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Power R, Akhter R, Muhit M, Wadud S, Heanoy E, Karim T, Badawi N, Khandaker G. Cross-cultural validation of the Bengali version KIDSCREEN-27 quality of life questionnaire. BMC Pediatr 2019; 19:19. [PMID: 30646887 PMCID: PMC6334442 DOI: 10.1186/s12887-018-1373-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background Measuring the health-related quality of life (HRQoL) of adolescents, including those with cerebral palsy (CP) (the major cause of childhood physical disability worldwide) in Bangladesh is pertinent although there is a dearth of validated instruments for assessing this concept. For application in a case-control study comparing HRQoL between adolescents with CP and peers without disability in Bangladesh (a typical low- and middle-income country) we cross-culturally translated and psychometrically tested KIDSCREEN-27. Methods KIDSCREEN-27 was translated to Bengali using forward and backwards translation protocol and interviewer administered to adolescents with CP and their age and sex matched peers without disability. Primary caregivers were included for proxy-report. Sociodeomgraphic characterists and clinical information were extracted from the Bangladesh Cerebral Palsy Register (BCPR) and adolescent mental health was assessed using the Bengali version Strenghts and Difficulties Questionnaire (SDQ). Feasibility, floor and ceiling effect, internal consistency, content and construct validity of KIDSCREEN-27 were tested. Results Feasibility, floor and ceiling effect and internal consistency of KIDSCREEN-27 was good for both self- and proxy-report questionnaires; nil missing scores except ‘school environment’ (11.0% to 74.7%) which correlated to rates of non-school attendance; floor and ceiling effect ≤10.4% except ‘peers and social support’ 23.4%; Cronbach’s alpha 0.67 to 0.91. Instrument validity was strong; factor analysis reflected original instrument dimensions within one to three factors and difference in known groups was observed by CP and adolescent mental health (p < 0.05). Conclusion KIDSCREEN-27 successfully translated to Bengali and both the self and proxy-report questionnaires showed good psychometric properties indicating suitability for case-control assessment of HRQoL between adolescents with CP and peers without disability in Bangladesh. Electronic supplementary material The online version of this article (10.1186/s12887-018-1373-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosalie Power
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. .,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh. .,The Children's Hospital at Westmead (Clinical School), Cnr Hawkesbury Rd and Hainsworth St, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Rahena Akhter
- Faculty of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - Mohammad Muhit
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Bangladesh, Dhaka, Bangladesh
| | | | - Eamin Heanoy
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Bangladesh, Dhaka, Bangladesh
| | - Tasneem Karim
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Bangladesh, Dhaka, Bangladesh
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh.,CSF Global, Bangladesh, Dhaka, Bangladesh.,Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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17
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Lee HY, Yun YJ, Yu SA, Park YH, Park BW, Kim BY, Hwang MS. A cross-sectional survey of clinical factors that influence the use of traditional Korean medicine among children with cerebral palsy. Integr Med Res 2018; 7:333-40. [PMID: 30591887 DOI: 10.1016/j.imr.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/26/2022] Open
Abstract
Background Traditional Korean medicine (TKM) is widely used to treat children with cerebral palsy (CP) in Korea; however, studies investigating factors that influence the use of TKM are scarce. Thus, we investigated the clinical factors that might influence the use of TKM. Methods A population-based, cross-sectional, multicenter survey was performed from August 2014 to May 2016. The history of TKM use, type and severity of CP, current treatment characteristics, presence of accompanying disabilities or other health problems not directly related to CP, and monthly cost for the treatment of CP were surveyed. Results In total, 182 children were recruited, and 78 children (42.9%) had used TKM. Among these 78 children, 50 (64.1% of the TKM-use group) had used both acupuncture and herbal medication, 15 (19.2%) had used acupuncture only, and 13 (16.7%) had used herbal medication only. Children with non-typical CP, accompanying disabilities and general health problems tended to use TKM. The monthly cost of treatment for CP was significantly higher in the TKM-use group than that in the no-TKM-use group, suggesting that economically disadvantaged children may have difficulty in accessing TKM. Dietary supplements, conventional pharmacological treatments, and rehabilitation therapies did not affect TKM use. Conclusion Children with non-typical symptoms or those with poor overall health status are likely to use TKM. Additionally, TKM use leads to increased treatment costs. Studies investigating the motivation for starting or ceasing TKM therapy, socioeconomic factors and the attitude of parents towards complementary and alternative medicine should be performed.
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18
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Jahan I, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C, Badawi N, Khandaker G. What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR). Disabil Rehabil 2018; 41:2247-2254. [PMID: 29658318 DOI: 10.1080/09638288.2018.1461260] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. Materials and methods: We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0-18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. Results: A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were -2.8 (standard deviation 1.8), -3.1 (standard deviation 2.2) and -1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. Conclusions: The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Implications for Rehabilitation Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs. Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries. Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population.
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Affiliation(s)
- Israt Jahan
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Mohammad Muhit
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Tasneem Karim
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Hayley Smithers-Sheedy
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Iona Novak
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia
| | - Cheryl Jones
- e Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) , University of Sydney , Sydney , Australia.,f Department of Paediatrics , The University of Melbourne , Parkville , Australia
| | - Nadia Badawi
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Gulam Khandaker
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
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Abstract
Spastic diplegic cerebral palsy (CP) is the most common form of CP. A specific goal-oriented approach, tailored to the child, is essential to management in all forms of CP. Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that permanently reduces lower limb spasticity in children with spastic diplegic CP. The current technique is performed through a single level laminectomy at the level of the conus and, with the aid of intraoperative electromyography (EMG), allows selective division of the afferent lumbosacral nerve roots. In carefully selected children, reduction in spasticity has positive effects on the growing child. SDR is associated with minimal complications and good long-term outcomes. This article describes the surgical technique and patient selection, including the importance of medical imaging, and discusses the long-term outcomes of SDR.
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Affiliation(s)
- David Graham
- Faculty of Medicine, the University of Sydney, Sydney, Australia.,Institute of Neuroscience and Muscle Research, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Neil Wimalasundera
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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20
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Abstract
Cerebral palsy (CP) is the most common movement disorder of childhood. Parents recognized the symptoms of CP at mean age of 13 months. However there was a mean delay of going to a doctor by 23 months and the mean age of diagnosis was 5½ years. Less than half of the CP children were diagnosed by a pediatrician and were receiving treatment methods with weak evidence base of efficacy. Delay in recognition of symptoms and help seeking due to lack of awareness and access to proper medical care and prevalent false beliefs were the leading reason for late diagnosis of CP in Nepal and thus children loose valuable time for intervention in their early developmental stage.
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Abstract
Children who suffer with cerebral palsy (CP) have a significant chance of developing scoliosis during their early years and adolescence. The behavior of this scoliosis is closely associated with the severity of the CP disability and unlike idiopathic scoliosis, it continues to progress beyond skeletal maturity. Conservative measures may slow the progression of the curve, however, surgery remains the only definitive management option. Advances in surgical technique over the last 50 years have provided methods to effectively treat the deformity while also reducing complication rates. The increased risk of surgical complications with these complex patients make decisions about treatment challenging, however with careful pre-operative optimization and post-operative care, surgery can offer a significant improvement in quality of life. This review discusses the development of scoliosis in CP patient, evaluates conservative and surgical treatment options and assesses post-operative outcome.
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Al-Kzayer LF, Keizer P, Abdulraheem FT, Sano K, Kamata M, Sakashita K, Habbaba LA, Koike K. Rapidly progressive Kaposi's Sarcoma in an Iraqi boy received Valproic acid: a case report and review of literature. BMC Pediatr 2016; 16:111. [PMID: 27459853 DOI: 10.1186/s12887-016-0653-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Kaposi’s sarcoma (KS), an endothelial neoplasm, is associated with human herpes virus (HHV) -8 infection. KS has four clinical sub-types: Mediterranean/classic, African/endemic, human immunodeficiency virus (HIV) -associated/epidemic, and transplantation-related/iatrogenic. Immunosuppression is an important cofactor in KS process. Classic KS (CKS) is exceedingly rare in children and when occurs, it is much more disseminated than adults. The epidemic, HIV-associated and the iatrogenic forms of childhood KS are a result of a profound and acquired T-cell deficiency. To our knowledge, this is the first paediatric KS case report from Iraq. Our patient was showing an unusual aggressive course of the disease while receiving Valproic acid (VPA) of the potential immune-suppressive effect. Case presentation A six-year-old Iraqi boy, who had cerebral palsy (CP) and epilepsy since the age of 9-months, had received VPA to control his seizures. He developed skin discoloration followed by nodules that disseminated proximally from the lower extremities to the groin, face, ears and oral cavity, and then he died from severe respiratory distress after 110 days from the disease evolution. KS diagnosis was proved by a skin biopsy. As the patient was of Arab-Asian ethnicity and was HIV-seronegative status, accordingly, his condition best fitted the classic form of KS. However, recent studies showed the link of VPA with the reactivation of HHV-8. Moreover, accumulated experimental and clinical data elucidated that VPA induces T-cell suppression. Given that there was a lack of facilities to perform the laboratory immunological diagnostic tests in Iraq, the VPA-induced effect on immunity in our case (iatrogenic KS) could not be evaluated. Conclusions Our report demonstrates a rare, rapidly progressing paediatric KS case and highlights the possible role of the 5-years’ administration of VPA and its challenging effect on cellular immunity based on recent studies. Thus, VPA could have promoted the development of the KS in our patient. This report also recalls the need of paediatricians to consider KS especially when the skin lesion appears at the child’s foot even in countries outside the geographical map of the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0653-3) contains supplementary material, which is available to authorized users.
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Asl MT, Yousefi F, Nemati R, Assadi M. 99mTc-ECD brain perfusion SPECT imaging for the assessment of brain perfusion in cerebral palsy (CP) patients with evaluation of the effect of hyperbaric oxygen therapy. Int J Clin Exp Med 2015; 8:1101-1107. [PMID: 25785099 PMCID: PMC4358554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The present study was carried out to evaluate cerebral perfusion in different types of cerebral palsy (CP) patients. For those patients who underwent hyperbaric oxygen therapy, brain perfusion before and after the therapy was compared. METHODS A total of 11 CP patients were enrolled in this study, of which 4 patients underwent oxygen therapy. Before oxygen therapy and at the end of 40 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed , and the results were compared. RESULTS A total of 11 CP patients, 7 females and 4 males with an age range of 5-27 years participated in the study. In brain SPECT studies, all the patients showed perfusion impairments. The region most significantly involved was the frontal lobe (54.54%), followed by the temporal lobe (27.27%), the occipital lobe (18.18%), the visual cortex (18.18%), the basal ganglia (9.09%), the parietal lobe (9.09%), and the cerebellum (9.09%). Frontal-lobe hypoperfusion was seen in all types of cerebral palsy. Two out of 4 patients (2 males and 2 females) who underwent oxygen therapy revealed certain degree of brain perfusion improvement. CONCLUSION This study demonstrated decreased cerebral perfusion in different types of CP patients. The study also showed that hyperbaric oxygen therapy improved cerebral perfusion in a few CP patients. However, it could keep the physiological discussion open and strenghten a link with other areas of neurology in which this approach may have some value.
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Affiliation(s)
| | - Farzaneh Yousefi
- Department of Neurology, Bushehr Medical University Hospital, Bushehr University of Medical SciencesBushehr, Iran
| | - Reza Nemati
- Department of Neurology, Bushehr Medical University Hospital, Bushehr University of Medical SciencesBushehr, Iran
| | - Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical SciencesBushehr, Iran
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Gofer-Levi M, Silberg T, Brezner A, Vakil E. Cognitive procedural learning among children and adolescents with or without spastic cerebral palsy: the differential effect of age. Res Dev Disabil 2014; 35:1952-1962. [PMID: 24858793 DOI: 10.1016/j.ridd.2014.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/02/2014] [Accepted: 04/09/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Children learn to engage their surroundings skillfully, adopting implicit knowledge of complex regularities and associations. Probabilistic classification learning (PCL) is a type of cognitive procedural learning in which different cues are probabilistically associated with specific outcomes. Little is known about the effects of developmental disorders on cognitive skill acquisition. METHODS Twenty-four children and adolescents with cerebral palsy (CP) were compared to 24 typically developing (TD) youth in their ability to learn probabilistic associations. Performance was examined in relation to general cognitive abilities, level of motor impairment and age. RESULTS Improvement in PCL was observed for all participants, with no relation to IQ. An age effect was found only among TD children. CONCLUSIONS Learning curves of children with CP on a cognitive procedural learning task differ from those of TD peers and do not appear to be age sensitive.
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Affiliation(s)
- M Gofer-Levi
- The Department of Psychology, Bar Ilan University, Ramat-Gan 52900, Israel.
| | - T Silberg
- The Department of Psychology, Bar Ilan University, Ramat-Gan 52900, Israel; The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
| | - A Brezner
- The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
| | - E Vakil
- The Department of Psychology, Bar Ilan University, Ramat-Gan 52900, Israel.
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