Associations of hamstring and triceps surae muscle spasticity and stance phase gait kinematics in children with spastic diplegic cerebral palsy

Clinical decisions on interventions to improve function in children with cerebral palsy (CP) are based, in part, on hypothesized interactions amongst physical signs of CP and functional deficits. However, a knowledge gap exists regarding associations between spasticity and gait function. This study quantified associations of hamstring and triceps surae spasticity with hip, knee and ankle CP gait patterns. This is a cohort study of children and adolescents [n = 51; 31 male; 20 female; spastic diplegia; Gross Motor Function Classification System I (n = 23) and II (n = 28)] who participated in a clinical consult including gait (Motion Analysis, USA) and modified Tardieu scale (MTS) testing (hamstrings, triceps surae). Shape-based clustering was performed on stance phase sagittal hip, knee and ankle patterns using z-normalized and non-normalized data. Linear regression (R, v3.5.0, R Core Team, Austria) was conducted to assess associations between MTS measures and data clusters (α = 0.05). Shape-clustering revealed two hip and three knee and ankle clusters for z-normalized and non-normalized data. Significant associations of hamstring spasticity and joint patterns were observed for z-normalized knee clusters (C_{Knee A} p = 0.002; C_{Knee B} p = 0.006) and interactions amongst non-normalized hip and knee clusters (C_HipA:C_{Knee B} p = 0.033). Trends were observed for soleus spasticity and gastrocnemius range of motion angle and non-normalized ankle clusters (C_{Ankle B} p = 0.051; C_{Ankle B} p = 0.053 respectively). Significant associations of early knee extension and hamstring spasticity, observed using shape-clustering of z-normalized data, provide unique information that may inform the identification of individuals most likely to benefit from spasticity management and targets for spasticity management assessment.

0908 The Impact Of Adenotonsillectomy On Obstructive Sleep Apnea In Children With Trisomy 21: A Retrospective Cohort Study

Introduction

Obstructive sleep apnea (OSA) has a prevalence of 1 - 5.7% in the general pediatric population. In children with Trisomy 21 (T21), OSA is estimated to be much higher, at 30-60%. The medical consequences of untreated OSA may be significant, therefore it is worthwhile to explore treatment options. Adenotonsillectomy (AT) is often the first line treatment in children, including those with T21. However, success rates of AT in patients with T21 is more variable, and postoperative complications can be higher. The aim of this study was to determine the impact of AT on the apnea hypopnea index (AHI) in patients with Trisomy 21.

Methods

A retrospective cohort study was conducted by reviewing children with T21 and the following criteria: 1) 0 to 18 years of age, 2) AT completed between January 2010 to December 2015, 3) pre- and post-operative polysomnogram (PSG). Data extraction included demographics, details of PSG both prior to and after surgery including severity of sleep apnea and oxygen levels, type of surgery, and surgical complications.

Results

Our sample consisted of 64 subjects. Mean pre-operative AHI was 32.2, while mean post-operative AHI was 8.0, for a difference of 21.7 (p = 0.0001). Mean pre-operative oxygen saturation was 92.5, while mean post-operative oxygen saturation was 93.7, for a difference of 1.2 (p = 0.01). There were 10 post-operative emergency room visits (15.3%), 2 admissions to hospital (3.1%) and 2 repeat surgeries for post-operative bleeding (3.1%).

Conclusion

Preliminary findings of this study show a statistically significant improvement in OSA severity as determined by change in AHI and mean oxygen saturations post AT in children with T21. Complication rates were low. Further data collection and analysis is underway.

Support

None.

Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study

OBJECTIVES

To evaluate the relationship between individual bacterial and viral pathogens and disease severity.

METHODS

Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up).

RESULTS

Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease.

CONCLUSIONS

In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.